bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concomitant Medial Patellofemoral Ligament Reconstruction and Tibial Tubercle Osteotomy Do Not Increase the Incidence of 30-Day Complications: An Analysis of the NSQIP Database
Authors: Agarwalla Avinesh , Gowd Anirudh K. , Liu Joseph N. , Puzzitiello Richard N. , Yanke Adam B. , Verma Nikhil N. , Forsythe Brian 
Published: April 2019

Background: Lateral patellar dislocations account for 2% to 3% of total knee injuries, especially in adolescents. Depending on the anatomic abnormality contributing to lateral patellar instability, medial patellofemoral ligament reconstruction (MPFLR) and/or tibial tubercle osteotomy (TTO) may be indicated. Purpose: To assess the risk of adverse events (AEs) after TTO, MPFLR, and concomitant MPFLR and TTO. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent MPFLR, TTO, and concomitant MPFLR and TTO between 2005 and 2016 were identified through the American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) database. Medical complications (eg, surgical site infection and deep vein thrombosis), readmission rates, and extended hospital stay within 30 days of the procedure were recorded. Outcomes were compared with bivariate and multivariate Poisson regression. Results: Out of 882 patients, 617 (70.0%) underwent isolated MPFLR, 170 (19.3%) underwent TTO, and 95 (10.8%) underwent concomitant MPFLR and TTO. The operative time for concomitant MPFLR and TTO was significantly longer (122 ± 45 minutes) compared with isolated MPFLR (97 ± 55 minutes; P < .001) and isolated TTO (89 ± 51 minutes; P < .001). There were 32 AEs (3.6%), with 10 AEs in the isolated TTO group (5.9%), 18 AEs in the isolated MPFLR group (2.9%), and 4 AEs in the MPFLR + TTO group (4.2%). There was no significant difference in the rate of AEs between the isolated MPFLR and isolated TTO groups ( P = .1), isolated MPFLR and MPFLR + TTO groups ( P = .5), and isolated TTO and MPFLR + TTO groups ( P = .8). Diabetes mellitus was associated with an increased risk of developing an AE (odds ratio, 4.0; P = .003), and hypertension resulted in an increased risk of an extended hospital stay (odds ratio, 4.0; P = .010). Conclusion: While concomitant MPFLR and TTO significantly increased operative time, there was no difference in the rate of AEs, extended hospital stay, and readmissions within 30 days after isolated MPFLR, isolated TTO, and concomitant MPFLR and TTO.
Intermittent Versus Continuous PEG-Asparaginase to Reduce Asparaginase-Associated Toxicities: A NOPHO ALL2008 Randomized Study
Authors: Albertsen Birgitte Klug , Grell Kathrine , Abrahamsson Jonas , Lund Bendik , Vettenranta Kim , Jónsson Ólafur G. , Frandsen Thomas L. , Wolthers Benjamin O. , Heyman Mats , Schmiegelow Kjeld 
Published: April 2019

PURPOSE Asparaginase is an essential drug in childhood acute lymphoblastic leukemia (ALL) therapy and is frequently given for months to obtain continuous asparagine depletion. We randomly assigned patients to continuous versus intermittent pegylated-asparaginase (PEG-asp) treatment, hypothesizing there would be decreased toxicity with unchanged efficacy. METHODS Children (median age, 4.2 years) treated for non–high-risk ALL according to the Nordic Society for Pediatric Hematology and Oncology ALL2008 protocol received five intramuscular PEG-asp injections (1,000 IU/m2) every two weeks and were then randomly assigned to additional three doses (6-week intervals [experimental arm], n = 309) versus 10 doses (2-week intervals [standard arm], n = 316). The primary end point was noninferior (6% margin) disease-free survival. Toxicity reduction was a secondary end point. Occurrence of asparaginase-associated hypersensitivity, pancreatitis, osteonecrosis, and thromboembolism were prospectively registered. RESULTS After a median follow-up of 4.1 years, the 5-year disease-free survival was 92.2% (95% CI, 88.6 to 95.8) and 90.8% (95% CI, 87.0 to 94.6) in the experimental and standard arms, respectively. The 3-year cumulative incidence of any first asparaginase-associated toxicity (hypersensitivity [n = 13]; osteonecrosis [n = 29]; pancreatitis [n = 24]; thromboembolism [n = 17]) was 9.3% in the experimental arm and 18.1% in the standard arm ( P = .001). Asparaginase-associated toxicity reduction was confirmed in sex- and risk-group–adjusted Cox regression analysis stratified by age (≥ 10 and < 10 years; hazard ratio, 0.48; P = .001). The experimental arm had the lowest incidences of all four toxicities, reaching significance for pancreatitis (6-month risk, 5.8% v 1.3%; P = .002). CONCLUSION The excellent cure rates and reduced toxicity risk support the use of intermittent PEG-asp therapy after the first 10 weeks in future childhood ALL trials that apply prolonged PEG-asp therapy.
Diet-Dependent Acid Load—The Missing Link Between an Animal Protein–Rich Diet and Nonalcoholic Fatty Liver Disease?
Authors: Alferink Louise J M , Kiefte-de Jong Jessica C , Erler Nicole S , de Knegt Robert J , Hoorn Ewout J , Ikram M Arfan , Janssen Harry L A , Metselaar Herold J , Franco Oscar H , Darwish Murad Sarwa 
Published: April 2019

Abstract

Objective
Our group recently showed that animal protein was independently associated with nonalcoholic fatty liver disease (NAFLD). We hypothesize that this may be explained by a high diet-dependent acid load [dietary acid load (DAL)].

Methods
This cross-sectional study is embedded in a prospective population-based cohort. We estimated DAL proxies via food-frequency questionnaires using potential renal acid load (PRAL; using dietary protein, phosphorus, potassium, calcium, and magnesium intake), net endogenous acid production (NEAP; using protein and potassium intake), and the animal protein–to–potassium ratio (A:P). We defined NAFLD using ultrasound after excluding secondary steatogenic causes. We used logistic regression models—adjusted for sociodemographic, lifestyle, and metabolic traits—on categorized [quartile (Q)1 to 4] and continuous DAL proxies (allowing for nonlinearity) and NAFLD.

Results
We included 3882 participants, of which 1337 had NAFLD. All DAL proxies were higher, meaning more acidic, in individuals with NAFLD (PRAL, −2.9 vs −5.5 mEq/d; NEAP, 37.0 vs 35.1 mEq/d; and A:P, 13.3 vs 12.4; all P < 0.001). The highest Q of DAL proxies was associated with NAFLD independent of sociodemographic and lifestyle confounders, but significance dissipated after correction for metabolic confounders and multiple testing. However, the P value for nonlinearity was significant in all DAL proxies (P < 0.001). Natural cubic splines performed better with than without DAL proxies in the fully adjusted model (all P ≤ 0.038). The highest probability of NAFLD was found for an acidic diet.

Conclusions
This study showed an independent nonlinear association between an acidic diet and NAFLD. Further studies with acid-base biomarkers are needed, but our findings might provide a mechanistic explanation for the harmful association between an animal protein–rich diet and NAFLD.
Protein-mediated gelation and nano-scale assembly of unfunctionalized hyaluronic acid and chondroitin sulfate
Authors: Tabet Anthony , Park June Y. , Shilts Jarrod , Sokolowski Kamil , Rana Vijay K. , Kamp Marlous , Warner Nina , Hoogland Dominique , Scherman Oren A. 
Published: April 2019

Background: Hyaluronic acid (HA) is a major component of the extracellular matrix (ECM) in the central nervous system and the only purely supramolecular glycosaminoglycan. Much focus has been given to using this high molecular weight polysaccharide for tissue engineering applications. In most studies, HA is covalently functionalized with moieties that can facilitate network formation through physical self-assembly, or covalent crosslinking (e.g. photo-catalyzed) as the polysaccharide does not gel on its own. However, these crosslinks are not the driving force of HA self-assembly in biological tissues. Methods: Oscillatory rheology, dynamic light scattering, and scanning electron microscopy were used to study albumin/HA structures. Dynamic light scattering and transmission electron microscopy were used to study albumin/chondroitin sulfate (CS) structures. UV-vis spectroscopy was used to demonstrate the potential for using protein-crosslinked polymers as an ECM-mimetic model to study transport of hydrophilic small molecules. Results: We examine the intermolecular interactions of two major glycosaminoglycans found in the human brain, HA and the lower molecular weight CS, with the model protein albumin. We report the properties of the resulting micro- and nano-materials. Albumin/HA mixtures formed supramolecular gels, and albumin/CS mixtures formed micro- and nanoparticles. These systems are formed from unfunctionalized polysaccharides, which is an attractive and simpler method of forming HA hydrogels and CS nanoparticles than functional chemistry-based approaches such as chemically modifying the polymer backbones. We also summarize the concentrations of HA and CS found in various mammalian brains, which could potentially be useful for biomimetic scaffold development in tissue engineering. Conclusions: Simple preparation and combination of commercially available charged biomacromolecules rapidly result in interesting self-assembled materials with structures at the micron and nanometer length-scales. Such materials may have utility in serving as cost-effective and simple models of nervous system electrostatic interactions and as in vitro drug release and model system for ECM transport studies.
Negative pressure wound therapy versus microcurrent electrical stimulation in wound healing in burns
Authors: Ibrahim Zizi M. , Waked Instar S. , Ibrahim Olfat 
Published: April 2019

Objective: To compare the efficacy of negative pressure wound therapy (NPWT) with that of microcurrent electrical stimulation (MES) on wound surface area, length of stay (LoS) and colony count of wounds in patients with burns. Method: Patients with thermal dermal burn injuries covering 25–40% of total body surface area were enrolled in this clinical trial. Participants were randomly allocated into three, equal-sized groups: patients receiving NPWT, patients receiving MES and a control group which received standard wound care. All groups received the same traditional physical therapy programme in addition to the same nursing and medical care. In all groups, wound surface area, colony count and LoS were measured 72 hours after thermal burn injury (pre), after 10 days and again at 21 days from the beginning of the study. Results: A total of 45 patients took part in the study. There were statistically significant decreases in wound surface area observed in all groups (p<0.05) while MES showed the highest mean percentage of reduction in wound surface. MES and NPWT both showed the lowest values for bacterial growth but NPWT was superior in colony count reduction. For LoS, both MES and NPWT showed the lowest mean value. Conclusion: From the findings of this study, MES was more effective in decreasing wound surface area in burn wounds while NPWT was more effective in reducing bacterial growth.
Re-evaluation of polihexanide use in wound antisepsis in order to clarify ambiguities of two animal studies
Authors: Kramer Axel , Eberlein Thomas , Müller Gerald , Dissemond Joachim , Assadian Ojan 
Published: April 2019

Objective: Due to classification of the agent polihexanide (PHMB) in category 2 ‘may cause cancer’ by the Committee for Risk Assessment of the European Chemicals Agency in 2011, the users of wound antiseptics may be highly confused. In 2017, this statement was updated, defining PHMB up to 0.1% as a preservative safe in all cosmetic products. In the interest of patient safety, a scientific clarification of the potential carcinogenicity of PHMB is necessary. Methods: A multidisciplinary team (MDT) of microbiologists, surgeons, dermatologists and biochemists conducted a benefit-risk assessment to clarify the hazard of antiseptic use of PHMB. Results: In two animal studies, from which the assessment of a carcinogenic risk was derived, PHMB was administered orally over two years in extremely high concentrations far above the NO(A)EL (no-observed-(adverse-) effect level) in rats and mice. Feeding in the NO(A)EL range resulted in no abnormal effects. In one male in the highest dose group of 4000ppm PHMB, an adenocarcinoma was found, which the author attributed to chronic inflammation of the colon with systemic atypical exposure. The increasing incidence of hemangiosarcomas highly probably resulted from increased endothelial proliferation, triggered by the exceedingly high dosage fed, because PHMB is not genotoxic and there is no evidence for epigenetic effects. Discussion: It is well known that PHMB is not absorbed when applied topically. Considering the absence of genotoxicity and epigenetic effects together with the interpretation of the animal studies, it is the consensus of the multidisciplinary experts that a carcinogenic risk from PHMB-use for wound antisepsis can be ruled out. Conclusion: On this basis and considering their effectiveness, tolerability and clinical evidence, the indications for PHMB based wound antiseptics are justified.
Pressure ulcer prevalence and prevention rates in Abu Dhabi: an update
Authors: Tariq Gulnaz , Hamed Jassin , George Beji , Cruz Salvacion , Jose Jasmine 
Published: April 2019

Objective: This article compares the results from a recent pressure ulcer (PU) prevalence audit at the Sheikh Khalifa Medical City (SKMC) hospital in Abu Dhabi to identify the impact of new prevention initiatives introduced around 2013 and establish the effectiveness of PU prevention strategies, judged quality of nursing care, and costs associated with patients developing a hospital-acquired pressure ulcer (HAPU). Method: The methods used were based on a previous point prevalence study involving 441 acute care patients, who were assessed using the International Pressure Ulcer Prevalence (IPUP) Survey. Following pre-selection of a 24-hour period for data capture, hospital staff collected PU data. Hill-Rom provided SKMC with an electronic report comprising various epidemiological and financial outputs. Results: PU prevalence was 10.4% in 2018 versus 6.4% in 2013. The 2018 HAPU prevalence was 1.8% versus 2% in 2013. The 2018 findings were in line with IPUP's international benchmarks. In 2018, 99% of patients had their skin assessed and PU risk documented within 24 hours of admission, leading to rapid implementation of a prevention care plan. Most patients who developed a HAPU (n=8) were female (62%) and aged 20–29 years old (25%) or 70–79 years old (25%). All HAPU patients lay on three layers of linen, most on their side (88%) and 75% were hospitalised for >30 days. Costs were estimated for the eight HAPU patients; weighted average cost (per case) was around US$8035.32, giving a total estimated cost of US$64,282.54. Total annual cost (average length of stay basis) for the eight patients was estimated at US$1,830,082.32. Conclusion: The PU prevention plan at SKMC proved to be effective, reflected by a low HAPU prevalence rate, suggesting an excellent quality of patient care.
Pregnancy and diabetes
Authors: Todd Diane 
Published: April 2019

Diabetes is an increasingly common condition observed in antenatal clinics. It describes not only those women with pre-existing diabetes, but also a significant number of women who develop diabetes during their pregnancy (gestational diabetes), which may resolves postnatally. These high-risk pregnancies are known to be associated with maternal, fetal and neonatal complications and require specialist care. This happy time in a woman's life can also be one of anxiety and concern over their baby's health. Having diabetes in pregnancy requires daily monitoring of blood glucose levels, adaptions to dietary intake, frequent hospital visits, additional ultrasound scans and the fear of the baby growing ‘too big’. This article describes the woman's journey from pre-conception to postnatal care and the management, guidance and support offered by the multidisciplinary team to keep her and her baby safe and achieve a successful pregnancy outcome.
Sacubitril/valsartan in patients with symptomatic chronic heart failure with reduced ejection fraction
Authors: Jalal Zahraa , Cabdi Summaya , Khan Nazish , Dorsch Marina , Gill Navneet , Stalker Fionnuala , Jones Alan M 
Published: April 2019

Background: Sacubitril/valsartan is a combination drug therapy for heart failure (HF) patients that has been shown to reduce mortality and hospitalisation. Aims: To explore clinically relevant real-life patient data regarding prescribing of sacubitril/valsartan for HF patients in three hospitals, in accordance with national guidelines. Methods: A retrospective multicentre study in three large UK hospital Trusts based in the West Midlands. Findings: A total of 118 symptomatic chronic HF patients with reduced ejection fraction were included in the study. A high proportion of prescribers adhered to NICE guidelines for treatment with sacubitril/valsartan; 99% of patients had a New York Heart Association functional class of at least II; 82% had a left ventricle ejection fraction of under 35%; 100% received an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker before commencing sacubitril/valsartan. The mean age of men and women at the three hospitals was 65 and 59 years, respectively. The proportion of men prescribed sacubitril/valsartan was greater than women: 80% compared to 20%, respectively. The majority of patients on the therapy were white British (65%). Total prescribing of sacubitril/valsartan at the three hospitals was 295 patients, lower than expected. Conclusion: The prescribing of sacubitril/valsartan at the Trusts generally adhered to NICE guidance; however, the prescribing rate was lower than expected compared with the NICE resource tool. Further investigations into the safety and scope of application of sacubitril/valsartan are required to match the prescribing of sacubitril/valsartan with eligible patients who could benefit from the medication.
The best of both worlds? combining specialist practice with hospital consultancy
Authors: Scott Paul , Shelton Andrew T 
Published: April 2019

This article describes the experience of undertaking post specialty consultant training, on a part-time basis, with its advantages and disadvantages, and how this experience is transferred into a current practice combining a hospital consultant and specialist practice position, with its challenges and benefits. CPD/Clinical Relevance: The workforce providing primary and secondary care orthodontics is evolving and it is important that alternative training modalities and working practices are available to allow flexibility in provision of care.
Pornografl-Pornoaksi Dalam Perundang-Undangan dan Perjuangan Membebaskan Perempuan
Authors: Zulfa Kholid 
Published: April 2019

Women still have to make hard effort to strive for liberating themselves. As most of them persistently fight for gender equality to gain their equal rights before men, and when men's sympathy hugely grows to take women as their equal contenders, many other women at the same time enjay being involved in pornography and porno-action. They harm people by committing sex exploitation in various actions. The question then comes up, how the acts govern the pornography and porno action and what impact it will make for women's struggle. This article describes the constitutions regulating porno. graphy and porno-action and elaborates the impact of pornography-porno action towards the entire women's liberation struggle. The term of porno. graphy-porno action, scope, and the object used in criminal laws vary in many countries. They use it both explicitly or implicitly in which the judge's reasoning plays a large role within it. Terminologically, the word of porno. graphy-pomo-action is not found in Indonesian Criminal Law. Nevertheless, it is substantially stated by: Crime against Norms. we can read that in chapters 281, 282, 283, 532 and533 of Criminal Law.
Pathways to political (dis-)engagement: motivations behind social media use and the role of incidental and intentional exposure modes in adolescents’ political engagement
Authors: Heiss Raffael , Knoll Johannes , Matthes Jörg 
Published: April 2019

Abstract
Based on the Social Media Political Participation Model (SMPPM), this study investigates the relationship between four key motivations behind the use of Social Network Sites (SNS) and political engagement among adolescents. We collected our data in a paper-pencil survey with 15- to 20-year-old adolescents (N=294), a highly underexplored group, which is most active on social media. We theorize that adolescents’ user motivations are related to political engagement via two modes of exposure: The intentional mode, which is related to active information seeking, and the incidental mode, in which adolescents run into politics only by accident. We found that political information and self-expression motivations were positively related to political engagement via the intentional mode. By contrast, entertainment motivations were negatively related to offline, but not to online engagement via the incidental mode.
Gender role portrayals in television advertisements: Do channel characteristics matter?
Authors: Karsay Kathrin , Matthes Jörg , Fröhlich Valerie 
Published: April 2019

Abstract
In the present study we investigated the role of channel characteristics with regard to gender role portrayals in television advertisements. Drawing on cultivation theory and social cognitive theory, we investigated six key variables in this line of research. We sampled a total of N = 1022 advertisements from four Austrian television channels: a public service channel, a commercial channel, and one commercial special interest channel for men and for women, respectively. Our results replicate well-known stereotypic gender role portrayals prevalent in television advertisements. The public service channel and the private channel did not differentiate from each other with regards to gender stereotyping. We found that a channel with a female target group aired advertisements containing the same or even amplified stereotypes compared to a male channel. The potential negative effects of stereotypic gender role portrayals in television advertisements are discussed.
“古、方、普、外”——论全球华语研究的四个视角
Authors: 晓梅 王 
Published: April 2019

摘要
进入二十一世纪，汉语研究的视角开始由以普通话为核心转向全球华语。这个转变反映了 “中国在语言规划方面也开始采用全球的视野”，将现代汉语在各地的标准变体囊括在 “全球华语” 研究范围之内。与此同时，全球华语研究的理论探讨也急需提上日程。本文将通过马来西亚华语研究的成果，来论证全球华语研究（无论是词汇研究、语音研究，还是语法研究）都应该充分考虑 “古、方、普、外” 四个视角，以解释各地华语特征的结构特点与形成原因。其中，“古” 指的是古代汉语，即马来西亚华语所受到的古汉语影响；“方” 指的是闽、粤、客等南方方言，即马来西亚华语所受到的闽、粤等方言的影响；“普” 指的是普通话，即马来西亚华语与普通话的异同；“外” 指的是英语、马来语、淡米尔语等语言，即马来西亚华语所受到的非汉语（当地语言）的影响。本文尝试从这四个视角来一一分析它们对马来西亚华语的影响，并建构研究全球华语的 “古、方、普、外” 的理论视角。
Maximum Hydrogen Production Rate Optimization for Tubular Steam Methane Reforming Reactor
Authors: Li Penglei , Chen Lingen , Xia Shaojun , Zhang Lei 
Published: April 2019

Abstract
The performance of a steam methane reforming (SMR) reactor is optimized by using the theory of finite time thermodynamics in this paper. The maximum hydrogen production rate (HPR) and the corresponding optimal exterior wall temperature (EWT) and the optimal pressure of the reaction mixture (PRM) profiles in the SMR reactor are obtained by using nonlinear programming method. In the optimization process, the fixed inlet mole flow rate of components, the thresholds of the state variables and the conservation equations are taken as the constraints. The performance of the optimal reactor is compared with that of the reference reactor with a linear EWT profile. The results show that the HPR of the optimal reactor increases by about 11.8 %. The optimal EWT profile is alike with the linear EWT profile. The HPR increases with the increase of the inlet temperature of reaction mixture and the decrease of the inlet PRM. The influence of the TRM on the HPR is smaller than that of the PRM. The results obtained herein are helpful to the optimal design of practical tubular reactors.