bluuebunny/crossref_metadata_2025_split huggingface dataset:
Segmentación y comportamiento de lealtad de los pacientes: un análisis clúster en los departamentos de salud de la Comunidad Valenciana
Authors: Calero Gimeno Remedios , Gallarza Granizo Martina G , Gadea Peña Sergio 
Published: September 2018

En un marco sanitario de fragmentación territorial y cohabitación de gestión pública con colaboración público-privada, tiene sentido analizar y clasificar los departamentos sanitarios, atendiendo a múltiples objetivos: conocer el comportamiento real de los pacientes cuando pueden elegir dónde ser atendidos, adaptar la cartera de ser vicios a las preferencias del paciente y organizar la asistencia sanitaria desde una óptica territorial, considerando si afecta el modelo de gestión. Se utilizan datos secundarios (más de dos millones) en la Comunidad Valenciana, con un análisis clúster del comportamiento de lealtad (captación, retención y deserción). Esta metodología permite la reagrupación por similitud de los departamentos, explicando su homogeneidad entre sí y heterogeneidad respecto a otros. Se muestra la bondad de este análisis en el sector sanitario. Asimismo, la clasificación obtenida supone una guía para la gestión estratégica de los ser vicios sanitarios (a nivel macro y micro) y ahonda en el debate de la colaboración público-privada.
Epidemiology, aetiology and seasonality of infectious diarrhoea in adult outpatients through active surveillance in Shanghai, China, 2012–2016: a cross-sectional study
Authors: Gong Xiao-Huan , Wu Huan-Yu , Li Jian , Xiao Wen-Jia , Zhang Xi , Chen Min , Teng Zheng , Pan Hao , Yuan Zheng-An 
Published: September 2018

ObjectivesThis study aimed to identify the epidemiology, clinical characteristics, aetiology and seasonality of sporadic infectious diarrhoea in adults in Shanghai.SettingThis study was based on a city-wide, active continuous hospital-based diarrhoea surveillance network established by Shanghai Municipal Center for Disease Control and Prevention. There were 22 sentinel hospitals in all 16 districts (9 primary-level hospitals, 6 secondary-level hospitals and 7 tertiary-level hospitals) which were selected using probability proportionate to size sampling method.ParticipantsFrom 1 May 2012 to 31 May 2016, 90 713 patients were included in this study. Among 8797 patients whose stool samples were collected and detected, 4392 patients were male.ResultsThe positive rate was 47.96%. Bacterial and viral infections accounted for 27.19% and 69.07% separately. Norovirus was the most common pathogen (43.10%), followed by rotavirus,Vibrio parahaemolyticus, diarrhoeagenicEscherichia coli(DEC) andSalmonellaspp. Patients between 30–44 and 45–59 years were more likely to have infectious diarrhoea and viral diarrhoea. Those aged 30–44 years were the most likely to get infected withV. parahaemolyticus(adjusted OR, aOR vs 60+ years: 2.04, 95% CI 1.47 to 2.78) and norovirus (aOR vs 60+ years: 1.32, 95% CI 1.12 to 1.56). Bacterial (exceptV. parahaemolyticus) diarrhoea was characterised by fever, abdominal pain and loose stool; while viral diarrhoea was characterised by nausea, vomiting and watery stool. A seasonal distribution of infectious diarrhoea was observed with larger peaks in winter and smaller peaks in summer. Winter peaks were mainly due to norovirus and rotavirus, and summer peaks were due to bacterial infections. An emerging spring peak of norovirus around March was observed in the past 3 years.ConclusionViral infections were predominant, and norovirus played a leading role. A seasonal distribution was observed and an emerging spring peak of norovirus was noted. Our findings highlight the necessity for conducting an active, comprehensive surveillance in adults, to monitor changing dynamics in the epidemiology and aetiology of infectious diarrhoea.
Comparing resource use between paediatric emergency department visits by triage level
Authors: Samuels-Kalow Margaret E , Niedzwiecki Matthew , Friedman Ari B , Sokolove Peter E , Hsia Renee Y 
Published: September 2018

ObjectiveThe majority of paediatric ED visits result in discharge but little is known about what ED resources are deployed for these visits. The goal of this study was to understand the utilisation of diagnostic testing, procedures and hospital admission for paediatric ED visits triaged as ‘non-urgent’.Study designWe examined US ED visits for children aged 0–17 years from 1 January 2009 to 31 December 2011 in the National Hospital Ambulatory Medical Care Survey. Visits triaged on arrival as ‘non-urgent’ (level 5) were compared with urgent visits (triage levels 1–4) for resource use and disposition. Sensitivity and specificity of triage for predicting resource use and disposition were assessed.ResultsAmong 21 052 observations, representing 86 620 988 visits, 11.1% were triaged as ‘non-urgent’. Diagnostic services were provided during 37.6% (95% CI 33.9% to 41.4%) of non-urgent and 55.2% (95% CI 53.3% to 57.2%) of urgent visits. Procedures were performed in 23.9% (95% CI 20.4% to 27.3%) of non-urgent and 33.9% (95% CI 31.2% to 35.9%) of urgent visits. 1.7% (95% CI 0.09% to 2.6%) of the non-urgent visits resulted in admission, with 0.08% (95% CI 0% to 0.2%) to critical care units, compared with 4.4% (95% CI 3.6% to 5.2%) of the urgent visits, with 0.3% (95% CI 0.2% to 0.4%) to critical care. Despite some substantial differences in the rates of resource use, triage score had poor sensitivity for identifying patients who did not receive ED tests, procedures or admission.ConclusionA significant percentage of ED patients with non-urgent ED triage scores received ED testing and procedures. More work is needed to improve methods of prospectively identifying patients with low acuity complaints who do not need significant ED resources.
Integration of echocardiographic screening by non-physicians with remote reading in primary care
Authors: Nascimento Bruno R , Beaton Andrea Z , Nunes Maria Carmo Pereira , Tompsett Allison R , Oliveira Kaciane K B , Diamantino Adriana C , Barbosa Márcia M , Lourenço Tainá V , Teixeira Isabella M , Ruiz Gabriela Z L , Rios João Pedro P , Ribeiro Antonio Luiz P , Sable Craig 
Published: September 2018

IntroductionHeart disease (HD) accounts for high morbidity and mortality in Brazil. Underserved populations often suffer long delays in diagnosis. We aimed to evaluate the feasibility of integrating screening echocardiography (echo) with remote interpretation in the established primary care system (PC) in Brazil and to assess HD prevalence.MethodsOver 11 months, 20 healthcare workers (four physicians, four nurses, and 12 technicians) at 16 PC centres were trained on simplified handheld echo protocols. Three screening (SC) groups, including all consented patients aged 17–20, 35–40 and 60–65 years, and patients referred (RF) for clinical indications underwent focused echo. Studies were remotely interpreted through telemedicine. Significant HD was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, wall-motion abnormalities and congenital heart disease.ResultsTotal 1004 patients underwent echo; 299 (29.8%) in the SC group. Median age was 51±18 years, 63.9% females; 42.7% had cardiovascular symptoms. Significant HD was found in 354 (35.3%) patients (23.4% in SC vs 40.3% in RF group, p<0.001). Prevalence was higher in patients in the SC group aged >60 years (29.2%), compared with 35–40 (14.9%) and under 20 (16.5%), p=0.012. Comparing SC to RF groups, moderate/severe left ventricular dysfunction was observed in 4.1% vs 8.1%, p=0.03, mitral regurgitation in 8.9% vs 20.3%, p<0.001 and aortic stenosis in 5.4% vs 4.3%, p=0.51.ConclusionsIntegration focused echo into PC is feasible in Brazil as a strategy to deliver cardiovascular care to low-resourced areas through task shifting. The burden of HD observed suggests this tool may improve early diagnosis and referral.
Does infection withChlamydia trachomatisinduce long-lasting partial immunity? Insights from mathematical modelling
Authors: Omori Ryosuke , Chemaitelly Hiam , Althaus Christian L , Abu-Raddad Laith J 
Published: September 2018

ObjectivesTo explore whether existence of long-lasting partial immunity against reinfection withChlamydia trachomatisis necessary to explainC. trachomatisprevalence patterns by age and sexual risk, and to provide a plausible estimate for the effect size, defined here as a reduction in susceptibility to reinfection.MethodsA population-based mathematical model was constructed to describeC. trachomatisnatural history and transmission dynamics by age and sexual risk. The model was parameterised using natural history, and epidemiological and sexual behaviour data, and applied for UK and US data. Sensitivity analyses were conducted to assess the robustness of predictions to variations in model structure and to examine the impact of alternative assumptions for the mechanism underlying partial immunity.ResultsPartial immunity against reinfection was found necessary to explain observedC. trachomatisprevalence patterns by age and sexual risk. The reduction in susceptibility to reinfection was estimated at 93% using UK data (95% uncertainty interval (UI)=88%–97%) and at 67% using US data (95% UI=24%–88%). The model-structure sensitivity analyses affirmed model predictions. The immunity-mechanism sensitivity analyses suggested a mechanism of susceptibility reduction against reinfection or a mechanism of infectious-period duration reduction upon reinfection.ConclusionsA strong long-lasting partial immunity againstC. trachomatisreinfection should be present to explain observed prevalence patterns. The mechanism of immunity could be either a reduction in susceptibility to reinfection or a reduction in duration of infection on reinfection.C. trachomatisinfection appears to naturally elicit a strong long-lasting immune response, supporting the concept of vaccine development.
Cross-sectional study of urethral exposures at last sexual episode associated with non-gonococcal urethritis among STD clinic patients
Authors: Chambers Laura C , Morgan Jennifer L , Lowens M Sylvan , Robinson Tashina S , Romano Sarah S , Leipertz Gina L , Hughes James P , Golden Matthew R , Khosropour Christine M , Fredricks David N , Manhart Lisa E 
Published: September 2018

ObjectiveAlthoughChlamydia trachomatis(CT) andMycoplasma genitalium(MG) are major causes of non-gonococcal urethritis (NGU), up to 50% of cases are of unknown aetiology. We sought to identify urethral exposures at last sexual episode associated with NGU and non-CT/non-MG NGU to identify anatomical sites from which aetiologically relevant micro-organisms may be acquired.MethodsWe enrolled STD clinic patients with and without NGU assigned male sex at birth and age ≥16 into a cross-sectional study. NGU was urethral symptoms or visible discharge plus ≥5 polymorphonuclear leucocytes withoutNeisseria gonorrhoeae. Urine was tested for CT and MG (Aptima). We used logistic regression to estimate the association between urethral exposures at last sex and NGU separately among cisgender men and transgender women who have sex with men (MSM/TGWSM) and cisgender men who have sex with women (MSW).ResultsBetween 8 August 2014 and 1 November 2017, we enrolled 432 patients, including 183 MSM/TGWSM (118 NGU+, 65 NGU−) and 249 MSW (126 NGU+, 123 NGU−). The mean age was 34; 59% were white. CT and MG were detected in 72 (30%) and 49 (20%) NGU+ participants, respectively. Compared with MSM/TGWSM reporting only non-urethral exposures at last sex, those reporting insertive anal intercourse (IAI) only (adjusted OR (AOR)=4.46, 95% CI 1.09 to 18.19) and IAI with insertive oral sex (IOS) (AOR=7.88, 95% CI 2.67 to 23.26) had higher odds of NGU. MSM/TGWSM reporting IOS only had no significant increased odds (AOR=1.67, 95% CI 0.58 to 4.85). Compared with MSW whose only urethral exposure at last sex was vaginal sex (VS), MSW reporting IOS and VS had similar odds of NGU (OR=0.84, 95% CI 0.50 to 1.41). The results were similar for non-CT/non-MG NGU.ConclusionsAmong MSM/TGWSM, IAI may lead to transmission of yet-unidentified rectal micro-organisms that cause non-CT/non-MG NGU, in addition to transmission of known pathogens. Sites of urethral exposure appear less important for understanding NGU risk among MSW due to minimal variation in behaviour.
Synergistic Interaction of HOXB13 and CIP2A Predisposes to Aggressive Prostate Cancer
Authors: Sipeky Csilla , Gao Ping , Zhang Qin , Wang Liang , Ettala Otto , Talala Kirsi M. , Tammela Teuvo L.J. , Auvinen Anssi , Wiklund Fredrik , Wei Gong-Hong , Schleutker Johanna 
Published: September 2018

Abstract

Purpose:
Distinguishing aggressive prostate cancer from indolent disease improves personalized treatment. Although only few genetic variants are known to predispose to aggressive prostate cancer, synergistic interactions of HOXB13 G84E high-risk prostate cancer susceptibility mutation with other genetic loci remain unknown. The purpose of this study was to examine the interplay of HOXB13 rs138213197 (G84E) and CIP2A rs2278911 (R229Q) germline variants on prostate cancer risk.

Experimental Design:
Genotyping was done in Finnish discovery cohort (n = 2,738) and validated in Swedish (n = 3,132) and independent Finnish (n = 1,155) prostate cancer cohorts. Expression pattern analysis was followed by functional studies in prostate cancer cell models.

Results:
Interplay of HOXB13 (G84E) and CIP2A (R229Q) variants results in highest observed inherited prostate cancer risk (OR, 21.1; P = 0.000024). In addition, this synergism indicates a significant association of HOXB13 T and CIP2A T dual carriers with elevated risk for high Gleason score (OR, 2.3; P = 0.025) and worse prostate cancer–specific life expectancy (HR, 3.9; P = 0.048), and it is linked with high PSA at diagnosis (OR, 3.30; P = 0.028). Furthermore, combined high expression of HOXB13-CIP2A correlates with earlier biochemical recurrence. Finally, functional experiments showed that ectopic expression of variants stimulates prostate cancer cell growth and migration. In addition, we observed strong chromatin binding of HOXB13 at CIP2A locus and revealed that HOXB13 functionally promotes CIP2A transcription. The study is limited to retrospective Nordic cohorts.

Conclusions:
Simultaneous presence of HOXB13 T and CIP2A T alleles confers for high prostate cancer risk and aggressiveness of disease, earlier biochemical relapse, and lower disease-specific life expectancy. HOXB13 protein binds to CIP2A gene and functionally promotes CIP2A transcription.
The Protease-Dependent Mesenchymal Migration of Tumor-Associated Macrophages as a Target in Cancer Immunotherapy
Authors: Gui Philippe , Ben-Neji Myriam , Belozertseva Ekaterina , Dalenc Florence , Franchet Camille , Gilhodes Julia , Labrousse Arnaud , Bellard Elisabeth , Golzio Muriel , Poincloux Renaud , Maridonneau-Parini Isabelle , Le Cabec Véronique 
Published: September 2018

Abstract
Macrophage recruitment is essential for tissue homeostasis but detrimental in most cancers. Tumor-associated macrophages (TAMs) play a key role in cancer progression. Controlling their migration is, thus, potentially therapeutic. It is assumed that macrophages use amoeboid motility in vivo like other leukocytes. However, it has not yet been explored. We examined TAM migration using intravital microscopy in mouse tumors and by monitoring ex vivo tissue infiltration in human surgical samples. We demonstrated that TAMs perform protease-dependent and ROCK-independent mesenchymal migration inside mouse fibrosarcoma and breast cancer explants using their own matrix metalloproteases (MMP). In contrast, macrophages use ROCK-dependent and protease-independent amoeboid migration inside inflamed ear derma and in connective tissue at the tumor periphery. We also showed that inhibition of mesenchymal migration correlates with decreased TAM recruitment and tumor growth. In conclusion, this study elucidates how macrophages migrate in vivo, and it reveals that the MMP-dependent migration mode of TAMs provides a rationale for a new strategy in cancer immunotherapy: to target TAMs specifically through their motility. Cancer Immunol Res; 6(11); 1337–51. ©2018 AACR.
ЛІКАРСЬКА ПОМИЛКА: СУЧАСНИЙ ПОГЛЯД НА ПРОБЛЕМУ З ПОЗИЦІЇ СУДОВО-МЕДИЧНОЇ ЕКСПЕРТНОЇ ПРАКТИКИ
Authors: Franchuk V. V. 
Published: September 2018

Випадки судових позовів, пов’язаних із неналежним наданням медичної допомоги, стали помітною проблемою сучасної України. Разом з тим, особливості невдалого виконання медичними працівниками різних фахів власних професійних обов’язків залишаються сьогодні в країні практично не дослідженими.Мета – з’ясування медико-правових особливостей лікарських помилок в Україні.Матеріал і методи. Досліджено матеріали судово-слідчих справ, порушених проти медичних працівників різних регіонів України, і виконаних відповідно до цих справ комісійних експертиз в Тернопільському, Чернівець­кому та Житомирському обласних бюро судово-медичної експертизи за 2007–2016 рр. (загалом вивчено 350 таких справ).Результати. Вивчені поширеність, особливості, причини та наслідки лікарських помилок. Недоліки у наданні медичної допомоги виявлені в 72,0 % експертиз за «лікарськими справами». Неналежне виконання професійних обов’язків допускали зазвичай лікарі стаціонарних відділень районних і міських лікарень. Найчастіше медичні працівники припускались діагностичних помилок, питома вага яких серед інших дефектів медичної допомоги склала 29,7 %, лікувально-тактичні помилки мали місце у 27,9 % випадків, помилки у веденні медичної документації – у 21,3 %, організаційні – у 14,6 %, деонтологічні – 7,5 %. Помилкові дії лікарів рідко були одиничними, зазвичай асоціюючись між собою. Структура лікарських помилок за якісною характеристикою була наступною: недос­татній обсяг медичної допомоги (54,3 %), несвоєчасність медичної допомоги (27,0 %), неправильність її надання (14,4 %), ненадання (4,3 %). Дефекти якості медичної допомоги зустрічались як поодиноко, так і комбіновано. Недоліки у наданні медичної допомоги майже завжди (97,0 %) супроводжувались тяжкими наслідками – смертю пацієнтів. Неналежні дії медичних працівників, які мали причинно-наслідковий зв’язок із несприятливими наслідками, констатовані в 12,9 % випадків експертиз.Висновки. Різноманітні дефекти у наданні медичної допомоги констатовані судово-медичними експертними комісіями серед 3/4 «лікарських справ». Медичні працівники найчастіше припускались діагностичних та лікувально-тактичних помилок. Майже кожен п’ятий випадок неналежної медичної допомоги був викликаний некваліфікованими діями лікарів.
Collateral Clock Is More Important Than Time Clock for Tissue Fate
Authors: Vagal Achala , Aviv Richard , Sucharew Heidi , Reddy Mahati , Hou Qinghua , Michel Patrik , Jovin Tudor , Tomsick Thomas , Wintermark Max , Khatri Pooja 
Published: September 2018

Background and Purpose—
Although perfusion abnormality is an increasingly important therapeutic target, the natural history of tissue at risk without reperfusion treatment is understudied. Our objective was to determine how time affects penumbral salvage and infarct growth in untreated acute ischemic stroke patients and whether collateral status affects this relationship.

Methods—
We used a prospectively collected, multicenter acute stroke registry to assess acute stroke patients who were not treated with intravenous thrombolysis or endovascular treatment. We analyzed baseline computed tomography angiogram and computed tomography perfusion within 24 hours of stroke onset along with follow-up imaging and assessed time from stroke onset to baseline imaging, ASPECTS (Alberta Stroke Program Early CT Score), vessel occlusion, collaterals, ischemic core, and penumbra. Penumbral salvage and infarct growth were calculated. Correlations between time and penumbral salvage and infarct growth were evaluated with Spearman correlation. Penumbral salvage and infarct growth were compared between subjects with good versus poor collateral status using the Wilcoxon rank-sum test. Clinical and imaging factors affecting penumbral salvage and infarct growth were evaluated by linear regression.

Results—

Among 94 untreated stroke patients eligible for this analysis, the mean age was 65 years, median National Institutes of Health Stroke Scale score was 13, and median (range) time from stroke onset to baseline imaging was 2.9 (0.4–23) hours. There was no correlation between time and salvaged penumbra (
r
=0.06;
P
=0.56) or infarct growth (
r
=−0.05;
P
=0.61). Infarct growth was higher among those with poor collaterals versus those with good collaterals (median, 52.3 versus 0.9 cm
3
;
P
<0.01). Penumbral salvage was lower among those with poor collaterals compared with those with good collaterals (poor, 0 [0–0]; good, 5.9 cm
3
[0–29.4];
P
<0.01). Multivariable linear regression demonstrated that collaterals, but not time, were significantly associated with infarct growth and penumbral salvage.

Conclusions—
In this natural history study, penumbral salvage and infarct growth were less time dependent and more a measure of collateral flow.
Angioedema and Hemorrhage After 4.5-Hour tPA (Tissue-Type Plasminogen Activator) Thrombolysis Ameliorated by T541 via Restoring Brain Microvascular Integrity
Authors: Chen Qing-Fang , Liu Yu-Ying , Pan Chun-Shui , Fan Jing-Yu , Yan Li , Hu Bai-He , Chang Xin , Li Quan , Han Jing-Yan 
Published: September 2018

Background and Purpose—
tPA (tissue-type plasminogen activator) is the only recommended intravenous thrombolytic agent for ischemic stroke. However, its application is limited because of increased risk of hemorrhagic transformation beyond the time window. T541 is a Chinese compound medicine with potential to attenuate ischemia and reperfusion injury. This study was to explore whether T541-benefited subjects underwent tPA thrombolysis extending the time window.

Methods—

Male C57BL/6 N mice were subjected to carotid artery thrombosis by stimulation with 10% FeCl
3
followed by 10 mg/kg tPA with/without 20 mg/kg T541 intervention at 4.5 hours. Thrombolysis and cerebral blood flow were observed dynamically until 24 hours after drug treatment. Neurological deficit scores, brain edema and hemorrhage, cerebral microvascular junctions and basement membrane proteins, and energy metabolism in cortex were assessed then. An in vitro hypoxia/reoxygenation model using human cerebral microvascular endothelial cells was used to evaluate effect of T541 on tight junctions and F-actin in the presence of tPA.

Results—
tPA administered at 4.5 hours after carotid thrombosis resulted in a decrease in thrombus area and survival rate, whereas no benefit on cerebral blood flow. Study at 24 hours after tPA administration revealed a significant angioedema and hemorrhage in the ischemia hemisphere, a decreased expression of junction proteins claudin-5, zonula occludens-1, occludin, junctional adhesion molecule-1 and vascular endothelial cadherin, and collagen IV and laminin. Meanwhile, ADP/ATP, AMP/ATP, and ATP5D (ATP synthase subunit) expression and activities of mitochondria complex I, II, and IV declined, whereas malondialdehyde and 8-Oxo-2′-deoxyguanosine increased and F-actin arrangement disordered. All the insults after tPA treatment were attenuated by addition of T541 dose dependently.

Conclusions—
The results suggest T541 as a potential remedy to attenuate delayed tPA-related angioedema and hemorrhage and extend time window for tPA treatment. The potential of T541 to upregulate energy metabolism and protect blood-brain barrier is likely attributable to its effects observed.