bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost effectiveness of focal impulse and rotor modulation guided ablation added to pulmonary vein isolation for atrial fibrillation
Authors: Baykaner Tina , Duff Steve , Hasegawa James T. , Mafilios Michael S. , Turakhia Mintu P. 
Published: February 2018

AbstractBackgroundAlthough ablation with focal impulse and rotor modulation (FIRM), as an adjunct to pulmonary vein isolation (PVI), has been shown to decrease atrial fibrillation (AF) recurrence, cost‐effectiveness has not been assessed.ObjectiveWe aimed to evaluate the cost effectiveness of FIRM‐guided ablation when added to PVI in a mixed AF population.Methods and resultsWe used a Markov model to estimate the costs, quality‐adjusted survival, and cost effectiveness of adding FIRM ablation to PVI. AF recurrence rates were based on 3‐year data from the CONFIRM trial. Model inputs for event probabilities and utilities were obtained from literature review. Costs were based on Medicare reimbursement, wholesale acquisition costs, and literature review.Three‐year total costs FIRM+PVI versus PVI alone were $27,686 versus $26,924. QALYs were 2.338 versus 2.316, respectively, resulting in an incremental cost‐effectiveness ratio (ICER) of $34,452 per QALY gained. Most of the cost (65–81%) was related to the index ablation procedure. Lower AF recurrence generated cost offsets of $4,266, primarily due to a reduced need for medications and repeat ablation. Probabilistic sensitivity analysis demonstrated ICER below $100,000/QALY in 74% of simulations.ConclusionBased on data from the CONFIRM study, the addition of FIRM to PVI does have the potential to be cost‐effective due to higher quality‐adjusted life years and lower follow‐up costs. Value is sensitive to the incremental reduction in AF recurrence, and FIRM may have the greatest economic value in patients with greater AF symptom severity. Results from ongoing randomized trials will provide further clarity.
Shifting the focus – the primary role of IL‐23 in psoriasis and other inflammatory disorders
Authors: Gooderham M.J. , Papp K.A. , Lynde C.W. 
Published: February 2018

AbstractInsights into the pathophysiology of autoimmune inflammatory diseases including psoriasis have advanced considerably in recent years, and in parallel, so too have the available treatment options. Current clinical paradigms for the treatment of psoriasis have evolved to include targeted biologic therapies, starting with tumour necrosis factor‐alpha (TNF‐α) inhibitors and later, agents targeting interleukin (IL)‐12/23 and IL‐17. The most recent evidence suggests that IL‐23 might be an even more potent target for the effective treatment of psoriasis and other autoimmune inflammatory disorders. This review will describe recent developments leading to the current understanding of the key role of IL‐23 as a ‘master regulator’ of autoimmune inflammation and the clinical evidence for agents that specifically target this modulator in the context of treating psoriasis, spondyloarthropathy and inflammatory bowel disease.
The Complexity of Determining Whether a Nursing Home Transfer Is Avoidable at Time of Transfer
Authors: Unroe Kathleen T. , Carnahan Jennifer L. , Hickman Susan E. , Sachs Greg A. , Hass Zachary , Arling Greg 
Published: February 2018

ObjectivesTo describe the relationship between nursing facility resident risk conditions and signs and symptoms at time of acute transfer and diagnosis of conditions associated with potentially avoidable acute transfers (pneumonia, urinary tract infection, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) or asthma, dehydration, pressure sores).DesignAs part of a demonstration project to reduce potentially avoidable hospital transfers, Optimizing Patient Transfers, Impacting Medical Quality, Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project clinical staff collected data on residents who transferred to the emergency department (ED) or hospital. Cross‐tabulations were used to identify associations between risk conditions or symptoms and hospital diagnoses or death. Mixed‐effects logistic regression models were used to describe the significance of risk conditions, signs, or symptoms as predictors of potentially avoidable hospital diagnoses or death.SettingIndiana nursing facilities (N=19).ParticipantsLong‐stay nursing facility residents (N=1,174), who experienced 1,931 acute transfers from November 2014 to July 2016.MeasurementsParticipant symptoms, transfers, risk factors, and hospital diagnoses.ResultsWe found that 44% of acute transfers were associated with 1 of 6 potentially avoidable diagnoses. Symptoms before transfer did not discriminate well among hospital diagnoses. Symptoms mapped into multiple diagnoses and most hospital diagnoses had multiple associated symptoms. For example, more than two‐thirds of acute transfers of residents with a history of CHF and COPD were for reasons other than exacerbations of those two conditions.ConclusionAlthough it is widely recognized that many transfers of nursing facility residents are potentially avoidable, determining “avoidability” at time of transfer is complex. Symptoms and risk conditions were only weakly predictive of hospital diagnoses.
A review of the role of estrogen in dermal aging and facial attractiveness in women
Authors: Lephart Edwin D 
Published: February 2018

SummaryEstrogens are known to have protective and favorable influences on skin health; conversely, androgens oppose the actions of estrogens. Estrogen's chemical messages are transmitted via the classical nuclear hormone estrogen receptors (ER) alpha and beta and the rapid‐acting G‐coupled membrane estrogen receptor. Androgens [both testosterone and 5α‐dihydrotestosterone (5α‐DHT)] bind the same androgen receptor. Estrogen levels peak in the mid‐ to late 20s in women and then decline by 50% by 50 years of age and dramatically decrease further after menopause. The loss of estrogens with aging contributes to diminished dermal health, whereas estrogen hormone therapy [eg, oral conjugated equine estrogens (CEE)] restores skin health. Several reports suggest positive correlations between the levels of circulating estrogens and: (1) perceived age, (2) attractiveness, (3) enhanced skin health, and (4) facial coloration in women. Based upon a psychological dermato‐endocrine perspective, the positive correspondence of high estrogens levels with perceived age and facial attractiveness in women especially with aging demonstrates the importance of hormonal influences on observed dermal health and youthful appearance.
Fetoscopic laser photocoagulation for twin–twin transfusion syndrome
Authors: Sago Haruhiko , Ishii Keisuke , Sugibayashi Rika , Ozawa Katsusuke , Sumie Masahiro , Wada Seiji 
Published: February 2018

AbstractThe aim of this study was to review fetoscopic laser photocoagulation (FLP), which ablates placental vascular anastomoses to treat twin–twin transfusion syndrome (TTTS). A review of studies reporting on the procedures, outcomes, complications and nonconventional applications of FLP for TTTS was conducted. FLP has been established as the primary treatment for monochorionic twin pregnancy associated with TTTS at 16–26 weeks. FLP is the only therapy that directly addresses the underlying pathophysiology. The recent technique modification of FLP, referred to as the ‘Solomon technique’, induces selective coagulation to connect the anastomoses ablation sites and has been introduced to reduce residual anastomoses. The perinatal survival following FLP improved significantly with advances in the technique after its introduction. The recent survival rates of both twins and at least one twin are 70% and more than 90%, respectively. However, there is still an 11–14% risk of long‐term neurodevelopment impairment. The premature rupture of membranes that leads to preterm labor is a common complication after FLP. FLP is a valuable treatment option for feto‐fetal transfusion syndrome in triplets and for TTTS after 26 weeks. FLP for selective intrauterine growth restriction may be potentially beneficial when accompanied by abnormal Doppler findings and oligohydramnios. FLP is the optimal treatment option for TTTS at 16–26 weeks of gestation. FLP appears to be applicable in triplets, TTTS after 26 weeks and cases of selective intrauterine growth restriction with abnormal Doppler findings and oligohydramnios. FLP is the most common and successful fetal intervention. Improvement in the neurodevelopmental outcomes after FLP is a future focus.
A unified model of melatonin, 6‐sulfatoxymelatonin, and sleep dynamics
Authors: Abeysuriya Romesh G. , Lockley Steven W. , Robinson Peter A. , Postnova Svetlana 
Published: February 2018

AbstractA biophysical model of the key aspects of melatonin synthesis and excretion has been developed, which is able to predict experimental dynamics of melatonin in plasma and saliva, and of its urinary metabolite 6‐sulfatoxymelatonin (aMT6s). This new model is coupled to an established model of arousal dynamics, which predicts sleep and circadian dynamics based on light exposure and times of wakefulness. The combined model thus predicts melatonin levels over the sleep‐wake/dark‐light cycle and enables prediction of melatonin‐based circadian phase markers, such as dim light melatonin onset (DLMO) and aMT6s acrophase under conditions of normal sleep and circadian misalignment. The model is calibrated and tested against group average data from 10 published experimental studies and is found to reproduce quantitatively the key dynamics of melatonin and aMT6s, including the timing of release and amplitude, as well as response to controlled lighting and shift work.
Melatonin attenuates smoking‐induced hyperglycemia via preserving insulin secretion and hepatic glycogen synthesis in rats
Authors: Li Tianjia , Ni Leng , Zhao Zhewei , Liu Xinnong , Lai Zhichao , Di Xiao , Xie Zhibo , Song Xitao , Wang Xuebin , Zhang Rui , Liu Changwei 
Published: February 2018

AbstractEpidemiology survey indicated that cigarette smoking is a risk factor of diabetes. However, the precise mechanisms remain to be clarified. In this study, we found that smoking caused metabolic malfunctions on pancreas and liver in experimental animal model. These were indicated by hyperglycemia, increased serum hemoglobin A1c level and decreased insulin secretion, inhibition of liver glycogen synthase (LGS), and hepatic glycogen synthesis. Mechanistic studies revealed that all these alterations were caused by the inflammatory reaction and reactive oxygen species (ROS) induced by the smoking. Melatonin treatment significantly preserved the functions of both pancreas and liver by reducing β cell apoptosis, CD68‐cell infiltration, ROS production, and caspase‐3 expression. The siRNA‐knockdown model identified that the protective effects of melatonin were mediated by melatonin receptor‐2 (MT2). This study uncovered potentially underlying mechanisms related to the association between smoking and diabetes. In addition, it is, for first time, to report that melatonin effectively protects against smoking‐induced glucose metabolic alterations and the signal transduction pathway of melatonin is mainly mediated by its MT2 receptor. These observations provide solid evidence for the clinically use of melatonin to reduce smoking‐related diabetes, and the therapeutic regimens are absent currently.
Sympathy between disciplines
Authors: Gurton‐Wachter Lily 
Published: February 2018

AbstractThis essay surveys some of the recent scholarship about sympathy (as fellow feeling between people) and the natural sympathies (as physiological or occult affinities or attractions, known now as “action at a distance”) to reconsider the shifting relation between the two. Though Michael Foucault famously tells the story of an early modern conception of “space governed by sympathy and antipathy, which are ceaselessly drawing things together and holding them apart” (28) that ends abruptly with the seventeenth century, recent interdisciplinary research into early modern and eighteenth‐century histories of the natural sympathies and antipathies suggests that the shift from sympathy as a physical “principle of mobility” to an ethical attitude was neither as clear nor as decisive as it once may have seemed. For Romanticists, this revision prompts us to rethink the now familiar history of fellow feeling and start to take into account the forgotten relationship between the movement of both emotion and matter.
Chemoembolization related to good survival for selected patients with hepatocellular carcinoma invading segmental portal vein
Authors: Kim Jin Hyoung , Shim Ju Hyun , Yoon Hyun‐Ki , Ko Heung‐Kyu , Kim Jong Woo , Gwon Dong Il 
Published: February 2018

AbstractBackground & AimsWe evaluated survival outcomes and prognostic factors associated with survival after TACE in a large cohort of 331 patients with HCC with segmental PVTT.MethodsFrom 1997 to 2015, a total of 331 patients were included in this study from among 507 patients who underwent TACE as a first‐line treatment for HCC with segmental PVTT.ResultsAfter TACE, the median survival of the whole cohort was 10.7 months, and the 1‐year, 3‐year and 5‐year survival rates were 44.9%, 16% and 12% respectively. Objective tumour response after TACE was achieved in 53.8% of patients. Multivariable Cox regression analyses confirmed that up‐to‐11 criteria, extrahepatic metastasis, Child–Pugh class, and tumour response to TACE were independent prognostic factors for patient survival. The expected median survival times among patients with 0, 1 and 2‐4 risk factors were 29.1, 15.1 and 5.3 months respectively. The 30‐day mortality and major complications rates after TACE were 0.9% and 5.4% respectively.ConclusionsTACE was well‐tolerated and effective in selected patients with HCC with segmental PVTT. We found that four risk factors were associated with decreased length of patient survival after TACE: a major tumour burden (up‐to‐11 criteria out), extrahepatic spread, Child–Pugh class B liver function and nonregression to TACE. TACE may not be recommended for HCC patients with segmental PVTT with 2‐4 risk factors because of poor survival outcome.
LytM factor Alr3353 affects filament morphology and cell–cell communication in the multicellular cyanobacterium Anabaena sp. PCC 7120
Authors: Bornikoel Jan , Staiger Julia , Madlung Johannes , Forchhammer Karl , Maldener Iris 
Published: February 2018

SummaryHeterocyst‐forming cyanobacteria are organized as multicellular filaments of tightly interacting, functionally specialized cells. N2‐fixing heterocysts differentiate from vegetative cells under nitrogen limitation in a semi‐regular pattern along the filament. Diazotrophic growth requires metabolite exchange between neighboring cells within the filament. This exchange occurs via cell–cell junction complexes that span the gap between the plasma membranes and thereby cross the septal peptidoglycan through an array of uniform nanopores formed by AmiC‐type cell wall hydrolases. We investigated how the lytic hydrolase AmiC1 (Alr0092) from Anabaena sp. PCC 7120, whose activity needs to be tightly controlled to avoid cell lysis, is regulated by the LytM factor Alr3353. Inactivation of alr3353 resulted in significantly fewer nanopores and as a consequence, a lower rate of fluorescent tracer exchange between cells. The mutant was not able to grow with N2 as sole nitrogen source, although heterocysts were formed. Alr3353 localized mainly to fully developed intercellular septa of vegetative cells. The purified protein bound to peptidoglycan and enhanced the hydrolytic activity of AmiC1 in vitro. Our data show that the LytM factor Alr3353 regulates nanopore formation and cell–cell communication by directly interacting with AmiC1.
Nutraceuticals and skin appearance: Is there any evidence to support this growing trend?
Authors: Spiro A. , Lockyer S. 
Published: February 2018

AbstractThe rise of the nutraceutical market, specifically oral nutrition supplements claiming to improve skin appearance, is striking. This paper aims to examine the published scientific evidence for beneficial effects of nutraceuticals on skin appearance. An overview of skin physiology and intrinsic and extrinsic ageing is provided which underlies the potential physiological processes nutraceuticals purport to counter. Common ingredients used are explored. Some of these (vitamins A, C, B2, B3, B7, copper, iodine, zinc) have authorised skin‐related health claims, but many do not. Current evidence for those without existing authorised claims (e.g. green tea extract, pomegranate extract, carotenoids, evening primrose oil, borage oil, fish oil, collagen and co‐enzyme Q10) is reviewed, focussing primarily on evidence from randomised controlled trials where available, in relation to skin parameters including wrinkles and hydration. Issues of safety are also considered, and the postulated mechanisms for some emerging ingredients, such as cocoa flavanols and probiotics, are explored. Evidence from high quality human trials demonstrating clear benefit is required by regulatory authorities in order for foods and nutrition supplements to carry a health or beauty claim. To date, the evidence for many ingredients in relation to skin appearance is limited, not sufficiently robust and/or inconsistent. Although there are a small number of human studies suggesting a potential benefit and some plausible biological mechanisms, much of the evidence to date comes from animal and in vitro studies. There are simply not enough good quality randomised controlled trials in this area to draw firm conclusions about the benefit of nutraceuticals to skin appearance.
Rising food bank use in the UK: Sign of a new public health emergency?
Authors: Loopstra R. 
Published: February 2018

AbstractThe provision of food aid through food banks has recently expanded in the UK. By providing free bags of food to people experiencing financial shortfalls, food banks aim to prevent individuals and families from going without food. A growing body of research has sought to understand this type of provisioning, from what it indicates about social security in the UK to what it indicates about the problem of food insecurity. Here, recent research on the characteristics of people receiving help from food banks is reviewed, highlighting that they serve the most financially vulnerable groups in the UK: people with disabilities, people receiving out‐of‐work benefits and lone parents. The severity and chronicity of food insecurity observed in this population is a public health concern, as is evidence of high rates of poor mental health. Food banks have largely gone unevaluated for how well they do at meeting the needs of people using them, but focusing on building better food banks may also serve to further entrench voluntary and charitable food assistance as part of the social safety net in the UK. Given evidence that policy interventions such as pensions and income transfers reduce food insecurity, the importance of restoring strong social safety nets for reducing the need for food banks and food insecurity is discussed.
British eggs: Back on the menu for all
Authors: Gray J. 
Published: February 2018

AbstractThis article updates the latest guidance and research on the suitability of eggs as a good source of nutrition for particular population groups. This follows the publication of two important UK government reports: revised advice for vulnerable groups from the Food Standards Agency and a draft report about infant feeding from the Scientific Advisory Committee on Nutrition (SACN), as well as a recent review on egg consumption and cardiovascular disease risk in people with type 2 diabetes. The Food Standards Agency now advises that raw or lightly cooked British eggs are safe to eat for vulnerable groups, such as pregnant women, babies, toddlers and older people, provided that the eggs bear the Lion mark. This indicates that they have been produced under the British Lion Code of Practice, a scheme that includes more than 700 auditable criteria, of which vaccination of laying hens against Salmonella is a key aspect. The draft SACN report Feeding in the First Year of Life recommends that first complementary foods should be introduced from around 6 months of age and that there is no need to differentiate hens’ egg from other foods in this respect. There is also a warning that the deliberate exclusion or delayed introduction of allergenic foods including egg may increase the risk of allergy to these foods later in childhood. As regards people with type 2 diabetes, despite earlier concerns from epidemiological studies that higher egg intake might increase cardiovascular disease risk, more recent high‐quality intervention studies indicate that, provided eggs are consumed as part of a healthy, energy‐controlled diet, there is no need for concern. Eggs provide a wide range of important nutrients, including several that are found in only a limited number of other foods, such as vitamin D, iodine and the long‐chain omega‐3 fatty acid, docosahexaenoic acid. They are therefore a useful and versatile ingredient for pregnant women, infants and children, and older people.
Clinicians’ attitudes and approaches to evaluating the potential living kidney donor‐recipient relationship: An interview study
Authors: Ralph Angelique F. , Butow Phyllis , Craig Jonathan C. , Chapman Jeremy R. , Gill John S. , Kanellis John , Tong Allison 
Published: February 2018

ABSTRACTAimCareful assessment of the potential donor‐recipient relationship is recommended by guidelines to prevent undue coercion, and to ensure realistic expectations and genuine motivations. However, relationships are complex, nuanced and value‐laden, and can be challenging to evaluate in living kidney donation. We aimed to describe the attitudes and approaches of transplant clinicians towards assessing the relationship between potential living kidney donors and their recipients.MethodsSemi‐structured interviews were conducted with 54 transplant clinicians (nephrologists, surgeons, coordinators, social workers, psychiatrists and psychologists) from 32 transplant centres across nine countries including Australia, United States, Canada and New Zealand. Transcripts were analyzed thematically.ResultsFour themes were identified: protecting against vulnerability and premature decisions (ensuring genuine motivation, uncovering precarious dynamics and pre‐empting conflict, shared accountability, relying on specialty psychosocial expertise, trusting intimate bonds, tempering emotional impulsivity); safeguarding against coercion (discerning power imbalance, justified inquiry, awareness of impression management); minimizing potential threat to relationships (preserving the bond, giving equitable attention to donors and recipients, ensuring realistic expectations); and ambiguities in making judgments (adjudicating appropriateness and authenticity of relationships, questioning professional intervening, uncertainties in subjective and emotional assessments).ConclusionsClinicians felt ethically compelled to minimize the risk of undue coercion and to protect donors and recipients when evaluating the donor‐recipient relationship. However, disentangling voluntariness and altruism from potential undisclosed pressures to enact societal and family duty, making decisions within this complex, multi‐stakeholder context, and avoiding the imposition of undue paternalism and donor autonomy, were challenging. Multidisciplinary expertise and practical strategies for managing uncertainties are required.