bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of cognitive impairment using the Montreal Cognitive Assessment questionnaire among patients with systemic lupus erythematosus: a cross-sectional study at two tertiary centres in Malaysia
Authors: Kanapathy A , Nik Jaafar N R , Shaharir S S , Chan L F , Rozita M , Ch’ng S S 
Published: June 2019

Introduction Cognitive impairment is a common neuropsychiatric manifestation of systemic lupus erythematosus (SLE). However, it is not routinely assessed for despite its high prevalence and significant disease burden. Aims This study aimed to determine the prevalence of mild cognitive impairment (MCI) using the Montreal Cognitive Assessment (MoCA) and its associated factors among patients diagnosed with SLE in Malaysia. Methods A total of 200 SLE patients were recruited prospectively from the outpatient clinics of two tertiary hospitals in Malaysia. Standardized clinical interview was utilized to obtain information on socio-demographic characteristics. All patients were then assessed using the MoCA questionnaire for presence of cognitive impairment; the Patient Health Questionnaire 9 (PHQ-9) for presence of depressive symptoms; and the Wong–Baker Faces Pain Scale (WBFPS) for severity of pain. The evaluation of disease activity and severity were performed by the treating rheumatologists and nephrologists using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and Systemic Lupus International Collaborating Clinics Damage Index (SLICC DI). Results The prevalence of MCI was 35%. The significant associated factors from the bivariate analysis were male gender ( p = 0.04), educational level ( p = 0.00), WBFPS score ( p = 0.035) and anticardiolipin IgM ( p = 0.01). Further analysis using logistic regression model found that male gender (OR = 7.43, 95% confidence interval 1.06–52.06, p = 0.04), lower educational level (OR = 4.4, 95% confidence interval 1.47–13.21, p = 0.01) and presence of anticardiolipin IgM (OR = 6.81, 95% confidence interval 1.45–32.01, p = 0.031) were associated with impaired MoCA scores. Also, increasing pain scores increased the risk of patients being affected by cognitive impairment. Conclusion Over one-third of patients with SLE in our cohort were found to have MCI. Risk factors included male gender, lower educational level, higher pain score and presence of anticardiolipin IgM. Physicians are encouraged to perform routine screening to detect cognitive dysfunction in patients with SLE in their clinical practice as part of a more comprehensive management.
Changing hospitalization trends for systemic lupus erythematosus and rheumatoid arthritis in England
Authors: Hannah J , Galloway J , Kaul A 
Published: June 2019

Objectives Systemic lupus erythematosus (SLE) is a chronic, multisystemic, immune-mediated disorder associated with a substantial hospitalization risk. As a comparatively rare disease, there is a sparsity of research examining the burden of hospital admission in the contemporary era. We aim to describe national trends in hospitalization rates in England between 1998 and 2015 for SLE, using rheumatoid arthritis (RA) and general population rates as comparison cohorts for benchmarking. Methods Hospital admission rates, emergency and day-case admission rates, length of stay and bed days used were calculated using finished consultant episodes from Hospital Episode Statistics data. Cochran-Armitage tests and linear regression quantified the significance and magnitude of change over time. Results SLE admissions increased from 8.97 to 9.04 per 100,000 ( p < 0.001) between 1998 and 2015. By comparison, RA admissions rose from 71.0 to 171.6 per 100,000 ( p < 0.001) and all-cause admissions rose from 24,500 to 34,500 per 100,000 ( p < 0.001). Emergency admissions decreased both for SLE (2.6 to 1.2 per 100,000) and RA (12.8 to 4.4 per 100,000) despite all-cause emergency admissions increasing from 9400 to 10,300 per 100,000. SLE and RA day cases increased, whilst median length of stay decreased. Despite increasing admissions, total bed days for SLE and RA fell by 60% and 90%, respectively. Conclusions Whilst all-cause emergency admissions rose in the general population, those for SLE fell. Length of stay and bed days reduced and day cases increased, probably reflecting changing therapeutic strategies. This potentially large reduction in resource utilization warrants consideration when assessing the impact of new therapies.
Craniofacial Cleft: A Case of Tessier 10 Cleft With a Novel Method to Repair Large Bilateral Colobomas
Authors: Barnett Joshua M. , Pang John H. Y. , Herman Sean , Lee Jonathan , Stefko S. Tonya , Losee Joseph E. , Goldstein Jesse 
Published: June 2019

Objective: To describe a reliable method utilizing large, rotation flaps to reconstruct a number 10 Tessier cleft. Design: This is a descriptive clinical case report. Setting: Pediatric teaching hospital affiliated with a university. Patients, Participants: One participant in this clinical case report. Interventions: Full-thickness excision of the clefted eyelid, brow, and forehead tissue was performed bilaterally to develop medial and lateral eyebrow and forehead flaps. Right: the forehead/brow flap was rotated caudally to reapproximate the eyebrow and an eyelid rotation flap was also used to reapproximate the lid margin. Left: forehead/brow rotation flap allowed realignment of the eyebrow and a series of Z-plasties were used in the eyelid to reapproximate the lid margin and to lengthen the eyelid. Main Outcome Measure(s): Develop and construct a reliable reconstruction with full-eyelid closure and minimal donor site morbidity. Results: Complete eyelid closure bilaterally was achieved intraoperatively, and was maintained at 6-month follow-up with no evidence of ocular pathology. Conclusions: Large, bilateral upper eyelid colobomas require repair to prevent blindness. Although free tarsomarginal grafts and lid-sharing procedures have been described, we demonstrate that large rotation flaps designed along the cleft margin can provide a reliable reconstruction and minimize donor-site morbidity.
Chronic B-Type Natriuretic Peptide Therapy Prevents Atrial Electrical Remodeling in a Rabbit Model of Atrial Fibrillation
Authors: Zhao Hongyan , Li Tiankai , Liu Guangzhong , Zhang Li , Li Guangnan , Yu Jia , Lou Qi , He Rui , Zhan Chengchuang , Li Luyifei , Yang Wen , Zang Yanxiang , Cheng Cheping , Li Weimin 
Published: June 2019

Background: Atrial fibrillation (AF) is an important and growing clinical problem. Current pharmacological treatments are unsatisfactory. Electrical remodeling has been identified as one of the principal pathophysiological mechanisms that promote AF, but there are no effective therapies to prevent or correct electrical remodeling in patients with AF. In AF, cardiac production and circulating levels of B-type natriuretic peptide (BNP) are increased. However, its functional significance in AF remains to be determined. We assessed the hypotheses that chronic BNP treatment may prevent the altered electrophysiology in AF, and preventing AF-induced activation of Ca2+/calmodulin-dependent protein kinase II (CaMKII) may play a role. Methods and Results: Forty-four rabbits were randomly divided into sham, rapid atrial pacing (RAP at 600 beats/min for 3 weeks), RAP/BNP, and sham/BNP groups. Rabbits in the RAP/BNP and sham/BNP groups received subcutaneous BNP (20 μg/kg twice daily) during the 3-week study period. HL-1 cells were subjected to rapid field stimulation for 24 hours in the presence or absence of BNP, KN-93 (a CaMKII inhibitor), or KN-92 (a nonactive analog of KN-93). We compared atrial electrical remodeling-related alterations in the ion channel/function/expression of these animals. We found that only in the RAP group, AF inducibility was significantly increased, atrial effective refractory periods and action potential duration were reduced, and the density of I Ca, L and I to decreased, while I K1 increased. The changes in the expressions of Cav1.2, Kv4.3, and Kir2.1 and currents showed a similar trend. In addition, in the RAP group, the activation of CaMKIIδ and phosphorylation of ryanodine receptor 2 and phospholamban significantly increased. Importantly, these changes were prevented in the RAP/BNP group, which were further validated by in vitro studies. Conclusions: Chronic BNP therapy prevents atrial electrical remodeling in AF. Inhibition of CaMKII activation plays an important role to its anti-AF efficacy in this model.
Assessment of compounded transdermal mirtazapine as an appetite stimulant in cats with chronic kidney disease
Authors: Quimby Jessica M , Benson Kellyi K , Summers Stacie C , Saffire Ashlie , Herndon Andrea K , Bai Shasha , Gustafson Daniel L 
Published: June 2019

Objectives The aim of this study was to assess the appetite stimulation properties of compounded transdermal mirtazapine (CTM) in cats with chronic kidney disease (CKD). Methods Two sequential double-blind placebo-controlled crossover prospective studies were performed in client-owned cats with stable stage 2 or 3 CKD and a history of decreased appetite. In the first study nine CKD cats were randomized to receive 3.75 mg/0.1 ml CTM gel or placebo on the inner pinna every other day for 3 weeks, then, after a 4 day washout period, the cats were crossed over to the alternate 3 week treatment. In a second study, 10 CKD cats were randomized to receive 1.88 mg/0.1 ml CTM or placebo on the same schedule. Physical examination and serum biochemistry were performed before and after each treatment period, and owners kept daily logs of appetite, activity and eating behaviors. Mirtazapine concentrations in CTM gels and steady-state mirtazapine serum concentrations were measured using liquid chromatography/tandem mass spectrometry. Results Administration of both 3.75 mg and 1.88 mg CTM resulted in a statistically significant increase in weight ( P = 0.002 for both), increase in appetite ( P = 0.01 and P = 0.005, respectively), and increase in rate of food consumption ( P = 0.03 and P = 0.008, respectively). No significant difference in activity or vocalization was seen at either dose; however, individual cats experienced excessive meowing. Median weight increase for the 3.75 mg arm was 0.22 kg (range 0.04–0.44 kg), while median weight increase for the 1.88 mg arm was 0.26 kg (range –0.25 to 0.5 kg). Improvement in body condition score was seen in 5/9 cats in the 3.75 mg arm (P = 0.04) and 6/10 cats in the 1.88 mg arm (P = 0.004). Conclusions and relevance CTM increased appetite and resulted in weight gain in CKD cats despite significant inconsistencies in compounding, and may benefit cats in countries where an approved product is not available.
Developing a crosswalk between the RAND-12 and the health utilities index for multiple sclerosis
Authors: Marrie Ruth Ann , Dufault Brenden , Tyry Tuula , Cutter Gary R , Fox Robert J , Salter Amber 
Published: June 2019

Background: Researchers studying health-related quality of life (HRQOL) in multiple sclerosis (MS) can choose from many instruments, but findings from studies which use different instruments cannot be easily combined. We aimed to develop a crosswalk that associates scores from the RAND-12 to scores on the Health Utilities Index—Mark III (HUI3) in persons with MS. Methods: In 2018, participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) registry completed the RAND-12 and the HUI3 to assess HRQOL. We used item-response theory (IRT) and equipercentile linking approaches to develop a crosswalk between instruments. We compared predicted scores for the HUI3 from each crosswalk to observed scores using Pearson correlations, intraclass correlation coefficients (ICCs), and Bland–Altman plots. Results: Of 11,389 invited participants, 7129 (62.6%) responded. Predicted and observed values of the HUI3 from the IRT-linking method were moderately correlated (Pearson r = 0.76) with good concordance (ICC = 0.72). However, the Bland–Altman plots suggested biased prediction. Predicted and observed values from the equipercentile linking method were also moderately correlated (Pearson r = 0.78, ICC = 0.78). The Bland–Altman plots suggested no bias. Conclusion: We developed a crosswalk between the RAND-12 and the HUI3 in the MS population which will facilitate data harmonization efforts.
Comprehensive Analysis of lncRNA–miRNA– mRNA Network Ascertains Prognostic Factors in Patients with Colon Cancer
Authors: Gao Zhenzhen , Fu Peng , Yu Zhengyi , Zhen Fuxi , Gu Yanhong 
Published: June 2019

Background: Non-coding RNAs are competing endogenous RNAs in the occurrence and development of tumorigenesis; numerous microRNAs are aberrantly expressed in colon cancer tissues and play significant roles in oncogenesis development and metastasis. However, large clinical and RNA data are lacking to further confirm the exact role of these RNAs in tumors. This study aimed to ascertain differential RNA expression between colon cancer and normal colon tissues. Materials and Methods: RNA sequencing and clinical data of patients with colon cancer were procured from The Cancer Genome Atlas database; differentially expressed long non-coding RNA, differentially expressed messenger RNAs, and differentially expressed microRNAs were achieved using the limma package in edgeR to generate competing endogenous RNAs networks. Then, Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analysis were conducted with ggplot2 package, the Kaplan-Meier survival method was used to predict survival in patients with colon cancer. Results: In total, 1174 differentially expressed long non-coding RNAs, 2068 differentially expressed messenger RNAs, and 239 differentially expressed microRNAs were generated between 480 colon cancer and 41 normal colon tissue samples. Three competing endogenous RNA networks were established. Gene Ontology analysis indicated that the genes of the up-regulated microRNA network were involved in negative regulation of transcription, DNA-template, and those of down-regulated microRNA network were involved in transforming growth factor β receptor signaling pathways, response to hypoxia, cell migration, while Kyoto Encyclopedia of Genes and Genomes analyses of these networks turned out to be negative. Three long non-coding RNAs (AP004609.1, ARHGEF26-AS1, and LINC00491), 3 microRNAs (miRNA-141, miRNA-216a, and miRNA-193b) and 3 RNAs (ULBP2, PHLPP2, and TPM2) were detected to be associated with prognosis by the Kaplan-Meier survival analysis. Additionally, univariate and multivariate Cox regression analyses showed that the microRNA-216a of the competing endogenous RNA might be an independent prognostic factor in colon cancer. Conclusions: This study constructed the non-coding RNA-related competing endogenous RNA networks in colon cancer and sheds lights on underlying biomarkers for colon cancer cohorts.
Atopy and Quality of Life in Pediatric Chronic Rhinosinusitis
Authors: Anamika Anamika , Chakravarti Arunabha , Kumar Raj 
Published: June 2019

Background Atopy has been suggested in the development of chronic rhinosinusitis (CRS), as allergic rhinitis (AR) is common coexisting disease in pediatric and adult patients with CRS. The contribution of AR to CRS is less clear till date. Objectives The objectives of this study were to determine atopic profile of children with CRS and impact of atopic status on disease severity and quality of life. Methods One hundred ten patients, aged between 7 and 18 years of age, diagnosed with CRS based on history, detailed clinical examination including nasal endoscopic examination were included in this cross-sectional study. Scoring of CRS was done according to Lund Mackay Endoscopic Appearance Score. Patients underwent skin prick test against 65 common aeroallergens (1:10 w/v, 50% glycerinated) for evidence of atopy. SN-5 Sinus and Nasal Quality of Life Survey was used to assess the quality of life in the study subjects. Results Positive skin prick test to at least one of the common aeroallergens was present in 58 (52.7%) patients. Most common aeroallergen sensitivity was seen with insects in 48 (43.6%) patients. Patients of CRS with atopy had higher mean Lund Mackay endoscopic score and SN-5 score than nonatopic patients which was statistically significant. Conclusion In conclusion, we recommend that testing for aeroallergen sensitivity and assessment of quality of life should be included in the protocol for diagnosis and management of pediatric patients with CRS. Early diagnosis and treatment of allergy may halt the progression of CRS and also the development of asthma and other allergic multimorbid disorders.
Preoperative Grades of Osteoarthritis and Meniscus Volume Correlate with Clinical Outcomes of Osteochondral Graft Treatment for Cartilage Defects in the Knee
Authors: Wang Dean , Marom Niv , Coxe Francesca R. , Kalia Vivek , Burge Alissa J. , Jones Kristofer J. , Rodeo Scott A. , Williams Riley J. 
Published: June 2019

Objective To identify preoperative imaging-based indicators of knee degeneration that correlate with graft failure risk and postoperative clinical outcome scores after osteochondral graft treatment for chondral defects of the knee. Design Prospectively collected data from 113 patients (mean age, 34 years; 65% male) treated with mosaicplasty or osteochondral allograft transplantation (OCA) was reviewed. Four different aspects of knee degeneration were examined based on preoperative radiographs or magnetic resonance imaging: (1) Osteoarthritis using the Kellgren-Lawrence (KL) grading system, (2) meniscus volume, (3) meniscus quality, and (4) synovitis. Primary outcomes included graft failure, defined by removal/revision of the graft or conversion to arthroplasty, and patient responses to clinical outcome scores. Results Forty-one knees (36%) underwent mosaicplasty, and 72 knees (64%) underwent OCA. Mean duration of follow-up was 4.5 years (range, 2-14 years). A preoperative KL grade of ≥3 was correlated with increased failure rates ( P = 0.01), lower postoperative International Knee Documentation Committee form (IKDC), Activities of Daily Living of the Knee Outcome Survey (KOS-ADL), and Overall Condition scores ( P < 0.01), and decreased improvement in Overall Condition scores ( P = 0.01). Within an individual tibiofemoral compartment, a preoperative meniscus volume grade of ≥3 (indicating <50% meniscus volume remaining) was correlated with increased condylar graft failure rates ( P < 0.01). Preoperative meniscus quality and synovitis grades were not associated with graft failure rates or clinically meaningful differences in postoperative outcome scores. Conclusions Greater preoperative osteoarthritis and meniscus volume loss were correlated with increased graft failure rates after osteochondral graft treatment for chondral defects of the knee.
Identification of the cerebral effects of paracetamol in healthy subjects: an fMRI study
Authors: De Coster Olivier , Forget Patrice , De Mey Johan , Van Schuerbeek Peter , Poelaert Jan 
Published: June 2019

Introduction: Paracetamol is commonly used for its antipyretic properties and analgesic effects, but the central mechanism remains elusive. We designed a study in healthy volunteers to detect the central functional working mechanism of paracetamol. Subjects, material and methods: A total of 20 subjects had a baseline functional magnetic resonance imaging (fMRI) before the intake of 1000 mg paracetamol orally; 60 minutes later, a second fMRI was made aiming detection of regional blood flow differences. Results: A decreased connectivity was observed in the ventral volume of interest (VOI), with the posterior cingulate (with both the left anterior cingulate cortex (ACC) and right ACC: respectively, Ke = 576; t = −6.8894 and Ke = 185; t = −4.8178) and the inferior temporal left (Ke = 103; t = −5.0993); in the combined ventral and dorsal VOIs, the posterior cingulate (with the left ACC; Ke = 149; t = −4.5658) and, both with the right ACC, the inferior temporal left (Ke = 88; t = −3.8456) and the inferior frontal gyrus (Ke = 86; t = −4.3937) had a decrease in connectivity. An increase was seen in other regions, including, among others, the middle frontal and temporal gyri (respectively, Ke = 85; t = 4.4256 and Ke = 85; t = 5.6851), the inferior frontal (with the left ACC: Ke = 165; t = 4.4998) and the superior frontal gyrus (with the right ACC; Ke = 281; t = 4.5992), and the post/precentral gyrus (with the right ACC, respectively, Ke = 102; t = 6.0582 and Ke = 105; t = 4.0776). Conclusions: On fMRIs in healthy volunteers, the ingestion of paracetamol affects connections with the ACC. This suggests a central effect of paracetamol in cerebral areas known to be associated with pain. Further studies are needed to demonstrate the same effects in acute and chronic pain states.
Standard smoking cessation services in sites participating in the SCIMITAR+ trial for people with severe mental ill health
Authors: Heron Paul , McCloud Tayla , Arundel Catherine , Bailey Della , Ker Suzy , Li Jinshuo , Mishu Masuma , Osborn David , Parrott Steve , Peckham Emily , Stribling Alison , Gilbody Simon 
Published: June 2019

Aims and methodThe SCIMITAR+ trial was commissioned to evaluate the effectiveness of a bespoke smoking cessation intervention for people with severe mental ill health compared with usual services. It is difficult to define what constitutes usual care in smoking cessation services. We aimed to define what this was during the trial. Twenty-two National Health Service healthcare providers participated in a bespoke survey asking about usual care in their area.ResultsAll sites offered smoking cessation support; however, service provider and service type varied substantially. In some cases services were not streamlined, meaning that people received smoking cessation counselling from one organisation and smoking cessation medication from another.Clinical implicationsTo better implement the National Institute for Health and Care Excellence guideline PH48, clearer referral pathways need to be implemented and communicated to patients, staff and carers. People with severe mental ill health need to be able to access services that combine nicotine replacement therapy and behavioural support in a streamlined manner.
External Beam, Brachytherapy, or Chemotherapy? Defining Adjuvant Therapy for Early-Stage and High- and High–Intermediate-Risk Endometrial Cancer
Authors: Jang Joanne Wei-un , Lee Larissa Janeen 
Published: June 2019

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 54-year-old postmenopausal female with a history of stroke and carotid endarterectomy presented with 3 weeks of vaginal bleeding with passage of clots. Gynecologic exam revealed a 3-cm barrel-shaped cervix with friability at the os and no appreciable parametrial involvement. Cervical biopsy showed high-grade endometrioid adenocarcinoma. Pelvic magnetic resonance imaging demonstrated a 9.9-cm × 4.5-cm × 6.2-cm mass extending from the uterus to the cervix with greater than 50% myometrial invasion (MMI; Fig 1 ). Total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy revealed International Federation of Gynecology and Obstetrics (FIGO) stage II endometrial cancer: a 12-cm grade 3 endometrioid adenocarcinoma with 80% MMI and lymphovascular invasion (LVI) involving the outer half of the cervical stroma ( Fig 1 ), and without pelvic lymph node involvement.