bluuebunny/crossref_metadata_2025_split huggingface dataset:
A hierarchy of corticospinal plasticity in human hand and forearm muscles
Authors: Foysal K. M. Riashad , Baker Stuart N. 
Published: March 2019

Key points
Pairing stimulation of a finger flexor or extensor muscle at the motor point with transcranial magnetic stimulation (TMS) of the motor cortex generated plastic changes in motor output.
Increases in output were greater in intrinsic hand muscles than in the finger flexor. No changes occurred in the finger extensor. This gradient was seen irrespective of which muscle was stimulated paired with transcranial magnetic stimulation.
Intermittent theta‐burst stimulation also produced increases in output, although these were similar across muscles.
We suggest that intrinsic hand and flexor muscles have a higher potential to show plasticity than extensors, although only when plasticity is induced by sensory input. This may relate to differences seen in recovery of function in these muscles after injury, such as post‐stroke.
AbstractThe ability of the motor system to show plastic change underlies skill learning and also permits recovery after injury. One puzzling observation is that, after stroke, upper limb flexor muscles show good recovery but extensors remain weak, with this being a major contributor to residual disability. We hypothesized that there might be differences in potential for plasticity across hand and forearm muscles. In the present study, we investigated this using two protocols based on transcranial magnetic brain stimulation (TMS) in healthy human subjects. Baseline TMS responses were recorded from two intrinsic hand muscles: flexor digitorum superficialis (FDS) and extensor digitorum communis (EDC). In the first study, paired associative stimulation (PAS) was delivered by pairing motor point stimulation of FDS or EDC with TMS. Responses were then remeasured. Increases were greatest in the hand muscles, smaller in FDS and non‐significant in EDC, irrespective of whether stimulation of FDS or EDC was used. In the second study, intermittent theta‐burst rapid rate TMS was applied instead of PAS. In this case, all muscles showed similar increases in TMS responses. We conclude that the potential to show plastic changes in motor cortical output has the gradient: hand muscles > flexors > extensors. However, this was only seen in a protocol that requires integration of sensory input (PAS) and not when plasticity was induced purely by cortical stimulation (rapid rate TMS). This observation may relate to why functional recovery tends to favour flexor and hand muscles over extensors.
Double-Poling Physiology and Kinematics of Elite Cross-Country Skiers: Specialized Long-Distance Versus All-Round Skiers
Authors: Skattebo Øyvind , Losnegard Thomas , Stadheim Hans Kristian 
Published: March 2019

Purpose:Long-distance cross-country skiers specialize to compete in races >50 km predominantly using double poling (DP). This emphasizes the need for highly developed upper-body endurance capacities and an efficient DP technique. The aim of this study was to investigate potential effects of specialization by comparing physiological capacities and kinematics in DP between long-distance skiers and skiers competing using both techniques (skating/classic) in several competition formats (“all-round skiers”).Methods:Seven male long-distance (32 [6] y, 183 [6] cm, 76 [5] kg) and 6 all-round (25 [3] y, 181 [5] cm, 75 [6] kg) skiers at high international levels conducted submaximal workloads and an incremental test to exhaustion for determination of peak oxygen uptake (VO2peak) and time to exhaustion (TTE) in DP and running.Results:In DP and running maximal tests, TTE showed no difference between groups. However, long-distance skiers had 5–6% lower VO2peak in running (81 [5] vs 85 [3] mL·kg−1·min−1;P = .07) and DP (73 [3] vs 78 [3] mL·kg−1·min−1;P < .01) than all-round skiers. In DP, long-distance skiers displayed lower submaximal O2cost than all-round skiers (3.8 ± 3.6%;P < .05) without any major differences in cycle times or cyclic patterns of joint angles and center of mass. Lactate concentration over a wide range of speeds (45–85% of VO2peak) did not differ between groups, even though each workload corresponded to a slightly higher percentage of VO2peak for long-distance skiers (effect size: 0.30–0.68).Conclusions:The long-distance skiers displayed lower VO2peak but compensated with lower O2cost to perform equally with the all-round skiers on a short TTE test in DP. Furthermore, similar submaximal lactate concentration and reduced O2cost could be beneficial in sustaining high skiing speeds in long-duration competitions.
Assessing the deprivation gap in stillbirths and neonatal deaths by cause of death: a national population-based study
Authors: Best Kate E , Seaton Sarah E , Draper Elizabeth S , Field David J , Kurinczuk Jennifer J , Manktelow Bradley N , Smith Lucy K 
Published: March 2019

ObjectiveTo investigate socioeconomic inequalities in cause-specific stillbirth and neonatal mortality to identify key areas of focus for future intervention strategies to achieve government ambitions to reduce mortality rates.DesignRetrospective cohort study.SettingEngland, Wales, Scotland and the UK Crown Dependencies.ParticipantsAll singleton births between 1 January 2014 and 31 December 2015 at ≥24 weeks’ gestation.Main outcome measureCause-specific stillbirth or neonatal death (0–27 days after birth) per 10 000 births by deprivation quintile.ResultsData on 5694 stillbirths (38.1 per 10 000 total births) and 2368 neonatal deaths (15.9 per 10 000 live births) were obtained from Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK). Women from the most deprived areas were 1.68 (95% CI 1.56 to 1.81) times more likely to experience a stillbirth and 1.67 (95% CI 1.48 to 1.87) times more likely to experience a neonatal death than those from the least deprived areas, equating to an excess of 690 stillbirths and 231 neonatal deaths per year associated with deprivation. Small for gestational age (SGA) unexplained antepartum stillbirth was the greatest contributor to excess stillbirths accounting for 33% of the deprivation gap in stillbirths. Congenital anomalies accounted for the majority (59%) of the deprivation gap in neonatal deaths, followed by preterm birth not SGA (24–27 weeks, 27%).ConclusionsCause-specific mortality rates at a national level allow identification of key areas of focus for future intervention strategies to reduce mortality. Despite a reduction in the deprivation gap for stillbirths and neonatal deaths, public health interventions should primarily focus on socioeconomic determinants of SGA stillbirth and congenital anomalies.
Measuring 21 low-value hospital procedures: claims analysis of Australian private health insurance data (2010–2014)
Authors: Chalmers Kelsey , Pearson Sallie-Anne , Badgery-Parker Tim , Brett Jonathan , Scott Ian A , Elshaug Adam G 
Published: March 2019

ObjectiveTo examine the prevalence, costs and trends (2010–2014) for 21 low-value inpatient procedures in a privately insured Australian patient cohort.DesignWe developed indicators for 21 low-value procedures from evidence-based lists such as Choosing Wisely, and applied them to a claims data set of hospital admissions. We used narrow and broad indicators where multiple low-value procedure definitions exist.Setting and participantsA cohort of 376 354 patients who claimed for an inpatient service from any of 13 insurance funds in calendar years 2010–2014; approximately 7% of the privately insured Australian population.Main outcome measuresCounts and proportions of low-value procedures in 2014, and relative change between 2010 and 2014. We also report both the Medicare (Australian government) and the private insurance financial contributions to these low-value admissions.ResultsOf the 14 662 patients with admissions for at least 1 of the 21 procedures in 2014, 20.8%–32.0% were low-value using the narrow and broad indicators, respectively. Of the 21 procedures, admissions for knee arthroscopy were highest in both the volume and the proportion that were low-value (1607–2956; 44.4%–81.7%).Seven low-value procedures decreased in use between 2010 and 2014, while admissions for low-value percutaneous coronary interventions and inpatient intravitreal injections increased (51% and 8%, respectively).For this sample, we estimated 2014 Medicare contributions for admissions with low-value procedures to be between $A1.8 and $A2.9 million, and total charges between $A12.4 and $A22.7 million.ConclusionsThe Australian federal government is currently reviewing low-value healthcare covered by Medicare and private health insurers. Estimates from this study can provide crucial baseline data and inform design and assessment of policy strategies within the Australian private healthcare sector aimed at curtailing the high volume and/or proportions of low-value procedures.
Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth
Authors: Fadahunsi Kayode Philip , Akinlua James Tosin , O’Connor Siobhan , Wark Petra A , Gallagher Joseph , Carroll Christopher , Majeed Azeem , O’Donoghue John 
Published: March 2019

IntroductionElectronic health (eHealth) applications have become a very large repository of health information which informs critical decisions relating to the diagnosis, treatment and prognosis of patients. Poor information quality (IQ) within eHealth may compromise patient safety. Evaluation of IQ in eHealth is therefore necessary to promote patient safety. An IQ framework specifies what aspects of information to assess and how to conduct the assessment. This systematic review aims to identify dimensions within existing IQ frameworks in eHealth and develop a new IQ framework for the assessment of eHealth.Method and analysisWe will search Embase, Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, PsycINFO (American Psychological Association), Global Health, Scopus, ProQuest Dissertations and Theses Global, Health Management Information Consortium and reference lists of relevant publications for articles published in English until November 2018. Studies will be selected by two independent reviewers based on prespecified eligibility criteria. Two reviewers will independently extract data in each eligible study using a prepiloted Microsoft Excel data extraction form. Thematic synthesis will be employed to define IQ dimensions and develop a new IQ framework for eHealth.Ethics and disseminationEthical approval is not required for this systematic review as primary data will not be collected. The result of the review will be disseminated through publication in an academic journal and scientific conferences.PROSPERO registration numberCRD42018097142.
Patterns of statin utilisation for new users and market dynamics in South Korea: a 13-year retrospective cohort study
Authors: Son Kyung-Bok , Bae SeungJin 
Published: March 2019

ObjectiveThis study analysed utilisation of statins for new statin users and assessed market dynamics of statins in South Korea.DesignThis study is a retrospective cohort study.SettingThe yearly claims data for statins were retrieved from the National Health Insurance Service-National Sample Cohort.Main outcome measureWe are interested in new statin users during 2003–2015 in Korea. Information on prescribed statins, including intensity of statins and entry of new and follow-on statins in the market, and healthcare institutions that prescribed the statins were also collected. In time series analysis, we estimated the effect of introduction of generics in the market, specifically for newly prescribed statin users.ResultsThis 13-year longitudinal study of a sample cohort provided by the National Health Insurance Service found that the incidence of new statin user increase from 838.1/100 000 persons in 2003 to 1626.9/100 000 persons in 2015. Most new users were initiated on a monotherapy that was prescribed at primary healthcare institutions. However, the statin market for new users were quite dynamic in Korea. First, the most commonly prescribed statin changed several times during the study period. Second, the use of moderate-intensity statins increased from 57% in 2003 to 92% in 2015. In line with this result, we could not observe substantial differences in prescription of statins in groups having selected diseases history. Lastly, we found market invasion or switch of statins among new statin users, specifically at primary healthcare institutions.ConclusionSimilar to other countries, the incidence of new statin users has been increased in Korea. However, the statin market in Korea is quite dynamic compared with other countries. Interestingly, discounted price of originals after the introduction of generics immediately expand markets or substitute the market particularly in primary healthcare institutions in Korea.
Vulvar soft tissue tumors
Authors: Behranwala K. A. , Latifaj B. , Blake P. , Barton D. P. J. , Shepherd J. H. , Thomas J. M. 
Published: March 2019

ObjectiveTo report our incidence of soft tissue tumors at this site and to discuss various prognostic factors.MethodsAll patients with a diagnosis of vulvar soft tissue neoplasms were studied from a prospective database at the Royal Marsden Hospital between January 1985 and July 2001.ResultsSeventeen vulvar soft tissue neoplasms (11 malignant and six benign) were treated during this period. Leiomyosarcoma (n= 5) and aggressive angiomyxoma (n= 4) were the most frequent histologic types. According to the grade, there were four G3, three G2, three G1 and could not be assessed in one patient. Local recurrence occurred in six patients with sarcoma (three with high grade and one each with intermediate, low, and undetermined grade). In this group, five patients had negative microscopic margins and one patient had positive microscopic margins on excision. All three women with low-grade sarcomas are alive without evidence of disease. Three patients with aggressive angiomyxoma also had a local recurrence.ConclusionSurgical excision is the primary treatment where possible. The grade of the tumor is an important predictor for local recurrence and outcome. Aggressive angiomyxoma is a local problem. Leiomyosarcoma and aggressive angiomyxoma are the most frequent histologic types.
Inability of immunohistochemistry to predict clinical outcomes of endometrial cancer patients
Authors: Gossett D. R. , Alo P. , Bristow R. E. , Galati M. , Kyshtoobayeva A. , Fruehauf J. , Montz F. J. 
Published: March 2019

IntroductionDespite optimal surgery, some patients with early endometrial carcinoma develop recurrence and die of disease. A number of immunohistochemical (IHC)-identified cell products (markers) have been proposed as predictors of recurrence. This study characterizes a large series of endometrial carcinomas with previously described markers as well as markers that have not been investigated in endometrial carcinoma.Patients and methodsWomen who had undergone surgery for endometrial carcinoma were identified and specimens accessed. Tissue blocks were evaluated for ten IHC markers. Results were correlated with last known clinical status.ResultsMean follow-up was 43 months; complete data were available on 117 patients. Two women died of other causes; of the remaining 115, eight died of disease and six were alive with recurrence at last follow-up (12%). Vascular endothelial growth factor staining independently predicted recurrence and death. However, in multivariate analyses, only FIGO stage predicted outcome.DiscussionOur goal was to identify markers to predict which women with endometrial carcinoma were likely to have disease recurrence. We evaluated cell-cycle regulatory proteins, growth factors, hormone receptors, and angiogenic factors, but did not identify any marker that independently predicted outcome in multivariate analysis. This may reflect the few negative outcomes in our population.
Relationship between children’s cognitions and later educational progress in rural South Africa: a longitudinal study
Authors: Cortina Melissa , Jack Helen E , Pearson Rebecca , Kahn Kathleen , Tollman Stephen , Hlungwani Tintswalo , Twine Rhian , Stein Alan , Fazel Mina 
Published: March 2019

BackgroundChildren in low-income and middle-income countries (LMICs) who remain in school have better health and employment outcomes. South Africa, like many LMICs, has a secondary school completion rate under 50%, leaving room for improvement if we can identify factors that affect educational attainment. This is the first longitudinal study to examine the effects of childhood mental health and cognitions on educational outcomes in LMIC.MethodsUsing the Strengths and Difficulties Questionnaire (SDQ) and Cognitive Triad Inventory for Children (CTI-C), we assessed the psychological functioning and cognition of children aged 10–12 in rural South Africa. We linked that data with measures of educational progress collected 5 years later and examined associations between educational progress and (1) behavioural and emotional problems and (2) cognitive interpretations, adjusting for possible confounders.ResultsEducational data were available for 443 individuals. 92% (n=408) of individuals had advanced three or fewer grades in 7 years. Having more positive cognitions (CTIC-C) was positively associated with progressing at least three grade levels (adjusted OR 1.43, 95% CI 1.14 to 1.79). There was no evidence for an association between emotional and behavioural problems (SDQ) and educational progress (OR 0.90, 95% CI 0.72 to 1.11).ConclusionIf children in LMICs can develop more positive perspectives, they may be able to stay in school longer. Cognitions can be modified, and future studies should test interventions that work to improve cognition in childhood, guided, for example, by principles of cognitive–behavioural therapy.
Need for rescue treatment and its implication: stent retriever versus contact aspiration thrombectomy
Authors: Kang Dong-Hun , Kim Jin Woo , Kim Byung Moon , Heo Ji Hoe , Nam Hyo Suk , Kim Young Dae , Hwang Yang-Ha , Kim Yong-Won , Baek Jang-Hyun , Yoo Joonsang , Kim Dong Joon , Jeon Pyoung , Bang Oh Young , Baik Seung Kug , Suh Sang Hyun , Lee Kyung-Yul , Kwak Hyo Sung , Roh Hong Gee , Lee Young-Jun , Kim Sang Heum , Ryu Chang-Woo , Ihn Yon-Kwon , Kim Byungjun , Jeon Hong Jun , Byun Jun Soo , Suh Sangil , Park Jeong Jin , Roh Jieun 
Published: March 2019

BackgroudThe need for rescue treatment (RT) may differ depending on first-line modality (stent retriever (SR) or contact aspiration (CA)) in endovascular thrombectomy (EVT). We aimed to investigate whether the type of first-line modality in EVT was associated with the need for RT.MethodsWe identified all patients who underwent EVT for anterior circulation large-vessel occlusion from prospectively maintained registries of 17 stroke centers. Patients were dichotomized into SR-first and CA-first. RT involved switching to the other device, balloon angioplasty, permanent stenting, thrombolytics, glycoprotein IIb/IIIa antagonist, or any combination of these. We compared clinical characteristics, procedural details, and final recanalization rate between the two groups and assessed whether first-line modality type was associated with RT requirement and if this affected clinical outcome.ResultsA total of 955 patients underwent EVT using either SR-first (n=526) or CA-first (n=429). No difference occurred in the final recanalization rate between SR-first (82.1%) and CA-first (80.2%). However, recanalization with the first-line modality alone and first-pass recanalization rates were significantly higher in SR-first than in CA-first. CA-first had more device passes and higher RT rate. The RT group had significantly longer puncture-to-recanalization time (93±48 min versus 53±28 min). After adjustment, CA-first remained associated with RT (OR, 1.367; 95% CI, 1.019 to 1.834). RT was negatively associated with good outcome (OR, 0.597; 95% CI, 0.410 to 0.870).ConclusionCA was associated with requiring RT, while recanalization with first-line modality alone and first-pass recanalization rates were higher with SR. RT was negatively associated with good outcome.
On the reflex mechanisms of cervical transcutaneous spinal cord stimulation in human subjects
Authors: Milosevic Matija , Masugi Yohei , Sasaki Atsushi , Sayenko Dimitry G. , Nakazawa Kimitaka 
Published: March 2019

Transcutaneous and epidural electrical spinal cord stimulation techniques are becoming more valuable as electrophysiological and clinical tools. Recently, remarkable recovery of the upper limb sensorimotor function during cervical spinal stimulation was demonstrated. In the present study, we sought to elucidate the neural mechanisms underlying the effects of transcutaneous spinal cord stimulation (tSCS) of the cervical spine. We hypothesized that cervical tSCS can be used to selectively activate the sensory route entering the spinal cord and transsynaptically converge on upper limb motor pools. To test this hypothesis, we applied cervical tSCS using paired stimuli (homosynaptic depression) and during passive muscle stretching of the wrist flexor (presynaptic inhibition via Ia afferents), voluntary hand muscle contraction (descending facilitation of motoneuron pool), and muscle-tendon vibration of the wrist (presynaptic inhibition via afferent occlusion). Our results demonstrate significant inhibition of the second evoked response during paired stimulus delivery, inhibition of responses during passive muscle stretching and muscle-tendon vibration, and facilitation during voluntary muscle contraction, which share similarities with responses evoked during lumbosacral tSCS. These results indicate that the route of the stimulation current transmission passes via afferents in the dorsal roots through the spinal cord to activate the motor pools and potentially interneuronal networks projecting to upper limb muscles. Using a novel stimulation paradigm, our study is the first to present evidence of the sensory neuronal pathway of the cervical tSCS propagation. Overall, our work demonstrates the utility and sensitivity of cervical tSCS to engage the sensory pathway projecting to the upper limbs. NEW & NOTEWORTHY Despite therapeutic effects that have been demonstrated previously using noninvasive cervical spinal stimulation, it has been unclear whether, and to what degree, the stimulation can activate the sensory afferent system. Our study presents evidence that cervical transcutaneous spinal cord stimulation can engage the sensory pathways and transsynaptically converge on motor pools projecting to upper limb muscles, demonstrating the utility and sensitivity of cervical spinal stimulation for electrophysiological assessments and neurorehabilitation.