bluuebunny/crossref_metadata_2025_split huggingface dataset:
Discovery and Validation of Agonistic Angiotensin Receptor Autoantibodies as Biomarkers of Adverse Outcomes
Authors: Abadir Peter M. , Jain Alka , Powell Laura J. , Xue Qian-Li , Tian Jing , Hamilton Robert G. , Bennett David A. , Finucane Thomas , Walston Jeremy D. , Fedarko Neal S. 
Published: December 2016

Background:
Agonistic angiotensin II type 1 receptor autoantibodies (AT1RaAbs) have not been associated with functional measures or risk for adverse health outcomes. AT1RaAbs could be used to stratify patient risk and to identify patients who can benefit from angiotensin receptor blocker treatment.

Methods:
Demographic and physiological covariates were measured in a discovery set of community-dwelling adults from Baltimore (N=255) and AT1RaAb associations with physical function tests and outcomes assessed. A group from Chicago (N=60) was used for validation of associations and to explore the impact of angiotensin receptor blocker treatment.

Results:

The Baltimore group had 28 subjects with falls, 32 frail subjects, and 5 deaths. Higher AT1RaAbs correlated significantly with interleukin-6 (Spearman
r
=0.33,
P
<0.0001), systolic blood pressure (Spearman
r
=0.28,
P
<0.0001), body mass index (Spearman
r
=0.28,
P
<0.0001), weaker grip strength (Spearman
r
=–0.34,
P
<0.01), and slower walking speed (Spearman
r
=–0.30,
P
<0.05). Individuals with high AT1RaAbs were 3.9 (95% confidence interval, 1.38–11.0) times more likely to be at high risk after adjusting for age (
P
<0.05). Every 1 µg/mL increase in AT1RaAbs increased the odds of falling 30% after adjusting for age, sex, body mass index, and blood pressure. The Chicago group had 46 subjects with falls and 60 deaths. Serum AT1RaAb levels were significantly correlated with grip strength (Spearman
r
=–0.57,
P
<0.005), walking speed (Spearman
r
=–0.47,
P
<0.005), and falls (Spearman
r
=0.30,
P
<0.05). Every 1 µg/mL increase in AT1RaAbs, decreased time to death by 9% after adjusting for age, sex, body mass index, and blood pressure. Chronic treatment with angiotensin receptor blockers was associated with better control of systolic blood pressure and attenuation of decline in both grip strength and time to death.

Conclusions:
In older individuals, higher AT1RaAb levels were associated with inflammation, hypertension, and adverse outcomes. Angiotensin receptor blocker treatment may blunt the harm associated with high levels of AT1RaAb.
“They Shouldn’t Be Coming to the ED, Should They?”: A Descriptive Service Evaluation of Why Patients With Palliative Care Needs Present to the Emergency Department
Authors: Green Emilie , Ward Sarah , Brierley Will , Riley Ben , Sattar Henna , Harris Tim 
Published: December 2016

Background: Patients with palliative care needs frequently attend the emergency department (ED). There is no international agreement on which patients are best cared for in the ED, compared to the primary care setting or direct admission to the hospital. This article presents the quantitative phase of a mixed-methods service evaluation, exploring the reasons why patients with palliative care needs present to the ED. Methods: This is a single-center, observational study including all patients under the care of a specialist palliative care team who presented to the ED over a 10-week period. Demographic and clinical data were collected from electronic health records. Results: A total of 105 patients made 112 presentations to the ED. The 2 most common presenting complaints were shortness of breath (35%) and pain (28%). Eighty-three percent of presentations required care in the ED according to a priori defined criteria. They either underwent urgent investigation or received immediate interventions that could not be delivered in another setting, were referred by a health-care professional, or were admitted. Conclusions: Findings challenge the misconception that patients known to a palliative care team should be cared for outside the ED. The importance and necessity of the ED for patients in their last years of life has been highlighted, specifically in terms of managing acute, unpredictable crises. Future service provision should not be based solely on a patient’s presenting complaint. Further qualitative research exploring patient perspective is required in order to explore the decision-making process that leads patients with palliative care needs to the ED.
Sericin ameliorated dysmorphic mitochondria in high-cholesterol diet/streptozotocin rat by antioxidative property
Authors: Ampawong Sumate , Isarangkul Duangnate , Aramwit Pornanong 
Published: December 2016

Sericin has been implicated in lower cholesterolemic effect due to its properties with several mechanisms. Mitochondria are one of the most important targets to be affected in high blood cholesterol and glucose conditions. The protective role of sericin on mitochondria remains doubtful. To examine this role, electron microscopic, histopathologic, immunohistochemical, and biochemical studies were performed in a high-cholesterol diet/streptozotocin rat model. The results demonstrated that sericin reduced blood cholesterol without hypoglycemic effect. Sericin alleviated dysmorphic mitochondria in heart and liver but not in kidney and also decreased peculiar endoplasmic reticulum in the exocrine pancreas. In addition, sericin decreased hepatic steatosis and preserved zymogen granule referable to the decline of reactive oxygen species production in hepatic mitochondrial extraction and down-regulation of malondialdehyde expression in the liver and exocrine pancreas however irrelevant to lipase activity. This study suggests that sericin has antioxidative property to reduce blood cholesterol by means of diminishing fat deposit in hepatocyte and improves mitochondria and endoplasmic reticulum integrities. [Box: see text]
Facilitating the interpretation of pedobarography: the relative midfoot index as marker for pathologic gait in ankle osteoarthritic and contralateral feet
Authors: Arno Frigg , Roman Frigg , Martin Wiewiorski , Jennifer Goldoni , Monika Horisberger 
Published: December 2016

AbstractBackgroundPedobarography offers dynamic information about the foot, but the interpretation of its large data is challenging. In a prior study it was shown that attention can be restricted to pedobarographic midfoot load data. We aim to verify this observation in ankle osteoarthritic and contralateral feet.MethodsWe assessed both feet of 120 patients with end‐stage ankle osteoarthritis (OA) and 35 healthy volunteers with AOFAS‐score and dynamic pedobarography in barefoot condition. We introduce a new parameter, the Relative Midfoot Index (RMI), representing the depth of the midfoot weighted by the maximal force (MF) in the hindfoot and forefoot. Main outcome measures were the RMI, MF and contact times in the hindfoot, midfoot and forefoot. Ankle OA, contralateral and healthy feet were compared with ANOVA.ResultsThe RMI was significantly smaller in OA feet (0.65 ± 0.19) and contralateral feet (0.69 ± 0.15) than in healthy feet (0.84 ± 0.08, p < 0.0001). There was no significant difference between OA and contralateral feet. The RMI showed a correlation of 0.48 with the AOFAS score. Contralateral and OA feet were significantly different from healthy feet (p < 0.001) in all parameters except the hindfoot MF. An RMI <0.8 showed a positive predictive value of 80% and sensitivity of 78% for being unhealthy.ConclusionThe RMI assists the interpretation of pedobarographic parameters and provides a user‐friendly indicator for unhealthy foot conditions with a cut‐off value of 0.8. The contralateral feet of ankle OA patients differed significantly from healthy feet and are therefore not suitable as control group.Level of Evidence: 3 case control study
The relationship between foot posture index, ankle equinus, body mass index and intermetatarsal neuroma
Authors: Naraghi Reza , Bremner Alexandra , Slack‐Smith Linda , Bryant Alan 
Published: December 2016

AbstractBackgroundThe main purpose of this study was to investigate the presence of an association between intermetatarsal neuroma and foot type, as measured by the Foot Posture Index. The study also examined whether there was a relationship between foot type and the interspace affected with intermetatarsal neuroma, and whether ankle equinus or body mass index had an effect.MethodsIn total, 100 participants were recruited from The University of Western Australia's Podiatry Clinic, 68 of whom were diagnosed with inter‐metatarsal neuroma from 2009 to 2015. There were 32 control participants recruited from 2014 to 2015. The age of subjects was recorded, as were weight and height, which were used to calculate body mass index. The foot posture index and ankle dorsiflexion were measured using standard technique. Independent t‐tests and Kruskal‐Wallis tests were used to compare differences in foot posture index, body mass index and ankle dorsiflexion between the inter‐metatarsal neuroma and control groups. Multivariable logistic regression was also used to model relationships for outcome.ResultsThe 68 intermetatarsal neuroma subjects had a mean age of 52 years (range 20 to 74 years) and comprised of 56 females and 12 males. The 32 control subjects had a mean age of 49 years (range 24 to 67 years) with 26 females and six males. There were no significant differences between the control and the intermetatarsal neuroma groups with respect to the mean foot posture index scores of the left and right foot (p = 0.21 and 0.87, respectively). Additionally no significant differences were detected between the affected intermetatarsal neuroma interspace and foot posture index (p = 0.27 and 0.47, respectively). There was no significant difference in mean body mass index between the intermetatarsal neuroma (26.9 ± 5.7) and control groups (26.5 ± 4.1) (p = 0.72). There was, however, a significant difference in mean ankle dorsiflexion between the intermetatarsal neuroma and control groups (p < 0.001 for both feet). Logistic regression models, adjusted for age, sex, foot posture index and body mass index estimated that the odds of having an intermetatarsal neuroma in the right foot increased by 61% (OR 1.61; 95% CI 1.32–1.96) with each one degree reduction of ankle dorsiflexion, and in the left foot by 43% (OR 1.43; 95% CI 1.22–1.69).ConclusionNo relationships were found between foot posture index and body mass index with intermetatarsal neuroma, or between foot posture index and the interspaces affected. However, a strong association was demonstrated between the presence of intermetatarsal neuroma and a restriction of ankle dorsiflexion.
Decreasing loco-regional recurrence for oral cavity cancer with total Mohs margins technique
Authors: Bergeron Mathieu , Gauthier Pierre , Audet Nathalie 
Published: December 2016

Background The conventional technique for cancer resection margin analysis studies only 0.1% of the surgical margins. Complete frozen section margins - also known as Mohs margins – allows for analysis of 100% of the surgical margins. Methods The objective of our study is to compare oral cavity cancer loco-regional recurrence rates when treated by total frozen sections technique (Total Mohs margins) versus conventional margins. We conducted a multicenter retrospective cohort chart review. Loco-regional oral cancer recurrence rates were compared between patients treated with total Mohs margins (2007–2013) and patients treated with conventional margins techniques (2002–2007). Results After applying inclusion criteria, a total of 60 patients treated by total Mohs margins and 57 patients with conventional margins were identified. Patients had similar baseline cancer stages, pathological types, past head and neck cancers and comorbidities (all p > 0.05). One-year recurrence rate was lower (10.0% vs 21.1%, p = 0.019) in favor of Mohs total margins and stayed significantly lower at 5 years of follow-up. When adjusted for T grade with N0 disease, Mohs technique was still beneficial in loco-regional recurrence for Tis-T4N0 up to 2 years (10.5% vs 25.7%, z-score 1.849, p = 0.032). The Number Needed to Treat at 2 years of follow-up for this subgroup of patients (Tis-T4N0) is 6.6. Margins had to be retaken more often intra-operatively in Mohs technique (68.3% vs 12.3%, p < 0.0001), mainly for positive deep margins (48.6% of all margins, p = 0.028). Duration of surgery was not increased with Mohs vs conventional technique (380 min vs 475 min respectively, p = 0.025). Conclusions Mohs total margins may result in a significant reduction in cancer recurrence rate at 5 years compare to conventional surgery. Moreover, duration of surgery was not increased when using Mohs technique when judiciously performed.
Metagenome phylogenetic profiling of microbial community evolution in a tetrachloroethene-contaminated aquifer responding to enhanced reductive dechlorination protocols
Authors: Reiss Rebecca A. , Guerra Peter , Makhnin Oleg 
Published: December 2016

AbstractChlorinated solvent contamination of potable water supplies is a serious problem worldwide. Biostimulation protocols can successfully remediate chlorinated solvent contamination through enhanced reductive dechlorination pathways, however the process is poorly understood and sometimes stalls creating a more serious problem. Whole metagenome techniques have the potential to reveal details of microbial community changes induced by biostimulation. Here we compare the metagenome of a tetrachloroethene contaminated Environmental Protection Agency Superfund Site before and after the application of biostimulation protocols. Environmental DNA was extracted from uncultured microbes that were harvested by on-site filtration of groundwater one month prior to and five months after the injection of emulsified vegetable oil, nutrients, and hydrogen gas bioamendments. Pair-end libraries were prepared for high-throughput DNA sequencing and 90 basepairs from both ends of randomly fragmented 400 basepair DNA fragments were sequenced. Over 31 millions reads were annotated with Metagenome Rapid Annotation using Subsystem Technology representing 32 prokaryotic phyla, 869 genera, and 3,181 species. A 3.6 log2 fold increase in biomass as measured by DNA yield per mL water was measured, but there was a 9% decrease in the number of genera detected post-remediation. We apply Bayesian statistical methods to assign false discovery rates to fold-change abundance data and use Zipf’s power law to filter genera with low read counts. Plotting the log-rank against the log-fold-change facilitates the visualization of the changes in the community in response to the enhanced reductive dechlorination protocol. Members of the Archaea domain increased 4.7 log2 fold, dominated by methanogens. Prior to remediation, classes Alphaproteobacteria and Betaproteobacteria dominated the community but exhibit significant decreases five months after biostimulation. Geobacter and Sulfurospirillum replace “Sideroxydans” and Burkholderia as the most abundant genera. As a result of biostimulation, Deltaproteobacteria and Epsilonproteobacteria capable of dehalogenation, iron and sulfate reduction, and sulfur oxidation increase. Matches to thermophilic, haloalkane respiring archaea is evidence for additional species involved in biodegradation of chlorinated solvents. Additionally, potentially pathogenic bacteria increase, indicating that there may be unintended consequences of bioremediation.
We should replace conventional mental health law with
capacity-based law
Authors: Szmukler George , Kelly Brendan D. 
Published: December 2016

SummaryAs general medicine moves away from ‘paternalism’ and places an increasing
emphasis on patient choice and autonomy, George Szmukler and Brendan D.
Kelly debate whether conventional mental health legislation should be
replaced with a model that focuses on the person's decision-making
capabilities.
Non-medical use of olanzapine by people on methadone treatment
Authors: James Philip David , Fida Ali Shaik , Konovalov Pavel , Smyth Bobby P. 
Published: December 2016

Aims and methodWe examined non-medical use (NMU) of olanzapine among adults on methadone treatment. Information was collected on patient demographics and NMU of olanzapine. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was administered to assess risk among current users of olanzapine.ResultsNinety-two clients participated and 30% reported lifetime history of NMU of olanzapine. Nine people reported doses of 30 mg or higher on a typical day of use, with three typically using 100 mg. The most common reasons for use were to relieve anxiety and to aid sleep, but a quarter used it to ‘get stoned’. Eleven participants (12%) reported NMU of olanzapine in the preceding month. Eight completed the ASSIST with four scoring in the high-risk zone.Clinical implicationsSelf-medication is the dominant motivator for NMU of olanzapine, but hedonic motivations also occur. A small minority show features of dependency. All doctors should be aware of the potential NMU of olanzapine, especially among patients with history of addiction.
What and who? Mindfulness in the mental health setting
Authors: Russell Tamara A. , Siegmund Gerson 
Published: December 2016

SummaryA strong and growing evidence base exists for the use of mindfulness-based interventions to prevent relapse in major depression and for the self-management of chronic physical health conditions (e.g. pain), but the evidence in other domains of mental health work is still emerging. Much work is being conducted outside the evidence base and standardised protocols, and by individuals with varied levels of experience and training. The (mis)perception of mindfulness as a ‘simple technique’ belies the complexity and skill needed to deliver a mindfulness training that has real therapeutic and transformative power. We propose a framework to help clinicians think through the suitability of mindfulness for their particular client group with the intention of providing guidance for thoughtful decision-making.
MRI appearances of atypical cartilaginous tumour/grade I chondrosarcoma after treatment by curettage, phenolisation and allografting
Authors: Verdegaal S. H. M. , van Rijswijk C. S. , Brouwers H. F. C. , Dijkstra P. D. S. , van de Sande M. A. J. , Hogendoorn P. C. W. , Taminiau A. H. M. 
Published: December 2016

Aims The purpose of this retrospective study was to differentiate between the MRI features of normal post-operative change and those of residual or recurrent disease after intralesional treatment of an atypical cartilage tumour (ACT)/grade I chondrosarcoma. Patients and Methods We reviewed the case notes, radiology and histology of 75 patients, who had been treated for an ACT/grade I chondrosarcoma by curettage, phenolisation and bone allografting between 1994 and 2005. The first post-operative Gd-enhanced MRI scan was carried out within one year of surgery. Patients had a minimum of two scans and a mean follow-up of 72 months (13 to 169). Further surgery was undertaken in cases of suspected recurrence. Results In 14 patients (18.6%) a second procedure was undertaken after a mean period of 59 months (8 to 114). Radio frequency ablation (RFA) was used in lesions of < 10 mm and curettage, phenolisation and bone grafting for those ≥ 10 mm. Only six of these (8% of total) had a histologically-proven recurrence. No increase in tumour grade was seen at time of recurrence. Conclusion Based on this study, we have been able to classify the post-operative MRI appearances into four groups. These groups differ in follow-up, and have a different risk of recurrence of the lesion. Follow-up and treatment vary for the patients in each group. We present a flow diagram for the appropriate and safe follow-up for this specific group of patients. Cite this article: Bone Joint J 2016;98-B:1674–81.
When is the ideal time to operate on a patient with a fracture of the hip?
Authors: Lewis P. M. , Waddell J. P. 
Published: December 2016

Fractures of the hip are common, often occurring in frail elderly patients, but also in younger fit healthy patients following trauma. They have a significant associated mortality and major social and financial implications to patients and health care providers. Many guidelines are available for the management of these patients, mostly recommending early surgery for the best outcomes. As a result, healthcare authorities now put pressure on surgical teams to ‘fast track’ patients with a fracture of the hip, often misquoting the available literature, which in itself can be confusing and even conflicting.This paper has been written following an extensive review of the available literature. An attempt is made to clarify what is meant by early surgery (expeditious versus emergency), and we conclude with a personal view for the practical management of these patients of variable age, fitness and type of surgery performed within services that are often under considerable pressure of finance and available operating theatres and qualified staff.Cite this article: Bone Joint J 2016;98-B:1573–81.
What is the morbidity of a non-invasive growing prosthesis?
Authors: Gilg M. M. , Gaston C. L. , Parry M. C. , Jeys L. , Abudu A. , Tillman R. M. , Carter S. R. , Grimer R. J. 
Published: December 2016

AimsExtendible endoprostheses have been available for more than 30 years and have become more sophisticated with time. The latest generation is ‘non-invasive’ and can be lengthened with an external magnetic force. Early results have shown a worryingly high rate of complications such as infection. This study investigates the incidence of complications and the need for further surgery in a cohort of patients with a non-invasive growing endoprosthesis.Patients and MethodsBetween 2003 and June 2014, 50 children (51 prostheses) had a non-invasive growing prosthesis implanted for a primary bone sarcoma. The minimum follow-up was 24 months for those who survived. Their mean age was 10.4 years (6 to 14). The incidence of complications and further surgery was documented.ResultsThe mean follow-up was 64 months (20 to 145). The overall survivorship of the patients was 84% at three years and 70% at five years. Revision-free survival was 81.7% at three years and 61.6% at five years with competing risk analysis. Deep infection occurred in 19.6% of implants at a mean of 12.5 months (0 to 55). Other complications were a failure of the lengthening mechanism in five prostheses (9.8%) and breakage of the implant in two (3.9%). Overall, there were 53 additional operations (0 to 5 per patient). A total of seven patients (14%) underwent amputation, three for local recurrence and four for infection. Their mean limb length discrepancy was 4.3 mm (0 to 25) and mean Musculoskeletal Tumor Society Score functional score was 26.5 (18 to 30) at the final follow-up.ConclusionsWhen compared with previously published early results, this mid-term series has shown continued good functional outcomes and compensation for leg-length discrepancy. Infection is still the most common complication: post-operative wound healing problems, central line infection and proximal tibial location are the main risk factors. Cite this article: Bone Joint J 2016;98-B:1697–1703.