bluuebunny/crossref_metadata_2025_split huggingface dataset:
Small-bowel Surveillance in Patients With Peutz-Jeghers Syndrome
Authors: Goverde Anne , Korsse Susanne E. , Wagner Anja , van Leerdam Monique E. , Krak Nanda C. , Stoker Jaap , van Buuren Henk R. , Hofstra Robert M.W. , Bruno Marco J. , Dewint Pieter , Dekker Evelien , Spaander Manon C.W. 
Published: July 2016

Background and Study Aims:
Small-bowel surveillance with polypectomy of polyps ≥15 mm prevents complications in patients with Peutz-Jeghers syndrome (PJS). We aimed to compare magnetic resonance enteroclysis (MRE) and double balloon enteroscopy (DBE) for diagnostic yield of these polyps and for patient preference.

Materials and Methods:
PJS patients prospectively underwent MRE followed by proximal DBE within 20 weeks. Endoscopists were blinded to the MRE results. We compared number of polyps ≥15 mm detected by MRE and DBE. Patients’ perceptions of both procedures were assessed using questionnaires.

Results:
Fifteen PJS patients (67% males, median age 47 y) underwent both MRE and DBE. Polyps ≥15 mm were identified by MRE and/or DBE in 12/15 (80%) patients. There was no significant difference in the detection of polyps ≥15 mm (38 by MRE vs. 50 by DBE, P=0.37). Sensitivity for these polyps was 62% (38/61) for MRE and 82% (50/61) for DBE. Patients’ perceived shame and burden did not differ significantly between MRE and DBE. Patients reported significantly more pain during preparation for MRE than for DBE (moderate vs. no pain, P=0.02), although perceived pain during the procedures was comparable (both mild, P=0.89). For future small-bowel surveillance 10/13 (77%) patients preferred DBE over MRE (P=0.09).

Conclusions:
Our results suggest that MRE and DBE have a comparable diagnostic yield of polyps ≥15 mm. However, DBE allows for direct intervention and was preferred over MRE by most patients in this series. Larger cohorts of PJS patients are needed to fully evaluate the diagnostic yield of DBE compared with other modalities.
Use of Reticulocyte Hemoglobin Content in the Assessment of Iron Deficiency in Children With Inflammatory Bowel Disease
Authors: Syed Sana , Kugathasan Subra , Kumar Archana , Prince Jarod , Schoen Bess T. , McCracken Courtney , Ziegler Thomas R. , Suchdev Parminder S. 
Published: July 2016

ABSTRACTBackground:Iron deficiency and anemia affect up to 50% to 75% of patients with inflammatory bowel disease (IBD). Iron deficiency in IBD may be difficult to diagnose because of the effect of inflammation on iron status biomarkers. Thus, there is a need for better methods to accurately determine iron status in IBD.Objective:The aim of the study was to investigate the association of inflammation with hemoglobin content of reticulocytes (CHr) and the utility of CHr in comparison to standard iron biomarkers.Methods:We conducted a cross‐sectional study of children with IBD. Iron biomarkers (CHr, ferritin, soluble transferrin receptor [sTfR], hepcidin, hemoglobin) were measured along with systemic biomarkers of inflammation (C‐reactive protein, α1‐acid glycoprotein]. Spearman correlations were used to evaluate the relation of inflammation and iron biomarkers. The criterion standard for iron deficiency was defined as inflammation‐corrected ferritin <15 μg/L or sTfR >8.3 mg/L. Receiver operating characteristic curves were used to estimate the prognostic values of all iron biomarkers to identify patients with iron deficiency.Results:We analyzed data in 62 children ages 5 to 18 years. Sixty‐nine percent of our subjects had Crohn disease and 31% had ulcerative colitis, of which 42% were girls and 53% African American. The prevalence of anemia was 32%, of iron deficiency was 52% using ferritin <15 μg/L or sTfR >8.3 mg/L, 39% using red blood cell distribution width of >14.5%, 26% using body iron stores of <0 mg/kg body weight, 25% using CHr of <28 pg, and 11% using mean corpuscular volume of <75 fL/cell. The prevalence of elevated CRP or AGP was 48%. After correcting ferritin and sTfR levels for inflammation, the prevalence of iron deficiency was 68%. CHr was correlated with C‐reactive protein (rs −0.44, P < 0.001) and α1‐acid glycoprotein (rs −0.37, P < 0.05). The optimal prognostic value for inflammation‐adjusted CHr to predict iron deficiency was 34 pg (area under the receiver operating characteristic of 0.70), with 88% sensitivity and 30% specificity.Conclusions:Iron deficiency and anemia are common in this pediatric IBD cohort. All explored iron biomarkers, including CHr, were affected by inflammation and should be adjusted. A single iron biomarker is unlikely to best predict iron deficiency in pediatric IBD. Iron intervention studies are needed to examine the response of iron biomarkers to iron supplementation in the setting of inflammation.
Tacrolimus Exerts Only a Transient Effectiveness in Refractory Pediatric Crohn Disease
Authors: Truffinet Oriane , Martinez‐Vinson Christine , Guerriero Emilie , Hugot Jean‐Pierre , Viala Jérôme 
Published: July 2016

ABSTRACTObjectives:Tacrolimus is an immunosuppressive agent that has been proposed in the treatment of severe ulcerative colitis. The present study examined the effectiveness and safety of tacrolimus in treating refractory Crohn disease (CD) colitis in children.Methods:All children treated by oral tacrolimus for CD colitis at a tertiary pediatric center were included in the study. All patients were refractory to steroids and infliximab. Clinical response (decreased pediatric CD activity index [PCDAI] >15 and PCDAI <30) and remission (PCDAI <10) were monitored at 2, 4, 6, 12, and 24 months after induction. Tacrolimus blood levels and adverse effects were also noted.Results:Among 220 patients with CD, 8 children (including 3 girls, median age 14 [9.5–18] years) were registered with a median PCDAI of 58.7 (32.5–65) before tacrolimus initiation. In patients treated with tacrolimus, the overall clinical response rates were 6/8, 3/8, 2/8, 2/8, and 1/8 with a remission rate of 4/8, 0/8, 0/8, 2/8, and 0/8 at 2, 4, 6, 12, and 24 months, respectively. At 2 months, the PCDAI scores were lower than those at induction (median 11.2; P = 0.004) with the mean whole plasma level of tacrolimus being 8.75 ng/mL (5.9–10 ng/mL). Adverse events occurred in 6 of 8 patients, including renal dysfunction, insulin‐dependent diabetes, paresthesia, and tremor. Tacrolimus interruption was required in 2 cases.Conclusions:Tacrolimus could be considered to transiently treat refractory CD colitis. Tacrolimus could be used as a “bridge” toward another medical option in pediatric CD, although its adverse events are frequent.
Planning, Designing, Building, and Moving a Large Volume Maternity Service to a New Labor and Birth Unit
Authors: Thompson Heather , Legorreta Kimberly , Maher Mary Ann , Lavin Melanie M. 
Published: July 2016

Abstract

Background:
Our health system recognized the need to update facility space and associated technology for the labor and birth unit within our large volume perinatal service to improve the patient experience, and enhance safety, quality of care, and staff satisfaction. When an organization decides to invest $30 million dollars in a construction project such as a new labor and birth unit, many factors and considerations are involved. Financial support, planning, design, and construction phases of building a new unit are complex and therefore require strong interdisciplinary collaboration, leadership, and project management.

Methods:
The new labor and birth unit required nearly 3 years of planning, designing, and construction. Patient and family preferences were elicited through consumer focus groups. Multiple meetings with the administrative and nursing leadership teams, staff nurses, nurse midwives, and physicians were held to generate ideas for improvement in the new space. Involving frontline clinicians and childbearing women in the process was critical to success. The labor and birth unit moved to a new patient tower in a space that was doubled in square footage and geographically now on three separate floors. In the 6 months prior to the move, many efforts were made in our community to share our new space. The marketing strategy was very detailed and creative with ongoing input from the nursing leadership team. The nursing staff was involved in every step along the way. It was critical to have champions as workflow teams emerged. We hosted simulation drills and tested scenarios with new workflows. Move day was rehearsed with representatives of all members of the perinatal team participating.

Results:
These efforts ultimately resulted in a move time of ~5 hours. Birth volumes increased 7% within the first 6 months. After 3 years in our new space, our birth volumes have risen nearly 15% and are still growing.

Clinical Implications:
Key processes and roles responsible for a successful build, efficient and safe move day, and optimal operational utility, as anticipated, of a new labor and birth unit in a large volume perinatal service are detailed.
Influence of External Visual Focus on Gait in Children With Bilateral Cerebral Palsy
Authors: Bartonek Asa , Lidbeck Cecilia M. , Gutierrez-Farewik Elena M. 
Published: July 2016

Purpose:
To explore whether focusing a target influenced gait in children with cerebral palsy (CP) and typical development (TD).

Methods:
Thirty children with bilateral CP (Gross Motor Function Classification System [GMFCS] I-III) and 22 with TD looked at a light at walkway end (Gaze Target) while walking and returned (No Target).

Results:
During Gaze versus No Target, children with TD reduced temporal-spatial parameters and movements in the sagittal (SPM) and transverse planes. In comparison, during Gaze Target, children in CP1 (GMFCS I) had larger trunk SPM, children in CP2 (GMFCS II) larger neck (SPM), and children in CP3 (GMFCS III) greater head and neck frontal plane movements, and reduced cadence and single support.

Conclusions:
Focusing a target altered gait in children with CP. Children in CP1 reduced movements similar to children with TD, children in CP2 behaved nearly unchanged, whereas children in CP3 reduced movements and temporal-spatial parameters, potentially as a consequence of lack of sensory information from lower limbs.
Relationship Between Abdominal Adiposity and Exercise Tolerance in Children With Obesity
Authors: Druce Axley Jennifer , Werk Lloyd N. 
Published: July 2016

Purpose:
To determine whether abdominal obesity is associated with lower exercise tolerance in children.

Methods:
Waist-to-height ratios (WHtRs) were determined for 50 children aged 8 to 12 years with body mass index greater than the 95th percentile and 6-minute walk distance (6MWD) conducted.

Results:
Mean 6MWD was found to be 510 (standard deviation = 60) m. Univariate analysis revealed that WHtR was the only significant predictor of 6MWD (P = .01). In modeling using multiple regression analysis, 26% of the variance in 6MWD could be attributed to the participant's age, WHtR, and sex; WHtR was the only significant contributor to 6MWD (P = .001).

Conclusion:
WHtR was the most strongly correlated factor with distance achieved on the 6-minute walk test, a measure of exercise tolerance, and is an important measure to screen for cardiovascular disease risk and to prompt further evaluation of functional exercise capacity.
Therapeutic Alliance in Patients With Schizophrenia: Introduction of a New Rating Instrument
Authors: WIDSCHWENDTER CHRISTIAN G. , HOFER ALEX , BAUMGARTNER SUSANNE , EDLINGER MONIKA , KEMMLER GEORG , RETTENBACHER MARIA A. 
Published: July 2016

Objective:
The quality of the patient-psychiatrist relationship can be seen as a cornerstone of adherence to medications in patients with chronic psychiatric disorders. Although therapeutic alliance in psychotherapy has been investigated broadly, it has received little attention in the context of medication adherence. The goal of this study was to develop and validate a user-friendly questionnaire for the assessment of therapeutic alliance in clinically stable outpatients with schizophrenia.

Methods:
The “Brief Questionnaire on Therapeutic Alliance” (BQTA) addresses both the physician and the patient, each of whom responds to 5 items that focus on important domains of the therapeutic alliance. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and patients’ attitudes toward the illness and medication were assessed using the Drug Attitude Inventory (DAI).

Results:
A total of 61 patients who met ICD-10 criteria for schizophrenia spectrum disorders and their treating psychiatrists were included in the study. Overall, patients and psychiatrists gave high (ie, favorable) ratings on all BQTA items. The 5 patient-related items showed high internal consistency (Cronbach α=0.77), whereas physician-related items showed slightly less internal consistency (Cronbach α=0.68). The concordance between patient and physician ratings was fair, although statistically significant (κ=0.33, P=0.007). Physicians’ total score on the BQTA was moderately correlated with patients’ PANSS total score and with the DAI total score and its compliance subscale, whereas patients’ total score on the BQTA did not correlate with DAI or PANSS scores.

Conclusion:
The BQTA was found to cover crucial aspects of the doctor-patient relationship in chronically ill individuals with schizophrenia. Further validation will shed more light on the usefulness of this questionnaire.
Reciprocal Relationship Between Sleep Macrostructure and Evening and Morning Cellular Inflammation in Rheumatoid Arthritis
Authors: Bjurström Martin F. , Olmstead Richard , Irwin Michael R. 
Published: July 2016

ABSTRACT

Objective
This study examined the reciprocal associations between sleep macrostructure and levels of cellular inflammation in rheumatoid arthritis (RA) patients and controls.

Methods
RA patients (n = 24) and matched controls (n = 48) underwent all-night polysomnography, along with assessment of spontaneous- and Toll-like receptor-4–stimulated monocytic production of tumor necrosis factor α (TNF) and interleukin (IL)-6 at 11:00 pm and 8:00 am.

Results
As compared with controls, RA patients showed lower levels of sleep efficiency (mean [standard deviation], 88.1 [6.1] versus 83.8 [7.0]), a higher percentage stage 3 sleep (9.3 [6.4] versus 13.1 [6.9]), and higher levels of percentage of monocytes either spontaneously expressing TNF at 11:00 pm (log transformed, 1.07 [0.28] versus 1.22 [0.17]), and higher Toll-like receptor-4–stimulated production of IL6 at 8:00 am (log transformed, 3.45 [0.80] versus 3.83 [0.39]). Higher levels of stimulated production of TNF at 11:00 pm were associated with higher sleep efficiency (0.74). In turn, sleep efficiency had a countervailing relationship on TNF production at 8:00 am (−0.64). Higher levels of spontaneous and stimulated production of IL6 at 11:00 pm were associated with more stage 3 (0.39), stage 4 (0.43), and slow-wave sleep (0.49), with evidence that stage 4 had a countervailing relationship on IL6 production at 8:00 am (−0.60).

Conclusions
RA patients show evidence of sleep fragmentation, greater sleep depth, and higher levels of cellular inflammation. Sleep maintenance and sleep depth show countervailing relationships with evening and morning levels of monocytic production of TNF and IL-6, respectively, which support the hypothesis of a feedback loop between sleep maintenance, slow-wave sleep, and cellular inflammation that is cytokine specific.
Life-Course Socioeconomic Position and Hippocampal Atrophy in a Prospective Cohort of Older Adults
Authors: Elbejjani Martine , Fuhrer Rebecca , Abrahamowicz Michal , Mazoyer Bernard , Crivello Fabrice , Tzourio Christophe , Dufouil Carole 
Published: July 2016

ABSTRACT

Objective
Low socioeconomic position (SEP) has been linked to an increased risk of dementia and cognitive decline. However, little is known about the association between SEP and morphologic brain changes in older age. This study examines the relationships between indicators of life-course SEP with both hippocampal volume (HcV) and HcV loss in a population-based cohort of 1328 older adults aged 65 to 80 years.

Methods
Multivariable linear regression models were used to estimate the associations of SEP with baseline HcV and the annual rate of HcV atrophy according to three life-course conceptual models: the sensitive/critical periods model (which explored SEP in specific periods: in childhood [using parental education], early adulthood [based on participants' education], and midlife [based on participants' socioprofessional group]); the accumulation-of-risk model (life-course cumulative SEP), and the social mobility model (life-course SEP trajectories).

Results
Participants with lower midlife SEP had smaller HcV (−0.08 cm3; 95% confidence interval, −0.15 to −0.01) and 0.17% (95% confidence interval, 0.04%–0.30%) faster hippocampal atrophy than participants with higher midlife SEP. Childhood and early adulthood SEPs were not related to hippocampal measures. The accumulation-of-risk and the social mobility models revealed that the accumulation of socioeconomic disadvantage and declining socioeconomic trajectories were related to faster hippocampal atrophy.

Conclusions
In this cohort of older adults, lower socioprofessional attainment in midlife and disadvantageous life-course socioeconomic position were associated with faster hippocampal atrophy, a cerebral change linked to cognitive disorders. Results support the hypothesized links between socioenvironmental exposures related to stress and/or cognitive enrichment and brain/cognitive reserve capacities.
Dimensions of Adversity, Physiological Reactivity, and Externalizing Psychopathology in Adolescence: Deprivation and Threat
Authors: Busso Daniel S. , McLaughlin Katie A. , Sheridan Margaret A. 
Published: July 2016

ABSTRACT

Objective
Dysregulation of autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis function is a putative intermediate phenotype linking childhood adversity (CA) with later psychopathology. However, associations of CAs with autonomic nervous system and HPA-axis function vary widely across studies. Here, we test a novel conceptual model discriminating between distinct forms of CA (deprivation and threat) and examine their independent associations with physiological reactivity and psychopathology.

Methods
Adolescents (N = 169; mean [SD] age, 14.9 [1.4] years) with a range of interpersonal violence (e.g., maltreatment, community violence) and poverty exposure participated in the Trier Social Stress test (TSST). During the TSST, electrocardiogram, impedance cardiograph, salivary cortisol, and dehydroepiandrosterone-sulfate data were collected. We compared the associations of poverty (an indicator of deprivation) and interpersonal violence (an indicator of threat) on sympathetic, parasympathetic, and HPA-axis reactivity to the TSST, and assessed whether these differences mediated the association of adversity with internalizing and externalizing symptoms.

Results
Exposure to poverty and interpersonal violence was associated with psychopathology. Interpersonal violence, adjusting for poverty, was associated with blunted sympathetic (b = 1.44, p = .050) and HPA-axis reactivity (b = −.09; p = .021). Blunted cortisol reactivity mediated the association of interpersonal violence with externalizing, but not internalizing, psychopathology. In contrast, poverty was not associated with physiological reactivity after adjusting for interpersonal violence.

Conclusions
We provide evidence for distinct neurobiological mechanisms through which adversity related to poverty and interpersonal violence is associated with psychopathology in adolescence. Distinguishing distinct pathways through which adversity influences mental health has implications for preventive interventions targeting youths exposed to childhood adversity.
Psychiatric Disorders, Morbidity, and Mortality: Tracing Mechanistic Pathways to Accelerated Aging
Authors: Kiecolt-Glaser Janice K. , Wilson Stephanie J. 
Published: July 2016

ABSTRACT
A meta-analysis published in this issue of Psychosomatic Medicine provides convincing evidence that certain psychiatric populations have shorter telomeres than nonpsychiatric controls, in accord with the strong evidence linking psychiatric disorders with premature mortality. After addressing the clinical significance of shorter telomeres, this editorial describes mechanistic pathways that lead to telomere shortening. Additionally, two other novel methods for measuring biological markers of accelerated aging are briefly discussed: DNA methylation and cellular senescence based on p16INK4a. These innovative approaches could be used to confirm and extend our understanding of psychiatric patients’ increased health and mortality risks.
UCP2 Expression Is Increased in Pancreas From Brain-Dead Donors and Involved in Cytokine-Induced β Cells Apoptosis
Authors: Brondani Leticia A. , Rech Tatiana H. , Boelter Gabriela , Bauer Andrea C. , Leitão Cristiane B. , Eizirik Décio L. , Crispim Daisy 
Published: July 2016

Background
Systemic inflammation associated with brain death (BD) decreases islet yield and quality, negatively affecting outcomes of human islet transplantation. A recent study from our group showed an increased expression of uncoupling protein-2 (UCP2) in pancreas from rats with BD as compared with controls. UCP2 is located in the mitochondrial inner membrane and regulates production of reactive oxygen species and glucose-stimulated insulin secretion. It has been suggested that UCP2 also plays a role in β cell apoptosis, but these findings remain controversial.

Methods
We have presently performed a case-control study to assess UCP2 expression in pancreas from BD donors (cases) and subjects who underwent pancreatectomy (controls). We next investigated the role of Ucp2 in cytokine-induced apoptosis of rat insulin-producing INS-1E cells.

Results

UCP2 gene expression was higher in pancreas from BD donors compared with controls (1.73 ± 0.93 vs 0.75 ± 0.66; fold change, P < 0.05). Ucp2 knockdown (80% at the protein and messenger RNA levels) reduced by 30% cytokine-induced apoptosis and nitric oxide production in INS-1E cells. This protection was associated with decreased expression of cleaved (activated) caspases 9 and 3, suggesting that Ucp2 knockdown interferes with cytokine triggering of the intrinsic apoptotic pathway. Moreover, both messenger RNA and protein concentrations of the antiapoptotic protein Bcl-2 were increased after Ucp2 knockdown in INS-1E cells.

Conclusions
These data suggest that UCP2 has an apoptotic effect in β cells via regulation of the intrinsic pathway of apoptosis.
Safety and Efficacy of Adjunctive Θ Burst Repetitive Transcranial Magnetic Stimulation to Right Inferior Parietal Lobule in Schizophrenia Patients With First-Rank Symptoms
Authors: Tikka Sai Krishna , Nizamie S. Haque , Venkatesh Babu G.M. , Aggarwal Nidhi , Das Archana Kumari , Goyal Nishant 
Published: July 2016

Background
First-rank symptoms (FRS) in schizophrenia have been found to be associated with various cognitive and biological markers. Repetitive transcranial magnetic stimulation (rTMS) has been shown to modulate such factors. We hypothesized that rTMS adjunctive to antipsychotics will be safe and effective in treatment of FRS in schizophrenia.

Methods
Schizophrenia patients with FRS randomly received either active or sham-magnetic resonance imaging navigated continuous Θ burst stimulation (cTBS)-rTMS to right inferior parietal lobule for 2 weeks; assessments were repeated. While primary outcome variables were safety profile, FRS and overall psychopathology; secondary outcomes were γ oscillatory activity, brain-derived neurotrophic factor levels, and self-monitoring function.

Results
No significant adverse events were reported in either group. None of the outcome measures showed sufficient power on the time by group analysis.

Conclusions
This study fails to demonstrate whether or not adjunctive cTBS to right inferior parietal lobule could significantly alleviate FRS. We also fail to provide evidence for whether this protocol has any effect on brain-derived neurotrophic factor levels, self-monitoring function, and right hemispheric γ oscillations.