bluuebunny/crossref_metadata_2025_split huggingface dataset:
The N-of-1 Clinical Trial: A Timely Research Opportunity in Homeopathy
Authors: Ulbrich-Zürni Susanne , Teut Michael , Roll Stephanie , Mathie Robert 
Published: January 2018

Background The randomised controlled trial (RCT) is considered the ‘gold standard’ for establishing treatment efficacy or effectiveness of an intervention, but its data do not infer response in an individual patient. Individualised clinical care, a fundamental principle in complementary and alternative medicine (CAM), including homeopathy, seems well disposed in principle to being researched by single-patient (N-of-1) study design. Guidelines for reporting N-of-1 trials have recently been developed.
Objective To overview the current status in the literature of the N-of-1 method and its application in medicine, including CAM. To consider whether the N-of-1 trial design offers an opportunity for novel research in homeopathy.
N-of-1 Trial Design The N-of-1 trial applies the principles of the conventional crossover, blinded, RCT design. The treatment under study and the comparator are repeated in a randomised order, and with suitable washout time, over a defined period. N-of-1 design is constrained for use in chronic stable conditions, and for interventions that have quick onset and cessation of effect, with modest or negligible carryover. Outcome data can be aggregated and interpreted for the individual subject; they can also be pooled with data from several similar N-of-1 trials, enabling more generalisable conclusions.
The N-of-1 Trial in CAM The typical individualisation of patient care can be accommodated in N-of-1 study design if the patient and the specific therapeutic intervention are selected within the constraints of the method. Application of the N-of-1 method in CAM has been advocated but has been mainly limited, in practice, to a small number of studies in herbal and traditional Chinese medicine.
The N-of-1 Trial in Homeopathy Individualised homeopathy can be accommodated for investigation within the same methodological constraints; less in-depth homeopathic approaches to prescribing are also amendable to investigation using the N-of-1 method. No such studies have been published. We identify three main targets in its ready applicability to homeopathy: (1) to optimise clinical care in an individual patient; (2) to investigate whether the outcomes of treatment using homeopathy differ from those of placebo; (3) to aggregate data from a series of N-of-1 trials to enable broader conclusions about a group of patients or intervention.
Conclusion The N-of-1 trial design offers important new investigative possibilities in homeopathy and should be explored as a means to optimise individualised health care or investigate effectiveness of the homeopathic intervention compared with placebo in individual subjects.
HPV bei Oropharynxkarzinomen in der 8. Ausgabe der TNM-Klassifikation
Authors: Hoffmann Markus , Tribius Silke 
Published: January 2018

ZusammenfassungDie 8. Ausgabe der TNM-Klassifikation ist seit dem 01.01.2017 gültig und beinhaltet Veränderungen dieser
Klassifikation für verschiedene Malignome. Solche Änderungen zeigen sich im Kopf-Hals-Bereich für
Plattenepithelkarzinome des Oropharynx (OPC): es wird zwischen HPV-positiven und HPV-negativen Karzinomen
unterschieden, um durch die daran adaptierte neue Stadieneinteilung die Prognose der Patienten mit OPC
insgesamt besser abschätzen zu können. Die Anwendung der neuen TNM-Klassifikation beim HPV-positiven OPC führt
in vielen Fällen zu einem signifikanten Downstaging von lokal fortgeschrittener (UICC III/IV) hin zu lokal
begrenzter (UICC I/II) Erkrankung. Letzterem zugrundliegende Daten mit einem signifikanten Überlebensvorteil
der Patienten mit HPV-positiven OPC entstammen bisher ausschließlich retrospektiven Analysen, die nicht dafür
ausgelegt sind zu testen, ob deeskalierte Therapieregime den Überlebensvorteil dieser Patienten erhalten
können. Dieser CME-Beitrag versucht Antworten auf offene Fragen hinsichtlich Pathologie, Tumorcharakteristik
und Lebensstil-Faktoren zu geben, die für die Prognose dieser Patientenpopulation eine Rolle spielen. Nur die
genaue Kenntnis aller Parameter, die die Überlebenszeiten von Patienten mit OPC beeinflussen und die präzise
Interpretation vorliegender und noch zu erhebender Daten wird es ermöglichen, den Patienten entsprechend ihrem
Risikoprofil die bestmögliche Therapie anzubieten und so das bestmögliche Behandlungsergebnis zu erzielen.
Response of Cerebral Blood Flow and Blood Pressure to Dynamic Exercise: A Study Using PET
Authors: Hiura Mikio , Nariai Tadashi , Sakata Muneyuki , Muta Akitaka , Ishibashi Kenji , Wagatsuma Kei , Tago Tetsuro , Toyohara Jun , Ishii Kenji , Maehara Taketoshi 
Published: January 2018

AbstractDynamic exercise elicits fluctuations in blood pressure (BP) and cerebral blood flow (CBF). This study investigated responses in BP and CBF during cycling exercise and post-exercise hypotension (PEH) using positron emission tomography (PET). CBF was measured using oxygen-15-labeled water (H2
15O) and PET in 11 human subjects at rest (Rest), at the onset of exercise (Ex1), later in the exercise (Ex2), and during PEH. Global CBF significantly increased by 13% at Ex1 compared with Rest, but was unchanged at Ex2 and during PEH. Compared with at Rest, regional CBF (rCBF) increased at Ex1 (20~42%) in the cerebellar vermis, sensorimotor cortex for the bilateral legs (M1Leg and S1Leg), insular cortex and brain stem, but increased at Ex2 (28~31%) only in the vermis and M1Leg and S1Leg. During PEH, rCBF decreased compared with Rest (8~13%) in the cerebellum, temporal gyrus, piriform lobe, thalamus and pons. The areas showing correlations between rCBF and mean BP during exercise and PEH were consistent with the central autonomic network, including the brain stem, cerebellum, and hypothalamus (R2=0.25–0.64). The present study suggests that higher brain regions are coordinated through reflex centers in the brain stem in order to regulate the cardiovascular response to exercise.
Role of Indocyanine Green in Fluorescence Imaging with Near-Infrared Light to Identify Sentinel Lymph Nodes, Lymphatic Vessels and Pathways Prior to Surgery – A Critical Evaluation of Options
Authors: Hackethal Andreas , Hirschburger Markus , Eicker Sven , Mücke Thomas , Lindner Christoph , Buchweitz Olaf 
Published: January 2018

AbstractModern surgical strategies aim to reduce trauma by using functional imaging to improve surgical outcomes. This reviews considers and evaluates the importance of the fluorescent dye indocyanine green (ICG) to visualize lymph nodes, lymphatic pathways and vessels and tissue borders in an interdisciplinary setting. The work is based on a selective search of the literature in PubMed, Scopus, and Google Scholar and the authorsʼ own clinical experience. Because of its simple, radiation-free and uncomplicated application, ICG has become an important clinical indicator in recent years. In oncologic surgery ICG is used extensively to identify sentinel lymph nodes with promising results. In some studies, the detection rates with ICG have been better than the rates obtained with established procedures. When ICG is used for visualization and the quantification of tissue perfusion, it can lead to fewer cases of anastomotic insufficiency or transplant necrosis. The use of ICG for the imaging of organ borders, flap plasty borders and postoperative vascularization has also been scientifically evaluated. Combining the easily applied ICG dye with technical options for intraoperative and interventional visualization has the potential to create new functional imaging procedures which, in future, could expand or even replace existing established surgical techniques, particularly the techniques used for sentinel lymph node and anastomosis imaging.
Veränderung der Symptombelastung und der Funktionsfähigkeit gemäß ICF in der stationären psychosomatischen Rehabilitation
Authors: Braunger Carina , Müller Gottfried , von Wietersheim Jörn , Oster Jörg 
Published: January 2018

Zusammenfassung
Hintergrund In dieser naturalistischen Studie wurden Veränderungen bei Patienten einer stationären psychosomatischen Rehabilitation im Hinblick auf die Funktionsfähigkeit und der Symptombelastung untersucht.
Methode Es wurden Selbsteinschätzungen der Patienten zu ihrer Funktionsfähigkeit anhand des ICF AT-50 Psych und der Symptombelastung (GSI) zu 3 Messzeitpunkten erhoben: bei Aufnahme (n=419), bei Entlassung (n=354) und 6 Monate nach Entlassung (n=297).
Ergebnisse Sowohl Funktionsfähigkeit als auch Symptombelastung verbesserten sich von t1 nach t2. Hinsichtlich der Funktionsfähigkeit zeigte sich dabei eine Verbesserung auf globaler und spezifischer Ebene. Von t2 nach t3 nahm die Symptombelastung wieder etwas zu, während das Niveau der Funktionsfähigkeit eher stabil blieb. Veränderungen der Symptombelastung korrelieren hoch mit Veränderungen der Funktionsfähigkeit.
Diskussion Die Ergebnisse weisen darauf hin, dass sich die Psychosomatische Rehabilitation positiv auf die Funktionsfähigkeit auswirkt. In der Therapieplanung sollten die Ebene der Symptombelastung und der Funktionsfähigkeit beachtet werden. Kontrollierte Studien sind zu fordern.
Secondary Hyperparathyroidism in HIV-Infected Patients in Central Europe
Authors: Noe Sebastian , Oldenbuettel Celia , Heldwein Silke , Wiese Carmen , von Krosigk Ariane , Pascucci Rita , Ruecker Katharina , Jaeger Hans , Wolf Eva 
Published: January 2018

AbstractSecondary hyperparathyroidism (sHPT) might be a contributor to increased risk of osteoporosis in adult HIV patients but there is little data available on this issue in this particular population. The aim of the study was to investigate the prevalence of sHPT in an HIV-infected population with normal kidney function and to evaluate its risk factors in HIV patients. This cross-sectional study was carried out in a single HIV center in Germany using routine data from patients with normal kidney function attending the clinic between January 1st and December 31st, 2016. In total, 1263 patients were included [998 (79.0%) male, median age 48 (IQR 38–54) years]. In 214 patients (16.9%) elevated PTH levels with low or normal calcium levels were found. Multivariate logistic regression modeling showed significant associations with elevated PTH for African ethnicity [OR: 2.12 (95% CI: 1.42–3.16); p<0.001], low 25-hydroxyvitamin D levels [OR: 1.82 (95% CI: 1.32–2.51); p<0.001], low calcium levels [OR 1.69 (95% CI: 1.22–2.33); p=0.001], and use of tenofovir disoproxil fumarate [OR 2.33 (95% CI: 1.62–3.36); p<0.001]. Additional to common risk factors like vitamin D insufficiency and hypocalcemia, we found a significant association between the use of TDF and sHPT. Prospective data are needed to ascertain whether PTH-mediated bone loss is the underlying mechanism of TDF bone-toxicity. Additional screening of PTH even in HIV-infected patients with normal or low calcium levels may help to identify patients at increased risk of bone mineral density loss.
Schwerpunktüberprüfung ambulanter Wohngemeinschaften der außerklinischen Intensivpflege im Stadtgebiet München – Ergebnisse und Rückschlüsse
Authors: Horvath Leila , Böhm Doris , Gleich Sabine 
Published: January 2018

Zusammenfassung
Hintergrund Die Versorgung intensivpflegebedürftiger, auch langzeitbeatmeter Menschen findet zunehmend in ambulanten Wohngemeinschaften der außerklinischen Intensivpflege (aWG) statt. Im Rahmen seiner Überwachungstätigkeit überprüfte das Referat für Gesundheit und Umwelt (RGU) im Zeitraum vom April 2015 bis August 2016 ambulante Pflegedienste, die sich auf diese Versorgungsform im Stadtgebiet München spezialisiert haben.
Methode Zunächst erfolgte die Strukturanalyse der Pflegeanbieter mithilfe von standardisierten Checklisten. Mit Einverständnis der Klienten bzw. Betreuer wurde im Anschluss eine Begehung der aWG durchgeführt. Die erhobenen Daten wurden ausgewertet und deskriptiv analysiert.
Ergebnisse Von 43 gemeldeten aWG im Stadtgebiet München waren 20 für die außerklinische Intensivpflege konzipiert. Diese wurden von 9 Pflegediensten versorgt. Es zeigte sich ein gutes Prüfergebnis in der Strukturanalyse und beim Hygienemanagement. Verbesserungspotenzial fand sich bei der Umsetzung infektionskritischer Tätigkeiten vor Ort und bei deren korrekter Darstellung in den Hygieneplänen. Grundsätzlicher Regelungsbedarf besteht für die Personalqualifikation sowie für die Strukturen für Notfallinterventionen z. B. bei Stromausfällen.
Schlussfolgerung Es zeigte sich, dass regelmäßige Beratungen, Schulungen sowie infektionshygienische Überprüfungen durch das Gesundheitsamt sich positiv auf das Hygiene- und Notfallmanagement von ambulanten Intensivpflegediensten auswirken. Bundesweit einheitliche und verbindliche Qualitätsstandards und Kontrollmöglichkeiten existieren bei dieser Versorgungsform jedoch nicht und sind bislang auch nicht vorgesehen.
Recent Advances in Cell Electrospining of Natural and Synthetic Nanofibers for Regenerative Medicine
Authors: Zamani Reza , Aval Sedigheh , Pilehvar-Soltanahmadi Younes , Nejati-Koshki Kazem , Zarghami Nosratollah 
Published: January 2018

AbstractThe progression of nanotechnology provides opportunities to manipulate synthetic and natural materials to mimic the natural structure for tissue engineering applications. The electrospinning technique applies electrostatic principle to fabricate electrospun nanofibers. Nanofiber scaffolds are precisely similar to the native extracellular matrix (ECM) and support cell proliferation, adhesion, tendency to preserve their phenotypic shape and directed growth according to the nanofiber direction. This study reviewed both the natural and synthetic type of nanofibers and described the different properties used to trigger certain process in the tissue development. Also, the potential applications of electrospun scaffolds for regenerative medicine were summarized.
Evolution of vertical and oblique transmission under fluctuating selection
Authors: Ram Yoav , Liberman Uri , Feldman Marcus W. 
Published: January 2018

Significance
Evolutionary dynamics of phenotypes in populations depend on how the traits are transmitted across generations and how the environments that cause selection on the traits fluctuate over time. We show that, under periodically fluctuating selection, a gene that increases the rate of vertical transmission is disfavored when the periods are short but approaches an intermediate stable rate for longer periods. This stable rate differs markedly from the rate that maximizes the geometric mean fitness. The evolution of learning rules thus differs qualitatively from the evolution of genetically modified rules of genetic transmission.
Greek primary school teachers’ awareness of the special features of scientific language: implications for science curricula and teachers’ professional development
Authors: Sagiannis Spyridon , Dimopoulos Kostas 
Published: January 2018

ABSTRACTThis exploratory study aims at investigating first the extent to which Greek primary school teachers recognize the features of scientific language (an archetype for the academic language employed in all school disciplines), and second and most importantly the functional role they attribute to these features in the construction of scientific discourse. Semi‐structured interviews were conducted with 30 teachers. Two versions of a one‐page extract, varying in linguistic specialization, were used as stimuli‐materials. Teachers correctly recognized the linguistically highly specialized version, but they were less able to spontaneously mention specific features (mainly syntactic complexity and terminology) contributing to this specialization. Worse still, they failed to recognize syntactic complexity as a feature of the specialized extract even after they were explicitly probed to do so. Moreover, teachers were found to only be partially aware of the functional role these features play in constructing the scientific world‐view. Specifically, teachers seem to put emphasis on the communicative rather than the epistemological role of the corresponding linguistic features. These findings stress the need for certain interventions both at initial and in‐service level of teacher education as well as at the level of science curricula.
Breast Cancer Stage at Diagnosis in a New Jersey Cancer Education and Early Detection Site
Authors: Jerome-D’Emilia Bonnie , Kushary Debashis , Burrell Sherry A. , Suplee Patricia D. , Hansen Katherine 
Published: January 2018

Objectives:
The National Breast and Cervical Cancer Early Detection Program provides free or low-cost screening to uninsured or underinsured women and has had positive results; however, only a few state programs have been evaluated. This study will provide a first snapshot of the effectiveness of the New Jersey program, by comparing stage at diagnosis for enrollees as compared with nonenrollees who received definitive treatment for breast cancer at the same academic medical center.

Materials and Methods:
A retrospective analysis of 5 years of breast cancer data abstracted from the Cancer Registry of a large urban hospital in the Northeast United States. Bivariate analysis and logistic regression were utilized.

Results:
One thousand forty women were screened for and diagnosed with breast cancer at this site; they were more likely to be racially (P<0.001) and ethnically (P<0.002) diverse as compared with nonenrollees. Enrollees were more likely to be symptomatic at diagnosis (P<0.001), and diagnosed at a late stage when compared with nonenrollees (odds ratio, 1.88; 95% confidence interval, 1.07-3.29).

Conclusions:
This national program was developed to serve low income, under and uninsured women who may otherwise have limited access to cancer screening services. It appears that many women enroll in this program needing diagnostic rather than screening services, after breast symptoms were noted. This finding helps to emphasize the fact that just providing free screening services is not enough to make up for the lack of a usual source of preventive care for low income and uninsured women.
Value of FDG–PET/CT Volumetry After Chemoradiotherapy in Rectal Cancer
Authors: Okuno Takayuki , Kawai Kazushige , Koyama Keitaro , Takahashi Miwako , Ishihara Soichiro , Momose Toshimitsu , Morikawa Teppei , Fukayama Masashi , Watanabe Toshiaki 
Published: January 2018

BACKGROUND:
Neoadjuvant chemoradiotherapy followed by an optimal surgery is the standard treatment for patients with locally advanced rectal cancer. FDG-PET/CT is commonly used as the modality for assessing the effect of chemoradiotherapy.

OBJECTIVE:
The purpose of this study was to investigate whether PET/CT-based volumetry could contribute to the prediction of pathological complete response or prognosis after neoadjuvant chemoradiotherapy.

DESIGN:
This was a retrospective cohort study.

SETTINGS:
This study was conducted at a single research center.

PATIENTS:
Ninety-one consecutive patients with locally advanced rectal cancer were enrolled between January 2005 and December 2015.

INTERVENTION:
Patients underwent PET/CT before and after neoadjuvant chemoradiotherapy.

MAIN OUTCOME MEASURES:
Maximum standardized uptake value and total lesion glycolysis on PET/CT before and after neoadjuvant chemoradiotherapy were calculated using isocontour methods. Correlations between these variables and clinicopathological factors and prognosis were assessed.

RESULTS:
PET/CT-associated variables before chemoradiotherapy were not correlated with either clinicopathological factors or prognosis. Maximum standardized uptake value was associated with pathological complete response, but total lesion glycolysis was not. Maximum standardized uptake value correlated with ypT, whereas total lesion glycolysis correlated with both ypT and ypN. High total lesion glycolysis was associated with a considerably poorer prognosis; the 5-year recurrence rate was 65% and the 5-year mortality rate 42%, whereas in lesions with low total lesion glycolysis, these were 6% and 2%. On multivariate analysis, high total lesion glycolysis was an independent risk factor for recurrence (HR = 4.718; p = 0.04).

LIMITATIONS:
The gain in fluoro-2-deoxy-d-glucose uptake may differ between scanners, thus the general applicability of this threshold should be validated.

CONCLUSIONS:
In patients with locally advanced rectal cancer, high total lesion glycolysis after neoadjuvant chemoradiotherapy is strongly associated with a worse prognosis. Total lesion glycolysis after chemoradiotherapy may be a promising preoperative predictor of recurrence and death. See Video Abstract at http://links.lww.com/DCR/A464.
Hyaluronic Acid Filler Injections Under the Metatarsal Heads Provide a Significant and Long-Lasting Improvement in Metatarsalgia From Wearing High-Heeled Shoes
Authors: Foumenteze Jean Paul , Simpson Helen , Kerrouche Nabil 
Published: January 2018

BACKGROUNDMetatarsalgia is a common overuse injury that may be caused by wearing high-heeled shoes.OBJECTIVETo evaluate the decrease in metatarsalgia using a hyaluronic acid dermal filler.METHODSA 6-month, open study was conducted in 15 subjects with metatarsalgia because of regularly wearing high-heeled shoes. Hyaluronic acid (20 mg/mL) with lidocaine hydrochloride (3 mg/mL) was injected under the metatarsal heads at baseline. Pain (on a 0–10 scale) under the metatarsal heads when walking in high heels was recorded in a weekly subject diary.RESULTSAt 6 months after injections, 5 subjects (33.3%) reported no metatarsalgia pain. For subjects with pain, they were able to wear high heels for significantly longer than before the injections (7.2 hours at 6 months vs 3.4 hours at baseline). Significant improvements from baseline were observed at Month 6 for time to onset of pain (3.5 hours longer), time between onset of pain and intolerable pain (1.9 hours longer), and pain sensation (−2.2 grades at onset and −3.8 grades at shoe removal). No adverse events were reported.CONCLUSIONInjection of hyaluronic acid filler to the forefeet provided a significant effective, long-lasting, and well-tolerated improvement in metatarsalgia because of wearing high-heeled shoes.
Combination of Melolabial Interpolation Flap and Nasal Sidewall and Cheek Advancement Flaps Allows for Repair of Complex Compound Defects
Authors: Patel Payal M. , Greenberg Judah N. , Kreicher Kathryn L. , Burkemper Nicole M. , Bordeaux Jeremy S. , Maher Ian A. 
Published: January 2018

BACKGROUND
The paramedian forehead flap (PMFF) is the repair of choice for large nasal defects involving multiple cosmetic subunits. However, the PMFF may not be optimal for all patients. The combination of a melolabial interpolation flap (MLIF) and a nasal sidewall flap may serve as an alternative.

OBJECTIVE
To present the surgical technique and aesthetic outcomes of the alternative reconstruction for surgical defects of the lower nose.

MATERIALS AND METHODS
Fourteen patients with multisubunit nasal Mohs defects reconstructed alternatively were identified from 2 academic centers in this retrospective case series. Illustrations and photographs were used to demonstrate surgical technique and outcomes. Final aesthetic results were analyzed using the Patient and Observer Scar Assessment Scale.

RESULTS
The physician observer rated the scar outcome a mean score of 10.9 ± 3.3. Patients rated their results as a mean of 9.1 ± 4.7. The mean “Patient” Overall Opinion score was 2.3 ± 2.6 and the mean “Observer” Overall Opinion score was 1.9 ± 0.9. No patients reported problems with nasal airflow or obstruction, and cosmetic complications such as pincushioning or alar buckling were not observed.

CONCLUSION
The combined MLIF and nasal sidewall flap is an alternative repair for complex distal nasal defects.