bluuebunny/crossref_metadata_2025_split huggingface dataset:
Kinetics of Procalcitonin in Pediatric Patients on Extracorporeal Membrane Oxygenation
Authors: Bobillo Sara , Rodríguez-Fanjul Javier , Solé Anna , Moreno Julio , Balaguer Mònica , Esteban Elisabeth , Cambra Francisco José , Jordan Iolanda 
Published: January 2018

Objectives: To assess the kinetics of procalcitonin (PCT) and C-reactive protein (CRP) in pediatric patients who required extracorporeal membrane oxygenation (ECMO) and to analyze its relationship with morbidity and mortality. Patients and methods: Prospective observational study including pediatric patients who required ECMO. Both PCT and CRP were sequentially drawn before ECMO (P0) and until 72 hours after ECMO. Results: A total of 40 patients were recruited. Two cohorts were established based on the value of the P0 PCT (>10 ng/mL). Comparing the kinetics of PCT and CRP in these cohorts, the described curves were the expected for each clinical situation. The cutoff for P0 PCT to predict multiple organ dysfunction syndrome was 2.55 ng/mL (sensibility 83%, specificity 100%). Both PCT and CRP did not predict risk of neurologic sequelae or mortality in any group. Conclusions: Procalcitonin does not seem to be modified by ECMO and could be a good biomarker of evolution.
Visible-Near Infrared Spectroscopic Assessment of Urogenital Tissue in Premenopausal and Postmenopausal Women
Authors: Farage Miranda A , Cambron Tom , Liu Kan-Zhi 
Published: January 2018

Background: A clinical study was conducted to evaluate the feasibility of using visible and near-infrared (NIR) spectroscopy as a potential noninvasive measure of genital skin health in premenopausal and postmenopausal women. Methods: A total of 45 female subjects (aged 21-70 years), all of whom gave fully informed consent to participate, were enrolled in the study and assigned to 1 of 3 groups: 15 premenopausal (Pre-M), 15 postmenopausal receiving hormone replacement therapy (Post-M HRT), and 15 postmenopausal receiving no form of hormone replacement therapy (Post-M non-HRT). Spectral measurements were taken at the vaginal mucosa, and spectral data were evaluated for the erythema index (EI), hemoglobin index (HI), bilirubin/β-carotene, and melanin. The color index (CI; calculated as the ratio of absorbance at 480 nm/540 nm) was also determined. Results were compared with previously published results on biomarkers and physical characteristic of genital tissue measured on the same groups of women. Results: Spectral measurements from the Post-M Non-HRT subjects indicated a significant reduction in HI compared with the Pre-M group ( P = .0003) and to the Post-M HRT group ( P < .0001). Similarly, EI was reduced in the Post-M Non-HRT ( P < .0001 and P = .0041 for the Pre-M and Post-M HRT groups, respectively). In contrast, the Post-M Non-HRT subjects exhibited a significant increase in β-carotene compared with the Pre-M subjects ( P = .0098). Bilirubin and melanin were not significantly affected. The Post-M Non-HRT group exhibited a significant increase in CI, indicating a shift away from the hemoglobin absorption region (510-620 nm wavelength) and toward the bilirubin/β-carotene absorption region (450-490 nm wavelength). This change was significant when compared with both the Pre-M group ( P < .0001) and the Post-M HRT group ( P = .0048). The changes in spectral measurements were consistent with previously reported changes in physical parameters (vaginal atrophy, increased pH, decreased skin temperature) and with decreased concentrations of the biomarkers histamine and histidine. Conclusions: Hemodynamic spectral characteristics differ in postmenopausal vaginal tissue compared with tissue in premenopausal women, with decreased absorbance in the hemoglobin absorption region (510-620 nm wavelength) and an increased absorbance in the bilirubin/β-carotene absorption region (450-490 nm wavelength). A change in absorbance in the visible and NIR wavelengths is a promising, additional measure of genital skin health related to menopause and vulvovaginal atrophy.
Dietary fatty acids and susceptibility to multiple sclerosis
Authors: Haase Stefanie , Haghikia Aiden , Gold Ralf , Linker Ralf A 
Published: January 2018

Background: The gut microbiome as well as dietary habits have recently been established as environmental contributors to the pathogenesis of multiple sclerosis (MS), a T-cell-mediated autoimmune disease of the central nervous system (CNS). Objective: To summarize recent findings on the Janus-faced effects of dietary short-chain fatty acids (SCFAs) and long-chain fatty acids (LCFAs) on T-cell immunity with a special focus on the gut and the microbiome as an interface linking diet and T-cell responses during MS. Methods: Review article. Results: The autoimmune basis of MS most likely stems from an imbalance between pro-inflammatory T helper cell (Th)1 and Th17 cells and anti-inflammatory or regulatory mechanisms including regulatory T cells (Treg). Hence, the rationale of currently available therapeutic interventions is to either suppress pathogenic Th1/Th17 and/or to foster Treg responses. Dietary fatty acids are often discussed for their detrimental role in MS. However, recent studies investigating saturated fatty acids in animal models of MS revealed harmful as well as beneficial effects depending on their aliphatic chain length. Conclusion: Dietary SCFAs constitute interesting candidates as safe and potent add-on therapy in the immunomodulatory treatment armamentarium for relapsing-remitting MS.
Motivations for Participation in an Online Social Media Community for Diabetes
Authors: White Katherine , Gebremariam Achamyeleh , Lewis Dana , Nordgren Weston , Wedding James , Pasek Josh , Garrity Ashley , Hirschfeld Emily , Lee Joyce M. 
Published: January 2018

Background: Our objectives were to describe individuals’ motivations for participation in an online social media community and to assess their level of trust in medical information provided by medical professionals and community members. Methods: A purposive survey was delivered to participants recruited through posts on the CGM in the Cloud group, Twitter, and blogs. Individuals were asked a series of demographic and social media use questions. Results: A total of 1268 members of the CGM in the Cloud community responded to the survey. The majority were non-Hispanic White (92.1%) and caregivers of an individual with diabetes (80.9%). Mean age was 41 years old, and 74.8% were female. Primary goals of the Facebook group were to learn more about Nightscout technology and to receive technological assistance. Individuals provided assistance to the community through spreading awareness, technical assistance, support, and donation. Respondents put a high level of trust in their peers versus health professionals in many health situations with nearly 40% of individuals reported to be helped by following advice found in the Facebook group, and 99% reported no harm. Conclusions: Our findings suggest that patients with diabetes and their caregivers use social media for many health-related purposes including medical recommendations and technical support for medical devices and systems as well as emotional support.
Do Postoperative Hallux Angles Correlate With Outcome in MP1 Fusion? Our Experience With 71 Cases
Authors: Paredes-Carnero Xavier , Fernández-Cebrián Antonio María , Villardefrancos-Gil Silvia 
Published: January 2018

Purpose: To determine if the postoperative alignment of the hallux influences the final clinical outcome of hallux metatarsophalangeal joint (first MTPJ) arthrodesis. Methods: A total of 71 consecutive cases (hallux rigidus) were studied in stages 3 and 4. They were operated through arthrodesis between 2008 and 2014. The follow-up mean was 7.3 years. The AOFAS (American Orthopaedic Foot and Ankle Society) test was performed preintervention and per annum. In radiology, both the hallux valgus angle and the dorsiflexion angle of the first MTPJ were studied. Furthermore, clinical outcomes were evaluated according to the type of implant used. Results: Preoperative AOFAS score was 27.5, rising to 91.3 after the intervention ( P < .01). The improvement test average was 63.6. There were 17 local complications (23%), 7 of them were considered to be major complications (9%), 6 of which needed reoperation (8.5%). The dorsiflexion angle postoperative mean was 21.7°. The hallux valgus angle postoperative mean was 10.9°. No correlations between both angles, and improved AOFAS score or complications ( P > .4 and P > .5, respectively), were found. Patients who had a dorsiflexion angle higher than 20° had greater improvement in the AOFAS score compared with those who had angles lower than 20° (64.5 vs 59.6 points). Nevertheless, this result was not statistically significant ( P = .059). No differences in AOFAS score improvement regarding arthrodesis plate ( P > .1) were found. Conclusion: First MTPJ arthrodesis is a good alternative for patients in advanced hallux rigidus stages when conservative treatment fails. We could not confirm if a better postoperative alignment may influence in clinical outcomes. However, better results are obtained with dorsiflexion angle greater than 20° than with those with less than 20°. Likewise, any differences between the 2 arthrodesis plates have been able to confirm. Levels of Evidence: Level III: Retrospective cohort study
Characteristics and prognosis of heart failure with improved compared with persistently reduced ejection fraction: A systematic review and meta-analyses
Authors: Jørgensen Mads E , Andersson Charlotte , Vasan Ramachandran S , Køber Lars , Abdulla Jawdat 
Published: January 2018

Aims We assessed the clinical characteristics and prognosis of chronic heart failure patients with improved ejection fraction (HFIEF) compared with persistently reduced ejection fraction (HFpREF) after evidence-based therapy. Methods and results We performed a meta-analysis including 24 eligible observational studies comparing 2663 HFIEF (≥5% left ventricular ejection fraction (LVEF) improvement) versus 8355 HFpREF patients who received recommended drug therapy, cardiac resynchronization therapy and/or intracardiac defibrillator. LVEF was assessed at baseline and reassessed after 19 ± 19 months. The primary endpoints were all-cause mortality and appropriate shocks. The mean duration of follow-up was 39 ± 12 months. Among HFIEF patients, LVEF improved 16.3 percentage points (95% confidence interval 15.9–16.6, p < 0.0001). Compared with HFpREF patients, HFIEF patients had a comparable mean age (60.9 years vs. 62.4 years, p = 0.11), were more often women (33% vs. 25%), had a higher prevalence of non-ischaemic heart failure (58% vs. 53%), less diabetes (27% vs. 28%), higher systolic blood pressure (127.5 ± 9 vs. 122 ± 12 mmHg) and lower left ventricle end-diastolic diameter (64.1 ± 3.7 vs. 67.4 ± 4.9 mmHg), all p-values < 0.05. Absolute risk of all-cause mortality was lower in HFIEF (5.8%) compared with HFpREF (17.5%) with a risk ratio of 0.34 (95% confidence interval 0.28-0.41), p < 0.001. Risk of appropriate shocks was significantly lower in HFIEF versus HFpREF (risk ratio 0.58 (95% confidence interval 0.46–0.74), p < 0.001). Conclusion In heart failure patients, we identified several baseline characteristics in favour of an improved LVEF, in response to evidence based therapy. Patients with improved LVEF had significantly lower risks of mortality and appropriate shocks compared with patients with persistently reduced LVEF.
Delayed celiac disease diagnosis predisposes to reduced quality of life and incremental use of health care services and medicines: A prospective nationwide study
Authors: Fuchs Valma , Kurppa Kalle , Huhtala Heini , Mäki Markku , Kekkonen Leila , Kaukinen Katri 
Published: January 2018

BackgroundCeliac disease is challenging to recognize, predisposing to long diagnostic delay. Currently, associated factors and significance of the delay remain obscure.ObjectiveThe objective of this article is to investigate associated sociodemographic risk factors and health consequences of diagnostic delay in celiac disease.MethodsAltogether 611 patients were surveyed at diagnosis and after one year on a gluten‐free diet regarding sociodemographic variables, well‐being and use of medicines and health care services. Quality of life was measured by a validated Psychological General Well‐Being (PGWB) questionnaire. The results were compared between patients with and without delayed (≥3 years) diagnosis.ResultsA total of 332 (54%) individuals reported a delay of ≥3 years. Associated with the delay were being a student or homemaker, but not gender, marital or occupational status, site of diagnosis or place of residence. Patients with the delay also had decreased self‐perceived health and poorer PGWB scores compared to those without delay; in anxiety and general health this was seen even on a gluten‐free diet. Days of sickness and doctor visits as well as use of drugs for dyspepsia and antidepressants were increased in the delay group both before and after diagnosis.ConclusionA delay in celiac disease diagnosis predisposes to reduced well‐being and incremental use of medicines and health care services, both before diagnosis and one year after diagnosis.
Staged Palliation of Cyanotic Obstructive Lesions With a Modified Right Ventricular Outflow Procedure
Authors: Batlivala Sarosh P. , Hood Mary K. , Dodge-Khatami Jannika , Shakti Divya , Taylor Mary B. , Ebeid Makram R. , Salazar Jorge D. , Dodge-Khatami Ali 
Published: January 2018

Background: Traditional palliation for biventricular cyanotic congenital heart lesions often involves staging with systemic-to-pulmonary arterial shunts to secure pulmonary blood flow (PBF) in the newborn period prior to complete repair. However, shunts may lead to life-threatening events secondary to shunt occlusion or acute coronary steal. They may be associated with morbidity secondary to diastolic runoff, systemic steal and volume loading, and do not provide pulsatile flow which has the potential to promote pulmonary artery (PA) growth. We have alternatively performed modified right ventricular outflow (mRVO) procedures by establishing antegrade right ventricle-to-PA flow. Methods: Retrospective review of data on all patients who underwent the mRVO procedure from 2013 to 2016, including anatomy, number of interstage catheterizations, reoperations, intensive care unit admissions, hypercyanotic episodes, interval to complete repair, and mortality. Results: Seventeen nonconsecutive patients included tetralogy of Fallot (n = 14), pulmonary valve stenosis (n = 2), and 1 with pulmonary atresia-intact septum; 14 had significant branch PA stenosis. Median age of first mRVO procedure was 14 days (range 5-193), and median duration of follow-up was 15.3 months (range 4-47 months). No patients had post-palliation acute hypercyanotic episodes. Nine were admitted to the ICU for persistent interstage hypoxemia, 7 of whom required reintervention prior to complete repair, which was achieved in 11 patients. Two late deaths unrelated to mRVO occurred. Conclusions: The mRVO procedure is a potential option with satisfactory results. It avoids potential shunt-related sudden death. The physiology of the mRVO palliation may provide unique benefits by providing antegrade pulsatile PBF, facilitates catheter interventions, and avoids branch PA distortion and stenosis.
Primary Arterial Switch Operation for Late Referral of Transposition of the Great Arteries with Intact Ventricular Septum in the Current Era: Do We Still Need a Rapid Two-Stage Operation?
Authors: Ota Noritaka , Sivalingam Sivakumar , Pau Kiew Kong , Hew Chee Chin , Dillon Jeswant , Latiff Haifa Abdul , Samion Hasri , Yakub Mohd Azhari 
Published: January 2018

Objective: We introduced primary arterial switch operation for the patient with transposition of great arteries and intact ventricular septum (TGA-IVS) who had more than 3.5 mm of posterior left ventricle (LV) wall thickness. Methods: Between January 2013 and June 2015, a total of 116 patients underwent arterial switch operation. Of the 116 patients, 26 with TGA-IVS underwent primary arterial switch operation at more than 30 days of age. Results: The age and body weight (mean ± SD) at the operation were 120.4 ± 93.8 days and 4.1 ±1.0 kg, respectively. There was no hospital mortality. The thickness of posterior LV wall (preoperation vs postoperation; mm) was 4.04 ± 0.71 versus 5.90 ± 1.3; P < .0001; interval: 11.8 ± 6.5 days. The left atrial pressure (mm Hg; postoperative day 0 vs 3) was 20.0 ± 3.2 versus 10.0 ± 2.0; P < .0001; and the maximum blood lactate level (mmol/dL) was 4.7 ± 1.4 versus 1.4 ± 0.3; P < .0001, which showed significant improvement in the postoperative course. All cases had delayed sternal closure. The patients who belonged to the thin LV posterior wall group (<4 mm [preoperative echo]: n = 13) had significantly longer ventilation time (days; 10.6 ± 4.8 vs 4.8 ± 1.7, P = .0039), and the intensive care unit stay (days) was 14 ± 9.2 versus 7.5 ± 3.5; P = .025, compared with thick LV wall group (≥4.0 mm: n = 13). Conclusions: The children older than 30 days with TGA-IVS can benefit from primary arterial switch operation with acceptable results under our indication. However, we need further investigation for LV function.
Words matter: after more than a century ‘schizophrenia’ needs rebranding
Authors: Lasalvia Antonio 
Published: January 2018

SUMMARYProfessionals, patients and patient organisations have advocated for the renaming of ‘schizophrenia’, seeing the term as misleading, stigmatising and a barrier to specialised care. In countries where a name change has occurred (e.g. Japan), the advantages of renaming seem to far outweigh disadvantages. Nevertheless, a name change would be a long and complex process that would not be useful if it were not accompanied by parallel changes in legislation, services and the education of professionals and the public.DECLARATION OF INTERESTNone.
Effect of singing interventions on symptoms of postnatal depression: three-arm randomised controlled trial
Authors: Fancourt D. , Perkins R. 
Published: January 2018

SummaryThis study assessed whether a novel psychosocial intervention could reduce symptoms of postnatal depression (PND) in the first 40 weeks post-birth. Analyses were carried out of 134 mothers with symptoms of PND randomised into 10 weeks of group singing workshops or group play workshops for them and their babies, or usual care (trial registration: NCT02526407). Overall, among all mothers with symptoms of PND, there was a non-significant faster improvement in symptoms in the singing group (F4,262 = 1.66, P = 0.16, η2 = 0.012). When isolating mothers with moderate–severe symptoms of PND, this result became significant, with a faster improvement in symptoms in the singing group (F3.9,139.8 = 2.74, P = 0.033, η2 = 0.028).Declaration of interestNone.
Unchaining people with mental disorders: medication is not the solution
Authors: Patel Vikram , Bhui Kamaldeep 
Published: January 2018

SummaryChaining of people with mental disorders, and their incarceration and abuse in prisons or mental hospitals, is an affront to psychiatry and humanity. Although mental healthcare always needs attention to cultural and social contexts, this must never be at the cost of allowing human rights violations to go unchallenged. A rights-based approach must enforce well-established international human rights conventions, and scale-up comprehensive community services around the needs and preferences of people affected by mental disorders.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2018.
Triage: a waiting list initiative in a child mental health service
Authors: Jones Elizabeth , Lucey Clare , Wadland Liz 
Published: January 2018

Aims and MethodLong waiting lists and failure to attend appointments are a common problem in child and adolescent psychiatry. We introduced a novel ‘triage’ stage waiting list initiative to decrease the long waiting time fora first appointment at our child mental health service.ResultsThe waiting time to first appointment was significantly reduced and increased satisfaction with this process was expressed by clinicians, the referred families and referrers.Clinical ImplicationsThe reduction in waiting time was sustained over time and the triage process has now been implemented as routine practice. Following this implementation, there is no longer a lengthy waiting list for treatment after initial assessment. We would recommend this initiative, which screened referrals more efficiently and accurately, as a successful model for other child and adolescent services with long waiting lists.
Part-time training: will it lead to part-time consultant?
Authors: Caswell Lucy , Lowe Kate 
Published: January 2018

Aims and MethodTo determine the preference of flexible trainees in psychiatry for consultant posts. A questionnaire survey was conducted among all flexible trainees in psychiatry in the West Midlands Region.ResultsThe overall response rate was 19 out of 21 (90%). The majority 15 out of 19 (68%) hoped to gain such a post at the end of their training. Of those wanting a consultant post, 15 of the 19 (79%) would only consider working part-time. If such a parttime consultant post was not available, 12 of the15 (80%) said they would considera non-career grade post.Clinical ImplicationsIn the West Midlands Region there has been an exponential growth in the number of flexible trainees. Approximately a third are within psychiatry alone and most wish to continue flexible working patterns as consultants. This has major workforce planning implications for the future.
Observations on Cholera,
Authors: Boyd Robt. 
Published: January 2018

“He came, he went, like the simoon, That harbinger of fate and gloom, Beneath whose widely-wasting breath, The very cypress droops to death.’'—Byron.The frequent occurrence of Cholera, in different parts of the United Kingdom, of late years, and its prevalence at present, secms to point out the necessity of our being prepared for its appearance, particularly in public institutions, and amongst others, Lunatic Asylums, which in some instances have suffered severely from this disease. In the West Riding of York Asylum, containing 633 patients, 98 are reported to have died from cholera in the autumn of 1849. The private asylums for pauper lunatics generally about London and in some other places, suffered more or less from the same epidemic; whether from cholera or some other cause, the mortality in the Lancaster Asylum was unusually high, 48 per cent in 1833, according to “a table of patients admitted, &c,” in the annual reports of that institution.
Flemish Interiors, by the writer of “A Glance behind the Grilles.” Longmans, 1856
Authors: Robertson C. Lockhart 
Published: January 2018

Notes on Belgian Lunatic Asylums, by John Webster, M.D., F.R.S. Part I. Journal of Psychological Medicine, January, 1857.A small volume styled “Flemish Interiors,” being notes of a tour of religious enquiry through Belgium, written by some recent convert to the Roman system, is a very readable book, and contains some interesting observations on the establishments for the insane, under the care of the religious orders in Belgium. These observations we were led to compare with a paper by Dr. Webster, in the present number of the “Psychological -Ioumal,” on the lunatic Asylums of Relgium; and the contrast between the hard dry facts of the man of science, and the bright colours which the religious votary throws over the same scenes, seemed to us worthy of being brought out in our pages.