bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia
Authors: Leonard Maeve , McInerney Shane , McFarland John , Condon Candice , Awan Fahad , O'Connor Margaret , Reynolds Paul , Meaney Anna Maria , Adamis Dimitrios , Dunne Colum , Cullen Walter , Trzepacz Paula T , Meagher David J 
Published: March 2016

ObjectivesDifferentiation of delirium and dementia is a key diagnostic challenge but there has been limited study of features that distinguish these conditions. We examined neuropsychiatric and neuropsychological symptoms in elderly medical inpatients to identify features that distinguish major neurocognitive disorders.SettingUniversity teaching hospital in Ireland.Participants and measures176 consecutive elderly medical inpatients (mean age 80.6±7.0 years (range 60–96); 85 males (48%)) referred to a psychiatry for later life consultation-liaison service with Diagnostic and Statistical Manual of Mental Disorders (DSM) IV delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Participants were assessed cross-sectionally with comparison of scores (including individual items) for the Revised Delirium Rating Scale (DRS-R98), Cognitive Test for Delirium (CTD) and Neuropsychiatric Inventory (NPI-Q).ResultsThe frequency of neurocognitive diagnoses was delirium (n=50), dementia (n=32), comorbid delirium–dementia (n=62) and cognitively intact patients (n=32). Both delirium and comorbid delirium–dementia groups scored higher than the dementia group for DRS-R98 and CTD total scores, but all three neurocognitively impaired groups scored similarly in respect of total NPI-Q scores. For individual DRS-R98 items, delirium groups were distinguished from dementia groups by a range of non-cognitive symptoms, but only for impaired attention of the cognitive items. For the CTD, attention (p=0.002) and vigilance (p=0.01) distinguished between delirium and dementia. No individual CTD item distinguished between comorbid delirium–dementia and delirium. For the NPI-Q, there were no differences between the three neurocognitively impaired groups for any individual item severity.ConclusionsThe neurocognitive profile of delirium is similar with or without comorbid dementia and differs from dementia without delirium. Simple tests of attention and vigilance can help to distinguish between delirium and other presentations. The NPI-Q does not readily distinguish between neuropsychiatric disturbances in delirium versus dementia. Cases of suspected behavioural and psychological symptoms of dementia should be carefully assessed for possible delirium.
Effect of acupuncture on sleep quality and hyperarousal state in patients with primary insomnia: study protocol for a randomised controlled trial
Authors: Guo Jing , Huang Wei , Tang Chu-ying , Wang Gui-Ling , Zhang Fan , Wang Lin-peng 
Published: March 2016

IntroductionPrimary insomnia (PI) is commonly defined as a state of having disturbed daytime activities due to poor night-time sleep quality. Studies have demonstrated that it is a disorder of 24 h hyperarousal, expressed in terms of physiological, cognitive and cortical activation. Acupuncture is considered to be beneficial to restore the normal sleep–wake cycle. The aim of the trial is to assess the therapeutic effects of acupuncture on sleep quality and hyperarousal state in patients with PI.Methods and analysisThis study is a randomised, patient-assessor-blinded, sham controlled trial. –88 eligible patients with PI will be randomised in a ratio of 1:1 to the intervention group (real acupuncture) and control group (sham acupuncture, superﬁcial insertion at irrelevant acupuncture points). Acupuncture intervention will be given to all participants three times a week for 4 weeks, followed up for 8 weeks.The primary outcome measures are the Pittsburgh Sleep Quality Index (PSQI) and Hyperarousal scale (HAS). The secondary outcomes are Fatigue scale-14 (FS-14), polysomnography (PSG), heart rate variability (HRV) and Morning Salivary Cortisol Level (MSCL). Outcomes will be evaluated at baseline, post-treatment period and 8 weeks follow-up. All main analyses will be carried out on the basis of the intention-to-treat principle.Ethics/disseminationThis protocol has been approved by the Medical Ethical Committee of Beijing Traditional Chinese Medicine Hospital (Beijing TCM Hospital) on 5 January 2015. The permission number is 2014BL-056-02. The study will present data concerning the clinical effects of treating primary insomnia with acupuncture. The results will help to demonstrate if acupuncture is an effective therapy for improving sleep quality in association with a decreased hyperarousal level as a possible underlying mechanism. The findings from this study will be shared with the healthcare professionals, general public and relevant organisations through publication of manuscripts and conference presentations.Trial registration numberISRCTN16079489; Pre-results.
Are you ready? Exploring readiness to engage in exercise among people living with HIV and multimorbidity in Toronto, Canada: a qualitative study
Authors: Simonik Alya , Vader Kyle , Ellis Denine , Kesbian Dirouhi , Leung Priscilla , Jachyra Patrick , Chan Carusone Soo , O'Brien Kelly K 
Published: March 2016

ObjectivesOur aim was to explore readiness to engage in exercise among people living with HIV and multimorbidity.DesignWe conducted a descriptive qualitative study using face-to-face semistructured interviews with adults living with HIV.SettingWe recruited adults (18 years or older) who self-identified as living with HIV and 2 or more additional health-related conditions from a specialty hospital in Toronto, Canada.Participants14 participants with a median age of 50 years and median number of 9 concurrent health-related conditions participated in the study. The majority of participants were men (64%) with an undetectable viral load (71%).Outcome measuresWe asked participants to describe their readiness to engage in exercise and explored how contextual factors influenced their readiness. We analysed interview transcripts using thematic analysis.ResultsWe developed a framework to describe readiness to engage in exercise and the interplay of factors and their influence on readiness among adults with HIV and multimorbidity. Readiness was described as a diverse, dynamic and fluctuating spectrum ranging from not thinking about exercise to routinely engaging in daily exercise. Readiness was influenced by the complex and episodic nature of HIV and multimorbidity comprised of physical impairments, mental health challenges and uncertainty from HIV and concurrent health conditions. This key factor created a context within which 4 additional subfactors (social supports, perceptions and beliefs, past experience with exercise, and accessibility) may further hinder or facilitate an individual's position along the spectrum of readiness to exercise.ConclusionsReadiness to engage in exercise among people living with HIV is a dynamic and fluctuating construct that may be influenced by the episodic nature of HIV and multimorbidity and 4 subfactors. Strategies to facilitate readiness to exercise should consider the interplay of these factors in order to enhance physical activity and subsequently improve health outcomes of people with HIV and multimorbidity.
Tweeting links to Cochrane Schizophrenia Group reviews: a randomised controlled trial
Authors: Adams C E , Jayaram M , Bodart A Y M , Sampson S , Zhao S , Montgomery A A 
Published: March 2016

ObjectiveTo assess the effects of using health social media on web activity.DesignIndividually randomised controlled parallel group superiority trial.SettingTwitter and Weibo.Participants170 Cochrane Schizophrenia Group full reviews with an abstract and plain language summary web page.InterventionsThree randomly ordered slightly different 140 character or less messages, each containing a short URL to the freely accessible summary page sent on specific times on one single day. This was compared with no messaging.OutcomeThe primary outcome was web page visits at 1 week. Secondary outcomes were other metrics of web activity at 1 week.Results85 reviews were randomised to each of the intervention and control arms. Google Analytics allowed 100% follow-up within 1 week of completion. Intervention and control reviews received a total of 1162 and 449 visits, respectively (IRR 2.7, 95% CI 2.2 to 3.3). Fewer intervention reviews had single page only visits (16% vs 31%, OR 0.41, 0.19 to 0.88) and users spent more time viewing intervention reviews (geometric mean 76 vs 31 s, ratio 2.5, 1.3 to 4.6). Other secondary metrics of web activity all showed strong evidence in favour of the intervention.ConclusionsTweeting in this limited area of healthcare increases ‘product placement’ of evidence with the potential for that to influence care.Trial registration numberISRCTN84658943.
Mortality and use of psychotropic medication in patients with stroke: a population-wide, register-based study
Authors: Jennum Poul , Baandrup Lone , Iversen Helle K , Ibsen Rikke , Kjellberg Jakob 
Published: March 2016

ObjectivesThe study sought to describe whether psychotropic medication may have long-term side effects in patients with stroke compared with controls.SettingUse of national register data from healthcare services were identified from the Danish National Patient Registry in Denmark. Information about psychotropic medication use was obtained from the Danish Register of Medicinal Product Statistics.ObjectivesWe aimed to evaluate all-cause mortality in relation to the use of benzodiazepines, antidepressants and antipsychotics in patients with stroke and matched controls.ParticipantsPatients with a diagnosis of stroke and either no drug use or preindex use of psychotropic medication (n=49 968) and compared with control subjects (n=86 100) matched on age, gender, marital status and community location.Primary outcome measureAll-cause mortality.ResultsAll-cause mortality was higher in patients with previous stroke compared with control subjects. Mortality HRs were increased for participants prescribed serotonergic antidepressant drugs (HR=1.699 (SD=0.030), p=0.001 in patients; HR=1.908 (0.022), p<0.001 in controls, respectively), tricyclic antidepressants (HR=1.365 (0.045), p<0.001; HR=1.733 (0.022), p<0.001), benzodiazepines (HR=1.643 (0.040), p<0.001; HR=1.776 (0.053), p<0.001), benzodiazepine-like drugs (HR=1.776 (0.021), p<0.001; HR=1.547 (0.025), p<0.001), first-generation antipsychotics (HR=2.001 (0.076), p<0.001; HR=3.361 (0.159), p<0.001) and second-generation antipsychotics (HR=1.645 (0.070), p<0.001; HR=2.555 (0.086), p<0.001), compared with no drug use. Interaction analysis suggested statistically significantly higher mortality HRs for most classes of psychotropic drugs in controls compared with patients with stroke.ConclusionsAll-cause mortality was higher in patients with stroke and controls treated with benzodiazepines, antidepressants and antipsychotics than in their untreated counterparts. Our findings suggest that care should be taken in the use and prescription of such drugs, and that they should be used in conjunction with adequate clinical controls.
Variation in preparation for gastroscopy: lessons towards safer and better outcomes
Authors: Callaghan J L , Neale J R , Boger P C , Sampson A P , Patel P 
Published: March 2016

ObjectiveTo identify the methods employed within the UK practice prior to diagnostic gastroscopy and compare with published guidelines for patients undergoing general anaesthesia.DesignNational Health Service (NHS) endoscopy units were invited to take part in a structured telephone survey to determine the length of time patients are kept nil-by-mouth (NBM) for food and fluids prior to gastroscopy, and whether a preprocedure mucolytic drink was used.Methods212 NHS Trusts providing endoscopy services were identified from the Joint Advisory Group on GI Endoscopy. Trusts were excluded if they were children's hospitals (n=5).Results207 NHS Trusts were telephoned. 193 completed the survey (93%), 11 Trusts declined and there was no response from 3 Trusts. 13 separate policies regarding NBM timings were identified. 51 Trusts (21%) used the timings ratified by Surgical and Anaesthetic Societies (6 h NBM for food, 2 h for clear fluid). 135 Trusts (70%) used a policy which starved patients in excess of the standard surgical guidelines. No Trust used a mucolytic drink prior to gastroscopy.ConclusionsThe survey revealed large variation in NHS Trust's policies regarding the times patients were starved prior to gastroscopy. Results of surgical studies demonstrate increased risk of significant pulmonary aspiration with increased fluid-starvation periods, 68% of NHS endoscopy policy would be deemed excessive by surgical practice. There is no routine use of a mucolytic drink to improve mucosal visualisation in the UK practice.
Clinical diffusion mismatch better discriminates infarct growth than mean transit time–diffusion weighted imaging mismatch in patients with middle cerebral artery–M1 occlusion and limited infarct core
Authors: Nogueira Raul G , Kemmling Andre , Souza Leticia M , Payabvash Seyedmehdi , Hirsch Joshua A , Yoo Albert J , Lev Michael H 
Published: March 2016

Background and purposeOur purpose was to compare clinical diffusion mismatch (CDM) and mean transit time (MTT)-diffusion mismatch as predictors of infarct growth in patients with proximal middle cerebral artery (MCA) occlusion and small infarct core on presentation.MethodsRetrospective analysis of consecutive stroke patients with: (1) MCA-M1 occlusion; (2) MRI performed ≤10 h from symptoms onset; and (3) baseline MRI-diffusion weighted imaging (DWI) volume ≤25 mL. Definitions included: CDM=baseline National Institutes of Health Stroke Scale (NIHSS) score ≥8 and DWI volume ≤25 mL; MTT-DWI mismatch=visually assessed unthresholded MTT lesion ((MTT-DWI))/DWI) ≥20% and ≥10 mL larger than the DWI lesion; and significant infarct growth (>20% (≥5 mL) increase in infarct volume on follow-up). Uni-/multivariate analyses were performed to define the predictors of infarct growth.Results63 stroke patients with MCA-M1 occlusions and MRI within 10 h of onset were evaluated. 20 patients were excluded on the basis of DWI volume >25 mL leaving 43 patients (mean age 75.8 years; median NIHSS=13) in the study cohort. On univariate analysis, larger admission DWI volume (p<0.0001), baseline NIHSS score ≥8 (p=0.001), lack of IV and/or endovascular treatment (p=0.021), glucose levels >125 mg/dL (p=0.024), poor CT angiography collaterals (p=0.046), and lower admission Alberta Stroke Program Early CT score (ASPECTS) (p=0.049) predicted infarct growth. Baseline NIHSS score ≥8 was the only independent predictor of stroke growth in the multivariate analysis (p=0.001). All patients had MTT-DWI mismatch >20%. There was no significant association between the amount of MTT-DWI mismatch and infarct growth (p=0.33).ConclusionsCDM is the most powerful predictor of infarct growth in patients with MCA-M1 occlusion and small infarct core. Most of these patients will have a significant oligemic MTT lesion regardless of admission NIHSS score.
Thermodynamic products for Sen black hole
Authors: Pradhan Parthapratim 
Published: March 2016

AbstractWe investigate the properties of inner and outer horizon thermodynamics of Sen black hole (BH) both in Einstein frame (EF) and string frame (SF). We also compute area (or entropy) product, area (or entropy) sum of the said BH in EF as well as SF. In the EF, we observe that the area (or entropy) product is universal, whereas area (or entropy) sum is not universal. On the other hand, in the SF, area (or entropy) product and area (or entropy) sum don’t have any universal behaviour because they all are depends on Arnowitt–Deser–Misner (ADM) mass parameter. We also verify that the first law is satisfied at the Cauchy horizon as well as event horizon (EH). In addition, we also compute other thermodynamic products and sums in the EF as well as in the SF. We further compute the Smarr mass formula and Christodoulou’s irreducible mass formula for Sen BH. Moreover, we compute the area bound and entropy bound for both the horizons. The upper area bound for EH is actually the Penrose like inequality, which is the first geometric inequality in BHs. Furthermore, we compute the central charges of the left and right moving sectors of the dual CFT in Sen/CFT correspondence using thermodynamic relations. These thermodynamic relations on the multi-horizons give us further understanding the microscopic nature of BH entropy (both interior and exterior).
Targeting Suppressive Myeloid Cells Potentiates Checkpoint Inhibitors to Control Spontaneous Neuroblastoma
Authors: Mao Yumeng , Eissler Nina , Blanc Katarina Le , Johnsen John Inge , Kogner Per , Kiessling Rolf 
Published: March 2016

Abstract
Purpose: Neuroblastoma is the most common extracranial solid cancer type in childhood, and high-risk patients have poor prognosis despite aggressive multimodal treatment. Neuroblastoma-driven inflammation contributes to the induction of suppressive myeloid cells that hamper efficient antitumor immune responses. Therefore, we sought to enhance antitumor immunity by removing immunosuppression mediated by myeloid cells.
Experimental Design: The prognostic values of myeloid cells are demonstrated by analyzing genomic datasets of neuroblastoma patients. The impact of tumor-derived factors on myelopoiesis and local induction of suppressive myeloid cells is dissected by in vitro culture models using freshly isolated human CD34+ hematopoietic stem cells, primary human monocytes, and murine bone marrow cells. To test the therapeutic efficacy of BLZ945 as a monotherapy or in combination with checkpoint inhibitors, we used a transgenic murine model (TH-MYCN) that develops aggressive spontaneous neuroblastoma.
Results: We report that infiltrating CSF-1R+ myeloid cells predict poor clinical outcome in patients with neuroblastoma. In vitro, neuroblastoma-derived factors interfere with early development of myeloid cells and enable suppressive functions on human monocytes through M-CSF/CSF-1R interaction. In a transgenic mouse model (TH-MYCN) resembling high-risk human neuroblastoma, antagonizing CSF-1R with a selective inhibitor (BLZ945) modulates the induction of human and murine suppressive myeloid cells and efficiently limit tumor progression. While checkpoint inhibitors are insufficient in controlling tumor growth, combining BLZ945 with PD-1/PD-L1 blocking antibodies results in superior tumor control.
Conclusions: Our results demonstrate the essential role of CSF-1R signaling during the induction of suppressive myeloid cells and emphasize its clinical potential as an immunotherapy for human cancers. Clin Cancer Res; 22(15); 3849–59. ©2016 AACR.
Tumor Evolution Inferred by Patterns of microRNA Expression through the Course of Disease, Therapy, and Recurrence in Breast Cancer
Authors: Dadiani Maya , Bossel Ben-Moshe Noa , Paluch-Shimon Shani , Perry Gili , Balint Nora , Marin Irina , Pavlovski Anya , Morzaev Dana , Kahana-Edwin Smadar , Yosepovich Ady , Gal-Yam Einav Nili , Berger Raanan , Barshack Iris , Domany Eytan , Kaufman Bella 
Published: March 2016

Abstract
Purpose: Molecular evolution of tumors during progression, therapy, and metastasis is a major clinical challenge and the main reason for resistance to therapy. We hypothesized that microRNAs (miRNAs) that exhibit similar variation of expression through the course of disease in several patients have a significant function in the tumorigenic process.
Experimental design: Exploration of evolving disease by profiling 800 miRNA expression from serial samples of individual breast cancer patients at several time points: pretreatment, posttreatment, lymph nodes, and recurrence sites when available (58 unique samples from 19 patients). Using a dynamic approach for analysis, we identified expression modulation patterns and classified varying miRNAs into one of the eight possible temporal expression patterns.
Results: The various patterns were found to be associated with different tumorigenic pathways. The dominant pattern identified an miRNA set that significantly differentiated between disease stages, and its pattern in each patient was also associated with response to therapy. These miRNAs were related to tumor proliferation and to the cell-cycle pathway, and their mRNA targets showed anticorrelated expression. Interestingly, the level of these miRNAs was lowest in matched recurrent samples from distant metastasis, indicating a gradual increase in proliferative potential through the course of disease. Finally, the average expression level of these miRNAs in the pretreatment biopsy was significantly different comparing patients experiencing recurrence to recurrence-free patients.
Conclusions: Serial tumor sampling combined with analysis of temporal expression patterns enabled to pinpoint significant signatures characterizing breast cancer progression, associated with response to therapy and with risk of recurrence. Clin Cancer Res; 22(14); 3651–62. ©2016 AACR.
Cytotoxic Cutaneous Adverse Drug Reactions during Anti-PD-1 Therapy
Authors: Goldinger Simone M. , Stieger Pascale , Meier Barbara , Micaletto Sara , Contassot Emmanuel , French Lars E. , Dummer Reinhard 
Published: March 2016

Abstract
Purpose: Immunotherapy has experienced impressive progress in cancer treatment. Antibodies against PD-1 improved survival in different types of cancer including melanoma. They are generally well tolerated. However, skin toxicities including pruritus, rashes, and vitiligo are reported. Although frequent, they have not been characterized further yet. In this analysis, we aimed to systematically assess and characterize the adverse cutaneous reactions observed in patients with melanoma treated with anti-PD-1 antibodies.
Experimental Design: Patients with melanoma were treated with anti-PD-1 antibodies within clinical trials and an early-access program. Adverse cutaneous eruptions that emerged in our melanoma patient cohort were systematically investigated and classified using histology and gene expression profiling in comparison with maculopapular drug rash, cutaneous GVHD, and the severe drug eruption toxic epidermal necrolysis (TEN).
Results: Between February 2013 and September 2015, 68 patients with stage IV melanoma were treated at the University Hospital Zurich (Zurich, Switzerland); 15 patients (22%) developed cutaneous reactions and 10 (15%) vitiligo. The cutaneous reactions ranged from small erythematous papules with mild pruritus to disseminated erythematous maculopapular rashes (MPR) without signs of epidermal involvement to severe MPRs, including epidermal detachment and mucosal involvement. Although skin involvement varied from mild rash to bullous drug eruptions, gene expression profiling pathogenically classified all investigated cases as TEN-like reactions.
Conclusions: As predicted by the PD-1 knockout mouse, anti-PD-1 antibodies frequently cause adverse cutaneous reactions. Gene expression profiling reminds in all cases of a TEN-like pattern, suggesting that PD-1/PD-L1 interaction is required to preserve epidermal integrity during inflammatory skin reactions. Clin Cancer Res; 22(16); 4023–9. ©2016 AACR.