bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of Combination Chemical Peel on Facial Photodamaged Skin
Authors: El Samahy May H. , Ghoz Mohamed M. , Ramzy Naglaa 
Published: July 2017

Introduction: Chemical peeling involves the topical application of a wounding agent with the goal of effecting an organized regeneration of the skin. The histologic and ultrastructural features of actinic and age-related damage include structural abnormalities that disrupt normal epidermal and dermal architecture. The purpose of the present study is to evaluate the clinical and histologic effects of an enhanced medium-depth peel on photodamaged skin. We aimed to correlate the clinical and histologic findings with the ultrastructural changes occurring after the peel. These ultrastructural features are supposed to be more precise and informative than the clinical or histological response. They may also be employed as markers of peel response. Materials and Methods: In the present study, five patients with actinically damaged skin underwent enhanced medium-depth peels using 70% glycolic acid and 35% trichloracetic acid. Biopsy specimens were taken before the peel and 3 months after the peel for histologic and electron microscopic examination. Results: Clinical resolution of actinic damage corresponded with restoration of epidermal polarity. Characteristic histologic and ultrastructural features of the skin after peeling include markedly decreased epidermal intracytoplasmic vacuoles, decreased elastic fibers, increased activated fibroblasts, and organized parallel arrays of collagen fibrils. The diameters of individual fibrils are consistent with recent production of collagen by activated fibroblasts. Conclusion: Glycolic acid—tricholoro-acetic acid (GA-TCA) is an effective combination for a medium-depth peel in photodamaged skin both clinically and histologically. Electron microscopic studies following medium-depth peels reveal changes more profound than those seen histologically. The characteristic changes occurring in the keratinocytes, collagen, and elastic fibrils may be considered as guidelines or markers of the peel response.
Height Prediction From Ulna Length of Critically Ill Patients
Authors: Tarnowski Micheli S. , Rabito Estela I. , Fernandes Daieni , Rosa Mariane , Oliveira Manoela L. , Hirakata Vânia N. , Marcadenti Aline 
Published: July 2017

AbstractBackground: Ulna length (UL) has been used in mathematical formulas to predict the body height of healthy and sick individuals. However, the evaluation of its use with patients admitted to intensive care units (ICU) is scarce. The objective of this study was to develop a mathematical equation to estimate critically ill patients’ height using the UL measure and to evaluate its agreement with measured standing height. Methods: This cross‐sectional study was performed at the ICU of a tertiary hospital in Brazil. A total of 100 patients aged ≥18 years who had their body height measured before ICU admission were enrolled. The equation was developed through multiple linear regression, and its agreement was assessed through paired Student’s t test and Bland‐Altman plot. Results: The following formula was obtained: height in cm = 153.492 – (7.97 × sex [sex: male = 1, female = 2]) + (0.974 × UL [in cm]). The difference between means of measured height (MH) and height estimated from UL was not significant (166.26 ± 8.75 cm and 166.30 ± 5.29 cm, respectively, P = .96), and a significant correlation (r = 0.624, P < .001) was detected. In the Bland‐Altman analysis, UL was in agreement with MH; however, there was a significant bias (P < .001) suggesting that it may be disproportional and dependent on the average’s height value. Conclusion: The mathematical equation for height estimation using UL developed in this study matched the MH of critically ill patients. However, we suggest more studies for its validation.
Microbiological and immunological profile of patients with severe lupus flares related to bloodstream infections: a retrospective cohort study
Authors: Torres-Ruiz J , Barrera-Vargas A , Ortiz-Hernández R , Alcocer-Varela J , Ponce-de-León A , Gómez-Martín D 
Published: July 2017

Background This study aimed to address whether bloodstream infections are a risk factor for the development of severe lupus flares, as well as clinical, immunological and microbiological features of patients with bloodstream infections that develop severe lupus flares. Methods We performed a retrospective cohort study comparing 87 systemic lupus erythematosus (SLE) patients with bloodstream infections and 87 hospitalized SLE patients without bloodstream infections as a comparison group. All patients were followed up for at least 3 months or until one of the primary outcomes was developed (severe SLE flare according to SELENA/SLEDAI score or death). Microbiological features of all bloodstream infections were recorded. The disease status at the end of follow up was registered. Results A total of 23 patients (13.2%) developed a severe flare during follow up; among them, 20 (87%) had an associated episode of bloodstream infection ( p < 0.001). The most frequent flares were renal (43.4%) and severe thrombocytopenia (26%). After multivariate analysis, baseline-independent factors associated with severe SLE flare were bloodstream infection [hazard ratio (HR) 7.3, 95% confidence interval (CI) 2.13–24.95; p = 0.002]. Among patients with bloodstream infections, low C4 levels (HR 2.43, 95% CI 1.04–5.69: p = 0.04) and Streptococcus pneumoniae were associated with severe SLE flare (HR 3.41, 95% CI 1.68–6.91; p = 0.012). Conclusions SLE patients with bloodstream infections, especially due to S. pneumoniae, and low C4 levels, are at higher risk for development of severe SLE flares.
Pregnancy outcomes among women with systemic lupus erythematosus: a retrospective cohort study from Thailand
Authors: Phansenee S , Sekararithi R , Jatavan P , Tongsong T 
Published: July 2017

Objective The objective of this paper is to compare adverse pregnancy outcomes between normal pregnancies and pregnancies with systemic lupus erythematosus (SLE), particularly focusing on uncomplicated SLE with remission. Methods A retrospective cohort study was conducted by accessing the Maternal-Fetal Medicine (MFM) Unit database and the full medical records of the women. The records of singleton pregnancies with SLE and no underlying disease were assigned as the study group and their medical records were reviewed. The low-risk pregnancies were randomly selected as the controls. The adverse pregnancy outcomes were compared between the control group vs women with SLE, control group vs uncomplicated SLE, and between the subgroups within the study group. Results Of 28,003 births during the study period, 1400 controls and 140 pregnancies with SLE were compared. The rates of fetal loss, preterm birth, small-for-date, low birth weight and preeclampsia were significantly higher in the study groups with a relative risk of 5.6 (95% CI: 2.9–10.9), 3.2 (95% CI: 2.5–4.1), 3.5 (95% CI: 2.4–4.9), 4.2 (95% CI: 3.4–5.3) and 2.9 (95% CI: 1.9–4.4), respectively. The increased rates of most adverse outcomes were still noted even in the cases of uncomplicated SLE. Among women with SLE, lupus nephritis, chronic hypertension, antiphospholipid syndrome, active disease at the onset of pregnancies, and proteinuria were significantly associated with such outcomes. Conclusions Pregnancies with SLE, even in uncomplicated cases with remission, increase the risk of poor pregnancy outcomes. The presence of lupus nephritis, chronic hypertension, antiphospholipid syndrome, active disease at the onset of pregnancies, and proteinuria were significantly associated with such outcomes.
Developing Entrepreneurial Intensity among Women Entrepreneurs of Jammu & Kashmir: Model Building through Confirmatory Factor Analysis
Authors: Siddiqui Saif , Jan Sumaira 
Published: July 2017

In developing nations like India, entrepreneurship can be a solution of many economy-related problems; to achieve this, high level of entrepreneurial intensity (EI) is to be ensured. EI measures the focus and commitment of an entrepreneur towards his/her venture. It can influence performance of firms, provide sustainable advantage to individuals, societies etc. The state of Jammu and Kashmir (J&K) is facing issues like low GDP and high unemployment. High level of EI, especially among women, can provide solution to many of its problems. So, the present endeavour assesses the level of intensity among the women entrepreneurs and then suggests some measures to enhance the same. The results of the study show that innovativeness, pro-activeness, risk-taking, competitive aggressiveness and autonomy, which are taken as the basic postulates of EI in study, show significant loading. Although women entrepreneurs tend to show pro-activeness and competitive aggressiveness strongly, it is innovativeness, risk-taking and autonomy are not good fit. This study proposes a model for training for the women entrepreneurs to improve their level of EI to accelerate the growth of entrepreneurship in the state. This will in turn enhance the overall economic growth of the state.
Zoophilia in an adolescent with high-functioning autism from Sri Lanka
Authors: Chandradasa Miyuru , Champika Layani 
Published: July 2017

Objective: Zoophilia is a rare paraphilic disorder with intense sexual urges involving animals. Autism is characterised by impairments in social communication and repetitive, restricted behaviours (RRB). Reported cases of zoophilia are limited worldwide, and zoophilia in autism is rarer. Method: This is a case report describing this unique and relatively unrecognised association in a male adolescent from Sri Lanka. Results: A 17-year-old boy diagnosed with autism has average intelligence and academic capabilities. He had spent increasing time at his grandparents’ cattle house. First, he was found masturbating near the cows and later having penetrative intercourse with a heifer. The shocked parents first sought traditional healing in the form of ‘thovil’, a demonic ritual of exorcist nature. Later, clinical evaluation found intense sexual urges towards cattle, which had led to marked distress and academic impairment. Sex hormone profile was normal. The adolescent was treated with a combination of cognitive–behaviour therapy and a selective serotonin reuptake inhibitor. Conclusion: We postulate that his persistent social difficulties contributed to the development of a paraphilic disorder. Unlike with his RRBs, he was markedly distressed about this sexual behaviour. Further research is required to explore this rarely reported, potential association.
Out, out, damned blind spot! The problem of anxiety with dynamic psychotherapy
Authors: Jeyasingam Neil Raveen 
Published: July 2017

Objectives: This article discusses Lady Macbeth’s famous sleepwalking scene from the Shakespearean tragedy, and how it became used as a template for the formulation of obsessive-compulsive disorder. Conclusions: Psychoanalysis maintained its role in understanding the condition, despite the lack of evidence base and the repeated finding from many therapists of a failure to control symptomatology. It is suggested that psychodynamic psychotherapy suffered from a failure to recognise what components of its practice were aesthetically attractive concepts rather than evidence-based medicine and outcome measures, and is an important issue in considering its future directions.
Noninvasive Assessment of Endothelium-Dependent Flow-Mediated Dilation of the Brachial Artery
Authors: Uehata Akimi , Lieberman Eric H , Gerhard Marie D , Anderson Todd J , Ganz Peter , Polak Joseph F , Creager Mark A , Yeung Alan C 
Published: July 2017

Coronary atherosclerosis is characterized by an early loss of endothelium-dependent vasodilation. However, the methods of assessing coronary endothelial function are invasive and difficult to repeat over time. Recently, a noninvasive ultrasound method has been widely used to measure flow-mediated dilation in the brachial artery as a surrogate test for endothelial function. We seek to further validate this method of measuring vascular function. The brachial artery diameters and blood flow of 20 normal volunteers (10 males and 10 females) were measured using high resolution (7.5 MHz) ultrasound and strain gauge plethysmography. Flow-mediated endothelium-dependent vasodilation was measured in the brachial artery during reactive hyperemia after 5 minutes of cuff occlusion in the upper arm. The brachial artery diameter increased maximally by 9.7 ± 4.3% from baseline at 1 min after cuff release and blood flow increased by 1002 ± 376%. Five min of cuff occlusion was sufficient to achieve 97 ± 6% of maximal brachial artery dilation and degree of dilation was not different whether the cuff was inflated proximally or distally to the image site. The intraobserver variability in measuring brachial diameters was 2.9 % and the variability of the hyperemic response was 1.4%. In young, healthy men and women, the baseline brachial artery diameter was the only factor that was predictive of the flow-mediated vasodilation response. The brachial noninvasive technique has been further validated by the determination of flow-mediated dilation. This method of assessing endothelial function may help to determine the importance of vasodilator dysfunction as a risk factor in the development of atherosclerosis.
Development of Vascular Complications in Diabetes
Authors: McMillan Donald E 
Published: July 2017

Chronic complications of diabetes are dominated by disorders of the vascular system. They are a much larger burden on both diabetic patients and overall medical costs than diabetes itself. Large vessel problems are far more frequent than microvascular disorders. Loss of arterial elasticity alters arterial flow patterns and increases microcirculatory peak flow rates. Hyperglycemia may directly disrupt elastin formation. Diabetic leg artery disease may be generated by nerve damage, reversing this interactive contribution sequence. The major anatomic feature of microangiopathy in long-term diabetes is an unevenly distributed thickening of the intima of smaller arterioles. The thickening is primarily due to accumulation of type IV (basement membrane) collagen. Arterioles change local vessel diameter to adjust blood distribution to meet current needs. The thickening compromises the maximum local blood flow that may be achieved by this means. Compromise of maximal arteriolar dilatation does not disrupt exercising muscle but in the kidney, retina, and possibly in nerve, local circumstances can generate serious damage. Each of these system's responses has unique features that mediate its vulnerability, but all these organs show arteriolar hyalinization. The increased arteriolar accumulation of type IV collagen appears to be a response to the tangential force generated by flow over local endothelial cells. An increase in peak arteriolar wall force is mediated by a diabetes-specific doubling of erythrocyte membrane curvature change resistance. Red cell aggregation rate determines the rate of damage. The same nonspecific burden may also predispose to heart disease and stroke. Intensive metabolic control improves red cell deformability and protects against arteriolar damage. Therapies that address the rheologic problem more directly may add to the effectiveness of good diabetes control in the future.
Factors influencing trends in trauma-associated orbital cavity reconstruction procedures and time delay: New Zealand national data 2000–2014
Authors: Samaranayaka Chamil , Samaranayaka Ari , Barson Dave , De Silva RK 
Published: July 2017

Aim Surgical reconstructions of orbital fractures due to trauma are increasing worldwide. This study identifies characteristics of patients facing such procedures, possible causes for increasing trends, and factors associated with the duration from trauma to surgical procedures. Methods Trauma-related orbital reconstruction procedures in New Zealand over a 15-year period were identified from Ministry of Health hospital discharge data. Age-standardised rates for each year and age-specific rates for each gender were calculated using age, sex and year-specific population data from New Zealand population censuses. The contribution of these procedures to total trauma-related maxillofacial procedures was assessed. Descriptive statistics were used to identify demographic, trauma-related, and procedure-related characteristics associated with higher frequency and increasing trends. Characteristics independently associated with time delay from trauma to surgery were identified by multivariable Cox regression modelling. Results Orbital procedures are most common among males and the young to middle aged, and trends in frequency and rates of procedures are sharply increasing outnumbering other types of trauma-related maxillofacial procedures, with interpersonal violence being a major contributor to this increase. Younger age and higher number of injuries are associated with less time delay from injury to procedure while Asian ethnicity, motor vehicle accidents, non-maxillofacial primary diagnoses, and higher number of medical comorbidities are associated with longer delay. Conclusion The first three findings are consistent with international literature, and could be considered by policy makers when deriving preventive measures. The findings related to time delay are new and could contribute information towards forming clinical guidelines if similar patterns were identified elsewhere.
Regulation of Human Immune Gene Expression as Influenced by a Commercial Blended Echinacea Product: Preliminary Studies
Authors: Randolph R.K. , Gellenbeck K. , Stonebrook K. , Brovelli E. , Qian Y. , Bankaitis-Davis D. , Cheronis J. 
Published: July 2017

Consumption of Echinacea at the first sign of symptoms has been clinically shown to reduce both the severity and duration of cold and flu. Quantitative polymerase chain reaction optimized for precision and reproducibility was utilized to explore in vitro and in vivo changes in the expression of immunomodulatory genes in response to Echinacea. In vitro exposure of THP-1 cells to 250 μg/ml of Echinacea species extracts induced expression (up to 10-fold) of the interleukin-1α, interleukin-1β, tumor necrosis factor-α, intracellular adhesion molecule, interleukin-8, and interleukin-10 genes. This preliminary result is consistent with a general immune response and activation of the nonspecific immune response cytokines. In vivo gene expression within peripheral leukocytes was evaluated in six healthy nonsmoking subjects (18–65 years of age). Blood samples were obtained at baseline and on Days 2, 3, 5, and 12 after consuming a commercial blended Echinacea product, three tablets three times daily (1518 mg/day) for two days plus one additional dose (506 mg) on day three. Serum chemistry and hematological values were not different from baseline, suggesting that liver or bone marrow responses were not involved in acute responses to Echinacea. The overall gene expression pattern at 48 hr to 12 days after taking Echinacea was consistent with an antiinflammatory response. The expression of interleukin-1β, tumor necrosis factor-α, intracellular adhesion molecule, and interleukin–8 was modestly decreased up through Day 5, returning to baseline by day 12. The expression of interferon-α steadily rose through Day 12, consistent with an antiviral response. These preliminary data present a gene expression response pattern that is consistent with Echinacea's reported ability to reduce both the duration and intensity of cold and flu symptoms.
Effect of Nitric Oxide Synthase Inhibition on Proteinuria in Glomerular Immune Injury
Authors: Datta Prasun K. , Sharma Mukut , Duann Pu , Lianos Elias A. 
Published: July 2017

In glomerular immune injury, the inducible isoform of nitric oxide synthase (iNOS) becomes a major catalyst of NO production. Although iNOS-catalyzed NO production is sustained and can be cytotoxic, iNOS inhibition exacerbates the magnitude of proteinuria that accompanies immune injury. To investigate putative mechanisms of this effect, we assessed changes in glomerular permeability to albumin by using the following two approaches: (i) an in vivo rat model of glomerular immune injury induced by antibody against the glomerular basement membrane (GBM), in which urine albumin excretion was measured under conditions of iNOS Inhibition, and (ii) an ex vivo model of isolated rat glomeruli, in which changes in glomerular capillary permeability to albumin were assessed under conditions of NOS inhibition. In rats with anti-GBM antibody–induced glomerular injury, there was an increase in urine albumin excretion. Treatment with two structurally dissimilar iNOS inhibitors at doses sufficient to decrease urine nitrate and/or nitrite exacerbated proteinuria. In these animals, urine excretion of the isoprostane 8-iso-PGF2α (marker of oxidative stress) was increased. In isolated glomeruli incubated with the NOS inhibitor L-NMMA, the permeability to albumin increased. This effect was reversed by the NO donor DETA NONOate and by the superoxide dismutase mimetic Tempol. We conclude that NOS-catalyzed NO production is an important mechanism in regulating glomerular permeability to protein. This mechanism involves control of the bioavailability of superoxide.
How to define the hemodynamic significance of an equivocal iliofemoral artery stenosis: Review of literature and outcomes of an international questionnaire
Authors: de Boer SW , Heinen SGH , van den Heuvel DAF , van de Vosse FN , de Vries JPPM 
Published: July 2017

Purpose The goal of the study was to review current literature regarding the diagnosis of equivocal (50–70%) iliofemoral artery stenosis and compare these findings with the daily practice of an international panel of endovascular experts. Methods The Medline Database was searched for relevant publications, and an electronic survey was sent to experts in the field covering the following topics: definition of an equivocal iliofemoral artery stenosis, angiographic visualization and investigation protocols of an equivocal stenosis, intra-arterial pressure measurements, and definition of hemodynamic significance of an equivocal iliofemoral artery stenosis using a physiologic measure. Results Of the 37 invited endovascular experts, 21 (53.8%) agreed to participate in the survey. Analysis of existing literature shows that the level of evidence for diagnosing equivocal iliofemoral artery stenosis is mediocre and is not being implemented by experts in the field. Conclusion Studies have shown that a stenosis of between 50% and 70% iliofemoral lumen diameter reduction shows a wide range of trans-stenotic pressure gradients. Equivocal iliofemoral artery stenosis can best be identified using three-dimensional quantitative vascular analysis software. Although evidence for a clear hemodynamic cutoff point is weak, performing trans-lesion intra-arterial pressure measurements at rest and during maximal hyperemia is preferred. Diagnosing iliofemoral artery stenosis solely on lumen diameter reduction is inadequate.