bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protective effects of miR-29a on diabetic glomerular dysfunction by modulation of DKK1/Wnt/β-catenin signaling
Authors: Hsu Yung-Chien , Chang Pey-Jium , Ho Cheng , Huang Yu-Ting , Shih Ya-Hsueh , Wang Ching-Jen , Lin Chun-Liang 
Published: July 2016

AbstractDysregulation of specific microRNAs or Wnt/β-catenin signaling pathway is critically implicated in the pathogenesis of various renal diseases. However, the relationship between microRNAs and Wnt/β-catenin signaling in diabetes-induced glomerular sclerosis remains unknown. Here, we found that decreased miR-29a expression and attenuated Wnt/β-catenin signaling were concomitantly detected in glomeruli of streptozotocin-induced diabetic mice. Gain of miR-29a function in diabetic mice substantially increased the expression of β-catenin and blocked the expressions of profibrotic gene markers, including DKK1 (a Wnt antagonist), TGF-β1 and fibronectin, in glomerular mesangium. Moreover, in the normal mice treated with miR-29a inhibitor, renal fibrosis was induced with an attenuated Wnt/β-catenin signaling activity. Consistently, the constructed miR-29a transgenic mice that supported sustained Wnt/β-catenin signaling had the ability to block the expressions of profibrotic genes after induction of diabetes. We also demonstrated that miR-29a acts as a positive regulator of Wnt/β-catenin signaling in cultured mesangial cells and functions to protect cell apoptosis and fibrosis. Importantly, we showed that activation of Wnt/β-catenin signaling in cultured mesangial cells by transfecting the β-catenin (Δ45) mutant or by a GSK-3β inhibitor reversely upregulated miR29a. Our findings suggest that the reciprocal relationship between miR-29a and DKK1/Wnt/β-catenin signaling may play an important part in protecting renal fibrogenesis.
Verbal and Extraverbal Components of Language as Related to Lateralized Brain Damage
Authors: Bonkowski Robert J. 
Published: July 2016

Twelve patients with left cerebral hemisphere lesions and 12 with right hemisphere lesions chose, from among four alternatives, the word that was identical in spelling to a sample word (verbal or extraverbal components sufficient to perform task at this level), and chose a synonym of the sample word from among four alternatives (verbal component necessary). The words were presented in unimodal and cross-modal conditions. In the unimodal conditions sample words and alternatives were presented in the same modality (aural or visual); in the cross-modal conditions the sample word was presented in one modality (A or V) and the alternatives in the opposite modality (V or A). The subject responded by pushing a button when he perceived the correct choice.
Patients with right-sided lesions had significantly greater response times, and more errors, than patients with left-sided lesions on those items in which the extraverbal component was crucial to successful performance. The converse was true on those items that called for greater facility with the verbal component of language. There were no significant differences between unimodal and cross-modal tasks.
The Effect of Methylphenidate on the Verbal Productivity of Children with Cerebral Dysfunction
Authors: Creager Ray O. , VanRiper Catharine 
Published: July 2016

Subjects were 30 children ranging from 8 to 10 years. They were studied to investigate the effect of methylphenidate on the verbal productivity of children of normal intelligence and a diagnosed condition of cerebral dysfunction. Three communicative samples were obtained from each child: one at the initiation of the study, one after administration of methylphenidate, and one following placebo condition. Sequence of drug and placebo medication was randomized.
Measures of speech as reflected in mean length of response, one word responses, five longest responses, and number of simple sentences without phrase showed no significant differences. Total number of words spoken, number of responses, and number of incomplete utterances showed significant increase under methylphenidate medication.
Bring in the Professionals
Authors: Clarke Daniel J. , Dercon Stefan 
Published: July 2016

Abstract
Good planning is based on an iterative dialogue among scientists, bureaucrats, implementers, and financiers about what or who is to be protected, how, and how much it will cost. A good plan will include a clear political statement before a disaster about these aspects of the plan. Useful political statements focus on target outcomes and leave the details on the ‘how’ to be worked out by the implementing agencies and financiers. Benefactors who want to maximize the development impact of their support should think through different natural disaster scenarios, assess what support they would provide in each scenario, and own up to this contingent liability when in discussions with other partners. Behavioural biases against good planning are strongest for the kinds of disasters that did not occur in the recent past—that is, for nearly all future disasters.
Invasive Aspergillus Sinusitis in Human Immunodeficiency Virus Infection: Case Report and Review of the Literature
Authors: Humphrey John M. , Walsh Thomas J. , Gulick Roy M. 
Published: July 2016

Abstract
Invasive Aspergillus (IA) sinusitis is a life-threatening opportunistic infection in immunocompromised individuals, but it is uncommon in human immunodeficiency virus (HIV) infection. To gain a better understanding of the characteristics of IA sinusitis in this population, we present a unique case of chronic IA sinusitis in an HIV-infected patient taking antiretroviral therapy and review the literature summarizing published cases of invasive aspergillosis of the paranasal (n = 41) and mastoid (n = 17) sinuses in HIV-infected individuals. Among these cases, only 4 were reported after 1999, and 98% of patients had acquired immune deficiency syndrome. Orbital invasion occurred in 54% of paranasal sinus cases, whereas intracranial invasion was reported in 53% of mastoid sinus cases. The overall mortality was 79%. We also discuss various clinical and immunologic factors that may play a role in the development of IA and consider the changing epidemiology of aspergillosis in the era of effective antiretroviral therapy.
Scombroid syndrome: it seems to be fish allergy but... it isn’t
Authors: Ridolo Erminia , Martignago Irene , Senna Gianenrico , Ricci Giorgio 
Published: July 2016

Purpose of review
Scombroid poisoning is a frequent cause of admission in emergency department. In everyday clinical practice, it can be difficult to discriminate between scombroid syndrome and fish allergy. The aim of this review is to provide the clinician some instruments to make a correct differential diagnosis.

Recent findings
In the last few years, a better characterization of scombroid syndrome occurred, in particular regarding its possible severe presentations. Two cases of Kounis syndrome secondary to scombroid syndrome have been described and in these cases a differential diagnosis in patients with this clinical presentation can be even more difficult. Finally, in term of diagnosis, the useful role of serum tryptase was recently consolidated.

Summary
Scombroid syndrome is a histamine-induced reaction because of the ingestion of histamine-contaminated fish, whereas fish allergy is an IgE-mediated reaction. Clinical presentation can be similar and for this reason scombroid syndrome is often misdiagnosed. The differences lie in pathogenic mechanisms, possible outcome, therapy, and prevention measures. Moreover, some laboratory tests are helpful to discriminate between the two diseases.
Assessment for Systems Learning: A Holistic Assessment Framework to Support Decision Making Across the Medical Education Continuum
Authors: Bowe Constance M. , Armstrong Elizabeth 
Published: July 2016

Viewing health care from a systems perspective—that is, “a collection of different things which, working together, produce a result not achievable by the things alone”—raises awareness of the complex interrelationships involved in meeting society’s goals for accessible, cost-effective, high-quality health care. This perspective also emphasizes the far-reaching consequences of changes in one sector of a system on other components’ performance. Medical education promotes this holistic view of health care in its curricula and competency requirements for graduation at the undergraduate and graduate training levels. But how completely does medical education apply a systems lens to itself?
The continuum of medical training has undergone a series of changes that have moved it more closely to a systems organizational model. Competency assessment criteria have been expanded and more explicitly defined for learners at all levels of training. Outcomes data, in multiple domains, are monitored by external reviewers for program accreditation. However, translating increasing amounts of individual outcomes into actionable intelligence for decision making poses a formidable information management challenge.
Assessment in systems is designed to impart a “big picture” of overall system performance through the synthesis, analysis, and interpretation of outcomes data to provide actionable information for continuous systems improvement, innovation, and long-term planning. A systems-based framework is presented for use across the medical education continuum to facilitate timely improvements in individual curriculum components, continuous improvement in overall program performance, and program decision making on changes required to better address society’s health care needs.
A Validated Fluorometric Method for the Rapid Determination of Pregabalin in Human Plasma Applied to Patients With Pain
Authors: Yoshikawa Nozomi , Naito Takafumi , Yagi Tatsuya , Kawakami Junichi 
Published: July 2016

Background:
Pregabalin has been used for the treatment of pain. A clinically accepted method applied to patients with pain has not been published for the determination of pregabalin in human plasma. This study developed a fluorometric ultrahigh-performance liquid chromatography (UHPLC) method to measure pregabalin concentration in patients with pain.

Methods:
After plasma pretreatment involving protein precipitation, pregabalin and gabapentin as an internal standard were derivatized with 4-fluoro-7-nitrobenzofurazan (NBD-F) under the following reaction conditions: 1 minute, pH 10, and 60°C. The UHPLC separation was performed using a 2.3-μm particle size octadecylsilyl column. The fluorescence detector was set at excitation and emission wavelengths of 470 and 530 nm, respectively. The predose blood samples were collected from 40 patients with pain who have been treated with 75 mg of pregabalin twice daily.

Results:
The chromatographic run time was 1.25 minutes. No interfering peaks were observed in the blank plasma at the retention times of NBD derivatives. The calibration curve of pregabalin was linear at a range of 0.05–10 mcg/mL (r > 0.999). The lower limit of quantification was 0.05 mcg/mL. The intra-assay accuracy and precision were 98.3%–99.8% and within 4.3%, respectively. The inter-assay accuracy and precision were 103.2%–107.1% and within 4.1%, respectively. The predose plasma concentration of pregabalin in patients with pain ranged from 0.14 to 8.5 mcg/mL.

Conclusions:
This study provides a validated fluorometric UHPLC method with fast analytical performance for the determination of pregabalin in human plasma. The present method could be applied to patients with pain and be used for the clinical research or therapeutic drug monitoring of pregabalin.
Lack of Left Ventricular Ejection Fraction Measurement Following a High B-type Natriuretic Peptide Value
Authors: Heidenreich Paul A. , Gholami Parisa , Lin Shoutzu 
Published: July 2016

Background:
The objective of this study was to determine how often providers did not obtain a recommended measure of left ventricular ejection fraction (LVEF) following a high B-type natriuretic peptide (BNP) value when the LVEF was not known to be low (<40%). Such patients may benefit from life-prolonging treatment.

Methods:
We identified consecutive patients (inpatient or outpatient) with a BNP value of at least 200 pg/mL within a single VA health care system (3 inpatient facilities and 8 community clinics) during a 10-month period (September 2008–June 2009). We performed chart review to determine results of any imaging study performed (inside or outside the health system) prior to or after the high BNP value.

Results:
Of the 296 patients with a high BNP, 212 were not known to have a low LVEF. Of these, 99 (47%) did not have the guideline recommended follow-up LVEF study. Among those that survived at least 6 months following BNP and a follow-up echocardiogram was indicated (no prior LVEF or prior LVEF was > 40%), mortality was 20% if an echocardiogram was performed within 6 months of the BNP and 27% if it was not performed within 6 months of BNP testing (P = 0.21).

Conclusion:
Approximately half of patients with a high BNP and an LVEF not known to be low did not have a follow-up guideline recommended LVEF study and may have unrecognized heart failure. Our findings suggest that a trial is warranted of a clinical pathway where those patients with a high BNP and without appropriate follow-up are randomized to have their physician receive a notification of the high BNP value.
Diagnostic Yield of Routine Stress Testing in Low and Intermediate Risk Chest Pain Patients Under 40 Years: A Systematic Review
Authors: Skoien Wade 
Published: July 2016

Objective:
Chest pain is one of the most frequent causes for presentation to emergency departments (EDs). The majority of patients will undergo diagnostic workup including stress testing to rule out an acute coronary syndrome, but very few patients will be diagnosed with a cardiac cause for their pain. Patients under 40 years represent a lower risk group in which routine stress testing may be of little benefit. This systematic review sought to determine the diagnostic yield of routine stress testing in low- and intermediate-risk chest pain patients under 40 years.

Methods:
Electronic databases were searched for relevant studies. The quality of the included primary studies was assessed using the National Health and Medical Research Council evidence hierarchy and the McMaster Critical Appraisal Tool for Quantitative Studies. Descriptive statistics summarized the findings.

Results:
Five primary studies were included in the review (all level III-3 evidence); 7 additional sources of relevant data were also included. Diagnostic yield of routine stress testing in low- and intermediate-risk patients under 40 years is reported between 0% and 1.1%. Combined data from included primary studies demonstrated just 4 out of 1683 true positive stress tests (0.24%), only one of which was definitively confirmed by coronary angiogram; additional data sources identified just 1 out of 310 true positive stress tests (0.32%).

Conclusions:
Diagnostic yield of routine stress testing in low- and intermediate-risk chest pain patients under 40 years is low. However, better quality studies are required to be able to draw definitive conclusions.
Agreement Between Patient-reported and Cardiology-adjudicated Medical History in Patients With Possible Ischemic Chest Pain: An Observational Study
Authors: Iliceto Alessandro , Berndt Sara Louise , Greenslade Jaimi H. , Parsonage William A. , Hammett Christopher , Than Martin , Hawkins Tracey , Parker Kate , O’Kane Shannen , Cullen Louise 
Published: July 2016

Objective:
Obtaining an accurate medical history is essential in the assessment of patients, particularly in emergency department (ED) patients with acute chest pain, as there can be a time imperative for diagnosis and commencement of treatment. We aimed to evaluate reliability of patient-reported compared with physician-adjudicated medical history by assessing patient’s recall and communication of personal events and its influence on the accuracy of the medical history.

Methods:
A total of 776 patients presenting at ED with suspected cardiac chest pain were recruited. Data collection included self-reported patient history, electrocardiogram testing, and troponin I measurements. Independent assessment of risk factors and medical history was adjudicated by cardiologists. Diagnosis of acute coronary syndrome (ACS) at 30 days after presentation was assessed. Cohen’s kappa measured patient–cardiologist agreement. Cardiologist adjudicated events were taken as true to assess accuracy.

Results:
A total of 83 participants (10.7%) were diagnosed with ACS at 30 days after presentation. “Previous coronary artery bypass grafting” showed highest agreement (K = 1.00) between patient-reported and cardiologist-adjudicated events. Lowest agreement between patient-reported and cardiologist-adjudicated events was found for “prior ventricular dysrhythmia” (K = 0.33). Accuracy of reported “prior congestive heart failure” differed significantly between patients with and without diagnosed ACS at 30 days (92.8% and 97.5%, respectively).

Conclusions:
Accuracy of patient’s recall and communication of medical history and risk factors was substantial but not perfect in the assessment of patients with ACS in the ED context. Our study reinforces the importance in the utilization of medical records and collateral information to address possible discrepancies in the medical history and improve patient care.
Gender Discrepancy in Diabetic Patients Hospitalized With Heart Failure
Authors: Mohammed Shaban , El-Menyar Ayman , Rafie Ihsan M. , AlBinAli Hajar A. , Singh Rajvir , Al Suwaidi Jassim 
Published: July 2016

Background:
Gender discrepancy in the cardiovascular diseases has been evaluated in several studies. We studied the impact of gender disparity on the presentation and outcome of diabetic heart failure (DHF) patients.

Methods:
A retrospective analysis was conducted including all DHF patients admitted to the Heart Hospital between 1991 and 2013. Patients’ demographics, presentation, management, and hospital outcomes were analyzed and compared based on gender and age.

Results:
Out of 8266 HF patients, 4684 (56.7%) were diabetic, of whom 1817 (39%) were females. Mean age was comparable in both genders. DHF female patients were more likely to be hypertensive (79% vs. 65%, P = 0.001) and obese (13% vs. 4.6%, P = 0.001). DHF females were less likely to receive beta-blockers and angiotensin-converting-enzyme inhibitors/angiotensinogen-receptor blockers (25% vs. 30%, P = 0.001, 54% vs. 57%, P = 0.01, respectively), but were more likely to be on insulin therapy (21% vs. 16%, P = 0.001). In-hospital atrial fibrillation (P =0.90), ventricular tachycardia (P = 0.07), stroke (P = 0.45), and cardiac arrest (P = 0.26) were comparable. Overall in-hospital mortality was comparable in both genders (P = 0.83). In age ≤50 years, male gender was associated with a 3-fold increase in death (13% vs. 4%, P = 0.01), however, this mortality difference disappeared in DHF patients aged >50 years (P = 0.62).

Conclusions:
In DHF, female gender is characterized by having a high prevalence of metabolic syndrome components. Also, females are more likely to have better Left ventricular ejection fraction but less likely to receive cardiovascular evidence based medications. There is no significant difference in the overall hospital mortality between both genders, however, in the younger age; males have a significantly higher mortality.
The Infant Aphakia Treatment Study Contact Lens Experience to Age 5 Years
Authors: Russell Buddy , DuBois Lindreth , Lynn Michael , Ward Michael A. , Lambert Scott R. ,   for The Infant Aphakia Treatment Study Group
Published: July 2016

Purpose:
To describe our experience treating a cohort of unilateral aphakic infants with contact lenses in the Infant Aphakia Treatment Study (IATS).

Materials and methods:
Fifty-seven of the 114 infants in the IATS were randomized to contact lens wear; all were followed until age 5 years, although a few had lapses in care. An examination under anesthesia, including keratometry, was performed at the time of enrollment and at approximately 1 year of age; keratometry was performed again at 5 years of age. A traveling examiner assessed visual acuity at approximately 1 year of age and again at 4.5 years of age.

Results:
Twenty-four treated eyes (46%) wore silicone elastomer (SE) contact lenses, 11 eyes (19%) rigid gas permeable (GP) contact lenses and 17 eyes (29%) wore both lens types at various points of time. Median logMAR visual acuity was +0.70 (interquartile range (IQR), +0.30 to 1.20) in the SE group and 2.03 (IQR, +0.20 to 2.28) in the GP group at age 4.5 years. The mean (±SD) keratometric power of the treated eyes was 46.3±2.8 diopter (D) at baseline, 44.6±2.3 D at 1 year of age, and 44.3±1.7 D at 5 years of age. Keratometric astigmatism of treated eyes was 1.98±1.37 D at baseline, 1.62±0.98 D at 1 year of age, and 2.00±1.00 D at 5 years of age. Thirteen contact lens-related adverse events occurred among 7 patients after age 1 year.

Conclusions:
A cohort of infants with unilateral aphakia successfully wore contact lenses with relatively few adverse events.
Serratia liquefaciens Causing Severe Ocular Damage in Noncontact Lens Wearer
Authors: Ranganatha Akshatha , Rana Mrinal , Murray Aidan 
Published: July 2016

Abstract:

Serratia liquefaciens is a rarely encountered gram-negative organism in ophthalmology practice. The only reported ocular infections are from contamination of contact lenses. The authors report the first case of a patient who developed orbital cellulitis secondary to severe S. liquefaciens microbial keratitis.
Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Treatment for Complications After LASIK
Authors: Mian Sophia Z. , Agranat Joshua S. , Jacobs Deborah S. 
Published: July 2016

Objectives:
To report experience with Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment for complications after laser in situ keratomileuisis (LASIK).

Methods:
Retrospective review of clinical and manufacturing records. A database of patients who underwent PROSE treatment from 1992 to 2007 was searched to yield all patients with history of LASIK. Primary indication for PROSE treatment and year of LASIK is reported as well as history of contact lens intolerance and pretreatment and posttreatment best-corrected visual acuity (BCVA).

Results:
From 1992 to 2007, 44 patients (75 eyes) with history of LASIK underwent PROSE treatment. Patients with corneal ectasia (n=23, 52%) comprise the largest group of patients, followed by those with other optical aberrations (n = 14.32%), dry eye (n = 4.9%), and corneal neuralgia (n=3.7%). Thirteen patients (30%) had more than one indication for PROSE treatment. The majority (71%) of patients referred for PROSE treatment had LASIK between 1998 and 2000, including every patient with aberrations as primary indication. Eighty-six percent of all patients had history of contact lens intolerance. Eighty-four percent of eyes showed improvement in BCVA after PROSE treatment, mean −0.3LogMAR, (P < 0.0001, 2-tailed paired t test, n = 75).

Conclusions:
PROSE treatment is an effective option for management of ectasia, cornea first surface aberrations, dry eye, and corneal neuralgia after LASIK, even in patients who are contact lens intolerant.