bluuebunny/crossref_metadata_2025_split huggingface dataset:
Actinic keratoses show variable histological basal growth patterns – a proposed classification adjustment
Authors: Schmitz L. , Gambichler T. , Gupta G. , Stücker M. , Stockfleth E. , Szeimies R.M. , Dirschka T. 
Published: August 2017

AbstractBackgroundCommon histological classification schemes of actinic keratoses (AK) do not evaluate growth patterns at basal epidermal aspects of AK. Until now, the importance of basal epidermal growth patterns of AK has not been studied.ObjectiveTo investigate the extent of atypical keratinocytes throughout the epidermis and variation in basal growth patterns of AK.MethodsAK lesions occurring on the head/face from patients seen in routine practice were assessed histologically. We determined histological grade (AK I‐III), basal growth patterns of atypical keratinocytes (crowding, budding and papillary sprouting) and accompanying parameters.ResultsOf the 246 lesions included, 28.0% were histologically classified as AK I, 46.7% as AK II and 25.2% as AK III. Approximately 26.4% of the basal growth patterns were classified as crowding (pro I), 49.6% as budding (pro II), 17.9% as papillary sprouting (pro III) and 6.1% without basal directed growth. No significant correlation of the histological AK I‐III grading and underlying growth patterns was observed (P = 0.4666). However, adnexal structure involvement (OR = 2.37; 95% CI 1.21–4.65), infiltration (OR = 2.53; 95% CI 1.31–4.90) and increased number of vessels (OR = 2.56; 95% CI 1.42–4.65) were independent positive predictive markers for pro II and pro III basal growth patterns.ConclusionsBasal growth patterns (pro I‐III) in AK do not correlate with the established AK I‐III histological grading system. Besides the degree of upward extension, varying degrees of downward extension exist. Histological classification should consider both, upwards and downward growth patterns when assessing AK.
Recommendations for the management of comorbidity in hidradenitis suppurativa
Authors: Dauden E. , Lazaro P. , Aguilar M.D. , Blasco A.J. , Suarez C. , Marin I. , Queiro R. , Bassas‐Vila J. , Martorell A. , García‐Campayo J. 
Published: August 2017

AbstractBackgroundThe association between hidradenitis suppurativa (HS) and some diseases is becoming relevant in recent years. Providing appropriate management of HS from an early stage requires to include prompt diagnosis and treatment of concomitant diseases and to prevent any potential comorbidity. This approach should consider the adverse events of the drugs used to treat HS potentially related to the onset of a comorbidity.ObjectiveTo provide the dermatologist with an accurate, easily used tool that will inform the diagnosis of HS comorbidity, and to facilitate decision‐making regarding the referral and treatment of patient with HS‐associated comorbidity.MethodsThese recommendations have been developed by a working group composed of seven experts (three dermatologists, a cardiovascular specialist internist, a rheumatologist expert in spondyloarthritis, a gastroenterologist and a psychiatrist) and a team of three methodologist researchers. The expert group selected the HS comorbidities considered in these recommendations through a literature review. The recommendations on diagnostic criteria are based on the relevant clinical practice guidelines for each of the comorbidities and on the recommendations of the experts. The information regarding the repercussion of HS medical treatments on associated comorbid diseases was obtained from the summary of product characteristics of each drug.ResultsThe comorbidities considered in this guide are as follows: cardiovascular risk factors (diabetes, dyslipidaemia, obesity, hypertension and metabolic syndrome), inflammatory bowel disease, inflammatory joint disorders and psychological disorders (anxiety and depression). In addition, the association between HS and the consumption of alcohol and tobacco is included. The tables and figures are a precise, easy‐to‐use tool to systematize the diagnosis of comorbidity in patients with HS and facilitate the decision‐making process regarding referral and treatment of patients with an associated disease.ConclusionThe application of these recommendations will facilitate the dermatologist practice and benefit HS patients’ health and quality of life.
Limited uptake of ulcerative colitis “treat‐to‐target” recommendations in real‐world practice
Authors: Bryant Robert V , Costello Samuel P , Schoeman Scott , Sathananthan Dharshan , Knight Emma , Lau Su‐Yin , Schoeman Mark N , Mountifield Reme , Tee Derrick , Travis Simon P L , Andrews Jane M 
Published: August 2017

AbstractBackground and AimsA “treat‐to‐target” approach has been proposed for ulcerative colitis (UC), with a target of combined clinical and endoscopic remission. The aim of the study was to evaluate the extent to which proposed targets are achieved in real‐world care, along with clinician perceptions and potential challenges.MethodsA multicentre, retrospective, cross‐sectional review of patients with UC attending outpatient services in South Australia was conducted. Clinical and objective assessment of disease activity (endoscopy, histology, and/or biomarkers) was recorded. A survey evaluated gastroenterologists' perceptions of treat to target in UC. Statistical analysis included logistic regression and Fisher's exact tests.ResultsOf 246 patients with UC, 61% were in clinical remission (normal bowel habit and no rectal bleeding), 35% in clinical and endoscopic remission (Mayo endoscopic sub‐score ≤ 1), and 16% in concordant clinical, endoscopic, and histological (Truelove and Richards' Index) remission. Rather than disease‐related factors (extent/activity), clinician‐related factors dominated outcome. Hospital location and the choice of therapy predicted combined clinical and endoscopic remission (OR 3.6, 95% CI 1.6–8.7, P < 0.001; OR 3.3, 95% CI 1.1–12.5, P = 0.04, respectively). Clinicians used C‐reactive protein more often than endoscopy as a biomarker for disease activity (75% vs 47%, P < 0.001). In the survey, 45/61 gastroenterologists responded, with significant disparity between clinician estimates of targets achieved in practice and real‐world data (P < 0.001 for clinical and endoscopic remission).ConclusionsMost patients with UC do not achieve composite clinical and endoscopic remission in “real‐world” practice. Clinician uptake of proposed treat‐to‐target guidelines is a challenge to their implementation.
Automated segmentation and quantification of actin stress fibres undergoing experimentally induced changes
Authors: ROGGE H. , ARTELT N. , ENDLICH N. , ENDLICH K. 
Published: August 2017

SummaryThe actin cytoskeleton is a main component of cells and it is crucially involved in many physiological processes, e.g. cell motility. Changes in the actin organization can be effected by diseases or vice versa. Due to the nonuniform pattern, it is difficult to quantify reasonable features of the actin cytoskeleton for a significantly high cell number. Here, we present an approach capable to fully segment and analyse the actin cytoskeleton of 2D fluorescence microscopic images with a special focus on stress fibres. The extracted feature data include length, width, orientation and intensity distributions of all traced stress fibres. Our approach combines morphological image processing techniques and a trace algorithm in an iterative manner, classifying the segmentation result with respect to the width of the stress fibres and in nonfibre‐like actin. This approach enables us to capture experimentally induced processes like the condensation or the collapse of the actin cytoskeleton. We successfully applied the algorithm to F‐actin images of cells that were treated with the actin polymerization inhibitor latrunculin A. Furthermore, we verified the robustness of our algorithm by a sensitivity analysis of the parameters, and we benchmarked our algorithm against established methods. In summary, we present a new approach to segment actin stress fibres over time to monitor condensation or collapse processes.
Climate Change Effects on Respiratory Health: Implications for Nursing
Authors: George Maureen , Bruzzese Jean‐Marie , Matura Lea Ann 
Published: August 2017

AbstractPurposeGreenhouse gases are driving climate change. This article explores the adverse health effects of climate change on a particularly vulnerable population: children and adults with respiratory conditions.ApproachThis review provides a general overview of the effects of increasing temperatures, extreme weather, desertification, and flooding on asthma, chronic obstructive lung disease, and respiratory infections. We offer suggestions for future research to better understand climate change hazards, policies to support prevention and mitigation efforts targeting climate change, and clinical actions to reduce individual risk.Findings and ConclusionsClimate change produces a number of changes to the natural and built environments that may potentially increase respiratory disease prevalence, morbidity, and mortality. Nurses might consider focusing their research efforts on reducing the effects of greenhouse gases and in directing policy to mitigate the harmful effects of climate change. Nurses can also continue to direct educational and clinical actions to reduce risks for all populations, but most importantly, for our most vulnerable groups.Clinical RelevanceWhile advancements have been made in understanding the impact of climate change on respiratory health, nurses can play an important role in reducing the deleterious effects of climate change. This will require a multipronged approach of research, policy, and clinical action.
Head‐to‐head comparison of prasugrel versus ticagrelor in patients undergoing percutaneous coronary intervention: A meta‐analysis of randomized controlled trials
Authors: Sakurai Ryota , Burazor Ivana , Bonneau Heidi N. , Kaneda Hideaki 
Published: August 2017

ObjectivesWe sought to compare the efficacy and safety of prasugrel and ticagrelor in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI).BackgroundEvidence from randomized head‐to‐head comparison between prasugrel and ticagrelor is rare regarding clinical endpoints.MethodsPubMed, the Cochrane Library, and Web of Science were queried with the terms “prasugrel,” “ticagrelor,” and “randomized.” Relevant randomized controlled trials (RCTs) or the same terms were also surveyed using clinicaltrials.gov, escardio.org, pcronline.org, and tctmd.com. The clinical endpoints were death, myocardial infarction (MI), stroke, and stent thrombosis (ST) for efficacy, and any bleeding for safety.ResultsA total number of 2068 patients in 12 RCTs, whose longest follow‐up period was 6 months, was included in this study. The risks of death (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.46‐1.62, P = 0.647), MI (OR: 1.61, 95%CI: 0.71‐3.62, P = 0.252), stroke (OR: 1.45, 95%CI: 0.25‐8.36, P = 0.680), and ST (OR: 0.76, 95%CI: 0.20‐2.81, P = 0.677) were similar between prasugrel and ticagrelor, respectively. While the incidence of bleeding according to the Bleeding Academic Research Consortium definitions was also comparable (OR: 0.83, 95%CI: 0.45‐1.52, P = 0.539), that according to the Thrombolysis in Myocardial Infarction criteria was lower in prasugrel than ticagrelor (OR: 0.49, 95%CI: 0.24‐0.97, P = 0.042).ConclusionsAlthough the efficacy was similar between prasugrel and ticagrelor, prasugrel may be associated with a lower risk of bleeding compared with ticagrelor during short‐ to mid‐term follow‐up period after PCI. Further studies are warranted in a larger patient population during longer‐term follow up to validate these findings.
Clinical phenotype of South–East Asian temporomandibular disorder patients with upper airway resistance syndrome
Authors: Tay D. K. L. , Pang K. P. 
Published: August 2017

SummaryClinical and radiographic characteristics of a subset of South East Asian temporomandibular disorder (TMD) patients with comorbid upper airway resistance syndrome (UARS) were documented in a multi‐center prospective series of 86 patients (26 men and 60 women / mean age 35.7 years). All had excessive daytime sleepiness, high arousal index and Apnoea‐Hypopnoea Index (AHI) <5. The mean body mass index was 20·1, mean arousal index 16·2, mean respiratory disturbance index 19·6, mean AHI 3·9 while the mean Epworth Sleepiness Scale was 14·8. Many had functional somatic complaints; 66·3% headaches, 41·9% neck aches, 53·5% masticatory muscle myalgia, 68·6% temporomandibular joint (TMJ) arthralgia while 90·7% reported sleep bruxism (SB). Unlike patients with obstructive sleep apnoea (OSA), hypertension was uncommon (4·7%) while depression was prevalent at 68·6% with short REM latency of <90 min and an increased REM composition >25% documented in 79·6% and 57·6% of these depressed patients, respectively. 65·1% displayed a posteriorly displaced condyle at maximum intercuspation with or without TMJ clicking. Most exhibited a forward head posture (FHP) characterised by loss of normal cervical lordosis (80·2%), C0–C1 narrowing (38·4%) or an elevated hyoid position (50%), and 91·9% had nasal congestion. We postulate the TMD‐UARS phenotype may have originally developed as an adaptive response to ‘awake’ disordered breathing during growth. Patients with persistent TMD and/or reporting SB should be screened for UARS and chronic nasal obstruction, especially when they also present with FHP. The lateral cephalogram is a useful tool in the differentiation of UARS from other OSA phenotypes.
Aquinas's Opposition to Killing the Innocent and its Distinctiveness within the Christian just War Tradition
Authors: Weiss Daniel H. 
Published: August 2017

AbstractThis essay argues that Aquinas's position regarding the killing of innocent people differs significantly from other representatives of the Christian just war tradition. While his predecessors, notably Augustine, as well as his successors, from Cajetan and Vitoria onward, affirm the legitimacy of causing the death of innocents in a just war in cases of necessity, Aquinas holds that causing the death of innocents in a foreseeable manner, whether intentionally or indirectly, is never justified. Even an otherwise legitimate act of just war cannot legitimate causing the death of innocent people, as this can never advance the common good. This stance also contrasts sharply with much modern and contemporary double effect theorizing in relation to jus in bello. In this regard, Aquinas's position, shaped decisively by his biblical and theological commitments, may point the way towards an ethical orientation beyond the typical divisions of “pacifism” and “just war.”
Relationship Between β‐cell Response and Insulin Sensitivity in Horses based on the Oral Sugar Test and the Euglycemic Hyperinsulinemic Clamp
Authors: Lindåse S. , Nostell K. , Söder J. , Bröjer J. 
Published: August 2017

BackgroundA hyperbolic relationship between β‐cell response and insulin sensitivity (IS) has been described in several species including rodents, dogs, and humans. This relationship has not been elucidated in the horse.Hypothesis/ObjectivesTo determine whether the hyperbolic relationship between β‐cell response and IS exists in horses by using indices of β‐cell response from the oral sugar test (OST) and IS measurements from the euglycemic hyperinsulinemic clamp (EHC). A second aim was to compare how well IS estimates from the OST and EHC correlate.AnimalsForty‐nine horses with different degrees of insulin regulation (normal‐to‐severe insulin dysregulation).MethodsCross‐sectional study. Horses were examined with an OST and an EHC.ResultsDecreased IS was associated with increased β‐cell response in the horses. Nine of 12 comparisons between indices of β‐cell response and IS measures fulfilled the criteria for a hyperbolic relationship. Indices of IS calculated from the OST correlated highly with the insulin‐dependent glucose disposal rate (M) and the insulin‐dependent glucose disposal rate per unit of insulin (M/I) determined from the EHC (r = 0.81–0.87).Conclusions and Clinical ImportanceA hyperbolic relationship between β‐cell response and IS exists in horses, which suggest that horses with insulin dysregulation respond not only with postprandial hyperinsulinemia but are also insulin resistant. The OST is primarily a test for β‐cell response rather than a test for IS, but calculated indices of IS from the OST may be useful to estimate IS in horses, especially when the horse is insulin resistant.
Handle with Care: Rethinking the Rights versus Culture Dichotomy in Cancer Disclosure in India
Authors: Van Hollen Cecilia Coale 
Published: August 2017

AbstractMedical practitioners, bioethicists, psychologists, and anthropologists have debated whether it is ethical to disclose or withhold information from patients about cancer diagnoses. This debate is framed as pitting universal individual human rights against cultural pluralism. The rights‐based argument asserts that people have a right to information about their own health to make the best decisions about their treatment. The cultural variation argument suggests that in some cultural contexts there is a perception that information about one's cancer diagnosis may cause more harm than good due to the psychological trauma this may cause. Based on ethnographic research with cancer patients in India, I argue that both sides of this debate overemphasize the importance of the content of the information that may be disclosed or withheld and underestimate the central ways in which the act of disclosing or withholding information is evaluated as a symbol of care of paramount concern to patients.
Subtle lower esophageal sphincter relaxation abnormalities in patients with unexplained esophageal dysphagia
Authors: Herregods T. V. K. , van Hoeij F. B. , Bredenoord A. J. , Smout A. J. P. M. 
Published: August 2017

AbstractBackgroundEsophageal dysphagia is a relatively common symptom. We aimed to evaluate whether subtle, presently not acknowledged forms of dysfunction of the lower esophageal sphincter (LES) could explain dysphagia in a subset of patients with normal findings at high‐resolution manometry (HRM) according to the Chicago classification v3.0.MethodsWe used HRM to compare LES relaxation characteristics in 97 patients with unexplained dysphagia with those in 44 healthy subjects. In addition, normative values for time to LES relaxation and completeness of LES relaxation were calculated. Patients with delayed or incomplete LES relaxation were compared with patients with normal relaxation.Key ResultsDysphagia patients had a higher nadir LES pressure (P=.001) and a longer time to LES relaxation (P=.012) than healthy subjects. Based on the findings in healthy subjects, normal values of LES relaxation were defined as: ≥50% of swallows with normal LES relaxation time (<5 seconds) and ≤20% of swallows with incomplete LES relaxation (not reaching a value below 10 mm Hg). Dysphagia patients had significantly more often >50% swallows with delayed and/or incomplete LES relaxation than healthy controls (25% vs 4.5%; P=.004). Dysphagia patients with >50% delayed and/or incomplete LES relaxation had a significantly higher LES resting pressure (P<.001) and a significantly higher intrabolus pressure (P<.001) than dysphagia patients who did not fulfill the criteria.Conclusions and InferencesSubtle LES relaxation abnormalities, such as a delayed relaxation of the LES and/or incomplete LES relaxation, could be a cause of dysphagia in approximately one quarter of the patients with otherwise unexplained esophageal dysphagia.
Cooperative considerations for a mobile resource that transcends property boundaries
Authors: Alrashidi Mohammed E. , Hearne John W. , McArthur Lynne , Zorzan Claudio 
Published: August 2017

AbstractThere are environmental advantages to the commercial harvesting of kangaroo over domestic stock. Kangaroo, however, are able to jump fences and move among properties with ease. Consequently, questions of ownership and the equitable distribution of profits arise. We model a cooperative where two neighboring ranches experience rainfall equally but asynchronously each year. A kangaroo population roams freely among the properties to graze. Through harvesting, the population can be regarded as constant. In a cooperative, the location at which harvesting occurs is irrelevant but significant differences in the consumption of resources will affect the profit sharing arrangements between the property owners. Results indicate that the resources consumed on each property with the same total primary production may differ depending on the timing of rainfall. On average, however, the population consumption on each property is independent of the intra‐annual differences in rainfall distribution and hence primary production.Recommendations for Resource Managers
The mobile nature of kangaroos should not be an impediment to their sustainable utilization for commercial purposes.
Spatial differences in the timing of the first rainfall in a season will affect the time a roving kangaroo population spends at each location. Hence in a cooperative these differences will affect the contribution of each ranch to the total secondary production of the cooperative.
Over the long term if there is no mean difference in the start of the rainfall season between two ranches then the annual fluctuations in this difference will not affect the contribution of each ranch to the cooperative enterprise.
For the purpose of distributing profits, a cooperative should focus attention on any differences in the longer‐term primary production of each property.
Clinical Outcome and Prognosis of Young Patients with Mycosis Fungoides
Authors: Virmani Pooja , Levin Laura , Myskowski Patricia L. , Flores Eileen , Marchetti Michael A. , Lucas Anna Skripnik , Pulitzer Melissa , Horwitz Steven , Trippett Tanya , Moskowitz Alison , Querfeld Christiane 
Published: August 2017

AbstractBackground/ObjectivesMycosis fungoides (MF) in young patients is rare and may have atypical presentations. There are limited data in these patients. The objective was to determine the clinical outcome and prognosis of young patients with MF.MethodsA search of our institutional cancer registry database was conducted for patients diagnosed with MF at younger than 30 years of age.ResultsOur study included 74 patients (median age at diagnosis 25.5 yrs). Sixty‐five (88%) presented with early stage disease and variants of MF (n = 44 [59%]), leading to a median delay in diagnosis of 2.5 years. Hypopigmented MF (n = 27 [36.5%]) was the most common variant, affecting predominantly African American (44.4% vs 19%; p = 0.02) and younger (20 vs 26 yrs; p < 0.001) patients. All patients with hypopigmented MF presented with early stage disease and were less likely to develop progressive disease (PD) than those with other variants (11% vs 34%; p = 0.03). Nineteen patients (26%) developed PD during a median follow‐up of 3.5 years, which was associated with advanced‐stage disease (89% vs 17%; p < 0.001), older age (>20 yrs) (31% vs 13%; p = 0.08), African American race (52.6% vs 20%; p = 0.009), and poikilodermatous presentation (p < 0.01). Overall survival was good (97.2% at 5 yrs, 95.9% at 10 yrs) despite the delay in diagnosis and atypical presentation.ConclusionsProgressive disease is associated with older age, African American race, the poikilodermatous variant, and advanced‐stage disease. The hypopigmented variant is a common presentation in young patients and has an indolent disease course. Our study confirms an overall favorable prognosis in young patients with MF.