bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Physician Knowledge, Attitudes, and Behavior Regarding ACEP's Choosing Wisely Recommendations: A Survey Study
Authors: Lin Michelle P. , Nguyen Thomas , Probst Marc A. , Richardson Lynne D. , Schuur Jeremiah D. 
Published: February 2017

AbstractObjectiveIn 2013, the American College of Emergency Physicians joined the Choosing Wisely campaign; however, its impact on emergency physician behavior is unknown. We assessed knowledge, attitudes, and self‐reported behaviors regarding the Choosing Wisely recommendations.MethodsWe performed a cross‐sectional survey of emergency physicians at a national meeting. We approached 819 physicians; 765 (93.4%) completed the survey.ResultsAs a result of the Choosing Wisely campaign, most respondents (64.5%) felt more comfortable discussing low‐value services with patients, 54.5% reported reducing utilization, and 52.5% were aware of local efforts to promote the campaign. A majority (62.97%) of respondents were able to identify at least four of five recommendations. The most prevalent low‐value practices were computed tomography (CT) brain for minor head injury (29.9%) and antibiotics for acute sinusitis (26.9%). Few respondents reported performing lumbar radiograph for nontraumatic low back pain (7.8%) and Foley catheter for patients who can void (5.6%). Respondents reported patient/family expectations as the most important reason for ordering antibiotics for sinusitis (68%) and imaging for low back pain (56.8%). However, concern for serious diagnosis was the most important reason for performing CT chest for patients with normal D‐dimer (49.7%) and CT abdomen for recurrent uncomplicated renal colic (42.5%). A minority (3.8% to 26.7%) of respondents identified malpractice risk as the primary reason for performing low‐value services.ConclusionsDespite familiarity with Choosing Wisely, many emergency physicians report performing low‐value services. Primary reasons for low‐value services differ: antibiotic prescribing was driven by patient/family expectations, while concern for serious diagnosis influenced advanced diagnostic imaging. Greater efforts are needed to promote effective dissemination and implementation; such efforts may be targeted based on differing reasons for low‐value services.
Nationwide surveys show that the incidence of recurrent Kawasaki disease in Japan has hardly changed over the last 30 years
Authors: Sudo Daisuke , Nakamura Yosikazu 
Published: February 2017

AbstractAimSince Kawasaki disease (KD) was first reported in 1967, its aetiology has been intensively investigated, but remains unclear. We investigated the incidence of recurrent KD in Japan in 2003–2012, compared with previous data from our team, and assessed the potential risk factors for disease recurrence.MethodsData from nationwide KD surveys were retrospectively analysed and 81 310 patients were observed. Incidence rates were compared between different years.ResultsThe incidence rates for recurrent KD were 3.89 per 1000 person‐years (January 2003 to December 2012), 4.95 (July 2003 to December 2010), 6.48 (January 2003 to December 2006) and 6.51 (January 2007 to December 2010). These rates were almost consistent with our previous data, which started in the 1980s. The incidence rate for recurrence was statistically higher among males, patients under the age of three years and those who received intravenous immunoglobulin or steroid therapy at the initial episode. The presence of cardiac sequelae during the initial episode did not affect the recurrence incidence.ConclusionAlthough the incidence of KD has increased, the incidence of recurrent KD has remained largely unchanged over the past 30 years. Risk factors for recurrence included male sex, young age and initial resistance to immunoglobulin therapy.
Liver fibrosis diagnosis by blood test and elastography in chronic hepatitis C: agreement or combination?
Authors: Calès P. , Boursier J. , Lebigot J. , de Ledinghen V. , Aubé C. , Hubert I. , Oberti F. 
Published: February 2017

SummaryBackgroundIn chronic hepatitis C, the European Association for the Study of the Liver and the Asociacion Latinoamericana para el Estudio del Higado recommend performing transient elastography plus a blood test to diagnose significant fibrosis; test concordance confirms the diagnosis.AimTo validate this rule and improve it by combining a blood test, FibroMeter (virus second generation, Echosens, Paris, France) and transient elastography (constitutive tests) into a single combined test, as suggested by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America.MethodsA total of 1199 patients were included in an exploratory set (HCV, n = 679) or in two validation sets (HCV ± HIV, HBV, n = 520). Accuracy was mainly evaluated by correct diagnosis rate for severe fibrosis (pathological Metavir F ≥ 3, primary outcome) by classical test scores or a fibrosis classification, reflecting Metavir staging, as a function of test concordance.ResultsScore accuracy: there were no significant differences between the blood test (75.7%), elastography (79.1%) and the combined test (79.4%) (P = 0.066); the score accuracy of each test was significantly (P < 0.001) decreased in discordant vs. concordant tests. Classification accuracy: combined test accuracy (91.7%) was significantly (P < 0.001) increased vs. the blood test (84.1%) and elastography (88.2%); accuracy of each constitutive test was significantly (P < 0.001) decreased in discordant vs. concordant tests but not with combined test: 89.0 vs. 92.7% (P = 0.118). Multivariate analysis for accuracy showed an interaction between concordance and fibrosis level: in the 1% of patients with full classification discordance and severe fibrosis, non‐invasive tests were unreliable. The advantage of combined test classification was confirmed in the validation sets.ConclusionsThe concordance recommendation is validated. A combined test, expressed in classification instead of score, improves this rule and validates the recommendation of a combined test, avoiding 99% of biopsies, and offering precise staging.
Dose de‐escalation to adalimumab 40 mg every 3 weeks in patients with Crohn's disease – a nested case–control study
Authors: Van Steenbergen S. , Bian S. , Vermeire S. , Van Assche G. , Gils A. , Ferrante M. 
Published: February 2017

Summary
BackgroundData on dose de‐escalation in patients with Crohn's disease (CD) are limited.AimTo evaluate outcomes of dose de‐escalation from adalimumab (ADM) every other week (EOW) to every three weeks (ETW).MethodsWe selected patients with CD receiving maintenance therapy with ADM 40 mg ETW with serum levels (SL) available before and after dose de‐escalation. Sex‐ and age‐matched controls continuing ADM 40 mg EOW were identified. Patient reported outcome, C‐reactive protein (CRP) and serum albumin were collected.ResultsOut of 898 patients, we identified 40 (11 male, median 37 years) who de‐escalated to ADM 40 mg ETW for ADM‐related adverse events (AE, n = 1), ADM SL >7 μg/mL (n = 8), or both (n = 31). Compared to controls, ADM SL dropped significantly within 4 months, without associated clinical or biochemical changes. In 53% of patients, dose de‐escalation was associated with disappearance of AE (8/16 skin manifestation, 3/6 arthralgia, 5/7 frequent infectious episodes). During a median follow‐up of 24 months, 65% of patients maintained clinical response, but 35% needed dose escalation back to ADM 40 mg EOW because of clinical relapse (n = 8), ADM SL <4 μg/mL (n = 2), or both (n = 4). CRP <3.5 mg/L at dose de‐escalation was independently associated with dose escalation‐free survival [odds ratio 6.28 (95% CI 1.83–21.59), P = 0.004]. We could not define a minimal ADM SL to consider or maintain dose de‐escalation.ConclusionsOverall, 65% of patients who de‐escalated to adalimumab 40 mg every 3 weeks remained in clinical remission for a median of 24 months. In 53% of patients, adalimumab‐related adverse events disappeared after dose de‐escalation. Regardless of adalimumab SL, disease remission should be assessed objectively prior to dose de‐escalation.
Odense Pharmacoepidemiological Database: A Review of Use and Content
Authors: Hallas Jesper , Hellfritzsch Maja , Rix Morten , Olesen Morten , Reilev Mette , Pottegård Anton 
Published: February 2017

AbstractThe Odense University Pharmacoepidemiological Database (OPED) is a prescription database established in 1990 by the University of Southern Denmark, covering reimbursed prescriptions from the county of Funen in Denmark and the region of Southern Denmark (1.2 million inhabitants). It is still active and thereby has more than 25 years of continuous coverage. In this MiniReview, we review its history, content, quality, coverage, governance and some of its uses. OPED's data include the Danish Civil Registration Number (CPR), which enables unambiguous linkage with virtually all other health‐related registers in Denmark. Among its research uses, we review record linkage studies of drug effects, advanced drug utilization studies, some examples of method development and use of OPED as sampling frame to recruit patients for field studies or clinical trials. With the advent of other, more comprehensive sources of prescription data in Denmark, OPED may still play a role as in certain data‐intensive regional studies.
Impact of senescence‐associated secretory phenotype and its potential as a therapeutic target for senescence‐associated diseases
Authors: Watanabe Sugiko , Kawamoto Shimpei , Ohtani Naoko , Hara Eiji 
Published: February 2017

“Cellular senescence” is a state in which cells undergo irreversible cell cycle arrest in response to a variety of cellular stresses. Once cells senesce, they are strongly resistant to any mitogens, including oncogenic stimuli. Therefore, cellular senescence has been assumed to be a potent anticancer mechanism. Although irreversible cell‐cycle arrest is traditionally considered the major characteristic of senescent cells, recent studies have revealed some additional functions. Most noteworthy is the increased secretion of various secretory proteins, such as inflammatory cytokines, chemokines, growth factors, and MMPs, into the surrounding extracellular fluid. These newly recognized senescent phenotypes, termed senescence‐associated secretory phenotypes (SASPs), reportedly contribute to tumor suppression, wound healing, embryonic development, and even tumorigenesis promotion. Thus, SASPs appear to be beneficial or deleterious, depending on the biological context. As senescent cells are known to accumulate during the aging process in vivo, it is quite possible that their accumulation in aged tissues promotes age‐associated functional decline and various diseases, including cancers, at least to some extent. Here, we focus on and discuss the functional and regulatory network of SASPs toward opening up new possibilities for controlling aging and aging‐associated diseases.
Controlled release of an endostatin peptide using chitosan nanoparticles
Authors: Ebrahimi Samani Sanaz , Seraj Zahra , Naderimanesh Hossein , Khajeh Khosro , Esmaeili Rastaghi Ahmad Reza , Droudi Taher , Kolivand Peirhosein , Kazemi Hadi , Asghari S. Mohsen 
Published: February 2017

Whereas several anticancer peptides are in different stages of clinical development, their administration is limited by the fast elimination from the systemic circulation. Peptide loading on nano‐carriers can pave the way for their future application. We have recently indicated that a disulfide loop rather than a Zn‐binding loop improves the anti‐angiogenic and antitumor activities of the N‐terminal fragment of endostatin. In this study, chitosan nanoparticles (CS NPs) are used for the controlled release of the engineered peptide. Loading of the peptide into CS NPs using the ionic gelation method was confirmed by FTIR and resulted in final particle size, poly‐dispersity index and surface charge of 186.5 ± 24.0 nm, 0.26 ± 0.02 and 20.1 ± 0.4 mV respectively. The SEM morphological analysis revealed spherical particles with an average size of 80 ± 5 nm. Peptide loading studies revealed that CS NPs are able to adsorb the peptide as ~70%. The release measurements indicated an initial burst release by 49% after 2 hr and complete release after 80 hr. According to in vitro studies, the loaded peptide was much more toxic for endothelial cells than different cancer cell lines. These results underscore the promise of CS NPs as therapeutics nanosystems and open a perspective for improving the clinical applications of peptide drugs.
Peri‐implant bleeding on probing: a cross‐sectional multilevel analysis of associated factors
Authors: Merli Mauro , Bernardelli Francesco , Giulianelli Erica , Toselli Ivano , Mariotti Giorgia , Nieri Michele 
Published: February 2017

AbstractObjectivesThe objective was to evaluate the association between peri‐implant bleeding on probing (BoP) and probing depth. Other factors regarding patients, implants, and sites were taken into consideration.Material and methodsConsecutive adult patients with ≥1 dental implant were eligible. Two calibrated operators examined the patients. BoP was the outcome variable. The effects of patient, implant and site factors on BoP were assessed using a 3‐level logistic model.ResultsFifty‐two patients for a total of 92 implants and 552 sites were included in the analysis. The BoP was observed in 217 sites (39%). The odds ratio increased by 1.81 (95% CI from 1.47 to 2.23; P < 0.0001) for each 1 mm increment in probing pocket depth. A significant higher risk was observed also for interproximal vs. approximal surfaces (OR = 1.55; 95% CI from 1.02 to 2.36; P = 0.0402).ConclusionsPeri‐implant bleeding was associated with site‐specific factors.
Recombinant bone morphogenetic protein‐2 and platelet‐derived growth factor‐BB for localized bone regeneration. Histologic and radiographic outcomes of a rabbit study
Authors: Thoma Daniel S. , Lim Hyun‐Chang , Sapata Vitor M. , Yoon Sora R. , Jung Ronald E. , Jung Ui‐Won 
Published: February 2017

AbstractObjectivesImprovement in localized bone regeneration is needed to avoid the use of autogenous tissue. For that purpose, the use biologic mediators was proposed. The aim was to test whether or not one of two biologic mediators, recombinant human bone morphogenetic protein‐2 (rhBMP‐2) or recombinant platelet‐derived growth factor (rhPDGF‐BB), is superior to the other and to control groups for localized bone regeneration.Materials and MethodsFour cylinders (height: 5 mm; diameter: 7 mm) were screwed on the parietal and frontal bones at the cranium in 12 rabbits. The cylinders either received (i) deproteinized bovine bone mineral (DBBM) mixed rhBMP‐2 (DBBM/BMP‐2), (ii) DBBM mixed with rhPDGF‐BB (DBBM/PDGF), (iii) DBBM (DBBM), and (iv) empty control (control). Rabbits were euthanized at 2 and 8 weeks (n = 6, respectively). Conventional histomorphometric and micro‐CT analyses were performed. Parametric linear mixed models were applied for the analyses with Bonferroni correction for the multiple group comparisons.ResultsThe area of bone regeneration (histology; AAHisto) at 2 weeks peaked for DBBM (41.91%) with statistically significantly greater values compared to DBBM/PDGF and the control group (P < 0.05). At 8 weeks, mean AAHisto values were 96.29% (DBBM/BMP‐2), 46.37% (DBBM/PDFG), 39.66% (DBBM), and 35.98% (control) (DBBM/BMP‐2 vs. all groups (P < 0.05)). At 8 weeks, bone regeneration was greatest for DBBM/BMP‐2 (35.62%) with statistically significant differences compared to all other groups (P < 0.05). The area of bone regeneration (micro‐CT; AAm‐CT) at 2 weeks amounted to 43.87% (DBBM/BMP‐2), 42.81% (DBBM/PDFG), 48.71% (DBBM), and 0.96% (control). The control group demonstrated statistically significantly less AAm‐CT compared to all groups (P < 0.05). At 8 weeks, mean AAm‐CT values were 63.65% (DBBM/BMP‐2), 50.21% (DBBM/PDFG), 44.81% (DBBM), and 4.57% (control) (P > 0.05).ConclusionsThe use of rhBMP‐2 significantly enhanced bone regeneration compared to all other groups including the group with rhPDGF‐BB.
The association of admission hyperglycaemia and adverse clinical outcome in medical emergencies: the multinational, prospective, observational TRIAGE study
Authors: Kutz A. , Struja T. , Hausfater P. , Amin D. , Amin A. , Haubitz S. , Bernard M. , Huber A. , Mueller B. , Schuetz P. ,   the TRIAGE study group
Published: February 2017

AbstractAimsThe clinical relevance of hyperglycaemia in an emergency department population remains incompletely understood. We investigated the association between admission blood glucose levels and adverse clinical outcomes in a large emergency department cohort.MethodsWe prospectively enrolled 7132 adult medical patients seeking emergency department care in three tertiary care hospitals in Switzerland, France and the USA. We used adjusted multivariable logistic regression models to examine the association between admission blood glucose levels and 30‐day mortality, as well as adverse clinical course stratified by pre‐existing diabetes and principal medical diagnoses.ResultsIn 6044 people without diabetes (84.7%), severe hyperglycaemia, defined as a glucose level of > 11.1 mmol/l (200 mg/dl), was associated with a doubling in the risk of 30‐day mortality [adjusted odds ratio (OR) 1.9; 95% confidence interval (95% CI), 1.1 to 3.3; P = 0.018] and a three‐fold increase in the risk of intensive care unit admission (adjusted OR 3.0; 95% CI, 1.9 to 4.9; P < 0.001). These associations were similar among different diagnoses. In the population with diabetes (n = 1088), no association with 30‐day mortality was found (adjusted OR 1.0; 95% CI, 0.6 to 1.8; P for interaction = 0.001), whereas the association with intensive care unit admission was weaker (adjusted OR 2.4; 95% CI, 1.5 to 4.1; P for interaction = 0.011). Overall 30‐day mortality was higher in those with diabetes than in those without (6.1 vs. 4.4%, P = 0.015).ConclusionsIn this large medical emergency department patient cohort, admission hyperglycaemia was strongly associated with adverse clinical course in people without diabetes. (Clinical Trial Registry No: NCT01768494)
Impact of neighbourhood‐level inequity on paediatric diabetes care
Authors: Clarke A. B. M. , Daneman D. , Curtis J. R. , Mahmud F. H. 
Published: February 2017

AbstractAimsTo evaluate the association between neighbourhood‐level inequity and glycaemic control in paediatric participants with Type 1 diabetes using the Neighbourhood Equity Index (NEI).MethodsThe NEI was linked to the clinical data of 519 children with diabetes followed at the Hospital for Sick Children (Toronto, Canada). The NEI is a composite measure of inequity developed using the World Health Organization's Urban Health Equity Assessment and Response Tool (HEART), which encompasses 15 weighted indicators evaluating economic, social, environmental and lifestyle factors. The geographic distribution of participants was determined using postal codes, and the relationship between HbA1c and NEI was evaluated using regression and spatial analysis techniques.ResultsParticipants’ mean HbA1c was significantly correlated with NEI (R = −0.24, P < 0.0001). Regression analysis demonstrated that NEI was a strong predictor of mean HbA1c (P < 0.0001), accounting for differences in HbA1c as large as 1.0% (11 mmol/mol) when controlled for age, sex, diabetes duration, insulin pump therapy and number of annual clinic visits. Geo‐mapping using spatial scan testing revealed the presence of two clusters of low‐equity neighbourhoods containing 3.22 (P = 0.001) and 2.83 (P = 0.02) times more participants with HbA1c ≥ 9.5% (80 mmol/mol) than expected.ConclusionsOur findings demonstrated that NEI was a significant predictor of HbA1c in our clinic population and a useful tool for investigating spatial trends related to inequities in health, providing evidence that a composite, area‐based measure of overall inequity is well suited to the study of glycaemic control in urban paediatric Type 1 diabetes populations.
Left ventricular diastolic dysfunction in patients with chronic obstructive pulmonary disease: Impact of methods of assessment
Authors: Farouk Heba , Albasmi Maged , El Chilali Karim , Mahmoud Kareem , Nasr Abdo , Heshmat Hussein , Abdel‐Moneim Samah , Baligh Essam 
Published: February 2017

BackgroundThe prevalence of left ventricular (LV) diastolic dysfunction in patients with chronic obstructive pulmonary disease (COPD), using different echocardiographic parameters, varies widely in the literature. The highest prevalence of LV diastolic dysfunction was detected using the mitral inflow indexes that are commonly altered in these patients due to the associated tachycardia, reduced preload, and ventricular septal shift. In this study, we aimed at evaluating the impact of the used echocardiographic method of assessment on the prevalence of LV diastolic dysfunction in patients with COPD and normal LV systolic function.MethodsWe studied 35 patients with COPD and 18 age‐matched controls. A comprehensive approach to diagnose and grade the LV diastolic dysfunction was performed in accordance with the recommendations of the American Society of Echocardiography published in 2009. The results were compared with those of mitral inflow indexes.ResultsLV diastolic dysfunction was reported in 20 patients using the mitral inflow indexes while in only 12 patients using the comprehensive approach (P=.021). Compared to the controls, LV diastolic dysfunction was significantly more common in patients using the mitral inflow indexes (P=.001), while no statistically significant difference was detected between both groups using the comprehensive approach (P=.1).ConclusionThe prevalence of LV diastolic dysfunction in patients with COPD varies according to the used echocardiographic approach. Further studies are recommended to determine which approach is the most accurate in estimating the true prevalence of LV diastolic dysfunction among this group of patients.
Assessment of myocardial ischemia by strain dobutamine stress echocardiography and cardiac magnetic resonance perfusion imaging before and after coronary artery bypass grafting
Authors: Rösner Assami , Schirmer Henrik , Iqbal Amjid , Bijnens Bart , Avenarius Derk , Malm Siri 
Published: February 2017

BackgroundFollowing coronary artery bypass grafting (CABG), testing for myocardial ischemia by noninvasive imaging is often hampered by false‐positive results. The aim of this study was to find test parameters with the best potential to identify myocardial ischemia in post‐CABG patients.MethodsFifty‐two consecutive patients scheduled for CABG, underwent both dobutamine stress echocardiography (DSE) and cardiac magnetic resonance first‐pass perfusion imaging (CMR‐FPPI) with adenosine vasodilation, before and 8–10 months after the surgical revascularization. A pathologic biphasic stress response (PBR) expresses the presence of contractile reserve during low‐dose dobutamine that decreases to hypo‐ or akinesia provoked by high‐dose dobutamine. During DSE, potential PBR, segmental wall‐motion score (WMS) as well as peak‐systolic longitudinal strain (PLS) at peak‐dose dobutamine were assessed.ResultsPost‐CABG, there was still a relatively high prevalence of ischemia‐positive segments evaluated by deformation imaging, but the number of such segments was significantly lower by PBR (20% and 22%) compared with peak‐dose strain and WMS (62% and 77%, respectively; P<.05). The use of PBR instead of peak‐dose WMS and strain could reduce the number of false‐positive test results post‐CABG.ConclusionAmong all imaging modalities tested, PBR by WMS and strain may be useful parameters for identifying patients with the need for new revascularization. We furthermore found that DSE may be interpreted as positive when revealing at least three ischemia‐positive segments. The sensitivity of these test modalities for detecting coronary restenosis needs to be determined in further studies on a cohort of symptomatic post‐CABG patients.