bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bericht über die neue ESPEN-Leitlinie zur Ernährung von polymorbiden, internistischen Patienten
Authors: Schuetz Philipp , Zurfluh Seline , Gomes Filomena , Bounoure Lisa , Fehr Rebecca , Norman Kristina , Stanga Zeno , Bischoff Stephan ,   Guideline-Arbeitsgruppe
Published: January 2018

Zusammenfassung
Hintergrund Die Mangelernährung ist ein zentrales Problem im Spitalalltag und korreliert mit Komplikationen, längeren Spitalaufenthalten und schlechteren Outcomes. Viele der hospitalisierten, internistischen Patienten sind polymorbide. Bisherige klinische Leitlinien für Ernährungstherapie befassen sich meist nur mit Einzelerkrankungen ohne Berücksichtigung der Polymorbidität. Ziel der ESPEN-Arbeitsgruppe war das Erstellen von Leitlinien zur Ernährungstherapie bei polymorbiden, hospitalisierten Patienten.
Methode Die Arbeitsgruppe formulierte Schlüsselfragen zu folgenden Aspekten der Ernährungstherapie: Indikation, Weg der Nahrungszufuhr, Energie- und Proteinbedarf, Mikronährstoffe, krankheitsspezifische Nährstoffe, Überwachung, zeitliche sowie prozedurale Aspekte. Es erfolgte eine systematische Literatursuche in 3 Datenbanken (Medline, Embase und Cochrane Library) sowie in sekundären Quellen (z. B. publizierte Guidelines). Darauf basierend wurden Empfehlungen formuliert. Die hier vorgestellte Arbeit ist eine deutsche Übersetzung der kürzlich publizierten ESPEN-Leitlinien.
Ergebnisse Bei polymorbiden, hospitalisierten Patienten sollte ein einfaches, standardisiertes Mangelernährungs-Screening innerhalb 48 Stunden nach Spitaleintritt durchgeführt werden. Der totale tägliche Energiebedarf kann bei polymorbiden Patienten > 65 Jahren mittels gewichtsbasierter Formel „27 – 30 kcal/kg Körpergewicht (KG)“ geschätzt werden. Der tägliche Proteinbedarf kann mit „≥ 1,0 g/kg KG“ geschätzt werden. Primär sollte eine orale Ernährung angestrebt werden, welche bei Bedarfsabdeckung < 75 % auf eine enterale oder parenterale eskaliert werden kann. Orale Nahrungssupplemente sollte als eine kosteneffektive Intervention zur Verbesserung des Ernährungszustands in Betracht gezogen werden.
Schlussfolgerungen Trotz methodischen Herausforderungen aufgrund der heterogenen Patientenpopulation und dem Fehlen großer Interventionsstudien ist es der Arbeitsgruppe gelungen, evidenzbasierte Empfehlungen zur nicht-krankheitsspezifischen Ernährungstherapie bei polymorbiden Patienten zu erarbeiten. Als Resultat sind 22 praktische Empfehlungen und 4 Stellungnahmen entstanden, welche im klinischen Alltag im Umgang mit mangelernährten, hospitalisierten, polymorbiden Patienten genutzt werden können. Einige Fragen bleiben bei mangelnder oder fehlender Evidenz offen und benötigen noch weiterer Untersuchungen.
Suppressive effect of ethanol extract from mango (Mangifera indicaL.) peel on IgE productionin vitroandin vivo
Authors: Ishida Momoko , Sasaki Tomoko , Nishi Kosuke , Tamamoto Takeshi , Sugahara Takuya 
Published: January 2018

AbstractImmunoglobulin E (IgE) is involved in the onset of allergic reaction, and the suppression of IgE production leads to alleviation of allergic symptoms. We found that mango peel ethanol extract (MPE) significantly suppresses IgE production by human myeloma cell line U266 cells, suggesting that MPE has an anti-allergic effect by inhibiting the production of IgE. Although mangiferin is contained in mango, which suppresses IgE production by U266 cells, it was not contained in MPE. We investigated the suppressive effect of MPE in 2,4-dinitrofluorobenzene (DNFB)-induced allergic contact dermatitis model mice. The elevation of serum IgE level was significantly suppressed by oral administration of MPE. Intake of MPE also suppressed the expression level of IL-4 in the DNFB-challenged ears, suggesting that MPE suppresses the IL-4-mediated maturation into IgE-producing cells. Our findings indicate that MPE has a potential to alleviate the increase in serum IgE level that is feature of type I allergy.
Increasing Geminid meteor shower activity
Authors: Ryabova G O , Rendtel J 
Published: January 2018

Abstract
Mathematical modelling has shown that activity of the Geminid meteor shower should rise with time, and that was confirmed by analysis of visual observations 1985–2016. We do not expect any outburst activity of the Geminid shower in 2017, even though the asteroid (3200) Phaethon has a close approach to Earth in December of 2017. A small probability to observe dust ejected at perihelia 2009–2016 still exists.
Normative justification for public arts funding: what can we learn from linking arts consumption and arts policy in Israel?
Authors: Feder Tal 
Published: January 2018

AbstractThis article studies the socioeconomics of government public expenditure for the arts and the normative foundations of state intervention in the arts. I pose two interrelated research questions: (a) what is the relationship between the public funding of the arts and their consumption? and (b) what mode of justification and what perception of the place of art in society is reflected in this relationship? Based on the philosophical work of Alan Badiou, I develop a novel conceptual framework to delineate three types of normative justifications for the public funding of arts organizations: romantic, didactic and classical. Using data from the public funding of 92 orchestras, theaters and dance troupes in Israel between 1999 and 2011, I estimate a cross-lagged panel data model to study how arts funding both affects and is affected by the levels of consumption of the organizations’ productions. The results of the study show a complex pattern of different relationships between funding and consumption that accord with the three types of normative justifications for public arts funding.
Delay Within the 3-Hour Surviving Sepsis Campaign Guideline on Mortality for Patients With Severe Sepsis and Septic Shock*
Authors: Pruinelli Lisiane , Westra Bonnie L. , Yadav Pranjul , Hoff Alexander , Steinbach Michael , Kumar Vipin , Delaney Connie W. , Simon Gyorgy 
Published: January 2018

Objectives:
To specify when delays of specific 3-hour bundle Surviving Sepsis Campaign guideline recommendations applied to severe sepsis or septic shock become harmful and impact mortality.

Design:
Retrospective cohort study.

Setting:
One health system composed of six hospitals and 45 clinics in a Midwest state from January 01, 2011, to July 31, 2015.

Patients:
All adult patients hospitalized with billing diagnosis of severe sepsis or septic shock.

Interventions:
Four 3-hour Surviving Sepsis Campaign guideline recommendations: 1) obtain blood culture before antibiotics, 2) obtain lactate level, 3) administer broad-spectrum antibiotics, and 4) administer 30 mL/kg of crystalloid fluid for hypotension (defined as “mean arterial pressure” < 65) or lactate (> 4).

Measurements and Main Results:
To determine the effect of t minutes of delay in carrying out each intervention, propensity score matching of “baseline” characteristics compensated for differences in health status. The average treatment effect in the treated computed as the average difference in outcomes between those treated after shorter versus longer delay. To estimate the uncertainty associated with the average treatment effect in the treated metric and to construct 95% CIs, bootstrap estimation with 1,000 replications was performed. From 5,072 patients with severe sepsis or septic shock, 1,412 (27.8%) had in-hospital mortality. The majority of patients had the four 3-hour bundle recommendations initiated within 3 hours. The statistically significant time in minutes after which a delay increased the risk of death for each recommendation was as follows: lactate, 20.0 minutes; blood culture, 50.0 minutes; crystalloids, 100.0 minutes; and antibiotic therapy, 125.0 minutes.

Conclusions:
The guideline recommendations showed that shorter delays indicates better outcomes. There was no evidence that 3 hours is safe; even very short delays adversely impact outcomes. Findings demonstrated a new approach to incorporate time t when analyzing the impact on outcomes and provide new evidence for clinical practice and research.
Longitudinal profiles of back pain across adulthood and their relationship with childhood factors: evidence from the 1946 British birth cohort
Authors: Muthuri Stella G. , Kuh Diana , Cooper Rachel 
Published: January 2018

Abstract
This study aimed to (1) characterise long-term profiles of back pain across adulthood and (2) examine whether childhood risk factors were associated with these profiles, using data from 3271 participants in the Medical Research Council National Survey of Health and Development. A longitudinal latent class analysis was conducted on binary outcomes of back pain at ages 31, 36, 43, 53, 60 to 64, and 68 years. Multinomial logistic regression models were used to examine associations between selected childhood risk factors and class membership; adjusted for sex, adult body size, health status and behaviours, socioeconomic position, and family history of back pain. Four profiles of back pain were identified: no or occasional pain (57.7%), early-adulthood only (16.1%), mid-adulthood onset (16.9%), and persistent (9.4%). The “no or occasional” profile was treated as the referent category in subsequent analyses. After adjustment, taller height at age 7 years was associated with a higher likelihood of early-adulthood only (relative risk ratio per 1 SD increase in height = 1.31 [95% confidence interval: 1.05-1.65]) and persistent pain (relative risk ratio = 1.33 [95% confidence interval: 1.01-1.74]) in women (P for sex interaction = 0.01). Factors associated with an increased risk of persistent pain in both sexes were abdominal pain, poorest care in childhood, and poorer maternal health. Abdominal pain and poorest housing quality were also associated with an increased likelihood of mid-adulthood onset pain. These findings suggest that there are different long-term profiles of back pain, each of which is associated with different early life risk factors. This highlights the potential importance of early life interventions for the prevention and management of back pain.
Updates in Management of Complicated Urinary Tract Infections: A Focus on Multidrug-Resistant Organisms
Authors: Ma Adrienne H. , Hughes Gregory J. 
Published: January 2018

Background:
Urinary tract infection treatment can be difficult in the geriatric population. These patients often require a more nuanced approach due to recurrent, resistant, and catheter-associated infections.

Areas of Uncertainty:
Although some attempts have been made to prevent urinary tract infections using cranberry products, probiotics, and nonpharmacologic means, current interest lies largely with the development of new antibiotics to treat increasingly resistant organisms.

Therapeutic Advances:
Efforts to reduce the development of resistance starts with judicious and appropriate empiric use of antibiotics. Fluoroquinolones are no longer recommended as first-line therapy due to adverse reactions and the development of resistance. Complicated and upper urinary tract infections require broader empiric coverage and measures should be taken to de-escalate treatment as early as possible. Antimicrobial stewardship programs are recommended to aid in these efforts in addition to antibiotic selection in the presence of multidrug-resistant organisms such as those producing extended spectrum beta-lactamase or carbapenemase. Multidrug-resistant organisms are often present in catheter-associated urinary tract infections so broad empiric coverage should be initially started. Catheter-associated urinary tract infections should generally be treated for 7–14 days depending on the rate of clinical improvement, and fungal coverage is often also necessary. Ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam were recently approved in the US for treating multidrug-resistant organisms and several more agents are in development, such as parenteral fosfomycin. Ceftolozane/tazobactam is effective for treating Pseudomonas aeruginosa and other gram-negative organisms, even those that produce extended spectrum beta-lactamases. Ceftazidime/avibactam is effective solely for gram-negative organisms, including those that produce various carbapenemases, but efficacy for P. aeruginosa is variable. Both combinations are approved for complicated urinary tract infections in addition to complicated intra-abdominal infections. Several medications are currently in the pipeline to treat multidrug-resistant organisms. Meropenem/vaborbactam was approved for complicated urinary tract infections and its coverage includes carbapenem-resistant Enterobacteriaceae. Fosfomycin, currently available orally and first line for uncomplicated urinary tract infections, is being evaluated for intravenous use for methicillin-resistant Staphylococcus, vancomycin-resistant Enterococcus, and gram-negative bacilli that produce both extended spectrum beta-lactamase and carbapenemase.

Conclusions:
Urinary Tract Infections are a common cause of hospitalization in older adults. Antibiotic selection and antimicrobial stewardship programs are important given the increasing prevalence of multidrug-resistant organisms.
Therapeutic Advances in the Management of Older Adults in the Intensive Care Unit: A Focus on Pain, Sedation, and Delirium
Authors: Moore Samantha 
Published: January 2018

Background:
Older adults currently account for over half of all intensive care unit admissions. Although advances in critical care medicine have led to improved survival, critical illness is still associated with high short-term and long-term morbidity and mortality.

Areas of Uncertainty:
Elderly survivors of critical illness often have long-lasting physical, cognitive, and psychological disabilities. Several iatrogenic risk factors for post-critical illness impairments have been identified, including delirium, deep sedation, and inadequate analgesia. Multicomponent interventions or bundles, which target many of these risk factors, have been shown to improve patient outcomes. However, there is limited literature that addresses the optimal pharmacologic management of analgesia and sedation in elderly critically ill patients who are known to have altered pharmacokinetics and pharmacodynamics. There are also uncertainties regarding the treatment and prophylaxis of delirium in this patient population.

Therapeutic Advances:
Various interventions can improve the pharmacologic management of pain, agitation, and delirium and subsequently improve outcomes in critically ill elderly patients. Pain should be managed with multimodal therapy and opioids should be used judiciously. Benzodiazepines should be avoided and dexmedetomidine may be the best first-line sedative in this population. Only patients with hyperactive delirium should receive treatment with antipsychotics and there is likely no role of antipsychotics for delirium prophylaxis. New literature suggests that dexmedetomidine may be effective for the prevention and treatment of intensive care unit delirium.

Conclusions:
Elderly patients are more sensitive to centrally acting medications and often require lower doses than younger patients because of alterations in pharmacokinetics. A newer medication, dexmedetomidine, has demonstrated some benefit over other sedatives and may have a role in the management of delirium. Overall, more research is needed on the pharmacologic management of pain, sedation, and delirium in the elderly critically ill population.
Bedside Ultrasound for the Evaluation of Epidural Hematoma After Infant Lumbar Puncture
Authors: Kusulas Matthew P. , Eutsler Eric P. , DePiero Andrew D. 
Published: January 2018

Background
Unsuccessful lumbar puncture (LP) attempts may lead to epidural hematoma (EH) formation within the spinal canal at the site of needle insertion, which can affect subsequent attempts. We aimed to determine the rate of EH formation after infant LP using bedside ultrasound (US). Furthermore, we aimed to correlate both perceived trauma during LP and cerebral spinal fluid (CSF) red blood cell (RBC) counts with EH formation.

Methods
We enrolled infants younger than 6 months who underwent LP in the emergency department. The primary investigator performed a bedside US of the lumbar spine, which was reviewed and interpreted by a pediatric radiologist. Treating clinicians performed the procedure and were asked to classify each attempt as “traumatic” or “atraumatic.” Cerebral spinal fluid RBC counts were recorded.

Results
Thirty-one percent of patients had evidence of post-LP EH, 17% of which completely effaced the thecal sac. Forty percent of patients with at least 1 traumatic attempt had evidence of EH, whereas 25% without reported trauma showed EH (P = 0.17). Patients with EH had a median CSF RBC cell count of 186 cells/mm3 (range, 0–239,525) compared with 5 cells/mm3 (range, 0–3429) in patients without evidence of EH (P = 0.008).

Conclusions
Epidural hematomas are frequent after LP. Perceived trauma during LP and CSF RBC counts are not adequate predictors of EH formation. Point-of-care US may be a valuable adjunct to help guide subsequent needle insertions sites for repeat attempts after an unsuccessful LP.
Loneliness in Multiple Sclerosis: Possible Antecedents and Correlates
Authors: Balto Julia M. , Pilutti Lara A. , Motl Robert W. 
Published: January 2018

Abstract

Purpose
The prevalence and possible antecedents and correlates of loneliness in multiple sclerosis (MS) was examined.

Design
Cross-sectional, comparative study of MS (n = 63) and healthy adults (n = 21).

Methods
Data were collected using self-reports of loneliness and antecedents and correlates and analyzed using inferential statistics.

Findings
Those with MS had significantly higher loneliness scores than healthy adults (p < .05), and this was explained by employment status. Possible antecedents included marital status (p < .05), upper extremity function (r= −.28, p < .03), social disability frequency (r= −.49, p < .00), social disability limitations (r= −.38, p < .00), and personal disability limitations (r= −.29, p < .03). Social disability frequency (beta = −.41, p < .001) and marital status (beta = −.23, p < .046) accounted for 25% of the variance in loneliness scores. Possible correlates included depression (r= .49, p < .00), cognitive fatigue (r= .34, p < .01), psychosocial fatigue (r= .30, p < .02), and psychological quality of life (r= .44, p < .00).

Conclusions
We provide evidence of loneliness in persons with MS, and this is associated with possible antecedents (e.g., marital status and disability limitations) and correlates (e.g., depression and fatigue).

Clinical Relevance
Loneliness should be recognized clinically as an important concomitant of MS.
Candidate urine biomarker discovery from only five pairs of samples before and after tumor resection in glioma patients
Authors: Wu Jianqiang , Zhang Jun , Zhao Yuanli , Gao Youhe 
Published: January 2018

AbstractBiomarkers are measurable changes associated with the disease. Without the control of homeostatic mechanisms, urine accumulates systemic body changes and thus serves as an excellent early biomarker source. However, urine is affected by many factors other than disease. Although many candidate biomarkers have been identified in animal models, a large number of clinical samples might still be required for the disease related changes. A self-controlled study should be able to avoid the interferences of individual differences among patients. Gliomas are the most common primary malignant brain tumors and have a very poor prognosis. Early diagnosis of gliomas and the monitoring of tumor recurrence are crucial to improve glioma patient outcomes. Here we set to try if biomarker candidates can be identified by comparing urine samples from five glioma patients collected at the time of tumor diagnosis and after surgical removal of the tumor. Using label-free liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) quantification, twenty-seven urinary proteins were significantly changed after tumor resection (fold change ≥ 1.5, P-value < 0.05, and similar changes in all 5 patients), many of which have been previously associated with gliomas, such as CEACAM1, ANXA7, CALR, CRYAB, CD276, pIgR and cathepsin D. Functions of these proteins were significantly enriched in the regulation of tissue remodeling, autophagy, the inhibition of gene expression, the positive regulation of natural killer cell-mediated cytotoxicity and angiogenesis, which are associated with glioma development. Our results suggested that using the self-control of before and after tumor resection is an effective method to identify differential proteins associated with the disease, even with a small number of patients.
Modified Potential Functions Result in Enhanced Predictions of a Protein Complex by All-Atom MD Simulations, Confirming a Step-wise Association Process for Native PPIs
Authors: Li Zhen-lu , Buck Matthias 
Published: January 2018

ABSTRACTNative protein-protein interactions (PPIs) are the cornerstone for understanding the structure, dynamics and mechanisms of function of protein complexes. In this study, we investigate the association of the SAM domains of the EphA2 receptor and SHIP2 enzyme by performing a combined total of 48 μs all-atom molecular dynamics (MD) simulations. While the native SAM heterodimer is only predicted at a low rate of 6.7% with the original CHARMM36 force field, the yield is increased to 16.7% and to 18.3% by scaling the vdW solute-solvent interactions (better fitting the solvation free energy of amino acid side chain analogues) and by an increase of vdW radius of guanidinium interactions, and thus a dramatic reduction of electrostatic interaction between Arg and Glu/Asn in CHARMM36m, respectively. These modifications effectively improve the overly sticky association of proteins, such as ubiquitin, using the original potential function. By analyzing the 25 native SAM complexes formed in the simulations, we find that their formation involves a pre-orientation guided by electrostatic interaction, consistent with an electrostatic steering mechanism. The complex could then transform to the native protein interaction surfaces directly from a well pre-orientated position (Δinterface-RMSD < 5Å). In other cases, modest (< 90°) orientational and/or translational adjustments are needed (5 Å <Δi-RMSD <10 Å) to the native complex. Although the tendency for non-native complexes to dissociate has nearly doubled with the modified potential functions, a re-association to the correct complex structure is still rare. Instead a most non-native complexes are undergoing configurational changes/surface searching, which do not lead to native structures on a timescale of 250 ns. These observations provide a rich picture on mechanisms of protein-protein complex formation, and suggest that computational predictions of native complex protein-protein interactions could be improved further.