bluuebunny/crossref_metadata_2025_split huggingface dataset:
Alpha-2-Makroglobulin-Serumspiegel bei Patienten mit Alpha-1-Antitrypsin-Mangel
Authors: Kotke V. , Wiedmann S. , Nell C. , Vogelmeier C. , Bals R. , Greulich T. , Klemmer A. 
Published: April 2017

Zusammenfassung
Hintergrund und Ziele Alpha-2-Makroglobulin (A2 M) ist ein Plasmaprotein mit proteolytischer Wirkung auf viele Proteasen. Bei Patienten mit einem angeborenen Alpha-1-Antitrypsinmangel (AATM) liegt ein funktioneller Protease-Überschuss vor. Ziel dieser Studie war es, die Hypothese zu prüfen, dass bei Patienten mit AATM ein erhöhter A2M-Spiegel nachweisbar ist.
Methoden Patienten mit AATM (Genpolymorphismus Pi*ZZ, Pi*SZ, Pi*MZ und seltene Genvarianten) wie auch Probanden mit einem normwertigen AAT-Spiegel (gesunde Probanden, Pi*MM) wurden der A2M- und AAT-Testung unterzogen. Die Serumkonzentrationen der Proteine wurden mittels Nephelometrie bestimmt. Die Polymorphismen Pi*Z und Pi*S wurden durch Polymerase-Kettenreaktion (PCR) nachgewiesen, seltene Genvarianten wurden durch Sequenzierung ermittelt.
Ergebnisse In unsere Studie wurden insgesamt 291 Individuen eingeschlossen. Es konnte gezeigt werden, dass es bei Vorliegen eines Genpolymorphismus (Pi*ZZ) und einem Alpha-1-Antitrypsin-Serumspiegel < 50 mg/dl zu einem signifikanten Anstieg des A2M-Spiegels im Serum gegenüber den gesunden Probanden kommt.
Schlussfolgerungen In dieser Studie konnte eine inverse Korrelation zwischen den Serumspiegeln von AAT und A2M bei Vorliegen eines Genpolymorphismus (Pi*ZZ) nachgewiesen werden. Weitere Studien sind erforderlich, um zu erfassen, welche klinische Bedeutung erhöhte A2M-Serumpiegel bei Patienten mit einem schweren AAT-Mangel Pi*ZZ und seltenen Genvarianten, deren AAT-Serumspiegel unter 50 mg/dl liegt, haben könnten.
Dual RAAS Blockade with Aliskiren in Patients with Severely Impaired Chronic Kidney Disease
Authors: Rasche Franz , Joel Claudia , Ebert Thomas , Frese Thomas , Barinka Filip , Busch Volker , Rasche Wilma , Lindner Tom , Schneider Jochen , Schiekofer Stephan 
Published: April 2017

Abstract
Dual renin-angiotensin-aldosterone blockade (dRAASb) is purposed in the prevention of the cardiorenal syndrome (CRS). However, all attempts with dRAASb even in patients with moderate impaired chronic kidney disease (CKD) were terminated due to the typical severe adverse events (SAE), e. g., hyperkalemia and rise of serum creatinine. The aim of our study with the direct renin inhibitor aliskiren was to evaluate the effect of dRAASb with a washout phase in patients with severely advanced CKD.
We have studied 45 patients (G3b to 4, A2 and >A3; median glomerular filtration rate (GFR) CKD-EPI 31 (23–40) ml/min per 1.73 m² BSA (body surface area), albumin-creatinine-ratio in urine (UACR) (0.413 (0.164 to 1.39) g/g) and proteinuria (0.5 (0.2 to 0.9) g/l) before, with and without aliskiren (150 respectively 300 mg per day) added to an angiotensin-converting enzyme inhibitor (ACEi) or an AT1-receptor blocker (ARB) over 4 ½ years.
The dRAASb with aliskiren showed a significant decrease of proteinuria (0.5 to 0.38 g/l), especially in patients with an UACR≥350 mg/g and in the subgroup analysis e. g., in patients with diabetes, but proteinuria increased in the washout phase again. The blood pressure (130/80 mm Hg), serum potassium (4.9 to 5.0 mmol/l) and GFR remained nearly constant (31 to 29.5 ml/min per 1.73 m2 BSA). A more than 30% increase in serum creatinine was associated with an UACR>300 mg/g.
The dRAASb has beneficial effects on proteinuria and is safe in patients with severely advanced CKD. However, in patients with high UACR (>300 mg/g) raise of creatinine and potassium have to be controlled.
Growth and Spawning Dynamics of Southern Flounder in the North-Central Gulf of Mexico
Authors: Corey Morgan M. , Leaf Robert T. , Brown-Peterson Nancy J. , Peterson Mark S. , Clardy Samuel D. , Dippold David A. 
Published: April 2017

Abstract
Southern Flounder Paralichthys lethostigma is the most commonly harvested flatfish in the north-central Gulf of Mexico (GOM), yet knowledge of this species’ growth and reproduction is limited for the Mississippi region. Given the offshore spawning migrations and likely mixing between state-managed units of the GOM Southern Flounder stock, small-scale environmental influences may constitute a major driver of life history dynamics during early life residency in nearshore estuaries. Therefore, estimates of local demographic characteristics are needed for effective fishery management. Here, we describe critical life history traits of Southern Flounder, including estimation of growth rates and maturity. The three-parameter von Bertalanffy growth function best described female-specific growth: mean asymptotic length L∞ was 514 mm TL, mean growth coefficient k was 0.67 year–1, and mean theoretical age at zero length t0 was –0.50 years. The estimated female-specific mean length at 50% maturity (L50) was 303 mm TL, and the female-specific mean age at maturity was 0.96 years. Although we observed significant differences between L50 estimates in the GOM, length-at-age parameter estimates were similar to those reported for other areas of the GOM. Both individual growth and length-at-maturity estimates were significantly different from those reported for the Atlantic, suggesting basin-level differences in population characteristics, with faster growth and earlier maturation in the GOM. Histological indicators and gonadosomatic index data indicated that the spawning season in the north-central GOM occurs from November to January and that Southern Flounder are batch spawners with asynchronous oocyte development. Our study provides a description of growth and spawning dynamics that will contribute to future stock assessment efforts focused on the Southern Flounder fishery in Mississippi and the GOM.
Regional differences in coronary revascularization procedures and outcomes: a nationwide 11-year observational study
Authors: Vaez Marjan , Dalén Magnus , Friberg Örjan , Nilsson Johan , Frøbert Ole , Lagerqvist Bo , Ivert Torbjörn 
Published: April 2017

Abstract

Aims
The study investigated whether regional differences in choice of coronary revascularization affected outcomes in Sweden.

Methods and results
We conducted a prospective nationwide study of outcome in patients undergoing coronary artery bypass grafting (CABG, n = 47 065) or percutaneous coronary intervention (PCI, n = 140 945) from 2001 through 2011, tracked for a median of 5 years. During this period, the proportion of CABG in revascularization procedures decreased nationwide from an average of 38% to 18%e. Three-vessel disease and left main stem coronary artery stenosis were more common among CABG patients than in PCI patients. In both males and females, all-cause mortality was higher in CABG patients than in PCI patients, while repeat PCI was performed more frequently in the PCI group. CABG proportions in 21 counties ranged from 13% to 42% in females and males. The combined outcomes of repeat revascularization, non-fatal acute myocardial infarction, and death during the tracking period was recorded in 151 936 patients without ST-elevation myocardial infarction after PCI (n = 37 820, 36%) and CABG (n = 18 903, 40%). The multivariable adjusted risk of combined outcomes was higher after both PCI and CABG in both females and males in the three quartiles of counties with a smaller proportion of CABG than in the quartile of counties with the highest proportion of CABG. Similar patterns persisted after including only mortality in the analyses.

Conclusion
There are subgroups of patients who have prognostic benefits of CABG in addition to symptomatic improvement that is well documented with both PCI and CABG.
Does the Internet Need a Hegemon?
Authors: Rovner Joshua , Moore Tyler 
Published: April 2017

AbstractHegemonic stability theory holds that a dominant power can produce international cooperation by providing public goods and resolving collective action dilemmas. Successful hegemons also resist the temptation to exploit their advantages in order to reduce other states’ fear of domination. This article asks whether or not the internet needs the United States to play a similar role. If so, Washington should pursue policies designed to strengthen internet security while eschewing espionage and cyberattacks that rely on some degree of internet insecurity. If not, it can go on the offensive without fear of undermining the system as a whole. We examine the technical and political fallout from revealed offensive cyberoperations to assess the relative fragility of the internet. Our findings suggest that it is relatively resilient.
Horace's Epistles and Ars Poetica
Authors: McCarter Stephanie 
Published: April 2017

The Epistles and the Ars Poetica consist of verse letters written in dactylic hexameter. Epistles 1, published in 19 bce, comprises twenty letters with a range of real and fictive addressees. The dating of Epistles 2 presents a more difficult puzzle, although scholars generally date the poems to the period between 13 bce and Horace’s death in 8 bce. This book contains two poems, the first addressed to Augustus and the second to Julius Florus. The 476-line Ars Poetica is addressed to a Piso and his two sons and has been variously dated, with some estimates as early as 24 bce and some as late as 8 bce. Debate persists as to whether the poems of Epistles 2 should be treated singly or as a unified book. Sometimes treated as “Epistles 2.3,” the Ars Poetica was nevertheless thought of as a discrete work already in Quintilian, Institutio Oratoria 8.3.60. Produced in the wake of Horace’s monumental Odes 1–3, Horace’s epistolary poems are the product of a mature poetic voice, and the persona constructed in them belongs to a man with the success and experience that allows him to address with authority not only younger colleagues and protégés but also his social superiors. In keeping with this experienced persona, the poems turn away from the erotic and sympotic themes prevalent in the Odes and focus instead on the ethical (Epistles 1) and literary (Epistles 2 and Ars Poetica) topics befitting his changed age and mentality (Epist. 1.1.4). The poet shifts away from the role of public vates adopted, for example, in the Roman Odes and instead occupies a secluded retreat from which he addresses men occupying a range of public and private positions. Horace ironically claims (Epist. 1.1.10, 2.2.52–57, and Ars 306) that these letters are something less than formal poetry, which, along with their short hexameter form and moral focus, connects the Epistles with his earlier Satires (cf. esp. 1.4.39–42), themselves the product of a “pedestrian muse” (Sat. 2.6.17). While the Epistles share strong thematic links to the Satires, Horace develops these themes anew in keeping not only with his own changed voice but also with the social and political transformations of Augustan Rome. Often viewed in the shadow of his more widely read Satires and Odes, the Epistles and Ars Poetica have nevertheless received an impressive amount of scholarly attention.
Vulnerability to Psychopathology and Dimensions of Personality in Patients With Fibromyalgia
Authors: Garcia-Fontanals Alba , Portell Mariona , García-Blanco Susanna , Poca-Dias Violant , García-Fructuoso Ferran , López-Ruiz Marina , Gutiérrez-Rosado Teresa , Gomà-i-Freixanet Montserrat , Deus Joan 
Published: April 2017

Objective:
Fibromyalgia (FM) patients may present psychopathology and some characteristic personality traits that may affect their adaptation to the disease. The aim of this paper was to study the relationship between personality dimensions according to the psychobiological model of Cloninger and the presence of psychopathology.

Materials and Methods:
The study sample consisted of 42 patients with FM and 38 pain-free controls. The assessment instruments administered were the Temperament and Character Inventory-Revised and the Millon Clinical Multiaxial Inventory.

Results:
A higher proportion of clinical psychopathologic syndromes (CPS) was observed in the FM group than in the control group, the most prevalent being anxiety disorder and dysthymia. Patients with FM (with CPS or without CPS) presented higher Harm Avoidance than the control group, and the presence of a CPS also increased Harm Avoidance scores. FM patients with CPS had low Self-directedness (SD) compared with both the control group and with their FM peers without CPS. Purposefulness and Anticipatory worry-Pessimism explained 38% of the variance of dysthymia, and anticipatory worry-Pessimism explained 18% of the variance of anxiety disorders.

Conclusions:
Patients with FM have a high probability of anxious-depressive-type psychopathologic alterations. Their vulnerability to these conditions may be determined by personality traits. The SD character dimension may have implications for therapy, as low SD is associated with the presence of psychopathology and with a low capacity to cope with the disease.
Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs*
Authors: Edwards Jeffrey D. , Lucas Adam R. , Boscardin W. John , Dudley R. Adams 
Published: April 2017

Objectives:
To determine the occurrence rate of unplanned readmissions to PICUs within 1 year and examine risk factors associated with repeated readmission.

Design:
Retrospective cohort analysis.

Setting:
Seventy-six North American PICUs that participated in the Virtual Pediatric Systems, LLC (VPS, LLC, Los Angeles, CA).

Patients:
Ninety-three thousand three hundred seventy-nine PICU patients discharged between 2009 and 2010.

Interventions:
None.

Measurements and Main Results:
Index admissions and unplanned readmissions were characterized and their outcomes compared. Time-to-event analyses were performed to examine factors associated with readmission within 1 year. Eleven percent (10,233) of patients had 15,625 unplanned readmissions within 1 year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared with index admissions (4.0% vs 2.5% and 2.5 vs 1.6 d; all p < 0.001). Median time to readmission was 30 days for all readmissions, 3.5 days for readmissions during the same hospitalization, and 66 days for different hospitalizations. Having more complex chronic conditions was associated with earlier readmission (adjusted hazard ratio, 2.9 for one complex chronic condition; hazard ratio, 4.8 for two complex chronic conditions; hazard ratio, 9.6 for three or more complex chronic conditions; all p < 0.001 compared no complex chronic condition). Most specific complex chronic condition conferred a greater risk of readmission, and some had considerably higher risk than others.

Conclusions:
Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with complex chronic conditions and particular conditions were at much higher risk for readmission.
A Mixed Method Review of Tobacco Cessation for the Cardiopulmonary Rehabilitation Clinician
Authors: Mola Ana , Lloyd Madeleine M. , Villegas-Pantoja Miguel A. 
Published: April 2017

PURPOSE:
To systematically survey the literature, describe the current tobacco science, and perform a mixed method review of randomized control trials of tobacco research in the cardiopulmonary population.

METHODS:
Mixed method review was conducted on major resource databases. Inclusion criteria were English language with a minimum follow-up of 6 months, published between January 1, 2007, and June 30, 2016; adult smokers ≥18 years of age with cardiovascular and/or pulmonary disease; initiation of subject recruitment from hospital or community; tobacco cessation (TC) as the main aim of the study; biometric validation of smoking status; first-line TC medications; and nonpharmacological treatments.

RESULTS:
The pooling of the 10 studies through forest plot analysis revealed the effect of tobacco continuous abstinence rates significant at 3, 6, and 12 months (total OR = 3.73; 95% CI, 2.58-5.38). Also, tobacco point prevalence rates of TC treatments demonstrated overall effects that were significant at the different end points (total OR = 2.63; 95% CI, 1.90-3.64). In both cases, the higher ORs were found in the 3 months end point. Most successful interventions consisted of a combination of pharmacological and nonpharmacological therapy (predominantly counseling).

CONCLUSIONS:
The evidence continues to support the recommended first-line TC pharmacotherapy and nonpharmacological practices published in the 2008 national guidelines. Implications for cardiopulmonary rehabilitation clinicians are discussed.
The effect of a lay-led, group-based self-management program for patients with chronic pain: a randomized controlled trial of the Danish version of the Chronic Pain Self-Management Programme
Authors: Mehlsen Mimi , Hegaard Lea , Ørnbøl Eva , Jensen Jens Søndergaard , Fink Per , Frostholm Lisbeth 
Published: April 2017

Abstract
The Stanford Chronic Pain Self-Management Programme (CPSMP) consists of 6 2½-hour weekly workshops focusing on how to manage pain in daily life. The workshops are facilitated by 2 workshop leaders of whom at least 1 must suffer from a long-term pain condition. The program is highly structured and manualized. Only few controlled trials testing the effect of CPSMP exist. Enrolled in the study were 424 adults from 19 Danish municipalities, (72% women; age: 25-93 years) with pain of any etiology and great variation in pain history (0-50 yrs). Of these, 216 were randomized to a lay-led version of the CPSMP. The primary outcome was pain-related disability. Secondary outcomes were pain, pain catastrophizing, self-efficacy, emotional distress, physical symptoms, and illness worry. Outcomes were measured before randomization, immediately after the CPSMP (response rate: 94%), and at 3-month follow-up (response rate: 92%). National register data on health expenditure were obtained to examine effects on health care use. ClinicalTrials.gov Identifier: NCT01306747. The CPSMP had no effect on the primary outcome pain-related disability or on health expenditure during intervention and follow-up period. Small positive effects on emotional distress and illness worry 3 months after CPSMP were observed. Lay-led CPSMP is not recommended as treatment for chronic pain-related disability. This heterogeneous group of patients with pain did not benefit from the CPSMP except for a small, but clinically insignificant improvement in psychological well-being.
Sensitivity and Specificity of the Modified Balance Error Scoring System in Concussed Collegiate Student Athletes
Authors: Buckley Thomas A. , Munkasy Barry A. , Clouse Brandy P. 
Published: April 2017

Objective:
To assess the efficacy of the modified Balance Error Scoring System (mBESS) compared with the Balance Error Scoring System (BESS) in an acutely concussed population.

Design:
Prospective observational study.

Setting:
University athletic training room.

Patients:
Thirty-five collegiate student-athletes (18 Female, 18.9 ± 0.8 year old, height: 1.71 ± 0.12 m, weight: 76.3 ± 24.1 kg) with diagnosed concussions and baseline BESS/mBESS tests.

Interventions:
All participants completed the BESS and mBESS on the day after the concussion (acute) and were retested daily until their BESS score achieved baseline value (recovery).

Main Outcome Measures:
The number of errors committed during the BESS and mBESS at each time point were recorded. The sensitivity and specificity of the BESS and mBESS compared with the baseline test was calculated for acute and recovery as well as the mBESS compared with the BESS.

Results:
At acute, the sensitivity of the BESS and mBESS were 60.0% and 71.4%, respectively. Relative to mBESS baseline, 60% of participants were misclassified at either acute or recovery.

Conclusions:
The mBESS had higher sensitivity at acute and identified lingering deficits at BESS recovery. Use of the mBESS is likely to produce different results than the BESS; however, the clinical implications of this warrant further investigation.
Sleep Quality and Quantity in Low-Income Postpartum Women
Authors: Doering Jennifer J. , Szabo Aniko , Goyal Deepika , Babler Elizabeth 
Published: April 2017

Abstract

Purpose:
To describe and explore patterns of postpartum sleep, fatigue, and depressive symptoms in low-income urban women.

Study Design and Methods:
In this descriptive, exploratory, nonexperimental study, participants were recruited from an inpatient postpartum unit. Subjective measures were completed by 132 participants across five time points. Objective sleep/wake patterns were measured by 72-hour wrist actigraphy at 4 and 8 weeks. Mean sample age was 25 years, high school educated with 3.1 children. Over half the sample reported an annual income less than 50% of the federal poverty level.

Results:
Objectively, total nighttime sleep was 5.5 hours (week 4) and 5.4 hours (week 8). Subjectively, 85% met criteria for “poor sleep quality” at week 4, and nearly half were persistently and severely fatigued through 8 weeks postpartum.

Clinical Implications:
The majority (65%) of women in this study met the definition of “short sleep duration,” defined as sleeping ≤ 6 hours per night. Adverse effects of this short sleep on physical and mental health as well as safety and functioning, especially within the context of poverty, may be profound. There is an urgent need for further research on sleep in low-income underrepresented women to identify interventions that can improve sleep and fatigue as well as discern the implications of sleep deprivation on the safety and physical and mental health of this population.
The Impact of Body Mass Index on Abdominal Wall Reconstruction Outcomes: A Comparative Study
Authors: Giordano Salvatore A. , Garvey Patrick B. , Baumann Donald P. , Liu Jun , Butler Charles E. 
Published: April 2017

Background:
Obesity and higher body mass index may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction. The authors hypothesized that higher body mass indexes result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in abdominal wall reconstruction patients.

Methods:
The authors included 511 consecutive patients who underwent abdominal wall reconstruction with underlay mesh. Patients were divided into three groups on the basis of preoperative body mass index: less than 30 kg/m2 (nonobese), 30 to 34.9 kg/m2 (class I obesity), and 35 kg/m2 or greater (class II/III obesity). The authors compared postoperative outcomes among these groups.

Results:
Class I and class II/III obesity patients had higher surgical-site occurrence rates than nonobese patients (26.4 percent versus 14.9 percent, p = 0.006; and 36.8 percent versus 14.9 percent, p < 0.001, respectively) and higher overall complication rates (37.9 percent versus 24.7 percent, p = 0.007; and 43.4 percent versus 24.7 percent, p < 0.001, respectively). Similarly, obese patients had significantly higher skin dehiscence (19.3 percent versus 7.2 percent, p < 0.001; and 26.5 percent versus 7.2 percent, p < 0.001, respectively) and fat necrosis rates (10.0 percent versus 2.1 percent, p = 0.001; and 11.8 percent versus 2.1 percent, p < 0.001, respectively) than nonobese patients. Obesity class II/III patients had higher infection and seroma rates than nonobese patients (9.6 percent versus 4.3 percent, p = 0.041; and 8.1 percent versus 2.1 percent, p = 0.006, respectively). However, class I and class II/III obesity patients experienced hernia recurrence rates (11.4 percent versus 7.7 percent, p = 0.204; and 10.3 percent versus 7.7 percent, p = 0.381, respectively) and freedom from hernia recurrence (overall log-rank, p = 0.41) similar to those of nonobese patients.

Conclusion:
Hernia recurrence rates do not appear to be affected by obesity on long-term follow-up in abdominal wall reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.