bluuebunny/crossref_metadata_2025_split huggingface dataset:
A standardised frankincense extract reduces disease activity in relapsing-remitting multiple sclerosis (the SABA phase IIa trial)
Authors: Stürner Klarissa Hanja , Stellmann Jan-Patrick , Dörr Jan , Paul Friedemann , Friede Tim , Schammler Sven , Reinhardt Stefanie , Gellissen Susanne , Weissflog Gainet , Faizy Tobias Djamsched , Werz Oliver , Fleischer Sabine , Vaas Lea A I , Herrmann Frank , Pless Ole , Martin Roland , Heesen Christoph 
Published: December 2017

ObjectiveTo investigate whether oral administration of a standardised frankincense extract (SFE) is safe and reduces disease activity in patients with relapsing-remitting multiple sclerosis (RRMS).MethodsWe performed an investigator-initiated, bicentric phase IIa, open-label, baseline-to-treatment pilot study with an oral SFE in patients with RRMS (NCT01450124). After a 4-month baseline observation phase, patients were treated for 8 months with an option to extend treatment for up to 36 months. The primary outcome measures were the number and volume of contrast-enhancing lesions (CEL) measured in MRI during the 4-month treatment period compared with the 4-month baseline period. Eighty patients were screened at two centres, 38 patients were included in the trial, 28 completed the 8-month treatment period and 18 of these participated in the extension period.ResultsThe SFE significantly reduced the median number of monthly CELs from 1.00 (IQR 0.75–3.38) to 0.50 (IQR 0.00–1.13; difference −0.625, 95% CI −1.25 to −0.50; P<0.0001) at months 5–8. We observed significantly less brain atrophy as assessed by parenchymal brain volume change (P=0.0081). Adverse events were generally mild (57.7%) or moderate (38.6%) and comprised mainly gastrointestinal symptoms and minor infections. Mechanistic studies showed a significant increase in regulatory CD4+ T cell markers and a significant decrease in interleukin-17A-producing CD8+ T cells indicating a distinct mechanism of action of the study drug.InterpretationThe oral SFE was safe, tolerated well and exhibited beneficial effects on RRMS disease activity warranting further investigation in a controlled phase IIb or III trial.Clinical trial registrationNCT01450124; Results.
The Voice of Autoimmunity: Antisynthetase Syndrome Manifesting as Vocal Fold Bamboo Nodes
Authors: Kim Matthew , Sadoughi Babak 
Published: December 2017

Objectives: To describe a case of vocal fold bamboo nodes leading to the diagnosis of antisynthetase syndrome, a rare autoimmune disorder. To highlight the link between these laryngeal lesions and autoimmunity. Methods: A case of vocal fold bamboo nodes in a patient with long-standing interstitial lung disease is presented. The presence of these characteristic lesions prompted a rheumatologic workup that led to the diagnosis of a rare autoimmune disorder. Results: The patient was ultimately diagnosed with antisynthetase syndrome, a rare condition characterized by inflammatory myositis and interstitial lung disease. She was treated with steroids and immunosuppressive agents with improvement in her symptoms and clinical findings. Conclusions: Vocal fold bamboo nodes are pathognomonic signs of autoimmunity. Management consists primarily of medical treatment of the underlying systemic disorder. Intralesional steroid injection or phonomicrosurgical excision may be considered for refractory cases.
The British Police Experience
Authors: St. Johnston Eric 
Published: December 2017

We have pleasure in publishing an address given by H.M. Chief Inspector in connexion with the University of Michigan's “Programme of Continuing Education in Urban Affairs”. Sir Eric's special relationship with the United States goes back to his service as a Colonel on the late General Eisenhower's staff in 1943–44, when his deputy was that famous American police thinker and police chief, Mr. Orlando Wilson. In his introduction to the address, Mr. William C. Rogers, Director of the above Programme, remarked: “The European urban experience can offer us Americans new choices and options for handling our pressing domestic affairs. The Europeans have a lot to teach us. They had cities long before they had nations. They know most of the answers to how to lead the good life in an urban setting… Most of us place law, order and justice at the top of our list of urban priorities. We will concede that our police systems could do with improvement. What could be more natural than to get advice on our police problems from Great Britain, which pioneered urban police systems?”
National Drugs Intelligence Unit
Authors: Stockley David 
Published: December 2017

Served 3–1/2 years as Deputy Head of the Metropolitan Police Central Drug Squad. During this time he was seconded to the Bahamas (between November 1983 and July 1984) as an investigator to assist a Commission of Inquiry into drug trafficking from South America to the USA using the Bahamas as a transhipment point. The inquiry also included investigating allegations of involvement by public officials including members of the Bahamian Government. He was promoted Detective Chief Superintendent in April 1986 and has since served in the National Drugs Intelligence Unit during the major part of its development. Any opinions expressed in this article are those of the author and should not be attributed to the NDIC, Metropolitan Police or Home Office.
Changes in medication use in a cohort of patients with advanced cancer: The international multicentre prospective European Palliative Care Cancer Symptom study
Authors: Paque Kristel , Elseviers Monique , Vander Stichele Robert , Pardon Koen , Hjermstad Marianne J , Kaasa Stein , Dilles Tinne , De Laat Martine , Van Belle Simon , Christiaens Thierry , Deliens Luc 
Published: December 2017

Background: Information on medication use in the last months of life is limited. Aim: To describe which medications are prescribed and deprescribed in advanced cancer patients receiving palliative care in relation to time before death and to explore associations with demographic variables. Design: Prospective study, using case report forms for monthly data collection. Medication included cancer treatment and 19 therapeutic groups, grouped into four categories for: (1) cancer therapy, (2) specific cancer-related symptom relief, (3) other symptom relief and (4) long-term prevention. Data were analysed retrospectively using death as the index date. We compared medication use at 5, 4, 3, 2 and 1 month(s) before death by constructing five cross-sectional subsamples with medication use during that month. Paired analyses were done on a subsample of patients with at least two assessments before death. Setting/participants: We studied the medication use of 720 patients (mean age 67, 56% male) in 30 cancer centres representing 12 countries. Results: From 5 to 1 month(s) before death, cancer therapy decreased (55%–24%), most medications for symptom relief increased, for example, opioids (62%–81%) and sedatives (35%–46%), but medication for long-term prevention decreased (38%–27%). The prevalence of chemotherapy was 15.5% in the last month of life, with 9% of new courses started in the last 2 months. With higher age, chemotherapy and opioid use decreased. Conclusion: Medications for symptom relief increased in almost all medication groups. Deprescribing was found in heart medication/anti-hypertensives and cancer therapy, although use of the latter remained relatively high.
The role of macrophages in the differentiation process of ureteral polyps
Authors: Wang Yue-Hui , Zhang Tian-Qi , Fu Ji-Ning , Liu Ying , Jia Hai-Yan 
Published: December 2017

Objective To evaluate the role of macrophage infiltration in the differentiation process of ureteral polyps and cancers. Methods This retrospective immunohistochemical study analysed archival samples of pathologically-confirmed specimens of low- and high-grade ureteral cancer, ureteral papilloma and ureteral polyps. The samples were immunohistochemically stained for cluster of differentiation (CD)4, CD8, CD16, CD25, CD56 and CD68 using immunofluorescence in order to identify different T-lymphocyte populations and macrophages. Results A total of 70 specimens were included in the analysis: 21 specimens of ureteral cancer, 17 specimens of ureteral papilloma, and 32 specimens of ureteral polyps. The largest proportion of CD4+CD25+ regulatory T cells was observed in the low-grade ureteral cancer group and almost none were observed in ureteral papillomas. The largest proportion of CD8+ cytotoxic T-lymphocytes was observed in the ureteral polyps. The largest proportion of CD56+ natural killer cells was detected in the ureteral polyps, with very low levels observed in the other three groups. The largest proportion of CD16+CD68+ macrophages was observed in the high-grade ureteral cancer group, which was significantly higher than that observed in the ureteral papillomas. Conclusions This study revealed that CD16+CD68+ macrophages appear to participate in ureteral neoplastic transformation.
Euglycemic Diabetic Ketoacidosis Associated With Sodium–Glucose Cotransporter Type 2 Inhibitors in Patients With Type 2 Diabetes Mellitus Receiving Oral Therapy
Authors: Dull Ryan B. , Spangler Mikayla L. , Knezevich Emily L. , Lau Britney M. 
Published: December 2017

Introduction and Objective: Postmarketing reports and warnings of serious adverse events such as diabetic ketoacidosis (DKA) have raised concern regarding the safety of sodium–glucose cotransporter 2 inhibitors (SGLT2i). This report describes 2 cases of symptomatic SGLT2i-associated euglycemic DKA (euDKA) leading to hospitalization in patients with type 2 diabetes mellitus (DM) previously well controlled on oral medications. Case Reports: Subject 1 is a 55-year-old female admitted with euDKA precipitated by infection and managed with intravenous insulin. This case was notable for a delayed diagnosis of euDKA and lack of clinical improvement despite withholding dapagliflozin. Subject 2 is a 62-year-old male admitted with euDKA precipitated by infection. His clinical condition improved rapidly and euDKA responded to withdrawal of empagliflozin alone. Discussion: Applying the Naranjo adverse medication reaction probability scale to each case (subject 1 score = 3 points; subject 2 score = 4 points) suggests these are possible adverse reactions to SGLT2i. Data from randomized controlled trials suggest DKA events in adults with type 2 DM receiving SGLT2i are rare and similar to placebo. However, data from a large cohort suggest these events occur more frequently and are associated with a 2-fold increased risk of DKA. Conclusion: This class of medications may be associated with a higher real-world risk of DKA in adults with type 2 DM than previously reported. Patients prescribed these medications should receive vigilant assessment for features of traditional DKA as well as euDKA.
Health and hierarchy: soldiers, civilians and mental healthcare in Scotland, 1914–34
Authors: Farquharson Jennifer 
Published: December 2017

During the First World War injured servicemen were constructed as a better class of patient than civilians, and their care was prioritized in social and political discourses. For the mentally disordered servicemen themselves, however, these distinctions were permeable and transient. This article will challenge the reality of the ‘privileged’ service patient in civil asylums in Scotland. By examining the impact of the war on asylum structures, economies and patient health, this study will explore exactly which patients were valued in these difficult years. In so doing, this paper will also reveal how the lives of institutionalized ex-servicemen and the civilian insane inside district asylums were not quite as distinct as political and social groups would have liked.
Posttraumatic Stress Disorder, Quality of Life, and the Subjective Experience in Liver Transplant Recipients
Authors: Paslakis Georgios , Beckmann Mingo , Beckebaum Susanne , Klein Christian , Gräf Jan , Erim Yesim 
Published: December 2017

Objective: A high prevalence of posttraumatic stress disorder (PTSD) symptoms among transplant recipients has been associated with a low adherence to treatment and poor survival. It is crucial to detect and prevent the development of posttraumatic stress in transplant settings. Methods: We examined the prevalence of posttraumatic stress symptoms in 3 liver transplant recipients by means of the Essen Trauma Inventory (ETI), a self-report questionnaire. The Short Form-36 was used to assess the perceived health-related quality of life. Patients were asked to indicate the most traumatic events within the context of the liver transplantation procedure. Results: Five patients (4.9%) fulfilled the criteria for PTSD related to liver disease or transplantation (ETI score greater than 27). In these patients, diagnosis was confirmed by a structured clinical interview. Fourteen (13.6%) patients had a partial PTSD with the ETI score less than 27 and greater than 16. Posttraumatic stress symptoms were significantly associated with perceived poor physical and mental health-related quality of life. Patients reported that the physicians’ disclosure of diagnosis was experienced as traumatic, followed by treatment in an intensive care unit and the liver transplantation itself. Conclusions: The ETI resulted in prevalence rates for PTSD comparable to previous studies in liver transplantation settings. Medical professionals requested additional training in how to deliver severe diagnoses to patients.
Donor Leucocytosis Predicts Bacterial and Fungal Contamination of the Preservation Solution in Visceral Organ Transplantation
Authors: Sotiropoulos Georgios C. , Steinmann Jörg , Stern Sabrina , Raduenz Sonia , Machairas Nikolaos , Rath Peter M. , Saner Fuat H. , Paul Andreas , Gallinat Anja 
Published: December 2017

Introduction: Contamination of the preservation solution may contribute to septic complications that can occur after transplantation and cause higher morbidity and mortality among recipients. The aim of this study was to determine potential donor-related predictors of positive microbiological findings in the preservation solution. Design: We retrospectively studied 16 donor parameters on data from our center for microbiological findings in the preservation solution used in solid-organ recovery. From January 2008 through December 2011, 976 solid organs were transplanted, and in 167, the solution was positive for contaminants. Results: The most frequently detected contaminant was coagulase-negative staphylococci. Only the donor leucocyte count (cutoff at 9.1 × 109/L) predicted positive microbiological findings in the preservation solution ( P = .0024). Multivariable regression analysis found that donor age, donor sex, intensive care unit stay, total number of organs recovered, and leucocyte count differentiated various categories of potentially pathogenic bacteria. Conclusion: Donor leucocyte count higher than 9.1 × 109/L predicts contamination of preservation solution.
Macrocognition in the Healthcare Built Environment (mHCBE): A Focused Ethnographic Study of “Neighborhoods” in a Pediatric Intensive Care Unit
Authors: O’Hara Susan , Klar Robin Toft , Patterson Emily S. , Morris Nancy S. , Ascenzi Judy , Fackler James C. , Perry Donna J. 
Published: December 2017

Objectives: The objectives of this research were to describe the interactions (formal and informal), in which macrocognitive functions occur and their location on a pediatric intensive care unit, to describe challenges and facilitators of macrocognition using space syntax constructs (openness, connectivity, and visibility), and to analyze the healthcare built environment (HCBE) using those constructs to explicate influences on macrocognition. Background: In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple healthcare settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, “macrocognition in the healthcare built environment” (mHCBE) addresses this relationship. Method: A focused ethnographic study was conducted including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data. Results: Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs). Conclusions: Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help increase understanding of how use of the framework of Macrocognition in the HCBE can improve design and support adaptation of interprofessional team practices, maximizing macrocognitive interaction opportunities for patient, family, and team safety and quality.
Association between route of illicit drug administration and hospitalizations for infective endocarditis
Authors: Olubamwo Olubunmi , Onyeka Ifeoma N , Aregbesola Alex , Ronkainen Kimmo , Tiihonen Jari , Föhr Jaana , Kauhanen Jussi 
Published: December 2017

Objective: This study examined the association between the route of drug administration and being hospitalized for infective endocarditis among 4817 treatment-seeking illicit drug users in Finland. Methods: Cox regression models were used to examine the association between the route of drug administration and infective endocarditis hospitalization, adjusted for age, gender, and homelessness. Cases of infective endocarditis as a primary/main diagnosis were tracked using the 10th version of the International Classification of Disease code I33. Results: In all, 47 persons had a primary diagnosis of infective endocarditis. These 47 persons contributed a total of 95 hospitalizations and their total length of hospital stay was 1393 days. There was a statistically significant difference in hospitalizations between injectors and non-injectors (Log-Rank test p = 0.018). Univariate Cox model showed that injectors had higher hazard or risk for infective endocarditis hospitalization compared to non-injectors (hazard ratio: 2.04, 95% confidence interval: 1.12–3.73, p = 0.020). After adjusting for age, gender, and homelessness in the multivariate model, the elevated hazard among injectors compared to non-injectors remained statistically significant with adjusted hazard ratio of 2.12 (95% confidence interval: 1.11–4.07, p = 0.024). Conclusion: The study findings suggested a need to boost harm reduction measures targeting high-risk injecting and other health behaviors among injecting drug users in order to reduce their hospitalizations for infective endocarditis.
mMRC dyspnoea scale indicates impaired quality of life and increased pain in patients with idiopathic pulmonary fibrosis
Authors: Rajala Kaisa , Lehto Juho T. , Sutinen Eva , Kautiainen Hannu , Myll�rniemi Marjukka , Saarto Tiina 
Published: December 2017

This study was undertaken to investigate idiopathic pulmonary fibrosis (IPF) patients' health-related quality of life (HRQoL) and symptoms in a real-life cross-sectional study. Our secondary aim was to create a simple identification method for patients with increased need for palliative care by studying the relationship between modified Medical Research Council (mMRC) dyspnoea scale, HRQoL and symptoms.
We sent a self-rating HRQoL questionnaire (RAND-36) and modified Edmonton Symptom Assessment Scale (ESAS) to 300 IPF patients; 84% of the patients responded to these questionnaires.
The most prevalent (>80%) symptoms were tiredness, breathlessness, cough and pain in movement. An increasing mMRC score showed a linear relationship (p<0.001) to impaired HRQoL in all dimensions of RAND-36 and the severity of all symptoms in ESAS. Dimensions of RAND-36 fell below general population reference values in patients with mMRC score =2. The intensity of pain in movement (p<0.001) and at rest (p=0.041), and the prevalence of chest pain (p<0.001) had a positive linear relationship to increased mMRC score.
An increasing mMRC score reflects impaired HRQoL and a high symptom burden. In clinical practice, the mMRC scale could be used for screening and identification of IPF patients with increased need for palliative care.
Cooperativity between antibiotics and antiseptics: testing the bactericidal effect
Authors: Jenull S. , Laggner H. , Hassl I. , Velimirov B. , Huettinger M. , Zemann N. 
Published: December 2017

Objective: Treatment with antibiotics together with local application of antiseptics is common in wound care. We investigated the effectiveness of an antiseptic in two variations: octenidine (Oct) and octenidine+ (Oct+ with isotonic glucose addition). Method: Using the agar diffusion test with cultures of pathogenic Staphylococcus aureus and the non-pathogenic Bordetella petrii, we compared the effectiveness of octenidine to the classical antiseptics beta-isodona (povidone-iodine; PI), chlorhexidine (Chl) and taurolin (Tau) alone, and in combination with various common antibiotics to uncover cooperativity between antiseptics and antibiotics. Results: We detected strong interactions between antibiotics and antiseptics, that either enhanced or reduced the bactericidal efficiency. Effectiveness was dependent on the type of organism tested. Oct applied together with ineffective antibiotics frequently led to effective growth inhibition of Bordetella petrii. With Staphylococcus aureus we did not find such an effect. To this end, we reason that positively charged Oct may associate with antibiotic compounds via electrostatic interactions and guide it more efficiently to the bacterial cell wall. Interaction with antibiotics sometimes led to sequestration and reduced availability of some antiseptic/antibiotic combinations, but never with Oct. Conclusion: These data provide new arguments for decision planning concerning the choice of agent in the treatment of wound infections.
Management of chronic diabetic foot ulcers using platelet-rich plasma
Authors: Babaei V. , Afradi H. , Gohardani H.Z. , Nasseri F. , Azarafza M. , Teimourian S. 
Published: December 2017

Objective: Platelet-rich plasma (PRP) has been proposed as an adjunct for the treatment of foot ulcers in patients with diabetes, as well as a treatment for chronic and acute wounds. This study examined the application of PRP in the treatment of diabetic foot ulcers (DFUs) in patients. Methods: This prospective study was conducted between 2011 and 2014. We used PRP, produced by a kit, for the treatment of DFUs. Patients were allocated to one of three groups, according to size of ulcer. The significance of changes in time for wound healing were statistically assessed. Results: The study was completed by 150 patients, and a total of 150 foot ulcers were assessed. Wound size reduction was detected in patients after four weeks of treatment. In DFUs with a 2–5.5 cm2 surface area, complete closure happened after 7.2 weeks, 5.5–8.5cm2 DFUs completely closed after 7.5 weeks, and 8.5–12.5cm2 DFUs healed completely after 8.8 weeks. None of the wounds reopened after eight months of monitoring. Conclusions: This study will provide more evidence for the use of autologous PRP for DFUs in patients.