bluuebunny/crossref_metadata_2025_split huggingface dataset:
Self-care of children with arthrogryposis in Gauteng, South Africa
Authors: Joubert Frances , Franzsen Denise 
Published: June 2015

Introduction This study investigated the functional ability of children with arthrogryposis, aged 6 months to 7.5 years, in South Africa, with the focus on the execution of age-appropriate self-care tasks. The level of independence, amount of caregiver assistance and modifications used during each task were ascertained, to assist in guiding occupational therapy intervention. Method This study was based on a quantitative cross-sectional design, with 19 participants divided into age groups assessed using the Pediatric Evaluation of Disability Inventory (PEDI). Results The infant and toddler group performed above expected levels in the self-care domain, whereas the preschool and school-aged group performed below the expected level. A significant correlation between the amount of caregiver assistance needed and the participants’ level of independence was found especially in the preschool and school-aged group. There was little use of modifications even with occupational therapy intervention and participants relied on compensatory methods and assistance to execute self-care tasks. Conclusion This study indicated that children with arthrogryposis need intervention to promote the independent execution of self-care tasks, and reduce the need for caregiver assistance. Therapists are encouraged to make use of modifications in furthering the age-appropriate independence of this population.
Prevalence of cranial autonomic parasympathetic symptoms in chronic migraine: Usefulness of a new scale
Authors: Riesco Nuria , Pérez-Alvarez Angel I , Verano Laura , García-Cabo Carmen , Martínez-Ramos Juana , Sánchez-Lozano Pablo , Cernuda-Morollón Eva , Pascual Julio 
Published: June 2015

Background Cranial autonomic symptoms (CAS) seem to appear in around half of migraine patients. Objective Our aim was to analyse the prevalence and profile of CAS, mainly of cranial autonomic parasympathetic symptoms (CAPS), in a series of patients with chronic migraine (CM) according the new criteria for autonomic symptoms in the current IHS classification. Patients and methods We recruited consecutive CM patients attending our headache clinic. Five CPAS were surveyed: lacrimation, conjunctival injection, eyelid oedema, ear fullness and nasal congestion. They were graded as 0 (absent), 1 (present and mild) and 2 (present and conspicuous); therefore the score in this CAPS scale ranges from 0 to 10 points. As a cranial autonomic sympathetic symptom (CSAS), we also asked about the presence of ptosis. Results We interviewed 100 CM patients. Their mean age was 45 years (18–63 years); 93 were females. Eighteen had no CAPS, while 82 reported at least one CAPS. There were only six patients with scores higher than 5, the mean and median CAPS being 2.1 and 2, respectively. Prevalence of CAPS was lacrimation (49%), conjunctival injection (44%), eyelid oedema (39%), ear fullness (30%) and nasal congestion (20%). Ptosis was reported by 42. Conclusion These results, by using for the first time an easy quantitative scale, confirm that (mild) CAPS are not the exception but the rule in CM patients. The score in this CAPS scale could be of help as a further endpoint in clinical trials or to be correlated with potential biomarkers of parasympathetic activation in primary headaches.
Mesenchymal Stem Cell Implantation in Knee Osteoarthritis
Authors: Kim Yong Sang , Choi Yun Jin , Koh Yong Gon 
Published: June 2015

Background: Several clinical studies have reported on cell-based treatment using mesenchymal stem cells (MSCs) for cartilage regeneration in knee osteoarthritis (OA). However, little is known about the factors that influence the clinical outcomes after surgery. Purpose/Hypothesis: This study aimed to investigate the clinical outcomes of MSC implantation in patients with knee OA and assess the factors that are associated with clinical outcomes. The hypothesis was that factors may exist that could influence clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: A total of 49 patients (55 knees) were retrospectively evaluated after MSC implantation for knee OA. The inclusion criteria were patients who had an isolated full-thickness cartilage lesion and Kellgren-Lawrence OA grade 1 or 2. Clinical outcomes were measured with the International Knee Documentation Committee (IKDC) score, Tegner activity score, and patients’ overall satisfaction with the surgery. Statistical analyses were performed to determine the effect of different factors on the clinical outcome. Results: The mean pre- and postoperative IKDC and Tegner activity scores significantly improved from 37.7 ± 6.3 to 67.3 ± 9.5 (IKDC) and from 2.2 ± 0.7 to 3.8 ± 0.7 (Tegner) ( P < .001 for both). Twenty-four patients reported their overall satisfaction with the surgery as excellent (43.6%), 17 as good (30.9%), 11 as fair (20.0%), and 3 as poor (5.5%). There were significant differences in clinical outcomes at the final follow-up among the age and lesion size groups ( P < .05 for all). Multivariate analyses showed high prognostic significance related to patient age and lesion size, and scatter plots suggested a cutoff age of 60 years and a cutoff lesion size of 6.0 cm2 for the optimum identification of poor clinical outcomes ( P < .05 for both). Conclusion: The clinical outcomes of MSC implantation for knee OA are encouraging. Patient age and lesion size are important factors that affect clinical outcomes; thus, these may serve as a basis for preoperative surgical decisions. Cutoff points exist for the risk of clinical failure in patients older than 60 years and those with a lesion size larger than 6.0 cm2.
Evaluation of Serum Lactate, Central Venous Saturation, and Venous-Arterial Carbon Dioxide Difference in the Prediction of Mortality in Postcardiac Arrest Syndrome
Authors: Riveiro Diego Fontoura Mendes , Oliveira Vanessa Martins de , Braunner Janete Salles , Vieira Silvia Regina Rios 
Published: June 2015

Introduction: Tissue hypoperfusion and hypoxia markers predict mortality in critically ill patients. This study evaluates the ability of serum lactate, central venous oxygen saturation (Scvo2), and venous-arterial carbon dioxide difference (GapCo2) to predict mortality in patients with postcardiac arrest (post-CA) syndrome. Methods: A prospective observational study of patients with post-CA in a tertiary teaching hospital. Serial assessments of lactate, lactate clearance (Clac), GapCo2, and Scvo2 in the first 72 hours post-CA were analyzed. Adults (≥18 years) patients resuscitated from CA were included. The primary end point was 28-day mortality and secondary end points were 24- and 72-hour mortality. Results: A total of 54 patients were recruited, 33 (61,1%) of 54 were men, with a 28-day mortality of 75.9%. Cardiac arrest occurred in-hospital in 84.6% of survivors and 97.5% of nonsurvivors. Lactate and Clac were significantly associated with mortality at 28 days, yielding an area under the receiver–operating characteristic curve of 0.797 (lactate 6 hours) and 0.717 (Clac 6 hours) with a positive predictive value of 96% for lactate 6 hours (> 2.5 mmol/L) and 89.5% for Clac 6 hours (<50%). Survival analysis confirmed the difference between the groups from the 24th hour post-CA. Considering mortality at 24 hours, lactate, Clac, and Scvo2 (immediately post-CA, 6 and 18 hours) were different between the groups. In mortality at 72 hours, lactate, Clac, Scvo2 (48 hours), and GapCo2 (36 and 48 hours) were associated with mortality. Conclusion: In post-CA syndrome, serum lactate and Clac were consistently able to predict mortality.
The Relationship between Prenatal Antidepressant Use and the Decision to Breastfeed among Women Enrolled in a Randomized Exercise Intervention Trial
Authors: Lewis Beth A. , Schuver Katie , Gjerdingen Dwenda , Avery Melissa , Sirard John , Marcus Bess H. 
Published: June 2015

Background: Despite the numerous health benefits associated with breastfeeding, only 49% of postpartum women in the United States breastfeed at 6 months. Therefore, it is important to understand factors that may influence a woman’s decision to breastfeed. Objective: The purpose of this study was to examine the relationship between prenatal antidepressant use and the decision to breastfeed among postpartum women. Methods: Participants were postpartum women (N = 87) who had participated in a randomized trial examining the efficacy of a 6-month exercise intervention for the prevention of postpartum depression (2009-2012). Participants were recruited from the upper Midwest and were at risk for postpartum depression. Participants completed telephone-based questionnaires assessing their prenatal antidepressant use and breastfeeding behavior. Results: Seventeen percent of the participants took an antidepressant medication during pregnancy and 91% breastfed at birth. After controlling for baseline depressive symptoms, body mass index, and condition assignment, participants who were taking an antidepressant during pregnancy were less likely to initiate breastfeeding than participants who were not taking an antidepressant during pregnancy, β = −2.042, P < .05 (odds ratio = 0.130; 95% confidence interval, 0.024-0.696). Conclusion: Our study indicates that prenatal antidepressant medication use may be a potential barrier to breastfeeding initiation. Additional research is needed to better understand the factors that play a role in the relationship between prenatal antidepressant use and breastfeeding initiation.
The Simulated Acculturation Model in the FOUNTAINS-Game
Authors: Männamaa Ivar , Leijen Äli 
Published: June 2015

Background. The problems and benefits of a multicultural society are actively discussed in many countries. FOUNTAINS is a table-top simulation game designed as a study aid to enhance comprehension of cultural integration processes. The game was developed for use in regular classroom settings and has been successfully tested with several groups of participants. The design of the game is based on the bi-dimensional model of acculturation that focuses on the joint issues of maintaining one’s culture and involvement in decision making. It also introduces the dilemma of cooperation and competition in a situation of limited resources. Participants must find ways to preserve their own comprehensive culture and at the same time provide other groups access to resources. Aim. The article examines the dynamics of the game and describes its basic design. The rules of the game and suggestions for debriefing are provided in an accompanying article – this issue. The purpose of the study was to evaluate the game’s validity and to assess the potential educational value and usability of the game. Method. FOUNTAINS was piloted with several groups, and a brief post-game questionnaire was conducted to evaluate learning outcomes. Experts of both integration and gaming were asked to evaluate the game; their feedback on the usability of the game referred to the face value of the game as an educational tool. After piloting the game was introduced to teachers, the majority of whom expressed willingness to use the game in their classes. Conclusion. The article concludes with the basic results of the evaluation. In spite of some limitations it can be said that FOUNTAINS is an efficient learning aid that works well with different age groups.
Remote Ischemic Conditioning for Preventing Contrast-Induced Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Interventions/Coronary Angiography
Authors: Bei Wei-jie , Duan Chong-yang , Chen Ji-yan , Wang Kun , Liu Yuan-hui , Liu Yong , Tan Ning 
Published: June 2015

Background: It is uncertain whether remote ischemic conditioning (RIC) has a protective effect on contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI)/coronary artery angiography (CAG). We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effect of RIC on CI-AKI in such patients. Methods: PubMed, MEDLINE, EMBASE, ClinicalTrials.gov , and the Cochrane Central Register of Controlled Trials databases were searched for RCTs that assessed the effect of RIC on CI-AKI in patients undergoing PCI/CAG. Results: Ten RCTs with 1389 patients (RIC group, 757 and control, 632) were included. The RIC group significantly exerted a lower risk of CI-AKI compared to the controls (odds ratio [OR] = 0.52, 95% confidence interval [CI] = 0.34-0.77, P = .001), and they had the similar effect on major adverse cardiovascular events within 1 year (OR = 0.36, 95% CI = 0.20-0.66, P < .001). The RIC reduced the rates of death within 30 days, but this was not significant (OR = 0.16, 95% CI = 0.02-1.34, P = .091). The RIC was associated with a significantly lower incidence of CI-AKI in patients following elective PCI/CAG (OR = 0.54, 95% CI = 0.33-0.87, P = .011). The RIC before not after the intervention was effective in reducing the occurrence of CI-AKI (OR: 0.37 vs 1.05, P = .022). The RIC of the upper arm has statistically significant effect on protecting CI-AKI but not that of the lower limb (OR: 0.41 vs 1.41, P = .004). The effect of RIC on CI-AKI was similar between patients with a mean estimated glomerular filtration rate <60 mL/min/1.73 m2 and those with mean rates ≥60 (OR: 0.23 vs 0.41, P = .333). Conclusion: The RIC reduced the incidence of CI-AKI in those receiving PCI/CAG. And RIC of the upper arm significantly reduced the risk of CI-AKI but not RIC of the lower limb in patients undergoing PCI/CAG.
Distinct functionality of neutrophils in multiple sclerosis and neuromyelitis optica
Authors: Hertwig Laura , Pache Florence , Romero-Suarez Silvina , Stürner Klarissa H , Borisow Nadja , Behrens Janina , Bellmann-Strobl Judith , Seeger Bibiane , Asselborn Natascha , Ruprecht Klemens , Millward Jason M , Infante-Duarte Carmen , Paul Friedemann 
Published: June 2015

Background: In contrast to multiple sclerosis (MS), lesions in neuromyelitis optica (NMO) frequently contain neutrophils. However, the phenotypic profile of neutrophils in these two distinct pathologies remains unknown. Objective: Our aim is to better understand the potential contribution of neutrophils to NMO and MS pathology. Methods: We performed the first functional analysis of blood neutrophils in NMO and MS, including evaluation of neutrophil immune response (fMLP receptor, TLR2), chemotaxis and migration (CXCR1, CD62L, CD43), regulation of complement (CD46, CD55, CD59), respiratory burst, phagocytosis and degranulation. Results: Compared with healthy controls (HC), neutrophils in NMO and MS show an activated phenotype characterized by an increased surface expression of TLR2 and fMLP receptor. However, contrary to MS neutrophils, NMO neutrophils show reduced adhesion and migratory capacity as well as decreased reduced production of reactive oxygen species (respiratory burst) and degranulation. Conclusion: Although NMO and MS neutrophils display an activated phenotype in comparison with HC, NMO neutrophils show a compromised functionality when compared with MS patients. These results suggest a distinct functional profile of neutrophils in MS and NMO.
Why does multiple sclerosis only affect human primates?
Authors: ‘t Hart Bert A 
Published: June 2015

Background: Multiple sclerosis (MS) develops exclusively in humans. Non-human primates are resistant against MS, although they are highly susceptible to the MS animal model, experimental autoimmune encephalomyelitis (EAE). Unravelling of the cause(s) underlying this discrepancy is highly relevant as insights might be gained into the elusive event(s) that trigger(s) MS. A well-established difference between the human primate ( Homo sapiens) and non-human primates is that humans are unable to synthesize the sialic acid N-glycolylneuraminic acid (Neu5Gc). Viewpoint: We propose the concept that long-term ingestion by human primates of the foreign Neu5Gc, via red meat consumption, is an ignored environmental risk factor for MS. Conceptually, incorporation of dietary Neu5Gc into vital regions of the central nervous system, such as the blood–brain barrier (BBB) and the axon–myelin unit, creates targets for binding of de novo synthesized heterophilic anti-NeuGc antibodies. Binding of the antibodies can cause BBB leakage and destabilization of the axon–myelin coupling. The ensuing cytodegeneration and release of self-antigens could be a start of the characteristic pathological features of MS.
Emergency medical service, nursing, and physician providers’ perspectives on delirium identification and management
Authors: LaMantia Michael A , Messina Frank C , Jhanji Shola , Nazir Arif , Maina Mungai , McGuire Siobhan , Hobgood Cherri D , Miller Douglas K 
Published: June 2015

Purpose of the study The study objective was to understand providers’ perceptions regarding identifying and treating older adults with delirium, a common complication of acute illness in persons with dementia, in the pre-hospital and emergency department environments. Design and methods The authors conducted structured focus group interviews with separate groups of emergency medical services staff, emergency nurses, and emergency physicians. Recordings of each session were transcribed, coded, and analyzed for themes with representative supporting quotations identified. Results Providers shared that the busy emergency department environment was the largest challenge to delirium recognition and treatment. When describing delirium, participants frequently detailed hyperactive features of delirium, rather than hypoactive features. Participants shared that they employed no clear diagnostic strategy for identifying the condition and that they used heterogeneous approaches to treat the condition. To improve care for older adults with delirium, emergency nurses identified the need for more training around the management of the condition. Emergency medical services providers identified the need for more support in managing agitated patients when in transport to the hospital and more guidance from emergency physicians on what information to collect from the patient’s home environment. Emergency physicians felt that delirium care would be improved if they could have baseline mental status data on their patients and if they had access to a simple, accurate diagnostic tool for the condition. Implications Emergency medical services providers, emergency nurses, and emergency physicians frequently encounter delirious patients, but do not employ clear diagnostic strategies for identifying the condition and have varying levels of comfort in managing the condition. Clear steps should be taken to improve delirium care in the emergency department including the development of mechanisms to communicate patients’ baseline mental status, the adoption of a systematized approach to recognizing delirium, and the institution of a standardized method to treat the condition when identified.
Flat-detector computed tomography evaluation in an experimental animal aneurysm model after endovascular treatment: A pilot study
Authors: Ott Sabine , Gölitz Philipp , Adamek Edyta , Royalty Kevin , Doerfler Arnd , Struffert Tobias 
Published: June 2015

We compared flat-detector computed tomography angiography (FD-CTA) to multislice computed tomography (MS-CTA) and digital subtracted angiography (DSA) for the visualization of experimental aneurysms treated with stents, coils or a combination of both. In 20 rabbits, aneurysms were created using the rabbit elastase aneurysm model. Seven aneurysms were treated with coils, seven with coils and stents, and six with self-expandable stents alone. Imaging was performed by DSA, MS-CTA and FD-CTA immediately after treatment. Multiplanar reconstruction (MPR) was performed and two experienced reviewers compared aneurysm/coil package size, aneurysm occlusion, stent diameters and artifacts for each modality. In aneurysms treated with stents alone, the visualization of the aneurysms was identical in all three imaging modalities. Residual aneurysm perfusion was present in two cases and visible in DSA and FD-CTA but not in MS-CTA. The diameter of coil-packages was overestimated in MS-CT by 56% and only by 16% in FD-CTA compared to DSA ( p < 0.05). The diameter of stents was identical for DSA and FD-CTA and was significantly overestimated in MS-CTA ( p < 0.05). Beam/metal hardening artifacts impaired image quality more severely in MS-CTA compared to FD-CTA. MS-CTA is impaired by blooming and beam/metal hardening artifacts in the visualization of implanted devices. There was no significant difference between measurements made with noninvasive FD-CTA compared to gold standard of DSA after stenting and after coiling/stent-assisted coiling of aneurysms. FD-CTA may be considered as a non-invasive alternative to the gold standard 2D DSA in selected patients that require follow up imaging after stenting.
Spironolactone is secure and reduces left ventricular hypertrophy in hemodialysis patients
Authors: Feniman-De-Stefano Greicy Mara Mengue , Zanati-Basan Silméia Garcia , De Stefano Laercio Martins , Xavier Patrícia Santi , Castro Ana Dóris , Caramori Jacqueline Costa Teixeira , Barretti Pasqual , Jorge da Silva Franco Roberto , Martin Luis Cuadrado 
Published: June 2015

Objectives: There is recent evidence that aldosterone play a role in the pathogenesis of cardiovascular disease in dialysis patients, which leads to the opportunity to block its actions for the benefit of these patients. In nondialytic chronic kidney disease, spironolactone was safe and effective in reducing left ventricular hypertrophy. However, routine use has been precluded in hemodialysis patients due to the risk of hyperkalemia. The aim of this study is to verify the safety and efficacy in regression of left ventricular hypertrophy with spironolactone in hemodialysis patients undergoing pharmacotherapeutic monitoring. Methods: We performed a controlled, randomized, double blind study evaluating 17 hemodialysis patients who received spironolactone at a dose of 12.5 mg titrated, in the second week, to 25 mg of spironolactone or placebo. The patients were treated for 6 months. Results: The groups were composed of eight patients (intervention) and nine patients (control). These groups did not differ in their baseline characteristics. The group receiving spironolactone had a left ventricular mass index reduction from 77 ± 14.6 g/m2.7 to 69 ± 10.5 g/m2.7, p < 0.04, whereas in placebo group there was an increase from 71 ± 14.2 g/m2.7 to 74 ± 17.4 g/m2.7. Systolic or diastolic blood pressure did not change during the study. Potassium did not differ statistically between groups in all instances. Conclusion: Spironolactone treatment in hemodialysis patients was secure and effective in regression of left ventricular hypertrophy, a major risk factor for cardiovascular events in these patients. This effect occurred in spite of blood pressure stability. Trial registration: ClinicalTrials.gov identifier NCT01128101