bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of impaired renal function on levels and performance of D-dimer in patients with suspected pulmonary embolism
Authors: Bertoletti Laurent , Combescure Christophe , Gal Grégoire Le , Bounameaux Henri , Righini Marc , Robert-Ebadi Helia 
Published: June 2014

SummaryClinical probability and D-dimer measurement play an essential role in the non-invasive diagnostic strategies for pulmonary embolism (PE). PE can be ruled out without further imaging in patients with non-high clinical probability and negative D-dimer. D-dimer level is increased in patients with renal impairment. Whether its diagnostic usefulness is maintained in these patients is not well determined. We aimed to evaluate the effects of renal impairment on diagnostic performances of D-dimer in patients with suspected PE. A retrospective analysis of 1,625 patients with suspected PE included in a multicentre prospective study was performed. D-dimer levels and percentages of patients with a negative D-dimer were compared between three subgroups according to glomerular filtration rate (GFR) estimated by the MDRD formula: ≥90 ml/min (normal renal function), 60–89 ml/min (mild renal impairment), 30–59 ml/min (moderate renal impairment). D-dimer levels increased and the proportion of negative D-dimer decreased significantly according to renal status: 46% negative D-dimer in patients with normal GFR, 31% in patients with mild renal impairment, 11% in those with moderate renal impairment, corresponding to number of patients needed to test to obtain one negative test of 2.2, 3.2 and 9, respectively. In conclusion, the clinical usefulness of D-dimer decreases with renal impairment. However, PE can still be ruled out by negative D-dimer in a substantial proportion of patients with non-high clinical probability, avoiding exposure to contrast media.
Enhanced factor VIIIa stability of A2 domain interface variants results from an increased apparent affinity for the A2 subunit
Authors: Griffiths Amy , Wintermute Jennifer , Fay Philip , Monaghan Morgan , Wakabayashi Hironao 
Published: June 2014

SummaryFactor (F)VIIIa, a heterotrimer comprised of A1, A2, and A3C1C2 subunits, is labile due to the tendency of the A2 subunit to dissociate from the A1/A3C1C2 dimer. As dissociation of the A2 subunit inactivates FVIIIa activity, retention of A2 defines FVIIIa stability and thus, FXase activity. Earlier results showed that replacing residues D519, E665, and E1984 at the A2 domain interface with Ala or Val reduced rates of FVIIIa decay, increasing FXa and thrombin generation. We now show the enhanced FVIIIa stability of these variants results from increases in inter-A2 subunit affinity. Using a FVIIIa reconstitution assay to monitor inter-subunit affinity by activity regeneration, the apparent Kd value for the interaction of wild-type (WT) A2 subunit with WT A1/A3C1C2 dimer (43 ± 2 nM) was significantly higher than values observed for the A2 point mutants D519A/V, E665A/V, and E1984A/V which ranged from ~5 to ~19 nM. Val was determined to be the optimal hydrophobic residue at position 665 (apparent Kd = 5.1 ± 0.7 nM) as substitutions with Ile or Leu at this position increased the apparent Kd value by ~3- and ~7-fold, respectively. Furthermore, the double mutant (D519V/E665V) showed an ~47-fold lower apparent Kd value (0.9 ± 0.6 nM) than WT. Thus these hydrophobic mutations at the A2 subunit interfaces result in high binding affinities for the A2 subunit and correlate well with previously observed reductions in rates in FVIIIa decay.
Avaliação da perfusão tecidual no choque
Authors: Silva Eliézer , Garrido Alejandra Gallardo , Assunção Murillo S. C. 
Published: June 2014

Apesar das diversas inovações tecnológicas e do melhor entendimento fisiopatológico dos estados de choque, esta condição permanece com elevada taxa de morbimortalidade. Uma das explicações mais aceitas para a taxa elevada é o desenvolvimento da síndrome de disfunção de múltiplos órgãos (SDMO), secundária à hipoperfusão tecidual persistente. Assim, é evidente a importância da avaliação da perfusão tecidual em tais quadros, bem como possíveis interferências terapêuticas a partir da avaliação. Nesta revisão, são abordadas noções básicas sobre a monitorização clínica e laboratorial da perfusão tecidual no choque, incluindo transporte de O2, consumo e taxa de extração de O2 saturação venosa mista de O2, lactato e gradiente gastroarterial de CO2. Tais dados são fundamentais para a correta interpretação e melhor intervenção terapêutica, visando adequar o desequilíbrio presente entre oferta/consumo de O2 e, desta forma, interromper a série de eventos fisiopatológicos que resulta em SDMO e, em muitas condições, em morte. Nesse contexto, algumas metas devem ser alcançadas durante a ressuscitação de pacientes com síndrome do choque, a saber: pressão arterial média > 65 mmHg; diurese ³ 1 ml/kg/hora; débito cardíaco suficiente para manter uma SvO2 >65%; lactato sérico < 2 mmol/L, destacando que, mesmo quando normalizadas as variáveis sistêmicas de oxigenação, graves distúrbios perfusionais regionais ainda podem existir, sendo necessário recorrer à monitorização regional através da avaliação do pCO2-gap.
Perdas auditivas condutivas
Authors: Hyppolito Miguel A. 
Published: June 2014

O sistema auditivo é constituído pelas orelhas externa, média e interna e pelas vias auditivas no sistema nervoso central. A membrana timpânica tem como função amplificar a pressão sonora, permitindo uma amplificação de sons. A orelha média compreende a cavidade timpânica composta pela membrana timpânica (camadas intermediária e interna), cadeia ossicular com seus músculos e ligamentos, a tuba auditiva, o adito, o antro e as células mastóideas. Conhecendo-se as estruturas das orelhas externa e média e sua fisiologia na transmissão sonora, pode-se reconhecer o que alterações neste sistema trazem de prejuízos para a função auditiva no ser humano, constituindo assim quadros clínicos diversos que cursam com perdas auditivas condutivas.
BAIXA VISÃO E REABILITAÇÃO: CONHECIMENTOS DE RESIDENTES DE OFTALMOLOGIA
Authors: Nobre Maria Inês Rubo de Souza , Temporini Edméa Rita , Montilha Rita de Cássia Ietto , Gasparetto Maria Elisabete Rodrigues Freire , Kara-José Newton 
Published: June 2014

Objetivo: Verificar conhecimentos de residentes de oftalmologia sobre baixa visão e reabilitação em um hospital universitário. Métodos: Realizou-se estudo exploratório, aplicando-se questionário sobre deficiência visual (baixa visão e cegueira), e serviços de reabilitação de deficientes visuais à amostra não probabilística formada por residentes de Oftalmologia. Resultados: A amostra foi composta por 20 residentes que cursavam 1o ano (45,0%), 2o ano (30,0%) e 3o ano (25,0%); todos já haviam participado de curso teórico sobre baixa visão. A maioria revelou conhecimentos a respeito de afecções oculares que podem causar deficiência visual como: catarata, retinopatias e neuropatias (100,0%), glaucoma, toxoplasmose e retinose pigmentar (95,0%). Em relação à reabilitação, 100,0% declararam ter recebido informações na residência médica. A maioria da amostra referiu conhecimento, à respeito das atividades de reabilitação sendo as mais citadas atividades de vida diária (100,0%), locomoção (90,0%). Conclusão: Embora os residentes tenham declarado ter conhecimento sobre a deficiência visual e preparo teórico sobre a reabilitação, informaram deter conhecimento insuficiente em relação a algumas dessas atividades.
SIGNIFICAÇÕES ATRIBUÍDAS POR PORTADORES DE VISÃO MONOCULAR À PERDA VISUAL E CIRURGIA DE CATARATA
Authors: Marback Roberta Ferrari , Temporini Edméa R. , Maia Júnior Otacílio O. , Kara-Júnior Newton 
Published: June 2014

Objetivo: Identificar percepções e significados referentes à perda visual de pacientes que apresentavam visão monocular e diagnóstico de catarata, com indicação cirúrgica, por comprometimento visual significativo. Métodos: Desenvolveu-se estudo qualitativo, por meio de entrevistas abertas, com 8 sujeitos identificados por Campanha da Catarata, realizada no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), em novembro de 2004.Resultados: Dos entrevistados, 4 eram do sexo feminino e 4 do sexo masculino, tendo a idade variado de 38 a 86 anos. Referiram atividades profissionais como responsáveis pela perda visual, apontaram dificuldades para conseguir o atendimento médico, manifestaram desconhecimento e crenças populares em relação ao próprio problema ocular e dificuldades encontradas no cotidiano em decorrência da doença. Conclusões: Foram identificados significados, percepções, sentimentos, reações e experiências relacionados à catarata e à perda visual. A ocorrência da catarata no único olho significou angústia e situação conflituosa relacionadas à perda da independência. A expectativa de voltar a enxergar mediante intervenção cirúrgica prendeu-se ao sentimento de ter uma vida “normal”, de sentir-se útil e do retorno ao mercado de trabalho.
PREVALÊNCIA DE SOBREPESO E OBESIDADE EM PRÉ-ESCOLARES DE ALTO NÍVEL SÓCIOECONÔMICO DA CIDADE DE ARACAJU-SE
Authors: Silva Diego A. S. 
Published: June 2014

Modelo de Estudo: Estudo de Prevalência. O objetivo do presente estudo foi estimar a prevalência de sobrepeso e obesidade em pré-escolares de alto nível socioeconô-mico da cidade de Aracaju-Sergipe, Brasil, medido de forma direta. Métodos: 243 crianças, sendo 51% do sexo feminino de 3,5 a 5,5 anos de idade de alto nível socioeconômico, segundo critérios da Associação Nacional de Empresa de Pesquisa, foram avaliadas quanto ao peso e a estatura, para se calcular o IMC e classificá-las em normal, sobrepeso ou obesidade de acordo com os critérios de Cole et al. Resultados: Na amostra estudada a prevalência de sobrepeso foi de 16% e a obesidade de 7,9%, sendo que não houve diferenças significativas na prevalência de sobrepeso e obesidade entre meninos e meninas (p > 0,05). Não houve também diferenças entre os grupos de idade para cada sexo (p > 0,05). Conclusão: O sobrepeso e a obesidade se fizeram presentes em uma amostra de crianças de 3,5 a 5,5 anos de idade de alto poder aquisitivo da cidade de Aracaju-SE.
Cost‐Effectiveness of Clopidogrel‐Aspirin Versus Aspirin Alone for Acute Transient Ischemic Attack and Minor Stroke
Authors: Pan Yuesong , Wang Anxin , Liu Gaifen , Zhao Xingquan , Meng Xia , Zhao Kun , Liu Liping , Wang Chunxue , Johnston S. Claiborne , Wang Yilong , Wang Yongjun ,   the CHANCE Investigators
Published: June 2014

Background

Treatment with the combination of clopidogrel and aspirin taken soon after a transient ischemic attack (
TIA
) or minor stroke was shown to reduce the 90‐day risk of stroke in a large trial in China, but the cost‐effectiveness is unknown. This study sought to estimate the cost‐effectiveness of the clopidogrel‐aspirin regimen for acute
TIA
or minor stroke.

Methods and Results

A Markov model was created to determine the cost‐effectiveness of treatment of acute
TIA
or minor stroke patients with clopidogrel‐aspirin compared with aspirin alone. Inputs for the model were obtained from clinical trial data, claims databases, and the published literature. The main outcome measure was cost per quality‐adjusted life‐years (
QALY
s) gained. One‐way and multivariable probabilistic sensitivity analyses were performed to test the robustness of the findings. Compared with aspirin alone, clopidogrel‐aspirin resulted in a lifetime gain of 0.037
QALY
s at an additional cost of
CNY
1250 (
US
$ 192), yielding an incremental cost‐effectiveness ratio of
CNY
33 800 (
US
$ 5200) per
QALY
gained. Probabilistic sensitivity analysis showed that clopidogrel‐aspirin therapy was more cost‐effective in 95.7% of the simulations at a willingness‐to‐pay threshold recommended by the World Health Organization of
CNY
105 000 (
US
$ 16 200) per
QALY
.

Conclusions

Early 90‐day clopidogrel‐aspirin regimen for acute
TIA
or minor stroke is highly cost‐effective in China. Although clopidogrel is generic, Plavix is brand in China. If Plavix were generic, treatment with clopidogrel‐aspirin would have been cost saving.
Stroke in Patients With Aortic Stenosis
Authors: Greve Anders M. , Dalsgaard Morten , Bang Casper N. , Egstrup Kenneth , Ray Simon , Boman Kurt , Rossebø Anne B. , Gohlke-Baerwolf Christa , Devereux Richard B. , Køber Lars , Wachtell Kristian 
Published: June 2014

Background and Purpose—
There are limited data on risk stratification of stroke in aortic stenosis. This study examined predictors of stroke in aortic stenosis, the prognostic implications of stroke, and how aortic valve replacement (AVR) with or without concomitant coronary artery bypass grafting influenced the predicted outcomes.

Methods—

Patients with mild-to-moderate aortic stenosis enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Diabetes mellitus, known atherosclerotic disease, and oral anticoagulation were exclusion criteria. Ischemic stroke was the primary end point, and poststroke survival a secondary outcome. Cox models treating AVR as a time-varying covariate were adjusted for atrial fibrillation and congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65–74 years and female sex (CHA
2
DS
2
-VASc) scores.

Results—

One thousand five hundred nine patients were followed for 4.3±0.8 years (6529 patient-years). Rates of stroke were 5.6 versus 21.8 per 1000 patient-years pre- and post-AVR; 429 (28%) underwent AVR and 139 (9%) died. Atrial fibrillation (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.1–6.6), CHA
2
DS
2
-VASc score (HR 1.4 per unit; 95% CI, 1.1–1.8), diastolic blood pressure (HR, 1.4 per 10 mm Hg; 95% CI, 1.1–1.8), and AVR with concomitant coronary artery bypass grafting (HR, 3.2; 95% CI, 1.4–7.2, all
P
≤0.026) were independently associated with stroke. Incident stroke predicted death (HR, 8.1; 95% CI, 4.7–14.0;
P
<0.001).

Conclusions—

In patients with aortic stenosis not prescribed oral anticoagulation, atrial fibrillation, AVR with concomitant coronary artery bypass grafting, and CHA
2
DS
2
-VASc score were the major predictors of stroke. Incident stroke was strongly associated with mortality.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00092677.
Point-of-Care Cluster Randomized Trial in Stroke Secondary Prevention Using Electronic Health Records
Authors: Dregan Alex , van Staa Tjeerd P. , McDermott Lisa , McCann Gerard , Ashworth Mark , Charlton Judith , Wolfe Charles D.A. , Rudd Anthony , Yardley Lucy , Gulliford Martin C. , Meredith Sarah , Kerry Sally , Murray Elizabeth , Mant Jonathan , Robson John , Haywood Andrew , Pursani Nanik 
Published: June 2014

Background and Purpose—
The aim of this study was to evaluate whether the remote introduction of electronic decision support tools into family practices improves risk factor control after first stroke. This study also aimed to develop methods to implement cluster randomized trials in stroke using electronic health records.

Methods—
Family practices were recruited from the UK Clinical Practice Research Datalink and allocated to intervention and control trial arms by minimization. Remotely installed, electronic decision support tools promoted intensified secondary prevention for 12 months with last measure of systolic blood pressure as the primary outcome. Outcome data from electronic health records were analyzed using marginal models.

Results—

There were 106 Clinical Practice Research Datalink family practices allocated (intervention, 53; control, 53), with 11 391 (control, 5516; intervention, 5875) participants with acute stroke ever diagnosed. Participants at trial practices had similar characteristics as 47 887 patients with stroke at nontrial practices. During the intervention period, blood pressure values were recorded in the electronic health records for 90% and cholesterol values for 84% of participants. After intervention, the latest mean systolic blood pressure was 131.7 (SD, 16.8) mm Hg in the control trial arm and 131.4 (16.7) mm Hg in the intervention trial arm, and adjusted mean difference was −0.56 mm Hg (95% confidence interval, −1.38 to 0.26;
P
=0.183). The financial cost of the trial was approximately US $22 per participant, or US $2400 per family practice allocated.

Conclusions—
Large pragmatic intervention studies may be implemented at low cost by using electronic health records. The intervention used in this trial was not found to be effective, and further research is needed to develop more effective intervention strategies.

Clinical Trial Registration—

URL:
http://www.controlled-trials.com
. Current Controlled Trials identifier: ISRCTN35701810.
Economic recession and suicidal behaviour: Possible mechanisms and ameliorating factors
Authors: Haw Camilla , Hawton Keith , Gunnell David , Platt Stephen 
Published: June 2014

Background: A growing body of research evidence from countries around the world indicates that economic recession is associated with increases in suicide, particularly in males of working age. Aims: To explore contributory and ameliorating factors associated with economic recession and suicide and thereby stimulate further research in this area and encourage policy makers to consider how best to reduce the impact of recession on mental health and suicidal behaviour. Method: We conducted a selective review of the worldwide literature focusing on possible risk factors, mechanisms and preventative strategies for suicidal behaviour linked to economic recession. Results: A model of how recession might affect suicide rates is presented. A major and often prolonged effect of recession is on unemployment and job insecurity. Other important effects include those exerted by financial loss, bankruptcy and home repossession. It is proposed these factors may lead directly or indirectly to mental health problems such as depression, anxiety and binge drinking and then to suicidal behaviour. Countries with active labour market programmes and sustained welfare spending during recessions have less marked increases in suicide rates than those that cut spending on welfare and job-search initiatives for the unemployed. Other measures likely to help include targeted interventions for unemployed people, membership of social organisations and responsible media reporting. Good primary care and mental health services are needed to cope with increased demand in times of economic recession but some governments have in fact reduced healthcare spending as an austerity measure. Conclusion: The research evidence linking recession, unemployment and suicide is substantial, but the evidence for the other mechanisms we have investigated is much more tentative. We describe the limitations of the existing body of research as well as make suggestions for future research into the effects of economic recession on suicidal behaviour.
Generating Public Consciousness around Land Acquisition for Private Industries
Authors: Guha Abhijit 
Published: June 2014

In course of my research on the acquisition of agricultural land for private industries, I came across a variety of public opinion which justified acquisitions. None of the supporters of land acquisition was ready to face the question of food security at the household level, let alone the role of local self-governments, which was endangered by the takeover of fertile land for industries by the government. Under the three sets of public opinion described in the paper, generating public consciousness regarding land acquisition for industries seemed to be a difficult task which should begin by exploring the justification of land acquisition for industries, in the context of food security and land reform. Here I have made an attempt to study the opinions of people around land expropriation with an aim to generate public awareness as regards the ground realities of government policy including the recent Land Acquisition Resettlement and Rehabilitation Act 2011.
Acute Mastoiditis in Children with Cochlear Implants: Is Explantation Required?
Authors: Zawawi Faisal , Cardona Isabel , Akinpelu Olubunmi V. , Daniel Sam J. 
Published: June 2014

ObjectiveAcute mastoiditis is an uncommon but challenging condition when it occurs in children with cochlear implant. The literature is scarce as to the management of this condition with regards to explantation. The objective of the study is to determine the need for explantation in patients with cochlear implants who suffer from acute mastoiditis.Data SourcesOnline medical databases—PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus.Review MethodsA systematic review of all publications addressing the treatment of mastoiditis in cochlear implant children prior to November 2013 was conducted. Data were collected from online medical databases—PubMed, Ovid Medline, Ovid Medline in process, Embase, Cochrane Library, CINAHL, Biosis, Google Scholar, and Scopus. The review was performed in 3 phases; an initial screening review of abstracts was performed, followed by a detailed review of full articles based on inclusion and exclusion criteria, and lastly a final review to extract data from selected articles.ResultsTwelve articles were found eligible for this systematic review including a total of 43 patients. Subperiosteal abscess was present in 14.3%. All patients received intravenous antibiotics as an initial treatment, and if needed, surgical intervention was performed. Only 1 patient required explantation (2.3%).ConclusionPrompt, aggressive medical and if needed surgical therapy can help in saving the implant and result in a favorable outcome.
Effect of Strong Fragrance on Olfactory Detection Threshold
Authors: Fasunla Ayotunde James , Douglas David Dayo , Adeosun Aderemi Adeleke , Steinbach Silke , Nwaorgu Onyekwere George Benjamin 
Published: June 2014

ObjectiveTo assess the olfactory threshold of healthy volunteers at the University College Hospital, Ibadan and to investigate the effect of perfume on their olfactory detection thresholds.Study DesignA quasi‐experimental study on olfactory detection thresholds of healthy volunteers from September 2013 to November 2013.SettingTertiary health institution.Subjects and MethodsA structured questionniare was administered to the participants in order to obtain information on sociodemographics, occupation, ability to perceive smell, use of perfume, effects of perfume on appetite and self‐confidence, history of allergy, and previous nasal surgery. Participants subjectively rated their olfactory performance. Subsequently, they had olfactory detection threshold testing done at baseline and after exposure to perfume with varied concentrations of n‐butanol in a forced triple response and staircase fashion.ResultsHealthy volunteers, 37 males and 63 females, were evaluated. Their ages ranged from 19 to 59 years with a mean of 31 years ± 8. Subjectively, 94% of the participants had excellent olfactory function. In the pre‐exposure forced triple response, 88% were able to detect the odor at ≤.25 mmol/l concentration while in the post‐exposure forced triple response, only 66% were able to detect the odor at ≤.25 mmol/l concentration. There is also a statistical significant difference in the olfactory detection threshold score between the pre‐exposure and post‐exposure period in the participants (P <. 05).ConclusionUse of strong fragrances affects the olfactory detection threshold. Therefore patients and clinicians should be aware of this and its effects on the outcome of test of olfaction.