bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mortality Risk Prediction With an Updated Acute Physiology and Chronic Health Evaluation II Score in Critically Ill Obstetric Patients
Authors: Paternina-Caicedo Angel J. , Rojas-Suarez José A. , Dueñas-Castel Carmelo , Miranda-Quintero Jezid E. , Bourjeily Ghada 
Published: September 2013

Background: Acute Physiology and Chronic Health Evaluation II (APACHE II) score has shown low prognostic ability to predict death in the obstetric population. The objective of this study was to evaluate whether an updated form of the APACHE II score would perform better in predicting mortality in critically ill obstetric patients. Methods: A retrospective cohort study of pregnant and postpartum women (up to 42 days after delivery) who were admitted to the intensive care unit (ICU) was carried out at an ICU at Rafael Calvo Maternity Hospital, a large obstetric hospital in Colombia. Data were collected on consecutive obstetric patients admitted to the ICU between 2006 and 2011. A discrimination and calibration analysis was completed on the original APACHE II score and an updated APACHE II score. Results: Data were collected on a total of 726 obstetric patients. The area under the receiver–operating characteristic curve was 0.86 (95% confidence interval [95% CI], 0.80-0.93) for both APACHE II and the updated APACHE II scores. Mortality ratio for the original APACHE II was 0.30 (95% CI, 0.19-0.41) and 0.85 (95% CI, 0.56-1.24) for the updated APACHE II. Conclusions: The APACHE II overestimates mortality in the sample population. The updated APACHE II model predicts mortality more accurately in the obstetric population. This formula may be useful in adapting the existing APACHE II to current mortality risk in obstetric critical care populations.
A Study on Green Advertisement and its Impact on Consumer Purchase Intention
Authors: Khandelwal Utkal , Bajpai Naval 
Published: September 2013

The purpose of this article is to find out the green advertising factors affecting purchase intention literature, and then to develop a simpler and more precise model of purchase intention. In this article, green advertising is taken as the instrument of measuring difference in purchase intention for metro and non-metro consumers. It is obviously hypothesized that metro and non-metro customers exhibit different degree of purchase intention for eight variables taken in the present study. The conceptual framework of factors affecting customer attitude—including credibility, consumers’ trust, viewers’ attitudes, brand image, the media, green education, reference group influence and perceived effectiveness of environmental behaviour—is developed by examining the theoretical foundation for general products and services. Linear regression and the z-test method were used to measure the impact of these attributes of green advertisement on purchase intention and difference in metro and non-metro customers, respectively. Results show that the purchase intention develops through the dimensions of green advertising, such as viewers’ attitudes, brand image, the media, green education, reference group influence and perceived effectiveness of environmental behaviour; these have a significant difference in these two regions and purchase intention based on credibility and consumers’ trust have no significant difference. Regression results establish a significant positive linear relationship between green advertising and purchase intention variables taken for the study in both the region. The article proposes a conceptual framework of green advertising factors affecting purchase intention. Results on difference of the green advertisement lead to purchase intention in metro and non-metro customers and linear impact of the same on purchase intention will help marketers, academicians and strategists in better understanding of these markets in formulation of better policies.
Evaluation of circulating osteopontin levels in an unselected cohort of patients with multiple sclerosis: relevance for biomarker development
Authors: Kivisäkk Pia , Healy Brian C , Francois Katiana , Gandhi Roopali , Gholipour Taha , Egorova Svetlana , Sevdalinova Velina , Quintana Francisco , Chitnis Tanuja , Weiner Howard L , Khoury Samia J 
Published: September 2013

Background: Osteopontin (OPN) is a pleiotropic protein with important roles in inflammation and immunity that has been suggested as a candidate biomarker for disease activity in multiple sclerosis (MS). Objective: We evaluated plasma levels of OPN in an unselected cohort of MS patients, to determine its potential as a biomarker for disease subtype and/or disease activity in a regular clinical setting. Methods: We analyzed OPN plasma levels in 492 consecutive MS patients, using a commercial enzyme-linked immunosorbent assay (ELISA). Results: OPN levels were higher in relapsing–remitting and secondary progressive MS, compared to healthy controls. Treatment with natalizumab or glatiramer acetate was associated with lower OPN levels. There was no significant association between the OPN levels and disease activity, as measured by clinical or radiological criteria. One-third of patients with high OPN levels had concurrent disorders that may also be associated with increased OPN expression, and which may mask a modest effect of MS disease activity on OPN levels. Conclusion: Our data do not support a role for circulating OPN levels as a biomarker for disease activity in a heterogeneous clinical setting, but does not rule out a potential role in the cerebrospinal fluid, in a controlled setting such as a clinical trial, or in concert with other biomarkers.
Development of a new model to engage patients and clinicians in setting research priorities
Authors: Pollock Alex , George Bridget St , Fenton Mark , Crowe Sally , Firkins Lester 
Published: September 2013

Objectives Equitable involvement of patients and clinicians in setting research and funding priorities is ethically desirable and can improve the quality, relevance and implementation of research. Survey methods used in previous priority setting projects to gather treatment uncertainties may not be sufficient to facilitate responses from patients and their lay carers for some health care topics. We aimed to develop a new model to engage patients and clinicians in setting research priorities relating to life after stroke, and to explore the use of this model within a James Lind Alliance (JLA) priority setting project. Methods We developed a model to facilitate involvement through targeted engagement and assisted involvement (FREE TEA model). We implemented both standard surveys and the FREE TEA model to gather research priorities (treatment uncertainties) from people affected by stroke living in Scotland. We explored and configured the number of treatment uncertainties elicited from different groups by the two approaches. Results We gathered 516 treatment uncertainties from stroke survivors, carers and health professionals. We achieved approximately equal numbers of contributions; 281 (54%) from stroke survivors/carers; 235 (46%) from health professionals. For stroke survivors and carers, 98 (35%) treatment uncertainties were elicited from the standard survey and 183 (65%) at FREE TEA face-to-face visits. This contrasted with the health professionals for whom 198 (84%) were elicited from the standard survey and only 37 (16%) from FREE TEA visits. Conclusions The FREE TEA model has implications for future priority setting projects and user-involvement relating to populations of people with complex health needs. Our results imply that reliance on standard surveys may result in poor and unrepresentative involvement of patients, thereby favouring the views of health professionals.
Gene Expression Profile and Functional Analysis of Alzheimer’s Disease
Authors: Chen Fei , Guan Qiang , Nie Zhi-Yu , Jin Ling-Jing 
Published: September 2013

Background: Alzheimer’s disease (AD) is a complex neurodegenerative disorder with largely unknown genetic mechanisms. Identifying altered neuronal gene expression in brain regions differentially affected by AD may provide the diagnostic or therapeutic targets of AD. Methods: The gene expression profile of AD was analyzed with bioinformatics. Function analysis was performed with Database for Annotation, Visualization and Integrated Discovery (DAVID), and TransFind was used to predict the possible transcriptional regulators in AD. Finally, connectivity map (cMap) database was used to explore small molecules targeted for AD. Results: The AD gene signatures associated with 6 different brain regions were identified. Functional analysis revealed that biological processes involved with metabolism, protein ubiquitination, and vasculature development were found dysregulated, and synaptic signaling pathways were found perturbated in AD. The WT1 was identified as an important transcriptional regulator in AD, and cMap database predicted that small molecules, such as histone deacetylase (HDAC) inhibitor, may be candidate drugs in the treatment of AD. Conclusion: According to our in silico analysis, Wilms' tumor suppressor may play regulatory roles in AD development and progress. The HDAC inhibitor could possibly be used to treat AD.
Caregivers of Patients With Dementia in Chinese Mainland
Authors: Liu Jia , Wang Lu-Ning 
Published: September 2013

Objective: We aimed to systematically search and summary the publications from 1990 to 2012 on Chinese dementia caregivers to understand the development in this field. Methods: We searched Pubmed and Chinese medical databases for all the original publications on the dementia caregivers in Chinese mainland until December 31st, 2012. Results: 126 papers involved 117 studies with 11178 participants were analyzed. The earliest study on Chinese caregivers with dementia patients was published in 1990. Most studies (92%) were reported in Chinese. 85% of studies were published between 2006 and 2012, while 42% were carried out in the most developed regions. Conclusions: In spite of the late start, the number of publications on Chinese dementia caregivers has rapidly increased since 2006. However, the quality of studies is still need to improve in sample size, intervention and outcome design. More attentions, policies and funds should be given to support the future study in dementia caregivers.
HDAC inhibition suppresses bladder cancer cell adhesion to collagen under flow conditions
Authors: Juengel Eva , Santos Sascha Meyer dos , Schneider Tanja , Makarević Jasmina , Hudak Lukasz , Bartsch Georg , Haferkamp Axel , Wiesner Christoph , Blaheta Roman A 
Published: September 2013

The influence of the histone deacetylase (HDAC)-inhibitor, valproic acid (VPA), on bladder cancer cell adhesion in vitro was investigated in this paper. TCCSUP and RT-112 bladder cancer cells were treated with VPA (0.5 or 1 mM) twice or thrice weekly for 14 days. Controls remained untreated. Tumour cell interaction with immobilized collagen was evaluated by a flow-based adhesion assay using a shear force of 2 or 4 dyne/cm2. The effects of VPA on the integrin adhesion receptors α3, α5, β1, β3 and β4 were assessed by flow cytometry to determine integrin surface expression and by western blotting to determine the cytoplasmic integrin level. VPA of 0.5 mM and 1 mM significantly prevented binding of both RT-112 and TCCSUP cells to collagen, compared with the untreated controls. Adhesion was reduced to a higher extent when RT-112 (subjected to 2 dyne/cm2) or TCCSUP (subjected to 2 or 4 dyne/cm2) tumour cells were treated with VPA three times a week, compared to the two times a week protocol. VPA caused a significant up-regulation of the integrin α3, α5, β1, β3 and β4 subtypes on the TCCSUP cell surface membrane. In RT-112 cells, only integrin α5 was elevated on the cell surface following VPA exposure. Western blotting revealed an up-regulation of α3, α5, β3 and β4 integrins and down-regulation of the integrin β1 protein by VPA in TCCSUP. VPA also up-regulated α5 and down-regulated β1 integrin in RT-112 cells, but also reduced α3 and β3 in TCCSUP. VPA exerted adhesion-blocking properties on bladder cancer cells under physiologic flow conditions. The effects were accompanied by distinct modifications of the integrin expression profile, which differ depending on the cell lines used. Application of VPA might be an innovative option to prevent bladder cancer dissemination.
Salvianolic acid B inhibits hepatic stellate cell activation through transforming growth factor beta-1 signal transduction pathwayin vivoandin vitro
Authors: Tao Yan-Yan , Wang Qing-Lan , Shen Li , Fu Wen-Wei , Liu Cheng-Hai 
Published: September 2013

Salvianolic acid B (Sal B) is a major water soluble component extracted from Radix Salviae miltiorrhizae, a traditional Chinese herb widely used for treating cardiovascular and hepatic diseases. Sal B has been reported to inhibit transforming growth factor (TGF)-β1-stimulated hepatic stellate cells (HSCs) activation and collagen type I expression. In this study, we further investigated the mechanisms of Sal B on liver fibrosis relating to TGF-β/Smads signalling pathway, especially to TGF-β1 receptors. Liver fibrosis model was induced by intraperitoneal injection of dimethylnitrosamine (DMN) for four weeks. Rats were randomly divided into three groups: normal, model, and Sal B groups. Rats in Sal B group were treated by oral administration of Sal B for four weeks from the first day of DMN exposure. Hydroxyproline (Hyp) content in liver tissue was assayed using Jamall's method and collagen deposition was visualized using Sirius red staining. HSCs were isolated from normal rats, and were cultured primarily in uncoated plastics. At day 4 after isolation, cells were stimulated with 2.5 ng/mL TGF-β1, and treated with 1 and 10 µmol/L Sal B and 10 µmol/L SB-431542 (TβR-I inhibitor) for 24 h, respectively. Cell proliferation was examined with 5-ethynyl-2'-deoxyuridine assay. The expressions of alpha smooth muscle actin (α-SMA) and Smad3 were assayed by immunofluorescent stain and Western blotting. The expression of TβR-I was analysed by Western blotting and real-time polymerase chain reaction. The activity of TβR-I kinase was measured by ADP-Glo kinase assay. The results showed that Sal B could inhibit collagen deposition and reduce Hyp content significantly, and decrease expressions of TGF-β1 and TβR-I in fibrotic liver in vivo. Also, Sal B decreased the expressions of α-SMA and TβR-I, inhibited Smad3 nuclear translocation and down-regulated TβR-I kinase activity in vitro. These findings suggested that Sal B could prevent HSCs activation through TGF-β signalling pathway, i.e. inhibiting TGF-β1 expression, activity of TβR-I kinase and Smads phosphorylation.
Lower Extremity Amputations
Authors: Shah Samir K. , Bena James F. , Allemang Matthew T. , Kelso Rebecca , Clair Daniel G. , Vargas Lina , Kashyap Vikram S. 
Published: September 2013

Background: Tissue loss or gangrene in the setting of lower extremity peripheral artery disease (PAD) may result in amputation. Previous studies have demonstrated elevated mortality rates after major transtibial and transfemoral amputation. Also, amputation of 1 leg may be associated with subsequent major amputation of the contralateral leg. The aim of our study was to identify patient variables associated with mortality and contralateral amputation. Methods: We reviewed the medical records of patients who underwent transfemoral or transtibial amputation secondary to PAD from 2004 to 2009. A total of 454 consecutive major amputations were performed on 391 patients, with 63 of these having a subsequent contralateral amputation. Standard demographic information, comorbidities, prior vascular interventions, and relevant procedural information were extracted from patient records. Kaplan-Meier estimates of survival were calculated. Cox proportional hazard models were used to estimate the risk of death and contralateral amputation. Multivariate Cox proportional hazards models were fit for all variables shown to be marginally associated in the univariate model. Results: In 391 amputees, the mean age was 67.3 years, 63% were male and 62% were caucasian. Patients had high rates of diabetes (63%), hypertension (83%), renal insufficiency (35%), hyperlipidemia (51%), and prior ipsilateral vascular intervention (75%). Seventy percent of patients had below-knee amputations. Perioperative mortality was 9.2% (n = 36). Survival at 12 and 24 months was 70% (95% confidence interval [CI], 65%-74%) and 60% (95% CI, 55%-65%), respectively. Multivariate analysis demonstrated that several independent factors were detrimental to survival including chronic obstructive pulmonary disease (hazard ratio [HR] 1.82, P = .002), dialysis dependence (HR 2.50, P < .001), high cardiac risk (HR 2.20, P < .001), and guillotine amputation (HR 2.49, P = .004). Dialysis (HR 2.42, P = .002) and revision of the index ipsilateral amputation to a higher level (HR 2.02, P = .014) were associated with a subsequent contralateral amputation. Conclusions: Patients with advanced PAD that require lower extremity amputation have diminished survival and significant contralateral amputation rates. Elderly patients on dialysis are particularly prone to dying or losing the other leg after a major amputation. These data support strategies to enhance limb preservation and optimize medical comorbidities in these patients.
Imperfect gold standards for biomarker evaluation
Authors: Waikar Sushrut S , Betensky Rebecca A , Emerson Sarah C , Bonventre Joseph V 
Published: September 2013

Background Serum creatinine has been used as the diagnostic test for acute kidney injury (AKI) for decades despite having imperfect sensitivity and specificity. Novel tubular injury biomarkers may revolutionize the diagnosis of AKI; however, even if a novel tubular injury biomarker is 100% sensitive and 100% specific, it may appear inaccurate when using serum creatinine as the gold standard. Conclusions In general, the apparent diagnostic performance of a biomarker depends not only on its ability to detect injury but also on disease prevalence and the sensitivity and specificity of the imperfect gold standard. Apparent errors in diagnosis using a new biomarker may be a reflection of errors in the imperfect gold standard itself rather than poor performance of the biomarker.
Associations between different measures of anticholinergic drug exposure and Barthel Index in older hospitalized patients
Authors: Bostock Clare V , Soiza Roy L , Mangoni Arduino A 
Published: September 2013

Objective: To compare associations between four measures of anticholinergic exposure (anticholinergic risk scale, ARS; anticholinergic drug burden, DBAC; number and use versus no use of anticholinergic drugs), Barthel Index (BI, physical function) and Abbreviated Mental Test (AMT, cognitive function) on admission in older hospitalized patients. Methods: Prospective observational study of a consecutive series of 271 older patients (age 83 ± 7 years) from community-dwelling and institutionalized settings, admitted to an acute geriatric admission unit between 28 September 2011 and 18 December 2011. The main outcome measures were BI quartiles (primary outcome) and AMT (secondary outcome) on admission. Results: Anticholinergic prevalence was 47%. Multinomial logistic regression showed higher DBAC was associated with a greater risk of being in the lower BI quartiles versus highest BI quartile (Q4). This risk was significant for Q3 ( p = 0.04) and Q2 ( p = 0.02) but not for Q1 ( p = 0.06). A greater number of anticholinergic drugs was associated with a higher risk of being in Q2 ( p = 0.02). This risk was not significant for either Q3 ( p = 0.10) or Q1 ( p = 0.06). No significant associations were observed either with use of anticholinergic medication or with ARS and BI quartiles. AMT did not show independent associations with any of the four measures of anticholinergic exposure. Conclusion: In older hospitalized patients, DBAC and some crude measures of anticholinergic exposure, but not ARS, showed independent associations with lower BI, but not AMT. These results highlight differences between various measures of anticholinergic drug exposure when studying their associations with functional status.
Pharmacists’ journey to clinical pharmacy practice in Ethiopia: Key informants’ perspective
Authors: Mekonnen Alemayehu B , Yesuf Elias A , Odegard Peggy S , Wega Sultan S 
Published: September 2013

Objective: Clinical pharmacy practice has developed internationally to expand the role of a pharmacist well beyond the traditional roles of compounding and supplying drugs to roles more directly in caring for patients and providing medication consultation to staff. This area of practice is at the infant stage in Ethiopia. The aim of this study was to explore key informants’ perspective in the implementation of clinical pharmacy practice in Jimma University Specialized Hospital, Ethiopia. Method: A qualitative study was conducted through in-depth interviews with the heads of departments (internal medicine, paediatrics, surgery, nurse, pharmacy, medical director, administration) and pharmacy student representatives. Qualitative data analysis was done after audiotapes were transcribed verbatim and notes were compiled. Results: All of the respondents interviewed express diverse and conflicting perspectives on pharmacists’ role, varying from a health-care professional to a business man. Despite this, the current pace of change worldwide takes the professions’ mission to that of a provider of clinical pharmacy services. The data ascertained the change in pharmacy practice, and integrating clinical pharmacy services within the health-care system should be seen as a must. Pharmacists should delineate from a business perspective and focus on widening the scope of the profession of pharmacy and should come close to the patient to serve directly. Conclusions: Although the perception of people on traditional roles of pharmacists was weak, there were promising steps in developing clinical pharmacy practice within the health-care system. Moreover, the results of this study revealed a high demand for this service among health-care providers.
Acquired copy number alterations of miRNA genes in acute myeloid leukemia are uncommon
Authors: Ramsingh Giridharan , Jacoby Meagan A. , Shao Jin , De Jesus Pizzaro Rigoberto E. , Shen Dong , Trissal Maria , Getz Angela H. , Ley Timothy J. , Walter Matthew J. , Link Daniel C. 
Published: September 2013

Key Points
Somatic copy number alterations of miRNA genes are uncommon in de novo and secondary AML. MIR223 silencing in AML occurs through both genetic and epigenetic mechanisms.
Defining characteristics of classical Hodgkin lymphoma microenvironment T-helper cells
Authors: Greaves Paul , Clear Andrew , Owen Andrew , Iqbal Sameena , Lee Abigail , Matthews Janet , Wilson Andrew , Calaminici Maria , Gribben John G. 
Published: September 2013

Key Points
Hodgkin lymphoma microenvironment T-helper cells express TH1/activation markers and lack TH2/immunosuppression markers. These cells are functional, retaining the capacity for cytokine secretion and proliferation in vitro.