bluuebunny/crossref_metadata_2025 huggingface dataset:
Metoclopramide as a prokinetic agent for diabetic gastroparesis: revisiting the risk of Parkinsonism
Authors: Lai Chien-Hsu , Yeh Yi-Chun , Chen Yen-Yu
Published: June 2019

Background:

Metoclopramide is used to relieve gastrointestinal symptoms, however, it could cause adverse reactions of motor disorders. The aim of this study was to investigate whether metoclopramide treatment has a duration–response or dose–response effect and to estimate the risk of developing Parkinsonism following different and specific durations of treatment.

Methods:

A cohort study of newly diagnosed type 2 diabetes mellitus in 45- to 79-year-old patients, between 1999 and 2008, was selected using the Longitudinal Health Insurance Database 2005. A nested case–control study was conducted in the diabetes cohort in which all incident cases of Parkinsonism were identified. We randomly matched each case with up to 10 controls from the risk set. Conditional logistic regression was utilized to estimate odds ratio of Parkinsonism associated with metoclopramide use.

Results:

A total of 34,685 patients with diabetes were assembled as the cohort, and 541 incident Parkinsonism cases were identified. There were duration–response and dose–response effects on the risk of developing Parkinsonism. Compared with never-use patients, the adjusted odds ratios (ORs) of continuing therapy for 0–1 month, 1–2 months, 2–3 months, 3–5 months, and more than 5 months were 1.17 [95% confidence interval (CI) 0.93–1.45], 1.44 (95% CI 1.04–2.00), 1.74 (95% CI 1.14–2.65), 1.90 (95% CI 1.23–2.93), and 2.17 (95% CI 1.50–3.12), respectively.

Conclusions:

With metoclopramide treatment, regardless of less or more than 3 months of use, the risk of developing Parkinsonism in patients with newly diagnosed diabetes escalated with the duration of therapy. Therefore, we recommend close monitoring for the development of Parkinsonism in patients treated with metoclopramide, particularly (but not limited to) those with prolonged exposure.
Dynamic right ventricular–pulmonary arterial uncoupling during maximum incremental exercise in exercise pulmonary hypertension and pulmonary arterial hypertension
Authors: Singh Inderjit , Rahaghi Farbod N. , Naeije Robert , Oliveira Rudolf K.F. , Vanderpool Rebecca R. , Waxman Aaron B. , Systrom David M.
Published: June 2019

Despite recent advances, the prognosis of pulmonary hypertension (PH) remains poor. While the initial insult in PH implicates the pulmonary vasculature, the functional state, exercise capacity, and survival of such patients are closely linked to right ventricular (RV) function. In the current study, we sought to investigate the effects of maximum incremental exercise on the matching of RV contractility and afterload (i.e. right ventricular–pulmonary arterial [RV–PA] coupling) in patients with exercise PH (ePH) and pulmonary arterial hypertension (PAH). End‐systolic elastance (Ees), pulmonary arterial elastance (Ea), and RV–PA coupling (Ees/Ea) were determined using single‐beat pressure‐volume loop analysis in 40 patients that underwent maximum invasive cardiopulmonary exercise testing. Eleven patients had ePH, nine had PAH, and 20 were age‐matched controls. During exercise, the impaired exertional contractile reserve in PAH was associated with blunted stroke volume index (SVI) augmentation and reduced peak oxygen consumption (peak VO2 %predicted). Compared to PAH, ePH demonstrated increased RV contractility in response to increasing RV afterload during exercise; however, this was insufficient and resulted in reduced peak RV–PA coupling. The dynamic RV–PA uncoupling in ePH was associated with similarly blunted SVI augmentation and peak VO2 as PAH. In conclusion, dynamic rest‐to‐peak exercise RV–PA uncoupling during maximum exercise blunts SV increase and reduces exercise capacity in exercise PH and PAH. In ePH, the insufficient increase in RV contractility to compensate for increasing RV afterload during maximum exercise leads to deterioration of RV–PA coupling. These data provide evidence that even in the early stages of PH, RV function is compromised.
Completion and adherence rates to exercise interventions in intermittent claudication: Traditional exercise versus alternative exercise – a systematic review
Authors: Lin Edward , Nguyen Cindy H , Thomas Scott G
Published: June 2019

Background

Intermittent claudication, defined as fatigue or pain in the legs while walking, is a common symptom in peripheral arterial disease. Although exercise effectively improves function and manages symptoms, adherence rates are not ideal. The high levels of pain experienced in traditional exercise programmes may explain the suboptimal adherence. Alternative modalities of exercise can elicit similar benefits to traditional walking exercise. The purpose of this systematic review was to compare completion and adherence rates of exercise programmes in traditional exercise interventions versus alternative exercise interventions among patients with intermittent claudication.

Design

Systematic review.

Methods

The electronic databases of Medline, SPORTDiscus and CINAHL were searched from the earliest records to March 2018. Search terms were based on ‘peripheral artery disease’ and ‘exercise’. Studies were included if they involved structured exercise and explicitly reported the number of participants that commenced and completed the programme.

Results

The search identified 6814 records based on inclusion criteria. Eighty-four full-text records were reviewed in further detail. Out of the 84 studies, there was a total of 122 separate exercise groups, with 64 groups of ‘traditional walking exercise’ and 58 groups of ‘alternative exercise’. Completion and adherence rates for traditional exercise were 80.8% and 77.6%, respectively. Completion and adherence rates for alternative exercise were 86.6% and 85.5%, respectively.

Conclusions

The use of alternative modalities of exercise, which have been proved to be as effective as traditional exercise, may offer a solution to the poor participation and adherence rates to exercise in this population.
Chronic annular pustular psoriasis resembling subcorneal pustular dermatosis: A case report
Authors: Khosravi-Hafshejani Touraj , Dutz Jan P
Published: June 2019

Generalized pustular psoriasis and subcorneal pustular dermatosis are generalized pustular dermatoses that are characterized by the subcorneal accumulation of neutrophils. Careful examination is important in distinguishing these diseases for appropriate management. Patients with acute generalized pustular psoriasis are systemically unwell with discrete pustules as opposed to the chronicity and associated hypopyon lesions in subcorneal pustular dermatosis. Generalized pustular psoriasis lesions demonstrate psoriasiform changes on histology and the increased expression of Th17 cytokines. We describe a middle-aged woman presenting with chronic annular generalized pustular psoriasis, initially mistaken for subcorneal pustular dermatosis due to their clinical and histological semblance. The patient had recurrent skin disease for 6 years despite conventional therapy of oral retinoid, immunosuppressant and biologic therapy. Complete and persistent clearance of her skin lesions was achieved with secukinumab, an interleukin 17A inhibitor.
SATB1 promotes epithelial-mesenchymal transition via Notch signaling pathway in colorectal cancer
Authors: Tang Jun , Yang Jingfang
Published: June 2019

Epithelial-mesenchymal transition (EMT) is essential for initiation of colorectal cancer (CRC) metastasis, but the diver proteins of EMT remain unclear. Special AT-rich sequence-binding protein 1 (SATB1) was found to be overexpressed in CRC cell lines, and its expression level was positively correlated with CRC progression. Strikingly, EMT process was regulated by SATB1, as SATB1 overexpression upregulated E-cadherin and SATB1 knockdown inhibited N-cadherin cell models. Mechanistically, SATB1 promoted EMT-mediated CRC metastasis via activation of Notch signaling pathway. Taken together, SATB1 plays a vital role in CRC metastasis and may act as a novel prognostic biomarker and a promising therapeutic target for CRC.
Role of Food Allergy Education: Measuring Teacher Knowledge, Attitudes, and Beliefs
Authors: Canon Nicole , Gharfeh Maya , Guffey Danielle , Anvari Sara , Davis Carla M.
Published: June 2019

Introduction

Almost 6 million children suffer from food allergies with roughly 2 affected per classroom. Deficiencies in knowledge and discrepancies in attitudes within school staff when addressing food allergies are associated with barriers to care. In this study, school teacher knowledge, beliefs, and attitudes were measured before and after a food allergy educational session.

Methods

Three hundred seventy-five personnel of similar age, socioeconomic status, ethnicity, and educational level completed the Chicago Food Allergy Research survey before and after a 1-hour educational session in 6 private schools in Houston randomly assigned into an intervention (n = 4) and control group (n = 2). Responses were measured using frequencies and percentages. The group score differences and survey question comparisons were evaluated with a linear mixed-effects model.

Results

Posttest, the intervention group had knowledge scores 19.58% points higher than control (95% confidence interval = 16.62–22.53; P < .001) with no differences pretest. Odds of agreeing that injectable epinephrine is important was higher in the intervention schools posteducation. Within the intervention group, personnel were more likely to agree to injectable epinephrine use for children posteducation.

Conclusion

A 1-hour educational session improved knowledge and attitudes in personnel in the intervention schools. Given the growing prevalence of food allergy, the emphasis on food allergy education is crucial to allow for familiarization of the condition, early recognition of anaphylaxis, and promotion of injectable epinephrine use.
The Impact of Nurse Scheduling Management on Nurses’ Job Satisfaction in Army Hospital: A Cross-Sectional Research
Authors: Rizany Ichsan , Hariyati Rr. Tutik Sri , Afifah Efy , Rusdiyansyah
Published: June 2019

There are many factors which affect nurse satisfaction level. This study aimed to identify the impact of nurse scheduling management on job satisfaction in Army hospital. This study used cross-sectional approach with total sample of 102 nurses. The sample was selected through stratified random sampling method with inclusion criteria of inpatient nurse with minimum pre-clinic level and at least 1-year experience. Pearson correlation, t-independent, one-way analysis of variance (ANOVA), and double linear regression were employed to analyze data. The results indicated that there was significant correlation between the implementation of nurse scheduling management with all management functions on nurse job satisfaction level ( p = .0001–.014). Organizing and controlling nurse schedule were the dominant factors affecting nurse job satisfaction level. Authors concluded that the management of nurse scheduling statistically correlated with nurse job satisfaction level. Nurse manager should have the capability to improve nurse satisfaction by optimizing the management of nurse scheduling, especially on organizing and controlling aspect.
Professional and Amateur Pitchers’ Perspective on the Ulnar Collateral Ligament Injury Risk
Authors: Vance Danica D. , Alexander Frank J. , Kunkle Brian W. , Littlefield Mark , Ahmad Christopher S.
Published: June 2019

Background:

Medial ulnar collateral ligament (UCL) injury is increasingly prevalent in professional baseball pitchers, and significant research has been devoted to understanding the risk factors and prevention strategies associated with it. To date, no study has investigated what the players themselves believe causes and prevents the injury.

Purpose:

To evaluate the opinions of UCL injuries among pitchers, including professional athletes.

Study Design:

Cross-sectional study.

Methods:

A total of 214 baseball pitchers (45 high school/college, 169 Major League Baseball [MLB]/Minor League Baseball) completed a 52-item questionnaire designed to evaluate their opinions on the cause of UCL injuries, injury prevention, and Tommy John surgery. Overall, 51 of the 214 pitchers had previously experienced a UCL injury. The frequency of the selection of each answer option was measured. Additionally, chi-square tests were used to compare (1) responses between professional and nonprofessional pitchers and (2) responses between pitchers with and without a previous UCL injury.

Results:

Only 45% of pitchers thought that UCL injuries are avoidable in MLB. Additionally, 55% of pitchers with a UCL injury had a history of elbow injuries as an adolescent/child, compared with 18% in the uninjured group ( P < .0001). Also, 72% of all surveyed pitchers agreed that fatigue over the course of a season increases the risk of UCL injuries, and the majority of pitchers agreed that inadequate rest from throwing both during the off-season (61%) and the season (59%) increases the risk of UCL injuries. Moreover, 59% of pitchers believed that a 6-man starting rotation would decrease the incidence of UCL injuries. Professional and nonprofessional pitchers significantly differed ( P = .005) in the type of pitch most prone to causing UCL injuries.

Conclusion:

Pitchers with a previous childhood elbow injury had a significantly higher incidence of UCL injuries during their adult career, suggesting possible predisposition to UCL injury and warranting further research. Fatigue and inadequate rest were of greatest concern among all pitchers for an increased risk of UCL injuries. Understanding and acknowledging the opinions that players have regarding UCL injuries are important to improve UCL education, prevention, and treatment.
Privacy in Social Media Friendships With Direct Supervisors: A Psychological Contract Perspective
Authors: Cistulli Mark D. , Snyder Jason L.
Published: June 2019

Social media in modern companies can connect workers with their supervisors in myriad ways via multiple platforms. This study analyzes the perceived relationships between workers and their supervisors using the theoretical framework of psychological contract violation (PCV). The role of social media in the workplace in terms of privacy and trust between workers and their supervisors and workers’ organizational commitment was analyzed. Demographic information, communication channels (platforms), and the source of the social media relationship request were also considered. An online survey of full- and part-time employees yielded a diverse sample of 327 participants. This social media privacy research is consistent with previous literature on e-mail privacy. Both social media privacy and PCV influenced perceptions of (supervisor) trust. Additionally, PCV and trust influenced perceptions of affective organizational commitment. Implications of the results are discussed.
Increasing Oral Communication Self-Efficacy Improves Oral Communication and General Academic Performance
Authors: Cavanagh Thomas M. , Leeds Christopher , Peters Janet M.
Published: June 2019

In order for students to effectively transfer oral communication skills from academic to professional settings, they must have high oral communication self-efficacy. We significantly increased oral communication self-efficacy in a sample of 97 undergraduate business majors by incorporating enactive mastery, vicarious experience, verbal persuasion, and physiological arousal into a business communication course. Self-efficacy was positively and significantly correlated with course performance, and increases in self-efficacy were positively and significantly correlated with changes in overall grade point average. By targeting self-efficacy, instructors can improve students’ oral communication skills and help them transfer these skills from academic to professional settings.
A Case of a Child With Several Anaphylactic Reactions to Drugs
Authors: Podlecka Daniela , Jerzynska Joanna , Malewska-Kaczmarek Kamila , Stelmach Iwona
Published: June 2019

Adverse drug reaction is defined as any harmful, unintended, and undesired effect of a drug that occurs at doses used for treatment, prevention, or diagnoses. Most of these reactions are classified as type A reactions, which by definition are predictable, common, dose-dependent, and caused by known pharmacological actions of the drug, drug toxicity, and side effects. Allergic reactions are qualified as type B reactions independent of dose, affecting a small population, suggesting that individual patient host factors are important. In pediatric population, β-lactam antibiotics are the most common reason for adverse drug reactions, followed by nonsteroidal anti-inflammatory drugs. In this article, we report the case of a child with several anaphylactic reactions to several drugs, including cefuroxime, amoxicillin/clavulanate, clarithromycin, ibuprofen, and budesonide, in a context of suspected Helicobacter pylori infection.
Efficacy of Empiric Treatment of Urinary Tract Infections in Neonates and Young Infants
Authors: Antoon James W. , Reilly Paige J. , Munns Erin H. , Schwartz Alan , Lohr Jacob A.
Published: June 2019

Background. The antibiotic resistance patterns of young infants with urinary tract infections (UTIs) have evolved over the past 2 decades. Whether current empiric antibiotic regimens are sufficient in this age group is unknown. Methods. A retrospective review of patients aged 0 to 60 days admitted with a UTI discharge diagnosis. Results. Overall susceptibility to empiric antibiotics was 87%. Antibiotic resistance and length of stay were highest among those who were afebrile, those admitted to the intensive care unit, and those with culture diagnosis of enterococcal infection. The sensitivity and specificity of ultrasound as a screening tool for genitourinary anomaly was 70% and 40%, respectively, with a positive predictive value of 31.8%. Conclusions. Empiric antibiotic regimens cover a high percentage of UTIs in infants. However, high rates of resistance and prolonged length of stay in patients with enterococcal infection highlight the need for continued surveillance of such patients in this age group.
Tumor microenvironment and clonal monocytes from chronic myelomonocytic leukemia induce a procoagulant climate
Authors: Zannoni Johanna , Mauz Natacha , Seyve Landry , Meunier Mathieu , Pernet-Gallay Karin , Brault Julie , Jouzier Claire , Laurin David , Pezet Mylène , Pernollet Martine , Cahn Jean-Yves , Cognasse Fabrice , Polack Benoît , Park Sophie
Published: June 2019

Chronic myelomonocytic leukemia (CMML) is a myeloid hematological malignancy with overlapping features of myelodysplastic syndromes (MDSs) and myeloproliferative neoplasms (MPNs). The knowledge of the role of the tumor microenvironment (TME), particularly mesenchymal stromal cells (MSCs), in MDS pathogenesis is increasing. Generally, cancer is associated with a procoagulant state participating in tumor development. Monocytes release procoagulant, tissue factor (TF)–bearing microparticles. We hypothesized that MSCs and clonal monocytes release procoagulant extracellular vesicles (EVs) within the CMML TME, inducing a procoagulant state that could modify hematopoietic stem cell (HSC) homeostasis. We isolated and cultured MSCs and monocytes from CMML patients and MSCs from healthy donors (HDs). Their medium EVs and small EVs (sEVs) were collected after iterative ultracentrifugations and characterized by nanoparticle tracking analysis. Their impact on hemostasis was studied with a thrombin generation assay and fibrinography. CMML or HD HSCs were exposed to sEVs from either CMML or HD MSCs. CMML MSC sEVs increased HD HSC procoagulant activity, suggesting a transfer of TF from the CMML TME to HD HSCs. The presence of TF on sEVs was shown by electron microscopy and western blot. Moreover, CMML monocyte EVs conferred a procoagulant activity to HD MSCs, which was reversed by an anti-TF antibody, suggesting the presence of TF on the EVs. Our findings revealed a procoagulant “climate” within the CMML environment related to TF-bearing sEVs secreted by CMML MSCs and monocytes.
Non-tuberculous mycobacterial pulmonary disease
Authors: Cowman Steven , van Ingen Jakko , Griffith David E. , Loebinger Michael R.
Published: June 2019

Nontuberculous mycobacterial pulmonary disease (NTM-PD) is a challenging infection which is becoming increasingly prevalent, particularly in the elderly, for reasons which are unknown. While underlying lung disease is a well-established risk factor for NTM-PD, it may also occur in apparently healthy individuals. No single common genetic or immunological defect has been identified in this group, and it is likely that multiple pathways contribute towards host susceptibility to NTM-PD which further interact with environmental and microbiological factors leading to the development of disease.

The diagnosis of NTM-PD relies on the integration of clinical, radiological and microbiological results. The clinical course of NTM-PD is heterogeneous, with some patients remaining stable without the need for treatment and others developing refractory disease associated with considerable mortality and morbidity. Treatment regimens are based on the identity of the isolated species, drug sensitivity testing (for some agents) and the severity of disease. Multiple antibiotics are typically required for prolonged periods of time and treatment is frequently poorly tolerated. Surgery may be beneficial in selected cases. In some circumstances cure may not be attainable and there is a pressing need for better regimens to treat refractory and drug-resistant NTM-PD.

This review summarises current knowledge on the epidemiology, aetiology and diagnosis of NTM-PD and discusses the treatment of two of the most clinically significant species, theM. aviumandM. abscessuscomplexes, with a focus on refractory disease and novel therapies.
Bronchodilator reversibility in asthma and COPD: findings from three large population studies
Authors: Janson Christer , Malinovschi Andrei , Amaral Andre F.S. , Accordini Simone , Bousquet Jean , Buist A. Sonia , Canonica Giorgio Walter , Dahlén Barbro , Garcia-Aymerich Judith , Gnatiuc Louisa , Kowalski Marek L , Patel Jaymini , Tan Wan , Torén Kjell , Zuberbier Torsten , Burney Peter , Jarvis Deborah
Published: June 2019

Bronchodilator response (BDR) testing is used as a diagnostic method in obstructive airway diseases. The aim of this investigation was to compare different methods for measuring BDR in participants with asthma and chronic obstructive pulmonary disease (COPD) and to study to the extent to which BDR was related to symptom burden and phenotypic characteristics.

Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured before and 15 min after 200 μg of salbutamol in 35 628 subjects aged ≥16 years from three large international population studies. The subjects were categorised in three groups: current asthma (n=2833), COPD (n=1146) and no airway disease (n=31 649). Three definitions for flow-related reversibility (increase in FEV1) and three for volume-related reversibility (increase in FVC) were used.

The prevalence of bronchodilator reversibility expressed as increase FEV1≥12% and 200 mL was 17.3% and 18.4% in participants with asthma and COPD, respectively, while the corresponding prevalence was 5.1% in those with no airway disease. In asthma, bronchodilator reversibility was associated with wheeze (OR 1.36, 95% CI 1.04–1.79), atopy (OR 1.36, 95% CI 1.04–1.79) and higher exhaled nitric oxide fraction, while in COPD neither flow- nor volume-related bronchodilator reversibility was associated with symptom burden, exacerbations or health status after adjusting for pre-bronchodilator FEV1.

Bronchodilator reversibility was at least as common in participants with COPD as those with asthma. This indicates that measures of reversibility are of limited value for distinguishing asthma from COPD in population studies. However, in asthma, bronchodilator reversibility may be a phenotypic marker.
Are smokers “hardening” or rather “softening”? An ecological and multilevel analysis across 28 European Union countries
Authors: Feliu Ariadna , Fernandez Esteve , Martinez Cristina , Filippidis Filippos T.
Published: June 2019

Background

Tobacco control policies can reduce smoking prevalence. These measures may be less effective where smoking prevalence has significantly declined, as the remaining smokers have “hardened”. Our aim was to empirically evaluate the “hardening hypothesis” at the population level in the European Union (EU) and explore factors associated with hardcore smoking.

Methods

We conducted two separate analyses in the EU using data on smoking from the Eurobarometer surveys (2009–2017, n=112 745). 1) A panel-data fixed-effects linear regression to investigate changes over time in the percentage of hardcore smokers in relation to standardised smoking prevalence at the country level. 2) A multilevel logistic regression analysis with hardcore (daily smokers, ≥15 cigarettes per day who have not attempted to quit in the last 12 months) or light (<5 cigarettes per day) smoking as the dependent variable and time as the main independent variable, controlling for individual and ecological variables.

Results

We studied 29 010 current smokers (43.8% hardcore smokers and 14.7% light smokers). The prevalence of hardcore smoking among adult smokers increased by 0.55 (95% CI 0.14–0.96) percentage points per each additional percentage point in the overall smoking prevalence. The odds of being a hardcore smoker increased over time and were higher in middle-aged males and people with financial difficulties, while the odds of being a light smoker significantly declined among females.

Conclusion

This study does not support the “hardening hypothesis” in the EU between 2009 and 2017, but suggests a softening of the smoking population. Existing tobacco control policies are likely to be suitable to further decrease smoking prevalence in Europe.
Proliferating SPP1/MERTK-expressing macrophages in idiopathic pulmonary fibrosis
Authors: Morse Christina , Tabib Tracy , Sembrat John , Buschur Kristina L. , Bittar Humberto Trejo , Valenzi Eleanor , Jiang Yale , Kass Daniel J. , Gibson Kevin , Chen Wei , Mora Ana , Benos Panayiotis V. , Rojas Mauricio , Lafyatis Robert
Published: June 2019

A comprehensive understanding of the changes in gene expression in cell types involved in idiopathic pulmonary fibrosis (IPF) will shed light on the mechanisms underlying the loss of alveolar epithelial cells and development of honeycomb cysts and fibroblastic foci. We sought to understand changes in IPF lung cell transcriptomes and gain insight into innate immune aspects of pathogenesis.

We investigated IPF pathogenesis using single-cell RNA-sequencing of fresh lung explants, comparing human IPF fibrotic lower lobes reflecting late disease, upper lobes reflecting early disease and normal lungs.

IPF lower lobes showed increased fibroblasts, and basal, ciliated, goblet and club cells, but decreased alveolar epithelial cells, and marked alterations in inflammatory cells. We found three discrete macrophage subpopulations in normal and fibrotic lungs, one expressing monocyte markers, one highly expressingFABP4andINHBA(FABP4hi), and one highly expressingSPP1andMERTK(SPP1hi). SPP1himacrophages in fibrotic lower lobes showed highly upregulatedSPP1andMERTKexpression. Low-level local proliferation of SPP1himacrophages in normal lungs was strikingly increased in IPF lungs.

Co-localisation and causal modelling supported the role for these highly proliferative SPP1himacrophages in activation of IPF myofibroblasts in lung fibrosis. These data suggest that SPP1himacrophages contribute importantly to lung fibrosis in IPF, and that therapeutic strategies targeting MERTK and macrophage proliferation may show promise for treatment of this disease.
Studies on wall painting materials and techniques at two historic buildings in Gyantse, Tibet
Authors: Yang Xinhui , Ji Xinyan , Cao Yongkang , Yu Taoyi
Published: June 2019

This paper presents a scientific examination of wall paintings at two nonmonastic sites in Gyantse, Tibet: Gazhi Lhakang, which is a family temple built in the mid-eighteenth century by local aristocrats, and the Lotso Residence, which was occupied by Nepalese merchants in the early twentieth century. Samples were analyzed with optical microscopy, scanning electron microscopy with energy-dispersive X-ray spectroscopy, Raman spectroscopy, and X-ray diffraction. Two phases of painting—an early phase and a late phase—were identified in Gazhi Lhakang, including three distinct types of mural stratigraphy. The earlier phase features an unusual technique known as “paperhanging”, wherein the pigments were applied on a layer of Tibetan paper glued to the wall. The later phase at Gazhi Lhakang and the painting of the Lotso Residence feature a relatively simple wall treatment with fewer coating layers and no ground layer. A typical mixture of clay and sand was used for the coating layers, while the structure slightly varied from what has been described in the literature. The techniques of powder embossing, gilding, and gold outlining were adopted in both buildings. The metallic material found at Gazhi Lhakang is a gold-silver alloy, while copper was used as imitation gold at the Lotso Residence. Mineral pigments, such as azurite, malachite, orpiment, cinnabar, and iron oxide, were used for both phases of Gazhi Lhakang. Modern synthetic pigments, such as chrome yellow, emerald green, and synthetic ultramarine, were used for the Lotso Residence, indicating that it was painted after the mid-nineteenth century.
The American Board of Anesthesiology’s Standardized Oral Examination for Initial Board Certification
Authors: Sun Huaping , Warner David O. , Patterson Andrew J. , Harman Ann E. , Rathmell James P. , Keegan Mark T. , Dainer Rupa J. , McLoughlin Thomas M. , Fahy Brenda G. , Macario Alex
Published: June 2019

The American Board of Anesthesiology (ABA) has been administering an oral examination as part of its initial certification process since 1939. Among the 24 member boards of the American Board of Medical Specialties, 13 other boards also require passing an oral examination for physicians to become certified in their specialties. However, the methods used to develop, administer, and score these examinations have not been published. The purpose of this report is to describe the history and evolution of the anesthesiology Standardized Oral Examination, its current examination development and administration, the psychometric model and scoring, physician examiner training and auditing, and validity evidence. The many-facet Rasch model is the analytic method used to convert examiner ratings into scaled scores for candidates and takes into account how difficult grader examiners are and the difficulty of the examination tasks. Validity evidence of the oral examination includes that it measures aspects of clinical performance not accounted for by written certifying examinations, and that passing the oral examination is associated with a decreased risk of subsequent license actions against the anesthesiologist. Explaining the details of the Standardized Oral Examination provides transparency about this component of initial certification in anesthesiology.
Coagulation Factor Levels and Underlying Thrombin Generation Patterns in Adult Extracorporeal Membrane Oxygenation Patients
Authors: Mazzeffi Michael , Strauss Erik , Meyer Michael , Hasan Shaheer , Judd Miranda , Abuelkasem Ezeldeen , Chow Jonathan , Nandwani Veena , McCarthy Paul , Tanaka Kenichi
Published: June 2019

BACKGROUND:

There is a paucity of data on the underlying procoagulant–anticoagulant balance during extracorporeal membrane oxygenation (ECMO). We hypothesized that adult ECMO patients would have an imbalance between procoagulant and anticoagulant factors, leading to an abnormal underlying thrombin generation (TG) pattern.

METHODS:

Twenty adult venoarterial (VA) ECMO patients had procoagulant and anticoagulant factor levels measured temporally on ECMO day 1 or 2, day 3, and day 5. In heparin-neutralized plasma, underlying TG patterns, and sensitivity to activated protein C were assessed using calibrated automated thrombogram. TG parameters including lag time, peak TG, and endogenous thrombin potential (ETP) were compared against 5 normal plasma controls (3 males and 2 females) obtained from a commercial supplier. Thrombomodulin (TM) was added to some samples to evaluate for activated protein C resistance.

RESULTS:

Procoagulant factors (factor [F] II, FV, and FX) were mostly in normal reference ranges and gradually increased during the first 5 ECMO days (P = .022, <.001, <.001). FVIII levels were elevated at all time points and did not change (P = .766). In contrast, FXI was in the low-normal range but did not increase during ECMO (P = .093). Antithrombin (AT) and protein C levels were below normal but increased during the first 5 ECMO days (P = .002 and P = .014). Heparinase-treated samples showed prolonged lag time, increased peak TG, and increased ETP compared to controls; mean difference in lag time on ECMO day 1 or 2 = 6.0 minutes (99% confidence interval [CI], 2.8–9.2), peak TG = 193.4 (99% CI, 122.5–264.3), and ETP = 1170.4 (99% CI, 723.2–1617.6). After in vitro TM treatment, differences in TG parameters were accentuated and ECMO samples appeared insensitive to TM treatment; mean difference in lag time on ECMO day 1 or 2 = 9.3 minutes (99% CI, 6.2–12.4), peak TG = 233.0 (99% CI, 140.9–325.1), and ETP = 1322.5 (99% CI, 764.8–1880.2). Similar differences in TG parameters were observed on ECMO days 3 and 5.

CONCLUSIONS:

Contact activation occurs during ECMO, but procoagulant factor levels are generally preserved. Although heparin-neutralized TG is delayed, peak TG and ETP are supranormal in the setting of high FVIII and low AT and protein C levels. Resistance to TM is also apparent. These changes demonstrate a possible mechanism for hypercoagulability during adult VA ECMO.
One Size Does Not Fit All: A Perspective on the American Society of Anesthesiologists Physical Status Classification for Pediatric Patients
Authors: Ferrari Lynne R. , Leahy Izabela , Staffa Steven J. , Johnson Connor , Crofton Charis , Methot Craig , Berry Jay G.
Published: June 2019

BACKGROUND:

The American Society of Anesthesiologists physical status (ASA-PS) classification system is used worldwide to classify patients based on comorbid conditions before general anesthesia. Despite its popularity, the ASA-PS classification system has been shown to have poor interrater reliability due to its subjective definitions, especially when applied to the pediatric population. We hypothesized that the clarification of ASA-PS definitions to better reflect pediatric conditions would improve the accuracy of ASA-PS applied to this population.

METHODS:

A stratified, randomized sample of 120 pediatric surgical cases was collected from a tertiary-care pediatric hospital. A team of senior anesthesiologists reclassified ASA-PS within this patient sample using the suggested pediatric-specific ASA-PS definitions. Interrater reliability was measured using intraclass correlation (ICC) and Fleiss κ statistic. In addition, a qualitative study component using small focus groups of senior anesthesiologists identified areas of ambiguity within the ASA-PS system.

RESULTS:

Among the 90 reclassifications within each ASA-PS group, 42.2% (n = 38) of ASA-PS I were upgraded to ASA-PS II, and 36.7% (n = 33) of ASA-PS II were upgraded to ASA-PS III. In addition, 28.9% (n = 26) of ASA-PS III were upgraded to ASA-PS IV, and 24.4% (n = 22) of ASA-PS IV were downgraded to III. ICC across the reclassified ASA-PS categories was 0.77 (95% confidence interval [CI], 0.71–0.83; P < .001) demonstrating strong overall agreement. Fleiss κ statistic was lowest in ASA-PS II and III patients (κ = 0.41 and κ = 0.30, respectively) indicating lower agreement beyond chance within these subgroups. Focus groups revealed common themes such as active sequelae of disease, active versus well-controlled presence of comorbidities, and the possible inclusion of functional limitations as important considerations.

CONCLUSIONS:

The ASA-PS classification system has several benefits including ease-of-use, simplicity, and flexibility. However, revising the ASA-PS system to provide better guidance for pediatric patients could be valuable. While this study demonstrates good interrater reliability with the included ASA-PS pediatric definitions, further work is needed to clarify accurate assignment of ASA-PS within the midrange of the scale (ASA-PS II and III) and explore its implementation in other institutions.
Polyunsaturated fatty acids promote Plasmodium falciparum gametocytogenesis
Authors: Tanaka Takeshi Q. , Tokuoka Suzumi M. , Nakatani Daichi , Hamano Fumie , Kawazu Shin-ichiro , Wellems Thomas E. , Kita Kiyoshi , Shimizu Takao , Tokumasu Fuyuki
Published: June 2019

The molecular triggers of sexual differentiation into gametocytes by blood stage Plasmodium falciparum, the most malignant human malaria parasites, are subjects of much investigation for potential transmission blocking strategies. The parasites are readily grown in vitro with culture media supplemented by addition of human serum (10%) or by a commercially available substitute (0.5% AlbuMAX). We found better gametocytemia with serum than AlbuMAX, suggesting suboptimal concentrations of some components in the commercial product; consistent with this hypothesis, substantial concentration differences of multiple fatty acids were detected between serum- and AlbuMAX-supplemented media. Mass spectroscopy analysis distinguished the lipid profiles of gametocyte- and asexual stage-parasite membranes. Delivery of various combinations of unsaturated fatty acid-containing phospholipids to AlbuMAX-supported gametocyte cultures improved gametocyte production to the levels achieved with human serum-supplemented media. Maturing gametocytes readily incorporated externally supplied d5-labeled glycerol with fatty acids into unsaturated phospholipids. Phospholipids identified in this work thus may be taken up from extracellular sources or generated internally for important steps of gametocyte development. Further study of polyunsaturated fatty acid metabolism and phospholipid profiles will improve understanding of gametocyte development and malaria parasite transmission.
Active receptor tyrosine kinases, but not Brachyury, are sufficient to trigger chordoma in zebrafish
Authors: D'Agati Gianluca , Cabello Elena María , Frontzek Karl , Rushing Elisabeth J. , Klemm Robin , Robinson Mark D. , White Richard M. , Mosimann Christian , Burger Alexa
Published: June 2019

The aberrant activation of developmental processes triggers diverse cancer types. Chordoma is a rare, aggressive tumor arising from transformed notochord remnants. Several potentially oncogenic factors have been found to be deregulated in chordoma, yet causation remains uncertain. In particular, sustained expression of TBXT – encoding the notochord regulator protein brachyury – is hypothesized as a key driver of chordoma, yet experimental evidence is absent. Here, we employ a zebrafish chordoma model to identify the notochord-transforming potential of implicated genes in vivo. We find that Brachyury, including a form with augmented transcriptional activity, is insufficient to initiate notochord hyperplasia. In contrast, the chordoma-implicated receptor tyrosine kinases (RTKs) EGFR and Kdr/VEGFR2 are sufficient to transform notochord cells. Aberrant activation of RTK/Ras signaling attenuates processes required for notochord differentiation, including the unfolded protein response and endoplasmic reticulum stress pathways. Our results provide the first in vivo evidence against a tumor-initiating potential of Brachyury in the notochord, and imply activated RTK signaling as a possible initiating event in chordoma. Furthermore, our work points at modulating endoplasmic reticulum and protein stress pathways as possible therapeutic avenues against chordoma.
Modern contraceptive use among female adolescents in rural Nigeria: Does exposure to family planning messages matter? A cross-sectional study
Authors: Chima Victor , Alawode Oluwatobi Abel
Published: June 2019

Background: The world currently has the highest number of adolescents in all of history. Africa is home to quite a number of them, with most of these adolescents in Africa live in rural areas where they are more disadvantaged and their reproductive decisions could have telling impacts on their lives, family planning (contraception) has been identified as important to avoid such impacts. Factors associated with the use of modern contraceptives among female adolescents have been extensively researched but the importance of mass media family planning messages on modern contraceptives use among female adolescents in rural Nigeria is under-researched, hence this study.

Method: This paper uses the 2013 Nigeria Demographic and Health Survey (NDHS) data with a weighted sample size (n=4473) to examine the association between exposure to family planning messages and use of modern contraceptives among female adolescents in rural Nigeria.

Results: Findings indicated that exposure to family planning messages on radio and television were significantly associated with modern contraceptive use, however, educational attainment and region of residence were other factors that influenced modern contraceptive use..

Conclusion: The study concludes that family planning messages through mass media especially radio and television are associated with modern contraceptives use among rural adolescents. The continued use of mass media would enhance opportunities to achieve more results, however, other interventions addressing education with objectives of closing the rural-urban socio-economic gap should be encouraged also, as these factors play critical roles in improving uptake of family planning among rural adolescents.  Further, messages on modern contraceptive use should be sensitive to regional divides in terms of content and delivery.
Enhanced recovery after anterior resection: earlier leak diagnosis and low mortality in a case series
Authors: D’Souza N , Robinson PD , Branagan G , Chave H
Published: June 2019

Introduction

Early detection and treatment of anastomotic leak may mitigate its consequences. Within an enhanced recovery setting, the subtle signs of a leak can be more apparent. There are multiple treatment options for anastomotic leak following anterior resection. This study aimed to determine when leaks are diagnosed in enhanced recovery, and whether the choice of intervention affects outcomes.

Materials and methods

We conducted a retrospective study of a prospectively maintained database of complications of anterior resections for rectal cancer in a district general hospital in the UK. Data were extracted on day of leak diagnosis, length of stay, intensive care admission, mortality and ileostomy reversal rate. Statistical analysis was performed using Student’s t, Mann–Whitney U and chi square tests.

Results

A total of 323 patients underwent anterior resection for colorectal cancer between 1 January 2007 and 1 October 2015. The leak rate was 10.8% (35/323). Patients were diagnosed in hospital with leaks on median day 4 compared with day 11 for patients diagnosed with leaks after readmission from home (P < 0.001). Defunctioned patients diagnosed with a leak had a longer median length of stay (24 vs 18.0 days, P = 0.31) but were more frequently managed non-operatively (100% vs 19.0%, P < 0.001) and had a lower admission rate to intensive care (9.5% vs 42.9%, P = 0.02) than patients who were not defunctioned at time of resection. Overall mortality from anastomotic leak was 2.9% (1/35). Ileostomies were reversed in 73.5% of patients (25/34).

Discussion

Enhanced recovery enables early diagnosis of leaks following anterior resection. Defunctioning of patients with anastomotic leak lowers mortality.
STRATEGI MEMPERCEPAT PEMBANGUNAN DESA MANDIRI: STUDI DI DESA KEMADANG GUNUNGKIDUL
Authors: Nur Arifah Miratun , Kusumastuti Nugrahani
Published: June 2019

The commitment of the government in developing villages has been implemented in ‘Nawacita Programs’, the theme of Developing Indonesia’s rural areas. For that, the developing country very impossible can regularly, if the government not prepared for this program with the excellently. Hence, this research is the goals for knowing of the strategy which doing of government in the implementation of developing transformation until making Kemadang Village become an independent rural area in 2015 old. In addition, this paper aims to explain about developing transformation form become in Kemadang Village who has an independent rural area. The result of the research shows to us that in the strategy of implementing, is the government of Village Kemadang conducted mapping potential area, coaching and mentoring, building of the network, and implemented of governance village become modern organizations. Meanwhile, the form of developing transformation is increasing of services, and health facilities. For the production of livelihood, society is increasingly in disaster mitigation.[Komitmen pemerintahan dalam membangun desa tertuang dalam Nawacita, yakni “Membangun Indonesia Dari Pinggiran Dengan Memperkuat Daerah-Daerah dan Desa dalam Kerangka Negara Kesatuan”. Sebuah pembangunan suatu daerah tidak akan terlepas dari campur tangan pemerintah itu sendiri. Oleh karena itu, penelitian ini bertujuan untuk mengetahui strategi yang dilakukan pemerintah dalam melaksanakan transformasi pembangunan hingga menjadikan Desa Kemadang menjadi desa mandiri pada tahun 2015. Selain itu, kajian ini hendak menjelaskan bentuk transformasi pembangunan yang terjadi di Desa Kemadang setelah menjadi desa mandiri. Hasil penelitian ini menunjukkan bahwa dalam hal strategi yang dilakukan, pemerintah Desa Kemdang melakukan pemetaan potensi, pembinaan dan pendampingan, membangun sinergisitas dan menerapkan tata kelola desa menjadi organisasi modern. Sedangkan wujud dari transformasi pembangunan itu sendiri ialah terjadi peningkatan pada pelayanan, sarana dan prasarana kesehatan. Dalam keragaman produksi masyarakat dan program dalam hal mitigasi bencana juga turut meningkat.]