bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Patient-Reported Outcome Measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney disease (PRO-trACK project): a mixed-methods project protocol
Authors: Aiyegbusi Olalekan Lee , Kyte Derek , Cockwell Paul , Marshall Tom , Dutton Mary , Slade Anita , Marklew Neil , Price Gary , Verdi Rav , Waters Judi , Sharpe Keeley , Calvert Melanie
Published: July 2017

Introduction

Advanced chronic kidney disease (CKD) has a major effect on the quality of life and health status of patients and requires accurate and responsive management. The use of electronic patient-reported outcome measures (ePROMs) could assist patients with advanced pre-dialysis CKD, and the clinicians responsible for their care, by identifying important changes in symptom burden in real time. We report the protocol for ‘Using Patient-Reported Outcome measures (PROMs) to promote quality of care and safety in the management of patients with Advanced Chronic Kidney Disease’ (PRO-trACK) project, which will explore the feasibility and validity of an ePROM system for use in patients with advanced CKD.

Methods and analysis

The project will use a mixed-methods approach in three studies: (1) usability testing of the ePROM system involving up to 30 patients and focusing on acceptability and technical performance/stability; (2) ascertaining the views of patient and clinician stakeholders on the optimal use and administration of the CKD ePROM system—this will involve qualitative face-to-face/telephone interviewing with up to 30 patients or until saturation is achieved, focus groups with up to 15 clinical staff, management and IT team members; (3) psychometric assessment of the system, within a cohort of at least 180 patients with advanced CKD, to establish the measurement properties of the ePROM.

Ethics and dissemination

This project was approved by the West Midlands Edgbaston Research Ethics Committee (Reference 17/WM/0010) and received Health Research Authority (HRA) approval on 24 February 2017.

The findings from this project will be provided to clinicians at the Department of Renal Medicine, Queen Elizabeth Hospitals, Birmingham (QEHB), NHS England, presented at conferences and to the Kidney Patients’ Association, British Kidney Patient Association and the British Renal Society. Articles based on the findings will be written and submitted for publication in peer-reviewed journals.
Corticosteroids in sepsis: an updated systematic review and meta-analysis (protocol)
Authors: Rochwerg Bram , Oczkowski Simon , Siemieniuk Reed Alexander , Menon Kusum , Szczeklik Wojciech , English Shane , Agoritsas Thomas , Belley-Cote Emilie , D’Aragon Frédérick , Alhazzani Waleed , Duan Erick , Gossack-Keenan Kira , Sevransky Jon , Vandvik Per , Venkatesh Bala , Guyatt Gordon , Annane Djillali
Published: July 2017

Introduction

Sepsis is associated with a dysregulated host response to infection and impaired endogenous corticosteroid metabolism. As such, therapeutic use of exogenous corticosteroids is a promising adjunctive intervention. Despite a large number of trials examining this research question, uncertainty persists regarding the effect of corticosteroids on survival in sepsis. Several large randomised controlled trials have been published recently prompting a re-evaluation of the available literature.

Methods and analysis

A rigorous and reproducible search and screening process from a Cochrane review on the same topic was comprehensive to October 2014. We will search MEDLINE, EMBASE, LILACS, the Cochrane trial registry and clinicaltrials.gov for eligible randomised controlled trials investigating the use of corticosteroids in patients with sepsis from September 2014. Outcomes have been chosen by a semi-independent guideline panel, created in the context of a parallelBMJRapid Recommendation on the topic. This panel includes clinicians, content experts, methodologists and patient representatives, who will help identify patient-important outcomes that are critical for deciding whether to use or not use corticosteroids in sepsis. Two reviewers will independently screen and identify eligible studies; a third reviewer will resolve any disagreements. We will use RevMan to pool effect estimates from included studies for each outcome using a random-effect model. We will present the results as relative risk with 95% CI for dichotomous outcomes and as mean difference or standardised mean difference for continuous outcomes with 95% CI. We will assess the certainty of evidence at the outcome level using the Grading of Recommendations, Assessment, Development and Evaluation approach. We will conduct a priori subgroup analyses, which have been chosen by the parallelBMJRapid Recommendation panel.

Ethics and dissemination

The aim of this systematic review is to summarise the updated evidence on the efficacy and safety of corticosteroids in patients with sepsis.

Trial registration number

CRD42017058537.
Efficacy evaluation of an anti-caries varnish: protocol for a phase II randomised controlled trial
Authors: Milgrom Peter , Tut Ohnmar , Rothen Marilynn , Mancl Lloyd , Gallen Marcelle , Tanzer Jason M
Published: July 2017

Introduction

Dental caries (tooth decay) is a common disease in which the products of sugar metabolism by certain bacteria that populate the tooth surface induce the development and progression of lesions (cavities). This is a phase II single-centre randomised, double-blind, active-controlled, parallel-group trial to assess the efficacy of a combination povidone iodine and sodium fluoride dental varnish to determine if it is superior to a varnish containing only sodium fluoride in the prevention of new caries lesions. The objective of this report is to describe the rationale and protocol for the trial.

Methods and analysis

The study site is Pohnpei State, Federated States of Micronesia. The study population is 284 children 48–84 months old. The primary outcome will be the surface-level primary molar caries increment (d2-3mfs/DMFS) at 2 years post baseline. The incremental dental caries at 1 year will also be compared between the two interventions. The secondary outcome is the Facial Image Scale after the initial treatment and after the fifth treatment at 1 year that gauges the child’s response to the treatment.

Ethics and dissemination

The Western Institutional Review Board (designated IRB) and the Institutional Review Board of the College of Micronesia-FSM approved all study procedures. The US Food and Drug Administration (FDA) has issued IND 128835 covering this study. The study results will be published and submitted to the FDA in support of a new drug application.

Trialregistration number

NCT03082196.
A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital
Authors: Milnes Sharyn , Orford Neil R , Berkeley Laura , Lambert Nigel , Simpson Nicholas , Elderkin Tania , Corke Charlie , Bailey Michael
Published: July 2017

Objectives

Report the use of an objective tool, UK Gold Standards Framework (GSF) criteria, to describe the prevalence, recognition and outcomes of patients with palliative care needs in an Australian acute health setting. The rationale for this is to enable hospital doctors to identify patients who should have a patient-centred discussion about goals of care in hospital.

Design

Prospective, observational, cohort study.

Participants

Adult in-patients during two separate 24 h periods.

Main outcome measures

Prevalence of in-patients with GSF criteria, documentation of treatment limitations, hospital and 1 year survival, admission and discharge destination and multivariate regression analysis of factors associated with the presence of hospital treatment limitations and 1 year survival.

Results

Of 626 in-patients reviewed, 171 (27.3%) had at least one GSF criterion, with documentation of a treatment limitation discussion in 60 (30.5%) of those patients who had GSF criteria. Hospital mortality was 9.9%, 1 year mortality 50.3% and 3-year mortality 70.2% in patients with GSF criteria. One-year mortality was highest in patients with GSF cancer (73%), renal failure (67%) and heart failure (60%) criteria. Multivariate analysis revealed age, hospital length of stay and presence of the GSF chronic obstructive pulmonary disease criteria were independently associated with the likelihood of an in-hospital treatment limitation. Non-survivors at 3 years were more likely to have a GSF cancer (25% vs 6%, p=0.004), neurological (10% vs 3%, p=0.04), or frailty (45% vs 3%, p=0.04) criteria. After multivariate logistic regression GSF cancer criteria, renal failure criteria and the presence of two or more GSF clinical criteria were independently associated with increased risk of death at 3 years. Patients returning home to live reduced from 69% (preadmission) to 27% after discharge.

Conclusions

The use of an objective clinical tool identifies a high prevalence of patients with palliative care needs in the acute tertiary Australian hospital setting, with a high 1 year mortality and poor return to independence in this population. The low rate of documentation of discussions about treatment limitations in this population suggests palliative care needs are not recognised and discussed in the majority of patients.

Trial registration number

11/121.
Analysis of plant root–induced preferential flow and pore-water pressure variation by a dual-permeability model
Authors: Shao Wei , Ni Junjun , Leung Anthony Kwan , Su Ye , Ng Charles Wang Wai
Published: July 2017

Vegetation can affect slope hydrology and stability via plant transpiration and induced matric suction. Previous work suggested that the presence of plant roots would induce preferential flow, and its effects may be more significant when the planting density is high. However, there is a lack of numerical studies on how planting density affects soil pore-water pressure and shear strength during heavy rainfall. This study aims to investigate the impact of plant root–induced preferential flow on hydromechanical processes of vegetated soils under different planting densities. Two modelling approaches, namely single- and dual-permeability models, were integrated with an infinite slope stability approach to simulate pore-water pressure dynamics and slope stability. Laboratory tests on soils with two different planting densities for a plant species, Schefflera heptaphylla, were conducted for numerical simulations. The single-permeability model overestimated the pore-water pressure in shallow soil and underestimated the infiltration depth. The dual-permeability model, which is able to model the effects of preferential flow, can better capture the observations of rapid increase of pore-water pressure and deeper pressure response in the vegetated soil. However, caution should be taken on the choice of pore-water pressure when using the dual-permeability model to assess the factor of safety. The dual-permeability model using the pore-water pressure in the preferential flow domain and that in the matrix domain would result in a lower and higher factor of safety, respectively.
Three-dimensional numerical investigation of flow through screens as energy dissipators
Authors: Daneshfaraz Rasoul , Sadeghfam Sina , Ghahramanzadeh Ali
Published: July 2017

Screens, perforated units to dissipate energy in hydraulic structures, are investigated numerically in this study. These units are part of a physical setup exposed to supercritical flows, normally created by sluice gates. The interaction of perforated screens and supercritical flows results in local complex three-dimensional flows, which can be analyzed by the application of RANS-based flow equations. The most important controlling parameters include supercritical Froude number between 2 and 10 and screen porosity of 40% and 50%. Numerical water surface profiles and energy dissipation are validated by the author’s experimental data. This paper derives a set of equations in terms of depth ratio of the hydraulic jump through the perforated screens and assesses the effect of baffles on energy dissipation. This study seeks a proof-of-concept for the application of the RANS-based technique for further application of the result to real hydraulic structures in due course.
Different quantum f-divergences and the reversibility of quantum operations
Authors: Hiai Fumio , Mosonyi Milán
Published: July 2017

The concept of classical [Formula: see text]-divergences gives a unified framework to construct and study measures of dissimilarity of probability distributions; special cases include the relative entropy and the Rényi divergences. Various quantum versions of this concept, and more narrowly, the concept of Rényi divergences, have been introduced in the literature with applications in quantum information theory; most notably Petz’ quasi-entropies (standard [Formula: see text]-divergences), Matsumoto’s maximal [Formula: see text]-divergences, measured [Formula: see text]-divergences, and sandwiched and [Formula: see text]-[Formula: see text]-Rényi divergences.

In this paper, we give a systematic overview of the various concepts of quantum [Formula: see text]-divergences, with a main focus on their monotonicity under quantum operations, and the implications of the preservation of a quantum [Formula: see text]-divergence by a quantum operation. In particular, we compare the standard and the maximal [Formula: see text]-divergences regarding their ability to detect the reversibility of quantum operations. We also show that these two quantum [Formula: see text]-divergences are strictly different for non-commuting operators unless [Formula: see text] is a polynomial, and obtain some analogous partial results for the relation between the measured and the standard [Formula: see text]-divergences.

We also study the monotonicity of the [Formula: see text]-[Formula: see text]-Rényi divergences under the special class of bistochastic maps that leave one of the arguments of the Rényi divergence invariant, and determine domains of the parameters [Formula: see text] where monotonicity holds, and where the preservation of the [Formula: see text]-[Formula: see text]-Rényi divergence implies the reversibility of the quantum operation.
Equilibrium and nonequilibrium models on solomon networks with two square lattices
Authors: Lima F. W. S.
Published: July 2017

We investigate the critical properties of the equilibrium and nonequilibrium two-dimensional (2D) systems on Solomon networks with both nearest and random neighbors. The equilibrium and nonequilibrium 2D systems studied here by Monte Carlo simulations are the Ising and Majority-vote 2D models, respectively. We calculate the critical points as well as the critical exponent ratios [Formula: see text], [Formula: see text], and [Formula: see text]. We find that numerically both systems present the same exponents on Solomon networks (2D) and are of different universality class than the regular 2D ferromagnetic model. Our results are in agreement with the Grinstein criterion for models with up and down symmetry on regular lattices.
Long-time behavior for crystal dislocation dynamics
Authors: Patrizi Stefania , Valdinoci Enrico
Published: July 2017

We describe the asymptotic states for the solutions of a nonlocal equation of evolutionary type, which have the physical meaning of the atom dislocation function in a periodic crystal. More precisely, we can describe accurately the “smoothing effect” on the dislocation function occurring slightly after a “particle collision” (roughly speaking, two opposite transitions layers average out) and, in this way, we can trap the atom dislocation function between a superposition of transition layers which, as time flows, approaches either a constant function or a single heteroclinic (depending on the algebraic properties of the orientations of the initial transition layers). The results are endowed with explicit and quantitative estimates and, as a byproduct, we show that the ODE systems of particles that govern the evolution of the transition layers does not admit stationary solutions (i.e. roughly speaking, transition layers always move).
Electromagnetic wave scattering by random surfaces: Shape holomorphy
Authors: Jerez-Hanckes Carlos , Schwab Christoph , Zech Jakob
Published: July 2017

For time-harmonic electromagnetic waves scattered by either perfectly conducting or dielectric bounded obstacles, we show that the fields depend holomorphically on the shape of the scatterer. In the presence of random geometrical perturbations, our results imply strong measurability of the fields, in weighted spaces in the exterior of the scatterer. These findings are key to prove dimension-independent convergence rates of sparse approximation techniques of polynomial chaos type for forward and inverse computational uncertainty quantification. Also, our shape-holomorphy results imply parsimonious approximate representations of the corresponding parametric solution families, which are produced, for example, by greedy strategies such as model order reduction or reduced basis approximations. Finally, the presently proved shape holomorphy results imply convergence of shape Taylor expansions of far-field patterns for fixed amplitude domain perturbations in a vicinity of the nominal domain, thereby extending the widely used asymptotic linearizations employed in first-order, second moment domain uncertainty quantification.
Global stability of combination of viscous contact wave with rarefaction wave for compressible Navier–Stokes equations with temperature-dependent viscosity
Authors: Huang Bingkang , Liao Yongkai
Published: July 2017

We study the nonlinear stability of a composite wave pattern, which is a combination of a viscous contact wave with a rarefaction wave, to the Cauchy problem of one-dimensional compressible Navier–Stokes equations for a viscous and heat conducting ideal polytropic gas with large initial perturbation when the transport coefficients depend on both temperature and density. Our main idea is to use the “smallness mechanism” induced by the structures of the equations under consideration and the smallness of the strengths of the two elementary waves to control the possible growth of the solutions caused by the nonlinearities of the equations, the interactions between the solutions themselves and the wave pattern, and the interactions of waves between different families. The main ingredient in the analysis is to derive the uniform positive lower and upper bounds on the specific volume and the temperature.
CURRENT–VOLTAGE CHARACTERISTICS OF THERMALLY ANNEALED Ni/n-GaAs SCHOTTKY CONTACTS
Authors: YILDIRIM NEZIR , TURUT ABDULMECIT , DOGAN HULYA
Published: July 2017

The Schottky barrier type Ni/[Formula: see text]-GaAs contacts fabricated by us were thermally annealed at 600[Formula: see text]C and 700[Formula: see text]C for 1[Formula: see text]min. The apparent barrier height [Formula: see text] and ideality factor of the diodes were calculated from the forward bias current–voltage characteristic in 60–320[Formula: see text]K range. The [Formula: see text] values for the nonannealed and 600[Formula: see text]C and 700[Formula: see text]C annealed diodes were obtained as 0.80, 0.81 and 0.67[Formula: see text]eV at 300[Formula: see text]K, respectively. Thus, it has been concluded that the reduced barrier due to the thermal annealing at 700[Formula: see text]C promises some device applications. The current preferentially flows through the lowest barrier height (BH) with the temperature due to the BH inhomogeneities. Therefore, it was seen that the [Formula: see text] versus [Formula: see text] plots for the nonannealed and annealed diodes showed the linear behavior according to Gaussian distributions.
Financial Deepening and Economic Growth in Transition Economies of Southeast Asia: A Geweke Causality Analysis
Authors: Tan Khee Giap , Gopalan Sasidaran , Le Phuong Anh Nguyen
Published: July 2017

Cambodia, Laos and Vietnam (CLV) have come to be recognized as the new growth frontiers in the Association of Southeast Asian Nations (ASEAN) bloc, especially since the 2000s. Though all the CLV countries were hit by the global financial crisis (GFC), there has been a sharp recovery in all the economies from around 2010 or so, partly aided by the rapid development of their financial sector. While this has formed the basis for optimism about the growth potential of these countries, there have also been concerns that these countries have been experiencing a period of excessive credit growth – an offshoot of rapid financial deepening – which in turn is hampering growth and aggravating financial instability. In light of this discussion, this paper examines the nexus between financial deepening and economic growth employing a Geweke causality framework with quarterly data for CLV countries from 1996 to 2010.
Simulation-Based Performance Analysis of Split Air Conditioner Incorporating Copper Tubes of Smaller Diameter
Authors: Doiphode Pushpak , Kumar Manish , Samanta Indraneel
Published: July 2017

Increasing cost of copper material has forced air conditioner manufacturers to lower copper consumption or focus on alternative materials in air conditioning applications in order to stand at upright position in cost competitive environment. Since copper possesses most of the well-suited characteristics that are needed for the air conditioning system, choice of reducing copper material is preferred over alternative materials. Present study focuses on simulation-based design methodology and performance analysis of split air conditioning system with R32 as a refrigerant. It includes replacement of 7[Formula: see text]mm outside diameter condenser coil with 5[Formula: see text]mm diameter copper tubes. Simulation technique for investigating optimal condenser coil geometry incorporating smaller diameter tubes is also demonstrated for typical air conditioning system. Simulation results show that cost of condenser coil with reduced tube diameter is much lower than that of existing coil of higher tube diameter without any compromise in the performance of air conditioning system.
Performance Evaluation of a Two-Dimensional Lattice Boltzmann Solver Using CUDA and PGAS UPC Based Parallelisation
Authors: Szőke Máté , Józsa Tamás István , Koleszár Ádám , Moulitsas Irene , Könözsy László
Published: July 2017

The Unified Parallel C (UPC) language from the Partitioned Global Address Space (PGAS) family unifies the advantages of shared and local memory spaces and offers a relatively straightforward code parallelisation with the Central Processing Unit (CPU). In contrast, the Computer Unified Device Architecture (CUDA) development kit gives a tool to make use of the Graphics Processing Unit (GPU). We provide a detailed comparison between these novel techniques through the parallelisation of a two-dimensional lattice Boltzmann method based fluid flow solver. Our comparison between the CUDA and UPC parallelisation takes into account the required conceptual effort, the performance gain, and the limitations of the approaches from the application oriented developers’ point of view. We demonstrated that UPC led to competitive efficiency with the local memory implementation. However, the performance of the shared memory code fell behind our expectations, and we concluded that the investigated UPC compilers could not efficiently treat the shared memory space. The CUDA implementation proved to be more complex compared to the UPC approach mainly because of the complicated memory structure of the graphics card which also makes GPUs suitable for the parallelisation of the lattice Boltzmann method.
Enhancing Transmission Collision Detection for Distributed TDMA in Vehicular Networks
Authors: Bharati Sailesh , Omar Hassan Aboubakr , Zhuang Weihua
Published: July 2017

The increasing number of road accidents has led to the evolution of vehicular ad hoc networks (VANETs), which allow vehicles and roadside infrastructure to continuously broadcast safety messages, including necessary information to avoid undesired events on the road. To support reliable broadcast of safety messages, distributed time division multiple access (D-TDMA) protocols are proposed for medium access control in VANETs. Existing D-TDMA protocols react to a transmission failure without distinguishing whether the failure comes from a transmission collision or from a poor radio channel condition, resulting in degraded performance. In this article, we present the importance of transmission failure differentiation due to a poor channel or due to a transmission collision for D-TDMA protocols in vehicular networks. We study the effects of such a transmission failure differentiation on the performance of a node when reserving a time slot to access the transmission channel. Furthermore, we propose a method for transmission failure differentiation, employing the concept of deep-learning techniques, for a node to decide whether to release or continue using its acquired time slot. The proposed method is based on the application of a Markov chain model to estimate the channel state when a transmission failure occurs. The Markov model parameters are dynamically updated by each node (i.e., vehicle or roadside unit) based on information included in the safety messages that are periodically received from neighboring nodes. In addition, from the D-TDMA protocol headers of received messages, a node approximately determines the error in estimating the channel state based on the proposed Markov model and then uses this channel estimation error to further improve subsequent channel state estimations. Through mathematical analysis, we show that transmission failure differentiation, or transmission collision detection, helps a node to efficiently reserve a time slot even with a large number of nodes contending for time slots. Furthermore, through extensive simulations in a highway scenario, we demonstrate that the proposed solution significantly improves the performance of D-TDMA protocols by reducing unnecessary contention on the available time slots, thus increasing the number of nodes having unique time slots for successful broadcast of safety messages.
Flexural Behaviour of RC Beams Strengthened with Prestressed CFRP NSM Tendon Using New Prestressing System
Authors: Jung Woo-tai , Park Jong-sup , Kang Jae-yoon , Keum Moon-seoung , Park Young-hwan
Published: July 2017

CFRP has been used mainly for strengthening of existing structures in civil engineering area. Prestressed strengthening is being studied to solve the bond failure model featuring EBR and NSMR methods. The largest disadvantage of the prestressing system is that the system cannot be removed until the filler is cured. This problem lowers the turning rate of the equipment and makes it limited to experiment, which stresses the necessity of a new prestressing system. Therefore, the present study applies a new prestressing system which reliefs the need to wait until the curing of the filler after jacking to the prestressing of NSMR and examines the effect of the prestressing size and location of the anchorage on the strengthened behaviour. The experimental results show that the crack and yield loads increase with higher level of prestress, while the ductility tends to reduce, and the anchor plate should be installed within the effective depth ds to minimize the occurrence of shear-induced diagonal cracks. The comparison of the experimental results and results by section analysis shows that the section analysis could predict the maximum load of the specimens strengthened by prestressed NSMR within an error between 4% and 6%.
Cryptanalysis of Three Password-Based Remote User Authentication Schemes with Non-Tamper-Resistant Smart Card
Authors: Wang Chenyu , Xu Guoai
Published: July 2017

Remote user authentication is the first step to guarantee the security of online services. Online services grow rapidly and numerous remote user authentication schemes were proposed with high capability and efficiency. Recently, there are three new improved remote user authentication schemes which claim to be resistant to various attacks. Unfortunately, according to our analysis, these schemes all fail to achieve some critical security goals. This paper demonstrates that they all suffer from offline dictionary attack or fail to achieve forward secrecy and user anonymity. It is worth mentioning that we divide offline dictionary attacks into two categories: (1) the ones using the verification from smart cards and (2) the ones using the verification from the open channel. The second is more complicated and intractable than the first type. Such distinction benefits the exploration of better design principles. We also discuss some practical solutions to the two kinds of attacks, respectively. Furthermore, we proposed a reference model to deal with the first kind of attack and proved its effectiveness by taking one of our cryptanalysis schemes as an example.
Multiple Osteolytic Lesions Causing Hypercalcemia: A Rare Presentation of Acute Lymphoblastic Leukemia
Authors: Mahmood Khalid , Ubaid Muhammad , Taliya Rizvi Syeda
Published: July 2017

Acute lymphoblastic leukemia is characterized by unchecked proliferation of malignant lymphoblasts which replaces the normal bone marrow culminating in anemia due to red blood cells inadequacy as well as in easy bruising/bleeding secondary to insufficient platelets production. Even the white blood cells which are produced excessively are immature and abnormal. ALL is the most common hematological malignancy in children. Most commonly, patients present with lymphadenopathy, recurrent infections, bleeding, fatigue, and bone pains. Bone pains, often particularly involving long bones, occur in about 21–38% of cases and are due to overcrowding of bone marrow with malignant cells. Vast majority of children with ALL have thrombocytopenia and/or anemia with a normal or mildly elevated white blood cells count with the presence of lymphoblasts on peripheral smear. About 50% of children present with bleeding while about 75% of patients have platelet count 100,000/microL. Visceromegaly is not uncommon but osteolytic lesions and hypercalcemia are rather uncommon. We present a 22-year-old gentleman with generalized fatigue and bone pains without visceromegaly. There was severe hypercalcemia with normal parathyroid levels but multiple osteolytic lesions. Peripheral smear showed anemia without blasts, whereas a bone marrow biopsy revealed > 30% blasts with interspersed CD 10 positive cells.
Results from Survey to Assess Current Trends in Surgical Practice in the Management of Women with Early Stage Cervical Cancer within the BGCS Community with an Emphasis on Routine Frozen Section Examination
Authors: Gubbala Kumar , Laios Alexandros , Madhuri Thulumuru Kavitha , Pathiraja Pubudu , Haldar Krishnayan , Kehoe Sean
Published: July 2017

In the UK, more than 3,200 new cases of cervical cancer are diagnosed each year. Early stage cervical cancer (IA2-IB1) treatment comprises central surgery mainly in the form of radical hysterectomy or fertility sparing surgery including trachelectomy as well as systematic pelvic lymphadenectomy to detect metastases and adjust treatment accordingly. Given the variation in determining the lymph node (LN) status, a major prognosticator, we reviewed the current UK practice of LN assessment in women undergoing surgery for early cervical cancer. A 7-question, web-based survey, screened by the BGCS committee, was circulated amongst BGCS members. The overall response rate was 51%. Only 12.5% of the respondents routinely performed frozen section examination (FSE); the main reasons for not doing FSE were the pressure on theatre time (54.5%) and the lack of available facilities (48.5%). When positive pelvic nodal disease was detected, in 21 out of 50 (42%) the planned radical hysterectomy (RH) was aborted. More than 70% of the respondents routinely performed RH without any prior resort to pelvic lymphadenectomy. Pretreatment surgical para-aortic LN assessment was performed by 20% of the respondents. The survey confirms the diversity of the UK practice patterns in the surgical treatment of early cervical cancer.
Pancreatogastrostomy versus Pancreatojejunostomy: An Up-to-Date Meta-Analysis of RCTs
Authors: Perivoliotis Konstantinos , Sioka Eleni , Tatsioni Athina , Stefanidis Ioannis , Zintzaras Elias , Zacharoulis Dimitrios
Published: July 2017

Background. A meta-analysis was conducted in order to provide an up-to-date comparison of pancreatogastrostomy (PG) and pancreatojejunostomy (PJ), after pancreatoduodenectomy (PD), in terms of clinically significant postoperative pancreatic fistula (POPF) and other postoperative complications. Methods. This meta-analysis was conducted according to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature search in MEDLINE and Cochrane Central Register of Controlled Clinical Trials was performed. Fixed Effects or Random Effects model was used, based on the Cochran Q test. Results. In total, 10 studies (1629 patients) were included. There was no statistical significance between PG and PJ regarding the rate of clinically significant POPF (OR: 0.70, 95%CI: 0.46–1.06). PG was associated with a higher rate of postpancreatoduodenectomy haemorrhage (PPH) (OR: 1.52, 95%CI: 1.08–2.14). There was no difference between the two techniques in terms of clinically significant PPH (OR: 1.35, 95%CI: 0.95–1.93) and clinically significant postoperative delayed gastric emptying (DGE) (OR: 0.98, 95%CI: 0.59–1.63). Discussion. There is no difference between the two anastomotic techniques regarding the rate of clinically significant POPF. Given several limitations, more large scale high quality RCTs are required.
Refining Lane-Based Traffic Signal Settings to Satisfy Spatial Lane Length Requirements
Authors: Liu Yanping , Wong C. K.
Published: July 2017

In conventional lane-based signal optimization models, lane markings guiding road users in making turns are optimized with traffic signal settings in a unified framework to maximize the overall intersection capacity or minimize the total delay. The spatial queue requirements of road lanes should be considered to avoid overdesigns of green durations. Point queue system adopted in the conventional lane-based framework causes overflow in practice. Based on the optimization results from the original lane-based designs, a refinement is proposed to enhance the lane-based settings to ensure that spatial holding limits of the approaching traffic lanes are not exceeded. A solution heuristic is developed to modify the green start times, green durations, and cycle length by considering the vehicle queuing patterns and physical holding capacities along the approaching traffic lanes. To show the effectiveness of this traffic signal refinement, a case study of one of the busiest and most complicated intersections in Hong Kong is given for demonstration. A site survey was conducted to collect existing traffic demand patterns and existing traffic signal settings in peak periods. Results show that the proposed refinement method is effective to ensure that all vehicle queue lengths satisfy spatial lane capacity limits, including short lanes, for daily operation.
Antineuroinflammatory Effects of Modified Wu‐Zi‐Yan‐Zong Prescription in β‐Amyloid‐Stimulated BV2 Microglia via the NF‐κB and ERK/p38 MAPK Signaling Pathways
Authors: Yu Qian , Song Fang-Jiao , Chen Jin-Feng , Dong Xin , Jiang Yong , Zeng Ke-Wu , Tu Peng-Fei , Wang Xue-Mei
Published: July 2017

Modified Wu‐Zi‐Yan‐Zong prescription (MWP), a traditional Chinese medicinal decoction, has possessed the neuroprotective and anti‐inflammatory properties. The mechanisms associated with these properties, however, are not completely understood. We designed the experiments to elucidate the antineuroinflammatory property of MWP in BV2 microglia activated by β‐amyloid (Aβ), which is a characteristic feature of Alzheimer’s disease (AD). The composition of MWP was studied using HPLC. BV2 microglia cells were then treated with Aβ in the presence or absence of MWP. The effects of MWP treatment on Aβ‐activated neuroinflammation were determined using PCR, western blotting, and immunofluorescence staining. MWP significantly inhibited the mRNA expression of inflammatory mediators such as IL‐1β, IL‐6, TNF‐α, and MCP‐1, as well as the expression of inducible nitric oxide synthase (iNOS) in Aβ‐activated BV2 microglia. MWP also inhibited the nuclear translocation and signaling pathway of nuclear factor kappa B (NF‐κB) by suppressing inhibitor of nuclear factor‐κB (IκB) degradation and downregulating IκB kinase β (IKKβ) phosphorylation. Moreover, MWP decreased extracellular regulated protein kinase (ERK)/p38 mitogen‐activated protein kinase (MAPK) phosphorylation, which is an important signaling pathway for proinflammatory gene expression. We concluded that MWP could suppress neuroinflammatory responses in Aβ‐activated BV2 microglia via the NF‐κB and ERK/p38 MAPK signaling cascades and could prove an effective therapeutic agent for the prevention and treatment of neuroinflammatory diseases such as AD.
Rare Reported Left Hepatic Subcapsular Biloma and Management
Authors: Brown Sarah , Giuseppucci Pablo , Esper Christopher
Published: July 2017

Subcapsular bilomas are a rare complication of laparoscopic cholecystectomy and an even more rare occurrence to occur spontaneously. We present a case of left sided subcapsular biloma following a laparoscopic cholecystectomy. The location of the biloma was unrelated to our area of dissection. The operation was without difficult dissection or pressurization of the biliary tree. In addition, we present percutaneous drainage alone, without ERCP as adequate management in subcapsular bilomas.
The Potential Role of Iatrogenic Comorbidity in the Interaction between Pharmacotherapy and Psychotherapy in Anxiety Disorders
Authors: Fava Giovanni A. , Benasi Giada , Cosci Fiammetta
Published: July 2017

The combination of pharmacotherapy and psychotherapy in the setting of anxiety disorders is often viewed as a potential source of augmentation of clinical effects, with little attention paid to the potential occurrence of negative events. In most of the studies, however, if benefits ensued, they were modest and likely to fade. Further, 4 high-quality and well-designed individual studies suggest that the addition of a benzodiazepine or an antidepressant to cognitive behavioral treatment of anxiety disorders could be detrimental compared to placebo at follow-up. The aim of this review was to outline a novel hypothesis, which needs to be adequately tested but may shed some new light on this interaction. Any type of psychotropic drug treatment, particularly after long-term use, may increase the risk of experiencing additional psychopathological problems that do not necessarily subside with discontinuation of the drug or of modifying responsiveness to subsequent treatments. The changes are persistent and not limited to a short phase, such as in the case of withdrawal reactions, and cannot be subsumed under the generic rubrics of adverse events or side effects. The term ‘iatrogenic comorbidity' refers to unfavorable modifications in the course, characteristics, and responsiveness of an illness that may be related to treatments that were administered previously. The likelihood of iatrogenic comorbidity needs to be considered in clinical practice: The concurrent use of pharmacotherapy and psychotherapy may yield advantages in the short term, but its costs at some later point in time may largely outweigh such benefits.
The Efficacy of Dienogest in the Treatment of Simple Endometrial Hyperplasia without Atypia
Authors: Uysal Gulsum , Acmaz Gokhan , Madendag Yusuf , Cagli Fulya , Akkaya Hatice , Madendag Ilknur , Karakilic Eda Ulku
Published: July 2017

Aim: The aim of the study was to compare the effectiveness of dienogest (DIE), depo medroxyprogesterone 17-acetate (MPA), and micronized progesteron (MP) regimens for treatment of simple endometrial hyperplasia (EH) without atypia. Methods: One hundred and twenty premenopausal patients aged between 35 and 55, with simple EH without atypia, were offered 3 types of progestins (MPA, MP, and DIE) and were randomized to one of them. After 6 months of treatment, patients were reevaluated. The efficacy of different progestins in treatment of EH was compared with regard to resolution and regression rates. We classified the terms of resolution and regression as “complete response” and persistence as “no response”. Results: A total of 99 patients continued the study (31 in MP, 35 in MPA, and 33 in the DIE group). None of the results of endometrial pathology were progressed to atypia or complex hyperplasia. The complete response resolution rate was 93.5% in the MP, 88.5% in the MPA, and 96.9% in the DIE group. The highest complete response rate was in the DIE group, although there was no statistically significant difference between groups (p = 0.39). The efficacy of progestins was similar between the groups. Conclusion: DIE is an effective and convenient method for thinning the endometrium.
Distinct Dynamics of Mitotic Transition in B-Cell Lymphoma and Reactive B-Cell Lymphoproliferations Determined by H3S10 Phosphohistone Immunolabeling
Authors: Méhes Gábor , Hegyi Katalin , Jobanputra Ravi , Beke Lívia , Vereb György , Bedekovics Judit
Published: July 2017

Objectives: Clonal selection in the follicular germinal centers in lymphatic tissues is accompanied by an intense proliferation of polyclonal B cells in a precisely regulated fashion. In contrast, B-cell neoplasias proliferate autonomously due to endogenous stimuli. The cell kinetic activity is obvious at many levels including progressive chromatin modification and elevated mitotic rates. We asked if there are differences in the kinetics of histone H3S10 phosphorylation required for mitotic entry between highly proliferating B cells of reactive germinal centers and in B-cell lymphomas with different proliferative capacity. Material and Methods: Phospho-H3 histone (pH3S10)-specific immunohistochemistry was applied to cultivated cell, reactive and selected indolent and aggressive lymphoma samples (diffuse large B-cell lymphoma, Burkitt lymphoma, lymphoblastic lymphoma, follicular lymphoma and small lymphocytic lymphoma). Microscopic quantification of the “dot-type” (representing late G2 phase) and “mitotic” immunolabeling patterns per field of view was performed and compared with classical cell proliferation markers. Results: In addition to the dense homogeneous chromatin labeling highlighting mitotic figures, we stated a selective dot-type nuclear labeling representing ongoing chromatin condensation in premitotic G2 phase cells. While cell proliferation and mitotic counts correlated in general with histology, statistical analysis indicated an accumulation of G2 phase pH3S10 pattern in the reactive germinal centers in contrast to lymphomas. The dot-type G2 staining pattern was surprisingly overrepresented (1,321.7 ± 356.5/10 HPF) in the reactive germinal centers compared to aggressive lymphomas (101.3 ± 33.1) (p < 0.005). The relative G2/M value was significantly higher (4.6 ± 0.6) in reactive germinal center B cells than in any lymphoma entity evaluated (0.7 ± 0.2 in Burkitt lymphoma, 0.9 ± 0.4 in grade 3b follicular lymphoma, 1.3 ± 1.1 in diffuse large B-cell lymphoma, 1.5 ± 0.6 in lymphoblastic lymphoma, and 0.9 ± 0.2 in small lymphocytic lymphoma). Conclusions: pH3S10 immunohistochemistry enabled the presentation of significant differences in the cell cycle kinetics between reactive and neoplastic B-cell lymphoproliferations. Accumulation of G2 phase B cells in reactive folliculi directs to physiological G2/M checkpoint blockade. In contrast, accelerated G2/M transition in lymphomas is potentially associated with impaired genomic repair and cell death mechanisms.
Fetal Urine Production Rate in Preterm Premature Rupture of Membranes Is Associated with Adverse Neonatal Outcome: A Pilot Study
Authors: Avitan Tehila , Drukker Lior , Pri-Chen Hadass , Rabinowitz Ron , Algur Nurit , Schimmel Michael S. , Schreiber Letizia , Bdolah-Abram Tali , Samueloff Arnon , Grisaru-Granovsky Sorina
Published: July 2017

Aim: In this study, we evaluate the associations between fetal urinary production rate (FUPR), measured by ultrasound, and adverse neonatal outcome in women with preterm premature rupture of membranes (PPROM). Methods: We conducted a prospective pilot cohort of singleton pregnancies complicated by PPROM occurring at gestational week 24 or later managed until spontaneous labor (after 48 h of admission), chorioamnionitis, or induction by protocol at 35 + 0 weeks. FUPR was evaluated by 2D sonography at admission (corrected for gestational age). The main neonatal outcome measures were chorioamnionitis, placental inflammatory grading, first neonatal creatinine value, first neonatal dextrose value, length of neonatal intensive care unit (NICU) stay, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) (grades I-IV), blood transfusions, reduced neonatal urine production rate (<4 mL/kg/h), and early neonatal sepsis. Samples of maternal (at admission) and umbilical cord blood were analyzed for interleukin-6 (IL-6) level. Results: The study included 38 women. Low FUPR was associated with clinical chorioamnionitis, longer NICU hospitalization (p = 0.01), higher rates of NEC or IVH (p = 0.008), and blood transfusion (p = 0.004). Conclusions: A finding of FUPR on in utero ultrasound examination in pregnancies complicated by PPROM may be indicative of adverse neonatal outcome.
Blood Group Distribution in Switzerland - a Historical Comparison
Authors: Volken Thomas , Crawford Rebecca J. , Amar Soraya , Mosimann Edgar , Tschaggelar Anita , Mansouri Taleghani Behrouz
Published: July 2017

Background: Ethnicities differ in prevalence of blood groups and antigens. Substantial donor-recipient mismatch within mixed-ethnic societies may render certain recipients at higher risk for alloimmunization. Data regarding antigen distribution within Switzerland by ethnicity is limited. We examined immigration patterns against the distribution of ABO blood groups using large cross-sectional Swiss samples spanning 70 years. Methods: Historical ABO blood group distribution data (1940-1945) from Swiss army personnel (n = 275,664) were sourced from the literature. Recent blood group phenotypes of 122,925 individuals who presented themselves at army recruitment centers (2004-2015) were obtained, alongside a validation sample of 175,202 patients from a university hospital. Two-sample tests with z-statistics assessing blood groups between samples were used. Results: The respective proportions of A (47.2% and 45.2%), B (8.4% and 9.8%), and AB (3.0 and 4.1) in the historical and recent army samples were significantly different (p < 0.001), while group O was not. Conclusion: ABO blood groups in Switzerland have remained stable despite substantial immigration with a changing foreign-national profile. Further research is needed to improve the understanding of antigen differences in newly introduced ethnic groups. Blood product requirements and public health initiatives aimed at recruiting blood donors would benefit from this information.