bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence for surface fusion in inertial electrostatic confinement devices
Authors: Bowden-Reid Richard , Khachan Joe , Wulfkühler Jan-Philipp , Tajmar Martin
Published: November 2018

Inertial electrostatic confinement is a method of producing nuclear fusion in which concentric spherical electrodes are used to accelerate ions to fusion relevant energies. Fusion events are generally attributed to collisions between accelerated ions and neutral gas molecules in the centre of the device, with ion–grid collisions considered detrimental. In this paper, we present data that indicate that collisions between ions and neutral gas molecules adsorbed on the grid surface may, in fact, contribute significantly to the observed fusion rate in deuterium fuelled systems. When operating in the 1 × 10−4–1 × 10−3 Torr, V ≤ 40 kV regime, fusion on the grid surface is found to contribute up to 80% of the measured fusion rate, as determined from hysteresis effects between the fusion rate and system pressure. Surface fusion measurements were also carried out for a selection of cathode materials, with graphite found to produce a fusion rate that is an order of magnitude greater than the highest performing metal targets.
Creation of a thermally assisted skyrmion lattice in Pt/Co/Ta multilayer films
Authors: Zhang Senfu , Zhang Junwei , Wen Yan , Chudnovsky Eugene M. , Zhang Xixiang
Published: November 2018

Néel-type magnetic skyrmions in multilayer films have recently attracted significant attention due to their stability at room temperature and low threshold for current-driven motion, offering the potential for the construction of high-speed and high-density spintronic devices. However, to date, research studies reported in the literature have rarely examined the effect of temperature on the formation and behavior of Néel-type skyrmions. Here, we investigate the effect of the temperature on the creation of a skyrmion lattice in [Pt/Co/Ta]10 multilayer samples, using in-situ Lorentz transmission electron microscopy. By imaging the magnetization reversal process from a positive (negative) to a negative (positive) saturation, we find that the skyrmions can be created by nucleation from a ferromagnetic state and by breaking the labyrinth domains under certain external fields. More importantly, we demonstrate that the density of skyrmions in the multilayers not only depend on the external magnetic field, but also depend on the temperature and the thermal history of the materials.
Optical emission spectroscopy investigation of the current sheet in a small-bore parallel-plate electromagnetic plasma accelerator
Authors: Liu Shuai , Huang Yizhi , Zhang Yongpeng , Zhan Wei , Yu Menghan , Yang Lanjun
Published: November 2018

The optical emission spectrum of the propagating current sheet in a small-bore parallel-plate electromagnetic plasma accelerator has been studied. The accelerator is powered by a fourteen stage pulse forming network, which yields a damped oscillation square wave of current with a pulse width of 20.5 μs. The movement of the first current sheet and the second current sheet is identified using three single magnetic probes placed at various axial positions. Current sheet canting is measured by two double magnetic probes. The spectrum of the current sheet is measured using a spectroscopic system. The electron density of the current sheet plasma is determined via Stark broadening of the hydrogen Hα line. The current sheet is almost perpendicular to the electrode. The current sheet electron density increases as the current sheet propagates. The current sheet electron density is mainly determined by the prefill pressure rather than the discharge current. The impurity charged particles caused by ablation of the back wall insulator exists in the current sheet. Residual particles are generally left behind the first current sheet and are swept and ionized by the second current sheet. The estimated current sheet sweeping efficiency is greater than 80%. The parallel-plate electromagnetic plasma accelerator developed in this paper shows great potential in generating high electron density plasma jets.
Bilingualism and aging
Authors: Del Maschio Nicola , Fedeli Davide , Abutalebi Jubin
Published: November 2018

Whether bilingualism acts positively against neurocognitive decline is intensely debated. Although some reasons for it might be ideological, variability in sampling procedures and experimental design represent potential sources of inconsistency among studies. In this paper, we contend that bilingualism renders the extra-years of life of an increasingly long-lived population cognitively healthy, but only under specific conditions such as continuous practice and immersion in bilingual environments. We thus disagree with some authors’ recommendation that bilingualism be removed from consideration as a neuroprotective factor. We suggest, at the same time, that bilingualism should not be treated as axiologically superior to other environmental measures that promise to contrast the progressive loss of functional independence with increasing age. We conclude by emphasizing the need to evaluate the protective effects of L2-learning on the aging brain in a multimodal intervention perspective, thereby dissociating the effects of bilingualism from those of other cognitively stimulating factors.
Does the shape of forelimb long bones co-vary with grasping behaviour in strepsirrhine primates?
Authors: Fabre Anne-Claire , Peckre Louise , Pouydebat Emmanuelle , Wall Christine E
Published: November 2018

Fine prehensile activities are often thought to have been associated with the evolution of the human hand. However, there has been no holistic approach establishing the link between the morphology of the forelimb and grasping ability in living primates. The present study investigated the possible relationships between grasping behaviour and the morphology of the forelimb in strepsirrhines in a phylogenetic context. To do so, grasping behaviour during feeding and the shape of the long bones of the forelimb were analysed for 22 species of strepsirrhines. The data obtained show that there is a phylogenetic signal in forelimb morphology in primates in relation to grasping behaviour, but also that there is a marked co-evolution between grasping behaviour and the shape of the humerus and radius. This latter finding suggests a functional association between grasping and forelimb shape, which in turn suggests that bone shape constrains or facilitates behaviour. This result may permit future inferences to be made regarding this behaviour in extinct species and deserves further examination in more detail.
Short-term Pasteurization of Breast Milk to Prevent Postnatal Cytomegalovirus Transmission in Very Preterm Infants
Authors: Bapistella Sascha , Hamprecht Klaus , Thomas Wolfgang , Speer Christian P , Dietz Klaus , Maschmann Jens , Poets Christian F , Goelz Rangmar
Published: November 2018

Background

Postnatally acquired cytomegalovirus (pCMV) infection through breast milk (BM) may cause severe illness and even death, yet BM is advantageous for preterm infants. Therefore, effective methods to prevent CMV transmission are needed.

Methods

To assess the effectiveness of short-term pasteurization (62°C for 5 seconds) in preventing CMV transmission via BM in preterm infants. Design: Prospective interventional bicentric cohort study with infant enrollment between 6/2010 and 1/2012. A cohort from the Tuebingen neonatal intensive care unit (NICU) from 1995–1998 served as historical controls. Differences in CMV transmission were compared with reference to the cumulative time at risk for CMV transmission. Setting: Two German level-3 NICUs. Eighty-seven preterm infants of 69 CMV immunoglobulin G-positive mothers with birth weight <1500 g or gestational age <32 weeks and 83 historical controls were included. Intervention: BM samples were short-term pasteurized from postnatal day 4 to discharge. Primary endpoint: CMV status at discharge, evaluated by polymerase chain reaction and short-term microculture from urine.

Results

Two of 87 (2.3%) study infants had a pCMV transmission. This compared to 17 of 83 (20.5%) controls. Total time under risk for infection was 9.6 years vs 10.0 years in controls, yielding an incidence of 0.21/year (95% confidence interval [CI], 0.03 to 0.75/year) vs 1.70/year (95% CI, 0.99 to 2.72/year), respectively. The risk ratio controls vs study infants was 8.3 (95% CI, 2.4 to 52.4) according to Cox proportional hazard model (P = .0003).

Conclusions

Short-term pasteurization significantly reduces the incidence of pCMV infection through BM in the NICU.

Clinical Trials Registration

NCT01178905.
Optimal error estimates of finite difference time domain methods for the Klein–Gordon–Dirac system
Authors: Yi Wenfan , Cai Yongyong
Published: November 2018

We propose and analyze finite difference methods for solving the Klein–Gordon–Dirac (KGD) system. Due to the nonlinear coupling between the complex Dirac ‘wave function’ and the real Klein–Gordon field, it is a great challenge to design and analyze numerical methods for KGD. To overcome the difficulty induced by the nonlinearity, four implicit/semi-implicit/explicit finite difference time domain (FDTD) methods are presented, which are time symmetric or time reversible. By rigorous error estimates, the FDTD methods converge with second-order accuracy in both spatial and temporal discretizations, and numerical results in one dimension are reported to support our conclusion. The error analysis relies on the energy method, the special nonlinear structure in KGD and the mathematical induction. Thanks to tensor grids and discrete Sobolev inequalities, our approach and convergence results are valid in higher dimensions under minor modifications.
Competing Principals and Non-Vote Decisions in the European Parliament
Authors: Font Nuria
Published: November 2018

This article analyses the effects of competing principals on legislators’ decisions not to vote in the European Parliament. We argue that Members of the European Parliament (MEPs) are likely to decide not to vote to avoid defecting from either the national party or the European political group when both political principals disagree. Moreover, the article demonstrates that competing demands between principals interact with the expected closeness of a vote. MEPs are more likely to opt for not voting when they have few chances to influence the vote outcome and are torn between the two main principals. Based on a novel data set on individual votes in the 2009–2014 term, this article demonstrates that competing demands moderate the effect of the expected vote closeness on non-vote decisions and highlights the need to incorporate this type of legislative non-response in future research.
PATIENTS DOSE ESTIMATION IN CT EXAMINATIONS USING SIZE SPECIFIC DOSE ESTIMATES
Authors: Choudhary Neha , Rana Bhupendra Singh , Shukla Arvind , Oinam Arun Singh , Singh Narinder Paul , Kumar Sanjeev
Published: November 2018

The present work reports data of radiation exposure to the patients during head, chest, pelvis and abdomen CT examinations performed on a third-generation 16-slice CT machine. Radiation exposure was estimated using size specific dose estimates (SSDE) method, which takes into account patient’s physical dimensions in phantom measured computed tomography dose index (CTDI) value. The reported median CT dose volume index CTDIvol values in head, chest, pelvis and abdomen examinations were 26.76, 16.27, 29.81 and 14.74 mGy, respectively. The median doses evaluated using SSDE methodology for the above mentioned procedure were 54.1, 23.1, 42.8 and 20.1 mGy, respectively. Our results showed variation in dose values estimated using CTDI and SSDE methods in all examinations. The evaluated SSDE values were also compared to the values derived from data reported by the American Association of Physicist in Medicine (AAPM). SSDE values in present measurements are 4–8% lower than AAPM values. The present results show that CTDI parameters recorded on CT console should not be used to specify patient dose during CT procedures.
Pregnancy and Childbirth After Sexual Trauma
Authors: Sobel Lauren , O'Rourke-Suchoff Danielle , Holland Erica , Remis Kimberly , Resnick Kirsten , Perkins Rebecca , Bell Shannon
Published: November 2018

OBJECTIVE:

To explore the pregnancy and childbirth experiences and preferences of women with a history of sexual trauma in order to identify trauma-informed care practices that health care providers may use to improve obstetric care.

METHODS:

We conducted a qualitative study consisting of semistructured interviews with women who either self-identified as having a history of sexual trauma or did not. Participants were recruited from a tertiary care ambulatory clinic and had at least one birth experience within the past 3 years. Interviews were audio-recorded and transcribed verbatim. Grounded theory was used to derive themes using the participants' own words.

RESULTS:

From 2015 to 2017, we interviewed 20 women with a history of sexual trauma and 10 without. Women with a history of sexual trauma desired clear communication about their history between prenatal care providers and the labor and delivery team. In the intrapartum period, they desired control over who was present in the labor room at the time of cervical examinations and for health care providers to avoid language that served as a stressing reminder of prior sexual trauma. They wanted control over the exposure of their bodies during labor and to be asked about their preference for a male health care provider. In the postpartum period, some women with a history of sexual trauma found breastfeeding healing and empowering.

CONCLUSION:

Women with a history of sexual trauma have clear needs, preferences, and recommendations for obstetric care providers regarding disclosure, cervical examinations, health care provider language, body exposure, and male health care providers. They offer insight into unique breastfeeding challenges and benefits.
Menopause-Related Cognitive Impairment
Authors: Devi Gayatri
Published: November 2018

BACKGROUND:

Identifying the cognitive changes associated with the menopausal transition prevents misattribution of symptoms to more ominous causes such as neurodegenerative disease.

CASE:

Two women with cognitive loss and objective evidence of menopause-related cognitive impairment are presented, misattributed to Alzheimer disease in one case and frontotemporal dementia in the other. Neurocognitive testing, neuroimaging, and laboratory findings are reviewed. Both women were diagnosed with menopause-related cognitive impairment and were stable in follow-up over 4 or more years.

CONCLUSIONS:

Recognizing the cognitive changes associated with menopause and distinguishing from cognitive impairment resulting from other etiologies—including neurodegenerative diseases such as Alzheimer disease—has important clinical implications both for treatment and for prognosis.
Home Self-Collection by Mail to Test for Human Papillomavirus and Sexually Transmitted Infections
Authors: Des Marais Andrea C. , Zhao Yuqian , Hobbs Marcia M. , Sivaraman Vijay , Barclay Lynn , Brewer Noel T. , Smith Jennifer S.
Published: November 2018

OBJECTIVE:

To evaluate the validity and acceptability of at-home self-collection to test for high-risk human papillomavirus (HPV) and sexually transmitted infections among women overdue for cervical cancer screening by national guidelines.

METHODS:

Low-income, infrequently screened women were recruited from the general population in North Carolina to participate in an observational study. Participants provided two self-collected cervicovaginal samples (one at home and one in the clinic) and a clinician-collected cervical sample. Samples were tested for high-risk HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium. Cervical samples were also tested by liquid-based cytology.

RESULTS:

Overall, 193 women had conclusive high-risk HPV results for all three samples and cytology results. Prevalence of high-risk HPV within self-home samples (12.4%) was not different from that within clinician samples (11.4%; P=.79) and from that within self clinic samples (15.5%; P=.21). Positivity for high-risk HPV in all sample types increased with increasing grades of cervical abnormality (P<.001). Self-home samples detected high-risk HPV in all identified cases of high-grade squamous intraepithelial lesions and of cervical intraepithelial neoplasia 2 or worse. Detection was comparable across sample types for T vaginalis (range 10.2–10.8%), M genitalium (3.3–5.5%), C trachomatis (1.1–2.1%), and N gonorrhoeae (0–0.5%). Kappa values between sample types ranged from 0.56 to 0.66 for high-risk HPV, 0.86–0.91 for T vaginalis, and 0.65–0.83 for M genitalium. Most participants reported no difficulty understanding self-collection instructions (93.6%) and were willing to use self-collection in the future (96.3%).

CONCLUSION:

Mail-based, at-home self-collection for high-risk HPV and sexually transmitted infection detection was valid and well accepted among infrequently screened women in our study. These findings support the future use of high-risk HPV self-collection to increase cervical cancer screening rates among higher risk women in the United States.
Retroperitoneal Ectopic Pregnancy
Authors: Pak Janie O. , Durfee John Keyes , Pedro Lucio , Osborne Alicea , Larkins-Pettigrew Margaret
Published: November 2018

BACKGROUND:

Retroperitoneal ectopic pregnancies are rare and have a tendency to implant along major vessels of the abdomen and pelvis. Clinical manifestations can vary from no symptoms to hypovolemic shock and death.

CASE:

A 30-year-old woman presented in hypovolemic shock with left flank and abdominal pain after attempting to medically terminate her first-trimester pregnancy. Intraoperative findings revealed normal pelvic organs with a massive retroperitoneal hematoma containing chorionic villi confirmed on histopathology.

CONCLUSIONS:

In a woman with a pregnancy of unknown location presenting with worsening flank pain, a retroperitoneal ectopic pregnancy must be considered. Prompt diagnosis and management in a low-resource setting presents additional challenges.
Antepartum Testing for the Prevention of Stillbirth
Authors: Johnson Grace J. , Clark Steven L. , Turrentine Mark A.
Published: November 2018

Unexpected antepartum fetal demise remains one of the most tragic complications of pregnancy. Various approaches to antepartum fetal assessment have been developed as a means of either reassuring the clinician of fetal well-being or identifying potential fetal jeopardy and the need for delivery. As additional high-risk groups of women are identified, indications for antenatal testing continue to expand despite a paucity of good-quality data linking such testing to improved outcomes for women with these additional risk factors. The expansion of established antepartum testing protocols to include women with conditions such as advanced maternal age or obesity without additional, well-established indications for testing is not warranted, particularly because baseline rates of stillbirth seen with these conditions before 39 weeks of gestation are already lower than stillbirth rates achieved with current antepartum testing protocols. Beyond 39 weeks of gestation, if the established risks of stillbirth are deemed unacceptable, delivery is a more rational and evidence-based approach than antepartum testing.
Sacral Nerve Stimulation as a Therapy for Patients With Refractory Voiding and Bowel Dysfunction
Authors: Noblett Karen L. , Buono Kristen
Published: November 2018

Sacral nerve stimulation delivers nonpainful electrical pulses to the sacral nerves that modulate the reflexes that control the bladder, bowels, and pelvic floor musculature. This relatively simple procedure was generated to improve and restore function in patients with a variety of pelvic floor disorders. Currently this therapy is approved for use in patients with urgency urinary incontinence, urinary urgency–frequency, nonobstructive urinary retention, and fecal incontinence. This review includes the history of this treatment modality, explains the mechanism of action, and describes the procedure for implantation of this device. Additionally, advancements in this treatment over the past two decades and landmark literature to date regarding sacral nerve stimulation are reviewed. Current literature regarding off-label uses of this treatment modality for a variety of pelvic floor disorders is also discussed.
Massive Hemorrhage From Suspected Iatrogenic Uterine Rupture
Authors: Nguyen Kim T. , Lozada M. James , Gorrindo Phillip , Peralta Feyce M.
Published: November 2018

BACKGROUND:

Intrauterine balloon tamponade is recommended for refractory postpartum hemorrhage resulting from atony, but few studies have assessed complications associated with placement.

CASE:

A 39-year-old woman, gravida 4 para 1, with posterior placenta previa and suspected placenta accreta had a postpartum hemorrhage after a scheduled cesarean delivery. An intrauterine balloon tamponade device was easily placed transcervically; however, the patient required additional analgesia for constant severe stabbing pain worsened on examination. Three hours after placement, the balloon was expelled from the cervix, resulting in 1,500 mL of fresh blood and clot. Emergent exploratory laparotomy identified a uterine rupture inferior and lateral to the hysterotomy site.

CONCLUSION:

Intrauterine balloon tamponade may contribute to iatrogenic uterine rupture and should be considered in patients with refractory hemorrhage, hemodynamic instability, or severe pain despite analgesia.
Nonsteroidal Antiinflammatory Drug Administration and Postpartum Blood Pressure in Women With Hypertensive Disorders of Pregnancy
Authors: Anastasio Hannah B. , Campbell Lauren E. , Buermeyer Alison , Saccone Gabriele , Moreno Sindy , Cruz Yuri , Berghella Vincenzo , Schoen Corina , Roman Amanda
Published: November 2018

OBJECTIVE:

To evaluate whether postpartum nonsteroidal antiinflammatory drug (NSAID) administration is associated with increased blood pressure in women with hypertensive disorders of pregnancy and to estimate the association between NSAID administration and use of opioid medication.

METHODS:

We conducted a retrospective cohort study of women with hypertensive disorders of pregnancy. Patients were analyzed in two groups according to whether they received NSAIDs postpartum. Study participants were women delivered at a tertiary care center from 2008 to 2015. The primary outcome was change in mean arterial pressure during the postpartum period. Secondary outcomes were postpartum pain scores, cumulative postpartum opioid requirement, initiation or dose escalation of antihypertensive agents, and adverse postpartum outcomes including acute renal failure, change in hematocrit, and maternal readmission for hypertensive disorder.

RESULTS:

Two hundred seventy-six women with hypertensive disorders of pregnancy were included (129 NSAID-unexposed and 147 NSAID-exposed). Postpartum NSAID administration was not associated with a statistically significant change in mean arterial pressure compared with no NSAID administration (−0.7 vs −1.8; mean difference 1.10, 95% CI −1.44 to 3.64). Similarly, no difference was observed between the cohorts in terms of need for initiation or escalation in dose of antihypertensive agents or maternal readmission for hypertensive disorder. The study was underpowered to determine whether NSAID administration was associated with any difference in less frequent secondary outcomes (eg, incidence of acute renal insufficiency, need for postpartum transfusion) or cumulative opioid use.

CONCLUSION:

Nonsteroidal antiinflammatory drug administration to postpartum patients with hypertensive disorders of pregnancy is not associated with a change in blood pressure or requirement for antihypertensive medication.
Impact of the Number of Levels on Adverse Events and Length of Stay Following Posterior Lumbar Fusion Procedures
Authors: Bohl Daniel D. , Haws Brittany E. , Khechen Benjamin , Patel Dil V. , Mayo Benjamin C. , Ahn Junyoung , Louie Philip K. , Cardinal Kaitlyn L. , Guntin Jordan A. , Singh Kern
Published: November 2018

Study design:

Retrospective

Summary of background data:

Little is known regarding the impact of the number of operative levels on the risk for adverse events following spinal procedures.

Objective:

The objective of this study was to test for associations between the number of operative levels and occurrence of adverse events following posterior lumbar fusion (PLF).

Methods:

Patients undergoing 1-, 2-, or 3-level PLFs were identified in the American College of Surgeons National Surgical Quality Improvement Program database. The number of operative levels was tested for association with occurrence of adverse events in the 30-days following the procedure using multivariate regression. Post hoc pairwise comparisons were made between 1- and 2-level and between 2- and 3-level procedures. Analyses were adjusted for differences in baseline characteristics.

Results:

In total, 8162 underwent 1-level, 3,527 underwent 2-level, and 718 underwent 3-level procedures. Patients undergoing 2-level procedures had a higher rate of anemia requiring blood transfusion than 1-level procedures (23.4% vs. 8.6%; adjusted relative risk [RR]=2.5; P<0.001). Furthermore, patient undergoing 3-level procedures had a higher rate of anemia requiring blood transfusion than 2-level procedures (29.9% vs. 23.4%; adjusted RR=1.3; P<0.001). In addition, patients undergoing 3-level procedures had a longer length of stay than 2-level procedures (4.6 vs. 3.9 d; P<0.001) and 2-level procedures had a longer length of stay than 1-level procedures (3.9 vs. 3.5 d; P<0.001).

Conclusions:

Increasing the number of operative levels by one level has minimal impact on the rates of most short-term postoperative adverse events following PLF. This is true both for an increase from 1 to 2 levels and from 2 to 3 levels. While surgeons should consider that an increase in the number of operative levels may increase the risk for blood transfusion and will almost certainly prolong the hospital stay, they need not fear a major increase in the rates of postoperative adverse events.
Factors associated with locoregional and metastatic breast cancer at diagnosis in a Southern Portuguese registry in the period 2005–2012
Authors: Gomes Inês A. , Miranda Ana , Nunes Carla
Published: November 2018

Breast cancer (BC) is the most frequent malignancy in Portuguese women, and more than half of the registered cases live in the south of the country. The main of this study was to characterize patients with locoregional and metastatic incident BC living in the Southern Portuguese and Madeira regions in 2005–2012 according to demographic, clinical and contextual characteristics. Additionally it aimns to find the associations and relative influences of these factors with locoregional or metastatic disease at diagnosis. After a descriptive approach, binary logistic regression models were used to estimate factors related to the presence of metastatic disease at diagnosis. A final multiple regression model was developed and presented graphically as a nomogram. The median age at diagnosis was 60.84 years, being statistically lower in locoregional cases (P < 0.001). Most patients presented a locoregional disease (78.4%) of unspecified location (44.5%) and had a ductal carcinoma (73.1%). The Lisbon region represented 50.5% of the analyzed cases. Metastatic disease significantly decreased over the period under analysis ( ≈ 7%/year). Demographic (age at diagnosis ≥ 50 years), clinical (lobular and ‘other’ morphologies, unspecified location) and contextual (residence in Portalegre) characteristics were statistically correlated with the presence of metastatic disease at the time of BC diagnosis in univariate logistic regression, with all but the last maintaining their significance in a multivariate model. Cases with metastatic BC disease at diagnosis are decreasing; however, additional information on their characteristics can improve the alignment of public health strategies, thus strengthening this trend, and contributing to the development of a graphically tailored screening tool.
The Development of a Diabetes Application for Patients With Poorly Controlled Type 2 Diabetes Mellitus
Authors: Kho Siok Ee Sharon , Lim Siew Geok , Hoi Wai Han , Ng Poh Leng , Tan Lucy , Kowitlawakul Yanika
Published: November 2018

The prevalence of patients with diabetes mellitus has increased in recent years. This has resulted in increased demand for face-to-face diabetes education by diabetes nurse clinicians. The use of mobile-health technologies in diabetes education is an innovative way of learning and has the potential to engage patients and influence positive health behaviors, including meeting desired goals and diabetes-related outcomes. The aim of the study was to develop and test the usability and feasibility of an empirical diabetes application for patients with type 2 diabetes mellitus. The mobile-based, gamified Diabetes Application was developed based on a full systems development life-cycle framework. Eight patients with poorly controlled type 2 diabetes mellitus completed a pilot study that consisted of a postapplication survey to assess the usability and feasibility of the diabetes application. The findings affirmed the usefulness and feasibility of the diabetes application for patients with diabetes mellitus. It increased awareness, enriched knowledge, promoted user engagement, motivated positive behaviors, and affirmed patient belief in diabetes self-management. This article discusses the development and evaluation of the diabetes application, including modifications made based on the results of the pilot study.
A Typology of Future Health Services by Exploring Core Concepts and Values
Authors: Kim Jeongeun , Piao Meihua , Byun Ahjung , Lee Jisan
Published: November 2018

Recent rapid development of medical and information technology has enabled the use of appropriate techniques for the delivery of healthcare. This project involved prediction of the meaning and structure of future health services, which are now commonly described through various keywords, without establishment of the concepts. The objectives of this study were to identify key concepts and values about future health services and to categorize the prediction of those from the perspectives of the concerned professionals using Q-methodology with 50 selected Q-statements. A total of 53 participants performed the Q-sort task using the 50 statements; collected data were analyzed using an associated program, pc-QUANL. Fifty Q-samples were selected to sort the concepts, and 53 professionals sorted the Q-samples. Six concepts were summarized, namely, the Optimistic Innovation Positive Type, Pessimistic Resistance to Technology-Driven Medicine Type, Intelligent Information Technology Centered Type, Bio-technology Centered Type, Personal Health Data Centered Type, and Customized Care Centered Type. The results could be used in the future design of consumer-centered health services. Advanced technology may accommodate the individual needs of different stakeholders and carve an ecosystem-wide suite of interacting complex adaptive systems.
Epigenetical Targeting of the FOXP3 Gene by S-Adenosylmethionine Diminishes the Suppressive Capacity of Regulatory T Cells Ex Vivo and Alters the Expression Profiles
Authors: Sahin Emel , Sahin Mehmet
Published: November 2018

Regulatory T cells (Treg cells), a subgroup of CD4+ lymphocytes, play a crucial role in serving as an immune suppressor and in maintaining peripheral tolerance. As the accumulation of Treg cells in the tumor microenvironment is significantly associated with a decreased survival time of patients, they are considered as an important therapeutic target in the immunotherapy of human cancers. These cells are either derived from the thymus, which are called (CD4CD25hiCD127low) natural Treg cells (nTreg cells), or they are generated from CD4+CD25− naive T cells by transforming growth factor-beta 1 and interleukin 2 (IL-2) in the periphery, which are called induced Treg cells (iTreg cells). Although iTreg cells are unstable, nTreg cells stably express forkhead box P3 (FOXP3) protein. Moreover, nTreg cells can be classified as memory (CD45RA−) and naive (CD45RA+) Treg cells, and this classification is based on the expression of CD45RA. FOXP3, which is a master regulator transcription factor, is essential for the functions of Treg cells, and it is mainly controlled by epigenetic mechanisms. The cyclooxygenase 2 (COX2)/prostaglandin E2 (PGE2) pathway is also reported to contribute to the regulatory functions of tumor-infiltrating Treg cells. As a new approach, we investigated whether S-adenosylmethionine (SAM), a substrate of DNA methyltransferase, attenuates the immune-suppressive capacity of the naive subtype of nTreg cells (CD4CD25hiCD127loCD45RA+). Moreover, we examined the effects of PGE2/COX2 pathway blockers on the suppressive capacity of Treg cells. We found that SAM diminished the suppression competency of Treg cells by decreasing the FOXP3 mRNA and protein levels in a dose-dependent manner. SAM increased the DNA methylation of FOXP3 at the first intron site. In addition, SAM decreased the mRNA and protein levels of the IL-10 cytokine, which has suppressive roles in the immune system. Moreover, mRNA levels of interferon gamma (IFNG) were found to be increased. COX2 inhibition and blockage of PGE2 receptors also reduced the protein and mRNA levels of IL-10, but they did not exhibit any significant effect on Treg cells’ suppression in the coculture system. Our results show that SAM might be considered and investigated as a promising agent for immunotherapy in the future.
Risk Factors Associated with Reconstructive Complications Following Sacrectomy
Authors: Vartanian Emma D. , Lynn Jeremy V. , Perrault David P. , Wolfswinkel Erik M. , Kaiser Andreas M. , Patel Ketan M. , Carey Joseph N. , Hsieh Patrick C. , Wong Alex K.
Published: November 2018

Background:

Sacral pathology requiring partial or total sacrectomy is rare, and reconstructing the ensuing defects requires careful decision-making to minimize morbidity. The purpose of this study was to review the experience of a single institution with reconstructing large sacral defects, to identify risk factors for suboptimal outcomes.

Methods:

A retrospective chart review was conducted of all patients who underwent sacrectomy over a 10-year period. Univariate analysis of differences in risk factors between patients with and without various postoperative complications was performed. Multivariate logistic regression was used to identify predictive variables.

Results:

Twenty-eight patients were identified. The most common diagnosis leading to sacrectomy was chordoma (39%). Total sacrectomy was performed on 4 patients, whereas 24 patients underwent partial resection. Reconstructive modalities included 15 gluteal advancement flaps, 4 pedicled rectus abdominis myocutaneous flaps, and 9 paraspinous muscle or other flap types. There was an overall complication rate of 57.1% (n = 12) and a 28.6% (n = 8) incidence of major complications. There were significantly more flap-related complications in patients who underwent total sacrectomy (P = 0.02). Large defect size resulted in significantly more unplanned returns to the operating room (P < 0.01).

Conclusion:

Consistent with other published series', the overall complication rate exceeded 50%. Defect volume and sacrectomy type were the strongest predictors of postoperative complications and return to the operating room, while reconstructive strategy showed limited power to predict patient outcomes. We recommend that patients anticipated to have large sacral defects should be appropriately counseled regarding the incidence of wound complications, regardless of reconstructive approach.
Emphysematous pyelonephritis and cystitis in a patient with uremia and anuria
Authors: Wang Qiang , Sun Meifeng , Ma Chengjun , Lv Hailin , Lu Peng , Wang Qi , Liu Guangyi , Hu Zhao , Gao Yanxia
Published: November 2018

Introduction:

Emphysematous pyelonephritis (EPN) or cystitis (EC) is a severe infection of the urinary tract with high mortality. EPN is uncommon among the patients of end stage of renal failure (ESRD)

Case presentation:

A 38-year-old male with uremia and anuria who was on hemodialysis was found to have gas formation in the bilateral pelvis, ureters, and urinary bladder by CT scan. The diagnosis was emphysematous pyelonephritis and cystitis. And Foley catheter was placed and bladder irrigation was performed. Escherichia coli infection was identified in urine culture and antibiotic was prescribed accordingly. Gas disappeared completely and the patient recovered uneventfully.

Conclusion:

This is the first case report of asymptomatic EPN and EC in uremic patient, and conservative management was optimistic in this condition. More attention should be paid to EPN and EC happening to ESRD patients.
Glucose-regulated protein 78 in the aqueous humor in diabetic macular edema patients
Authors: Kwon Jin-woo , Jung Ilyoung , Jee Donghyun
Published: November 2018

In this study, we explored the presence and elevation of glucose-regulated protein 78 (GRP78) in aqueous humor of patients with diabetic macular edema (DME).

After comparing DME patients with the controls, we analyzed GRP78 and vascular endothelial growth factor (VEGF) levels in DME patients. We examined factors associated with GRP78 levels in DME patients.

GRP78 was detected in aqueous humor with elevated levels in DME patients. Stepwise backward regression analysis showed that GRP78 levels were associated with the VEGF levels and the duration of diabetes (P < .001 and P = .002, respectively). However, no statistical significance was observed between GRP78 levels and the decrease in CST following 3 monthly anti-VEGF treatments in univariate regression analysis (P = .695).

We showed that GRP78 is elevated in DME patients. In addition, there is a correlation between GRP78 and VEGF levels in aqueous humor. However, GRP78 levels were not associated with the responsiveness of anti-VEGF in DME patients.
XRCC1 polymorphism and overall survival in ovarian cancer patients treated with platinum-based chemotherapy
Authors: Zhang Zhuo , Xiang Qian , Mu Guangyan , Xie Qiufen , Chen Shuqing , Zhou Shuang , Hu Kun , Cui Yi-min
Published: November 2018

Objectives:

Although platinum-based chemotherapy is widely used for advanced ovarian cancer (OC), genetic polymorphisms can influence the chemotherapeutic response. This study investigated the association between XRCC1 polymorphisms Arg194Trp, Arg280His, and Arg399Gln, and overall survival (OS) in OC patients who received platinum-based chemotherapy.

Methods:

We systematically searched PubMed, Embase, the Cochrane library, Chinese National Knowledge Infrastructure, Wanfang, and Weipu databases for relevant studies from inception to October, 2017. OS was calculated using a random-effects model. Sensitivity, subgroup, and publication bias analyses were also performed.

Results:

Five studies involving 1159 OC patients were included. When compared with 194ArgArg, 194TrpTrp (hazard ratio [HR] 1.09, 95% confidence interval [CI] 0.71–1.69, P = .69) and 194TrpArg (HR 1.00, 95% CI 0.78–1.28, P = .98) carriers were not associated with OS. Similarly, compared with 280ArgArg carriers, neither 280HisHis (HR 1.39, 95% CI 0.82 to −2.34, P = .22) nor 280HisArg (HR 0.98, 95% CI 0.73 to −1.31, P = .90) affected OS. Furthermore, there were no significant differences in OS between 399GlnGln (HR 1.00, 95% CI 0.46–2.16, P > .99), 399GlnArg (HR 1.05, 95% CI 0.81–1.37, P = .70), and 399ArgArg. Finally, subgroup analysis suggested that 399GlnGln significantly decreased OS when the percentage of III or IV cases was >80.0% (HR 1.79, 95% CI 1.22–2.62, P = .003), while OS was increased when this percentage was <80.0% (HR 0.47, 95% CI 0.28–0.79, P = .004).

Conclusions:

This study indicated that XRCC1 Arg194Trp, Arg280His, and Arg399Gln did not affect OS after platinum-based chemotherapy in OC patients. However, disease status could affect the relationship between Arg399Gln and OS in these patients.
Genetic polymorphism (rs6776158) in CaSR gene is associated with risk of nephrolithiasis in Chinese population
Authors: Zhou Hai , Huang Huaxing , You Zebin , Shadhu Kamleshsingh , Ramlagun Dadhija , Qiang Cao , Li Pu , Qi Lezhong , Shen Yuyong , Zhou Ming , Chen Yuming , Fei Shangchun , Wang Xiaoxiang
Published: November 2018

The objective of this study is to find about the association between calcium-sensing receptor (CaSR) genetic variants and susceptibility to nephrolithiasis in the Chinese Han population.

This hospital-based case-control study included 319 nephrolithiasis cases and 378 healthy controls subjects. Two SNPs in CaSR were genotyped using the TaqMan assay.

We found that subjects carrying the G allele of rs6776158 (AG and GG) had significantly higher risk of nephrolithiasis compared to the AA genotype (P = .015 and .009, respectively).

Our results indicate that rs6776158 polymorphism that might elevate the risk of nephrolithiasis in the Chinese population.
Pneumocardia and septic pulmonary embolism due to nongas-forming liver abscess
Authors: Yao Zhoujia , Zheng Jun , Si Youguang , Wang Wenhong
Published: November 2018

Rationale:

Pneumocardia and septic pulmonary embolism are uncommon complications of Klebsiella pneumoniae primary liver abscess (KPLA); however, they may lead to a poor clinical outcome.

Patient concerns:

A 67-year-old woman was admitted to our hospital with fever, chills, cough, and dyspnea for 4 days. She had a previous history of diabetes mellitus.

Diagnoses:

The chest computed tomography (CT) revealed multiple peripheral nodules in both lungs and wedge-shaped peripheral infiltrative lesions abutting the pleura, suggestive of septic pulmonary embolism. An abdominal CT on the following day showed a large liver abscess without gas formation and pneumocardia of the right ventricle.

Interventions:

After the antibiotic therapy of intravenous imipenem and drainage of the liver abscess, our patient made a complete recovery.

Outcomes:

The patient was discharged on the 25th hospital day after full recovery and was doing well on follow-up at 10 months.

Lessons:

KPLA is potentially fatal due to the associated serious metastatic complications. Attention must be paid not only to the primary focus of infection but also to infection of other organs. It is important to detect to diagnose the spread of infection accurately, in a timely manner, to improve the prognosis of this condition.
Age, sex, and the association of chronic kidney disease with all-cause mortality in Buddhist priests
Authors: Kim Hyo Jin , Kim Yunmi , Kim Sejoong , Chin Ho Jun , Lee Hajeong , Lee Jung Pyo , Kim Dong Ki , Oh Kook-Hwan , Joo Kwon Wook , Kim Yon Su , Nah Deuk-Young , Shin Sung Joon , Kim Kyung Soo , Park Jae Yoon , Yoo Kyung Don
Published: November 2018

Buddhist priests lead a unique lifestyle, practicing asceticism, with a vegetarian diet. Such behavior may have an impact on clinical outcomes. Hence, we explored the mortality among Korean Buddhist priests as compared with the general population.

This study is a single-center, retrospective study. Among the 3867 Buddhist priests who visited Dongguk University Gyeongju Hospital between January 2000 and February 2016, 3639 subjects were available for mortality data from Statistics Korea. Standardized mortality ratio (SMR) was computed for all causes of death and compared with the general population using national statistics in Korea. Information regarding end-stage renal disease (ESRD) was investigated from the Korean Society of Nephrology registry. Among the 3639 patients, the baseline laboratory results were obtained in 724 patients. Chronic kidney disease (CKD) was defined as dipstick proteinuria ≥1 or an estimated glomerular filtration rate <60 mL/min/1.73 m2.

The mean age was 50.0 ± 12.5 years, and 51.0% were men. During the follow-up period for 31.1 ± 35.6 months, 55 (7.6%) patients died. During the follow-up period, 3 (0.4%) and 23 (3.2%) patients developed ESRD and urinary stone, respectively. The SMR for all causes of death was 0.76 (95% confidence interval [CI] 0.57–0.99; men 0.91, 95% CI 0.65–1.23; women 0.52, 95% CI 0.28–0.87). Among 724 patients, 74 (10.2%) patients had CKD. The SMR for non-CKD patients (0.61, 95% CI 0.43–0.85) was significantly lower than the general population. Female and patients older than 50 years (0.74, 95% CI 0.55–0.98) had a significantly lower SMR. In the Cox proportional hazards model with adjustment, older age (adjusted HR 1.04, 95% CI 1.10–1.07) and presence of CKD (adjusted HR 2.55, 95% CI 1.07–6.06) were independently associated with increased all-cause mortality.

Buddhist priests and especially Buddhist priests without CKD showed a significantly lower mortality compared with the general population.
Management of chronic pain in Ehlers–Danlos syndrome
Authors: Zhou Zhengyang , Rewari Abhitej , Shanthanna Harsha
Published: November 2018

Rationale:

Ehlers–Danlos syndromes (EDSs) are a heterogeneous group of heritable connective tissue disorders involving defective collagen synthesis. Patients with EDS are prone for chronic myofascial pain, apart from other comorbidities. Although the initial pathology is commonly nociceptive, progression of EDS leads to neuropathies and central sensitization of pain signals. Overall, approximately 90% or more EDS patients suffer from chronic pain. There are no existing guidelines to manage chronic pain in EDS patients. In this article, we illustrate 2 case reports of EDS patients with chronic pain and review the relevant literature regarding the pathological considerations and management of chronic pain in EDS.

Patient concerns:

Our first patient had worsening multiple joint pains despite treatment with medications and a recent diagnosis of EDS-type 3. The second patient had a complicated history including longstanding EDS and multiple previous surgeries. She was referred due to concern about complex regional pain syndrome (CRPS) in her upper extremity.

Diagnoses:

For the first patient, apart from chronic pain due to her EDS, her history also revealed that she suffered from kinesiophobia. For the second patient, a detailed clinical assessment revealed no signs of CRPS but instead a generalized worsening of EDS symptoms.

Interventions:

Both patients were evaluated by the multidisciplinary team consisting of a pain physician, nurse, pain psychologist, and a kinesiologist. Their treatment involved optimization of daily medications, participation in pain self-management sessions that included cognitive behavioral therapy, graded exercises, coping, and relaxation strategies.

Outcomes:

Both patients demonstrated significantly better pain control and achieved overall improvement in daily living.

Lessons:

EDS is a complex illness with a multitude of symptoms. As in our patients, EDS patients also suffer from panic and anxiety disorders that increase the burden of pain. Apart from optimization of medications, EDS patients are best managed by a multidisciplinary approach that includes pain education and life style changes. The caution that they are resistant to local anesthetics is unwarranted. Appropriate pain interventions in selected patients may have a role to decrease pain intensity.