bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Early Introduction of Palliative Care Limit Intensive Care, Emergency and Hospital Admissions in Patients with Severe Chronic Obstructive Pulmonary Disease? A Pilot Randomized Study
Authors: Janssens Jean-Paul , Weber Catherine , Herrmann François R. , Cantero Chloé , Pessina Aline , Matis Caroline , Merlet Viollet Roselyne , Boiche-Brouillard Ludivine , Stirnemann Jerôme , Pautex Sophie
Published: January 2019

Background: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. Objectives: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). Methods: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. Results: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean ± SD) 71 ± 8 years; FEV1 was 37 ± 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. Conclusion: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.
The Pioneering and Unknown Stereotactic Approach of Roeder and Orthner from Göttingen. Part II: Long-Term Outcome and Postmortem Analysis of Bilateral Pallidotomy in the Pre-Levodopa Era
Authors: Hamel Wolfgang , Köppen Johannes A. , Müller Dieter , Hariz Marwan , Moll Christian K.E. , Krack Paul
Published: January 2019

Before the advent of levodopa, pallidotomy was initially the most effective treatment for Parkinson disease, but it was soon superseded by thalamotomy. It is widely unknown that, similar to Leksell, 2 neurologists from Göttingen, Orthner and Roeder, perpetuated pallidotomy against the mainstream of their time. Postmortem studies demonstrated that true posterior and ventral pallidoansotomy sparing the overwhelming mass of the pallidum was accomplished. This was due to a unique and individually tailored stereotactic technique even allowing bilateral staged pallidotomies. In 1962, the long-term effects (3-year follow-up on average) of the first 18 out of 36 patients with staged bilateral pallidotomies were reported in great detail. Meticulous descriptions of each case indicate long-term improvements in parkinsonian rigidity and associated pain, as well as posture, gait, and akinesia (e.g., improved repetitive movements and arm swinging). Alleviation of tremor was found to require larger lesions than needed for suppression of rigidity. No improvement in speech, drooling, or seborrhea was observed. By 1962, the team had operated 13 patients with postencephalitic oculogyric crises with remarkable results (mean follow-up: 5 years). They also described alleviation of nonparkinsonian hyperkinetic disorders (e.g., hemiballism and chorea) with pallidotomy. The reported rates for surgical mortality and other complications had been remarkably low, even if compared to those reported after the revival of pallidotomy by Laitinen in the post-levodopa era. This applies also to bilateral pallidotomy performed with a positive risk-benefit ratio that has remained unparalleled to date. The intricate history of pallidotomy for movement disorders is incomplete without an appreciation of the achievements of the Göttingen group.
Gamma Knife Radiosurgery for Trigeminal Neuralgia Caused by a Cavernous Malformation: Case Report and Literature Review
Authors: Pease Matthew , Withrow Joseph , Ozpinar Alp , Lunsford L. Dade
Published: January 2019

Objective: Trigeminal neuralgia (TN) related to a brainstem cavernous malformation (CM) is a rare entity. We present the first radiosurgical management of a patient with TN secondary to a CM. Clinical Presentation: An 80-year-old female presented with a 33-year history of progressively severe TN refractory to medications. Imaging confirmed a solitary CM located at the pontine dorsal root entry zone of cranial nerve 5. Treatment: Stereotactic radiosurgery of the trigeminal nerve was performed using the Leksell gamma knife. A single 4-mm isocenter of radiation was focused on the trigeminal nerve and a maximum dose of 80 Gy (40 Gy at the 50% isodose line) was delivered to the nerve. Results: At 1 year, the patient noted that the severe pain attacks had been reduced by 75%, although a background lingering discomfort persisted. Pain suppression medications had been significantly reduced to lamotrigine 100 mg twice daily. Her preoperative distribution of sensory dysfunction mildly increased. Conclusion: For medically refractory TN related to a CM, radiosurgery of the afferent nerve may ameliorate pain without a major decrease in sensation. The more than 30-year history of pain in our patient may have reduced the chance of more significant pain relief.
Long-Term Outcomes of Vibroplasty Coupler Implantations to Treat Mixed/Conductive Hearing Loss
Authors: Zahnert Thomas , Mlynski Robert , Löwenheim Hubert , Beutner Dirk , Hagen Rudolf , Ernst Arneborg , Zehlicke Thorsten , Kühne Hilke , Friese Natascha , Tropitzsch Anke , Luers Jan Christoffer , Todt Ingo , Hüttenbrink Karl-Bernd
Published: January 2019

Objective: To evaluate the long-term safety and performance of four different vibroplasty couplers (round window, oval window, CliP and Bell coupler) in combination with an active middle ear implant. Methods: This was a multicentre, prospective, long-term study including 5 German hospitals. Thirty adult subjects suffering from conductive or mixed hearing loss were initially enrolled for the study, 24 of these were included in the final analysis with up to 36 months of postsurgical follow-up data. Bone conduction and air conduction were measured pre- and postoperatively to evalu ate safety. Postoperative aided sound field thresholds and Freiburger monosyllable word recognition scores were compared to unaided pre-implantation results to confirm performance. Additional speech tests compared postoperative unaided with aided results. To determine patient satisfaction, an established quality-of-life questionnaire developed for conventional hearing aid usage was administered to all subjects. Results: Mean postoperative bone conduction thresholds remained stable throughout the whole study period. Mean functional gain for all couplers investigated was 38.5 ± 11.4 dB HL (12 months) and 38.8 ± 12.5 dB HL (36 months). Mean word recognition scores at 65 dB SPL increased from 2.9% in the unaided by 64.2% to 67.1% in the aided situation. The mean postoperative speech reception in quiet (or 50% understanding of words in sentences) shows a speech intelligibility improvement at 36 months of 17.8 ± 12.4 dB SPL over the unaided condition. The signal-to-noise ratio (SNR) improved by 5.9 ± 7.2 dB SNR over the unaided condition. High subjective device satisfaction was reflected by the International Inventory for Hearing Aids scored very positively. Conclusion: A significant improvement was seen with all couplers, and audiological performance did not significantly differ between 12 and 36 months after surgery.
Dose and Location of Irradiation Determine Survival for Patients with Hepatocellular Carcinoma with Macrovascular Invasion in External Beam Radiation Therapy
Authors: Iwamoto Hideki , Nomiyama Mika , Niizeki Takashi , Shimose Shigeo , Shirono Tomotake , Nakano Masahito , Satani Manabu , Okamura Syusuke , Noda Yu , Kamachi Naoki , Sakai Miwa , Suzuki Hiroyuki , Kuromatsu Ryoko , Ogo Etsuyo , Abe Toshi , Tanaka Masatoshi , Koga Hironori , Torimura Takuji
Published: January 2019

Aim: Prognosis of hepatocellular carcinoma (HCC) with macrovascular invasion (MVI) is extremely poor. However, proper therapeutic strategies have not been established yet. The purpose of this study is to identify the effects of external beam radiation therapy (EBRT) for MVI of HCC. Methods: We have analyzed and evaluated 80 consecutive patients with HCC with MVI who underwent EBRT, and factors associated with enhanced survival in EBRT were evaluated by univariate and multivariate analysis. Results: The local response rate of radiotherapy for the irradiated MVI was 66.2%. The time to progression of the irradiated MVI was 5.8 months. Univariate and multivariate analyses showed that the higher irradiation dose (over 45 Gy) and the irradiation location (hepatic vein tumor thrombus – HVTT) were significant factors associated with survival benefits of EBRT. The response of EBRT for HVTT was significantly superior to that for portal vein or bile duct tumor thrombus. Conclusion: We conclude that a multidisciplinary therapeutic strategy based on EBRT should be proactively selected in the treatment of advanced HCC with MVI.
Use and Impact of the 21-Gene Recurrence Score in Relation to the Clinical Risk of Developing Metastases in Early Breast Cancer Patients in the Netherlands
Authors: Schreuder Kay , Kuijer Anne , Bentum Sanne , van Dalen Thijs , Siesling Sabine
Published: January 2019

Background: The nationwide use of the 21-gene recurrence score (21-RS) and implications regarding chemotherapy administration in relation to clinical risk in early breast cancer patients are investigated. Methods: Breast cancer patients surgically treated between 2014 and 2016 were selected from the Netherlands Cancer Registry and categorized as having a clinical low, intermediate, or high risk of developing metastases. Deployment of the 21-RS is advocated in patients with an intermediate risk of developing metastases. The use and impact of the 21-RS test result on chemotherapy administration were assessed in relation to the clinical risk as well as patient and tumor characteristics; χ2 tests were used for analysis. Results: Of all patients, 20,488 were considered as clinical low-, 4,309 as intermediate-, and 15,266 as high-risk patients. The 21-RS was deployed in 0.1% (n = 23), 3.2% (n = 137), and 0.6% (n = 90) of these categories, respectively. In the clinical intermediate-risk group, the 21-RS assigned 73.7, 13.1, and 13.1% of patients to the genomic low-, intermediate-, and high-risk category, respectively. Adherence to the 21-RS was 95.6% in these patients. Conclusion: In the Netherlands, the 21-RS test is applied both inside and outside the guideline-directed area. In case of discordance between the genomic and clinical risk, patients were treated in line with the result of the 21-RS.
Furosemide Stress Test as a Predicting Biomarker for Delayed Graft Function in Kidney Transplantation
Authors: Udomkarnjananun Suwasin , Townamchai Natavudh , Iampenkhae Kroonpong , Petchlorlian Aisawan , Srisawat Nattachai , Katavetin Pisut , Sutherasan Methee , Santingamkun Apirak , Praditpornsilpa Kearkiat , Eiam-Ong Somchai , Avihingsanon Yingyos
Published: January 2019

Background: Delayed graft function (DGF) could worsen early and long-term outcomes of kidney transplantation (KT). DGF is caused by several pre-transplantation and perioperative factors in both donors and recipients. At present, there are no biomarkers or tests during the immediate post-KT period that can accurately predict the development of DGF. Materials and methods: This prospective study was conducted in deceased donor KT (DDKT) at King Chulalongkorn Memorial Hospital, Thailand. All recipients underwent furosemide stress test (FST) by receiving a single dose of intravenous furosemide, 1.5 mg/kg at 3 h after allograft reperfusion. We determined the correlations between DGF (requiring dialysis within the first week after transplantation) and the values of urine volume recorded hourly after FST until 6 h, the parameters of postoperative dynamic tests, including resistive index (RI) of renal arteries and effective renal plasma flow (ERPF), and urine neutrophil gelatinase-associated lipocalin (NGAL). Results: Of the 59 total DDKT recipients enrolled, 24 developed DGF. The FST is a more accurate biomarker than urine NGAL, RI of renal arteries, and ERPF in the prediction of DGF. The 4-h urine volume less than 350 mL (FST non-responsive) was the best cut-off value in predicting DGF with 87.5% sensitivity, 82.9% specificity, and 82.5% accuracy. Multiple logistic regression analyses showed an odds ratio of 0.993 (0.986–0.999, p = 0.035) for the 4-h urine volume to predict DGF. Conclusions: The FST is a simple and accurate biomarker for predicting DGF in early post-KT period. Close monitoring and well prepared dialysis are suggested in patients with urine volume < 350 mL after 4 h of FST. The FST non-responsive patients could be the target for further DGF preventive intervention. ClinicalTrials.gov identifier: NCT03071536.
The Difficulty of Diagnosing Invasive Aspergillosis Initially Manifesting as Optic Neuropathy
Authors: Mori Sotaro , Kurimoto Takuji , Kawara Kana , Ueda Kaori , Sakamoto Mari , Keshi Yukako , Yamada-Nakanishi Yuko , Tachibana Hisatsugu , Nakamura Makoto
Published: January 2019

Background: Invasive aspergillosis is often fatal. Here, we report a patient with invasive aspergillosis primarily involving the optic nerve diagnosed on autopsy. Case Presentation: A 77-year-old female with underlying diabetes mellitus, hyperlipidemia, and hypertension presented with disc swelling of the left eye. Although mini-pulse steroid therapy improved visual acuity (VA) of the left eye, it abruptly decreased to no light perception within a month, followed by a decrease in VA of the right eye to 0.5. At referral, VA was 0.3 in the right eye, and there was no light perception in the left eye. Results: Fundus examination revealed optic disc swelling of both eyes. Goldmann perimetry showed irregular visual field defects, whereas magnetic resonance imaging (MRI), general, and cerebrospinal fluid (CSF) examinations revealed no distinct abnormalities. We suspected anterior ischemic optic neuropathy and invasive optic neuropathy. As with the left eye, steroid pulse therapy temporarily improved VA of the right eye and then decreased to 0.2. Additional anticoagulant therapy did not improve VA. Concurrent to therapy, the patient became febrile with depressed consciousness. Repeat MRI identified suspected midbrain infarction, and CSF examination indicated cerebral meningitis. In spite of administering transfusions and antibiotics, she died on hospital day 40. Autopsy revealed large amounts of Aspergillus hyphae mainly localized in the dura mater of the optic nerve and destruction of the cerebral artery wall, suggesting an etiology of subarachnoid hemorrhage. Conclusions: When examining refractory and persistent disc swelling, we should rule out fungal infections of the optic nerve.
Long-Wave Medical Infrared Thermography: A Clinical Biomarker of Inflammation in Hidradenitis Suppurativa/Acne Inversa
Authors: Zouboulis Christos C. , Nogueira da Costa André , Jemec Gregor B.E. , Trebing Dietrich
Published: January 2019

Background: A more reliable classification of skin inflammation and severity of active disease results from ultrasound sonography and the new hidradenitis suppurativa/acne inversa (HS) classification system IHS4. However, an objective assessment of skin inflammation in a continuous mode is still the ultimate goal. Long-wave medical infrared thermography (MIT) may offer a blood flow and temperature differential assessment in inflammatory conditions. Objective: To evaluate the application of MIT in HS. Methods: Standardized photography of the areas involved or been candidates for HS involvement was performed and MIT pictures were taken simultaneously and superimposed on the photographs of 18 patients (11 female, 7 male, median age 38.75 years [95% confidence interval 28.5 and 51 years], Hurley score I 5.6%, Hurley score II 38.9%, and Hurley score III 55.5%). A modification of the Otsu’s method facilitated the automatic lesion segmentation from the background, depicting the inflammation area. Moreover, MIT was administered in real-time mode during radical HS surgery. Results: A 1°C temperature difference from a corresponding symmetric body region was indicative of inflammation. MIT figures detected a gradual increase of skin temperature from 33.0°C in healthy skin on average to 35.0–36.6°C at the center of inflamma tory lesions in the axilla and to 35.4–36.9°C at the center of inflammation in the groin area. Real-time MIT assessment enabled the definition of the margins and depth of the surgical intervention during the procedure. Conclusion: MIT is a promising tool for the detection of inflammation severity in HS lesions and can be used as a clinical biomarker in evaluation studies of medical and surgical HS treatment.
Probable Etoricoxib-Induced Severe Thrombocytopenia: A Case Report
Authors: Recinella Guerino , De Marchi Alessandro , Pirazzoli Enrico , Bianchi Giampaolo
Published: January 2019

Objective: To describe a case of likely etoricoxib-induced severe thrombocytopenia. Clinical Presentation and Intervention: A 32-year-old woman was referred to our hospital for disseminated petechial rash after 7 days of therapy with etoricoxib. At admission, the patient’s platelet count was 3,000/mm3. At Naranjo’s scale correlation between thrombocytopenia and drug was considered as “probable.” With the diagnostic tests performed we did not find other causes of thrombocytopenia. Etoricoxib was discontinued. The patient was treated with intravenous immunoglobulin and corticosteroids with a complete resolution of the thrombocytopenia in a few days. Conclusion: The prevalence of thrombocytopenia induced by etoricoxib should be studied as it may not be very rare.
Gastrointestinal nematodes of Paramelomys rubex (Rodentia: Muridae) from Papua Indonesia and Papua New Guinea with the descriptions of three new genera and four new species of Helligmonellidae and Herpetostrongylidae (Nematoda: Trichostrongylida)
Authors: SMALES L. R. , HEINRICH B.
Published: January 2019

Nematodes, comprising 17 species, including 3 new genera, 4 new species and 3 putative new species, from the families Chabertiidae, Heligmonellidae, Herpetostrongylidae, Molineidae, Oxyuridae and Spiruridae were collected from the digestive tracts of 31 Paramelomys rubex (Murinae: Hydromyini) from Papua, Indonesia and Papua New Guinea. Mawsonema mokwanensis n. gen., n. sp. differs from all other genera in the Heligmonellidae in the characters of the synlophe, 15 ridges oriented sub frontally in the anterior body, the asymmetry of the bursa, the left lobe larger and the proportions of the dorsal ray. Melomystrongylus somoroensis n. sp. differs from its congener M. sepikensis in the number of ridges in the synlophe and the length of the spicules and female tail. A combination of the characters of the synlophe, 15 ridges oriented 55–60° from the saggital plane, lacking a carene, the asymmetry of the bursa and the proportions of the dorsal rays distinguishes Montistrongylus ingati n. gen., n. sp. from all other helligmonellids. Paraheligmosomoides singauwaensis is redescribed. It can be distinguished from P. amplicaudae n. sp., which has a similar number of synlophe ridges, but of differing proportions by the shape of the female tail and the proportions of the bursal lobes. Paraheligmosomoides ennisae n. sp. is characterized by the number of ridges of the synlophe, the shape of the female posterior end and the trilobed right spicule tip. Parasabanema n. gen., n. sp. differs from other heligmonellid genera in the arrangement and proportions of the 45 ridges and the left lateral dilatation of the synlophe. The herpetostrongylid Paraustrostrongylus paramelomysi n. sp. can be distinguished from its congenerics by a combination of characters including the number of synlophe ridges, the extent of the lateral floats in the female and the length of the proximally twisted spicules. Species richness of this nematode assemblage is similar to that of Melomys rufescens and Uromys caudimaculatus but species composition is not. Ten, including the three putative species, of the 17 species found in this study were unique to P. rubex. Biogeographic distributions within the helminth assemblage were discussed.
Eviota karaspila, a new gobiid fish from Fiji (Teleostei: Gobiidae)
Authors: GREENFIELD DAVID W. , RANDALL JOHN E.
Published: January 2019

A new species of goby, Eviota karaspila, most similar to E. melasma, is described from Fiji. It differs from E. melasma in having a larger eye and in live coloration and from E. smaragdus in having a more slender caudal peduncle, and in coloration.
Sabellaria isumiensis n. sp. (Annelida: Polychaeta: Sabellariidae) from shallow waters off Onjuku, Boso Peninsula, Japan, and re-descriptions of three Indo-West Pacific sabellariid species
Authors: NISHI EIJIROH , BAILEY-BROCK JULIE HELEN , SANTOS ANDRE SOUZA DOS , TACHIKAWA HIROYUKI , KUPRIYANOVA ELENA K.
Published: January 2019

A new species of the genus Sabellaria Lamarck, 1812, is described from shallow waters off Onjuku, the Pacific side of Boso Peninsula, Chiba, Japan. Sabellaria isumiensis n. sp. is a gregarious species building colonies of tubes made of sand and shell debris over 2 m wide in the intertidal to subtidal zone of the rocky shores. The new species is distinguished by the character combination of having 1 or 2 pairs of nuchal spines, median teeth of outer paleae with 3–5 lateral spines, two kinds (long and short) of opercular paleae in the middle row of the crown, with slender blades of long ones curved outward. Morphological features of the species are described in details and compared to those of congeners from Japan and world-wide. We re-describe three poorly known sabellariid species, Sabellaria javanica Augener, 1934 from Java, Indonesia, S. chandraae de Silva, 1961 from Galle Force, Sri Lanka, and Neosabellaria uschakovi Kirtley, 1994 from the Far Eastern Seas of Russia. The descriptions are based on the type specimens, and we particularly emphasize the head morphology and paleal characters. We provide a summary of diagnostic characters in the genus Sabellaria and propose new morphological groupings that later will be tested in the framework of a formal phylogenetic analysis.
A new species of Ricinulei of the genus Cryptocellus Westwood (Arachnida) from northern Brazil
Authors: TOURINHO ANA LÚCIA , MAN-HUNG NANCY F. LO , BONALDO ALEXANDRE BRAGIO
Published: January 2019

Cryptocellus iaci sp. nov. is described from an adult female collected during a field campaign organized by the World Wildlife Fund to the median Negro River at the Jauaperí river, in the state of Roraima, northern Brazil.
The genus Iare Barbalho and Penteado-Dias (Hymenoptera: Braconidae: Doryctinae) in Mexico, with the description of two new species
Authors: MARTÍNEZ JUAN JOSÉ , CECCARELLI FADIA SARA , ZALDÍVAR-RIVERÓN ALEJANDRO
Published: January 2019

Two new species of the doryctine genus Iare, I. mexicanus sp. nov. and I. cheguevarai sp. nov., are genetically and morphologically described from a tropical dry forest in Jalisco, Mexico. Iare belokobylskiji Marsh is also reported for the latter region. These species represent the northernmost distribution records for the genus. A simultaneous Bayesian analysis with COI and 28S DNA sequence data recovered the three examined species of Iare within a single clade, though with low support. This genus appears nested within a large doryctine Neotropical clade as sister group of a cluster containing species of Callihormius Ashmead, Leluthia Cameron, Histeromeroides Marsh and Panama Marsh.
Neocordulia pedroi sp. nov. (Odonata: Corduliidae) from southeastern Brazil
Authors: COSTA J. M. , CARRIÇO C. , SANTOS T. C.
Published: January 2019

Neocordulia (Mesocordulia) pedroi sp. n. is described and illustrated based on a reared adult male from Tapinuã stream, Estação Biológica de Santa Lúcia, Santa Teresa municipality, Espírito Santo State, Brazil. The holotype is deposited in the Museu Nacional, UFRJ, Rio de Janeiro, Brazil. This new species can be separated of the other species of the genus by the following characters: cerci strongly convergent and vesica spermalis with shorter flagellum.
Three new species of the family Pennellidae (Copepoda: Siphonostomatoida) from gobiid fishes (Actinopterygii: Perciformes) in coastal waters of the western Pacific Ocean
Authors: UYENO DAISUKE , NAGASAWA KAZUYA
Published: January 2019

Three new species of pennellid copepods are described based on specimens taken from gobiid fishes. Creopelates nohmijimensis n. sp. was found on Priolepis boreus (Snyder) in the Seto Inland Sea, Japan. This new species is distinguishable from its sole congener, C. floridus Shiino, 1958, by the presence of four finely digitate lobes on the cephalothorax and in having four pairs of legs occurring closely together at the anterior end of the neck. Two new species of Cardiodectes, C. asper n. sp. and C. bertrandi n. sp., were collected, from Trimma grammistes (Tomiyama) off IzuOshima Island, Japan and Eviota sp. off the Loyalty Islands, New Caledonia, respectively. Cardiodectes asper n. sp. is distinguished from its 12 congeners by the absence of the abdomen, byhaving a trunk not longer than twice of its width, a cephalothorax with three pairs of lateral lobes, and a pair of neck lobes carrying leg 3 on the posterior surface of their bases. Cardiodectes bertrandi n. sp. is identifiable by the presence of two pairs of lateral cephalothoracic lobes, with smaller anterior pairs; a trunk twice as long as wide; and leg 3 located at the posterior end of the anterior neck lobe.
Impact of Selective Decontamination of the Digestive Tract on Carriage and Infection Due to Gram-Negative and Gram-Positive Bacteria: A Systematic Review of Randomised Controlled Trials
Authors: Silvestri L. , Van Saene H. K. F. , Casarin A. , Berlot G. , Gullo A.
Published: January 2019

Meta-analyses of randomised controlled trials of selective digestive decontamination have clinical outcome measures, mainly pneumonia and mortality. This meta-analysis has a microbiological endpoint and explores the impact of selective digestive decontamination on Gram-negative and Gram-positive carriage and severe infections. We searched electronic databases, Cochrane Register of Controlled Trials, previous meta-analyses and conference proceedings with no language restrictions. We included randomised controlled trials which compared the selective digestive decontamination protocol with no treatment or placebo. Three reviewers independently applied selection criteria, performed the quality assessment and extracted the data. The outcome measures were carriage and severe infection due to Gram-negative and Gram-positive bacteria. Odds ratios were pooled with the random effect model. Fifty-four randomised controlled trials comprising 9473 patients were included; 4672 patients received selective digestive decontamination and 4801 were controls. Selective digestive decontamination significantly reduced oropharyngeal carriage (odds ratio [OR] 0.13, 95% confidence interval [CI] 0.07 to 0.23), rectal carriage (OR 0.15, 95% CI 0.07 to 0.31), overall infection (OR 0.17, 95% CI 0.10 to 0.28), lower respiratory tract infection (OR 0.11, 95% CI 0.06 to 0.20) and bloodstream infection (OR 0.35, 95% CI 0.21 to 0.67) due to Gram-negative bacteria. Reduction in Gram-positive carriage was not significant. Gram-positive lower airway infections were significantly reduced (OR 0.52, 95% CI 0.34 to 0.78). Gram-positive bloodstream infections were not significantly increased (OR 1.03, 95% CI 0.75 to 1.41). The association of parenteral and enteral antimicrobials was superior to enteral antimicrobials in reducing carriage and severe infections due to Gram-negative bacteria. This meta-analysis confirms that selective digestive decontamination mainly targets Gram-negative bacteria; it does not show a significant increase in Gram-positive infection.
A Study of Methoxyflurane/Air as an Agent for Analgesia in Obstetrics
Authors: O'Leary J.
Published: January 2019

A study was carried out to assess the value of methoxyflurane/air in the relief of pain in labour. It was found that the agent is safe and produces minimal neonatal depression. It has average to good analgesic properties with a high degree of acceptance by the mothers. Easily portable and simple apparatus is available for its administration.
Improved Sampling System for Mass Spectrometric Measurement of Water Vapour Pressure
Authors: Ilsley A. H. , Vedig A. E.
Published: January 2019

A modified heated sampling system for the Centronics Medical Spectrometer has been developed and tested for signal delay and response times. The modified system has improved sampling characteristics which should lead to more reliable dynamic measurement of water vapour pressure.
Investigating tire friction on snow-covered runways using electrical conductivity
Authors: Abe Takaya , Kanda Atsushi , Kasamura Keiji , Nakashima Yuta , Nakanishi Yoshitaka
Published: January 2019

The accumulation of snow on runways is a significant problem for airplane landings. This is because the existence of snow between the tires and runway reduces the friction coefficient and increases the braking distance required for landing. Therefore, in Japan, where sudden weather changes can occur within a day, the development of a system that can predict the friction coefficient from the runway conditions immediately before the airplane lands is needed to determine whether an airplane can land safely. This study focuses on the interposition of snow between a landing unit with a rotating tire and a stainless-steel plate and investigates its influence on the friction coefficient. The investigation uses electrical conductivity to observe the microscopic separation between the silicon rubber and stainless-steel plate. The results show that when using this method, the microscopic separation due to snow can be observed as a range between 0 (direct contact) and 1 (noncontact). In addition, we suggest that the friction mode that occurs during landing may be classified based on the state of snow.
Stabilization of polyacrylonitrile nanofiber mats obtained by needleless electrospinning using dimethyl sulfoxide as solvent
Authors: Sabantina Lilia , Klöcker Michaela , Wortmann Martin , Mirasol José Rodríguez , Cordero Tomás , Moritzer Elmar , Finsterbusch Karin , Ehrmann Andrea
Published: January 2019

Polyacrylonitrile can be used as a base material for thermochemical conversion into carbon. Especially nanofiber mats, produced by electrospinning, are of interest to create carbon nanofibers. Optimal stabilization and carbonization parameters, however, strongly depend on the spatial features of the original material. While differences between nano- and microfibers are well known, this paper shows that depending on the electrospinning method and the solvent used, considerable differences between various nanofiber mats have to be taken into account for the optimization of the stabilization conditions. Here, we examine for the first time polyacrylonitrile nanofiber mats, electrospun with wire electrospinning from the low-toxic dimethyl sulfoxide as a solvent, instead of the typically used needle electrospinning from the toxic dimethylformamide. Additionally, we used inexpensive polyacrylonitrile from knitting yarn instead of highly specialized material, tailored for carbonization. Our results show that by carefully controlling the maximum stabilization temperature and especially the heating rate, fully stabilized polyacrylonitrile fibers without undesired interconnections can be created as precursors for carbonization.
A combination of serum anti‐Helicobacter pylori antibody titer and Kyoto classification score could provide a more accurate diagnosis of H pylori
Authors: Nishizawa Toshihiro , Sakitani Kosuke , Suzuki Hidekazu , Yamakawa Tadahiro , Takahashi Yoshiyuki , Yamamichi Nobutake , Watanabe Hidenobu , Seto Yasuyuki , Koike Kazuhiko , Toyoshima Osamu
Published: January 2019

Background

We previously showed that the endoscopic Kyoto classification for gastritis could predict Helicobacter pylori infection in individuals with a high negative titer of serum anti‐H pylori antibodies. This study evaluated H pylori infection and the Kyoto classification score in patients with a low negative titer (<3 U/ml), high negative titer (3–9.9 U/ml), low positive titer (10–49.9 U/ml), and high positive titer (≥50 U/ml).

Methods

Serum antibody levels, Kyoto classification score and histology were investigated in 870 individuals with no history of H pylori‐eradication therapy. Urea breath tests (UBTs) were additionally conducted for patients with a low negative titer and a Kyoto score ≥1 or an antibody titer ≥10 U/ml and a Kyoto score of 0 or 1. UBTs and/or histological studies were conducted for participants with a high negative titer.

Results

False diagnoses based on anti‐H pylori antibody titers were observed in 0.3% of the low‐negative‐titer group, 11.7% of the high‐negative‐titer group, 18.9% of the low‐positive‐titer group and 2.2% of the high‐positive‐titer group. Surprisingly, false diagnoses based on antibody titers were noted in 63.2% of patients with a low positive titer and a Kyoto score of 0 and in 62.5% of patients with a high negative titer and a Kyoto score ≥2, respectively.

Conclusions

Endoscopic findings could predict false diagnoses determined using serum antibody titers.
SIRT6/HIF-1α axis promotes papillary thyroid cancer progression by inducing epithelial–mesenchymal transition
Authors: Yang Zhou , Yu Weiping , Huang Renhong , Ye Min , Min Zhijun
Published: January 2019

Background

In our previous study, we demonstrated that Sirtuin 6 (SIRT6) is upregulated and associated with papillary thyroid cancer (PTC) progression (Qu et al. in Int J Oncol 50(5):1683–92, 2017). This study examined whether SIRT6 promotes epithelial–mesenchymal transition (EMT) of papillary thyroid cancer through hypoxia inducible factor-1α (HIF-1α).

Methods

SIRT6-upregulated TPC-1 and B-CPAP cells were generated by lentivirus. Western blotting, RT-qPCR, immunofluorescence was performed to detect the following EMT associated markers: E-cadherin, Vimentin, Snail, and TWIST. Cell proliferation was detected by CCK8, and cell invasion and migration were detected by transwell and wound healing assays, respectively. HIF-1α expression was further detected by western blotting in both normoxia and hypoxia conditions. A HIF-1α inhibitor was then used to block HIF-1α expression in SIRT6-upregulated PTC cells. The same parameters were then assessed and compared with control HIF-1α cells.

Results

E-cadherin was significantly decreased, whereas Vimentin, Snail, and TWIST were increased in SIRT6-upregulated PTC cells. Additionally, SIRT6 promoted the invasion and migration of PTC cells. We found that SIRT6 enhanced HIF-1α stability and synthesis and prolonged the protein half-life. The changes in the EMT associated markers and in the invasion and migration ability were rescued after inhibition of HIF-1α expression. Furthermore, we found that SIRT6 increased PTC resistance to HIF-1α inhibitor-mediated proliferation changes.

Conclusion

These results confirm that the SIRT6/HIF-1α axis promotes papillary thyroid cancer progression by inducing EMT.
Following in their footsteps: an analysis of the impact of successive migration on rural household welfare in Ghana
Authors: Egger Eva-Maria , Litchfield Julie
Published: January 2019

We explore patterns of successive migration within rural households in Ghana and the impact that these successive migrants have on household welfare outcomes. Specifically, we use a household panel survey collected in 2013 and 2015. We exploit the panel nature of the data and a weighting method to overcome sources of bias. Welfare is measured with an index of housing quality. We find that successive migrants face lower migration costs, and few of them remit. We find no effect of sending a new migrant on the housing quality index. We conclude that the different nature of migration of successive migrants implies neither an economic gain for the household nor a loss. The reason is that the successive migration becomes less costly for migrants from households with prior migration experience, but at the same time, these migrants remit less or not at all compared to earlier waves of migrants.
Vasopressor Infusion During Prone Spine Surgery and Acute Renal Injury: A Retrospective Cohort Analysis
Authors: Farag Ehab , Makarova Natalya , Argalious Maged , Cywinski Jacek B. , Benzel Edward , Kalfas Iain , Sessler Daniel I.
Published: January 2019

BACKGROUND:

Hypotension is associated with acute kidney injury, but vasopressors used to treat hypotension may also compromise renal function. We therefore tested the hypothesis that vasopressor infusion during complex spine surgery is not associated with impaired renal function.

METHODS:

In this retrospective cohort analysis, we considered adults who had complex spine surgery between January 2005 and September 2014 at the Cleveland Clinic Main Campus. Our primary outcome was postoperative estimated glomerular filtration rate. Secondarily, we evaluated renal function using Acute Kidney Injury Network criteria. We obtained data for 1814 surgeries, including 689 patients (38%) who were given intraoperative vasopressors infusion for ≥30 minutes and 1125 patients (62%) who were not. Five hundred forty patients with and 540 patients without vasopressor infusions were well matched across 32 potential confounding variables.

RESULTS:

In matched patients, vasopressor infusions lasted an average of 173 ± 100 minutes (SD) and were given a median dose (1st quintile, 3rd quintile) of 3.4-mg (1.5, 6.7 mg) phenylephrine equivalents. Mean arterial pressure and the amounts of hypotension were similar in each matched group. The postoperative difference in mean estimated glomerular filtration rate in patients with and without vasopressor infusions was only 0.8 mL/min/1.73 m2 (95% CI, −0.6 to 2.2 mL/min/1.73 m2) (P = .28). Intraoperative vasopressor infusion was also not associated with increased odds of augmented acute kidney injury stage.

CONCLUSIONS:

Clinicians should not avoid typical perioperative doses of vasopressors for fear of promoting kidney injury. Tolerating hypotension to avoid vasopressor use would probably be a poor strategy.
Perioperative Dextrose Infusion and Postoperative Nausea and Vomiting: A Meta-analysis of Randomized Trials
Authors: Zorrilla-Vaca Andres , Marmolejo-Posso Diana , Stone Alexander , Li Jinlei , Grant Michael C.
Published: January 2019

BACKGROUND:

Perioperative IV dextrose infusions have been investigated for their potential to reduce the risk of postoperative nausea and vomiting. In this meta-analysis, we investigated the use of an intraoperative or postoperative infusion of dextrose for the prevention of postoperative nausea and vomiting.

METHODS:

Our group searched PubMed, Embase, Cochrane library, and Google Scholar for relevant randomized controlled trials examining the use of perioperative IV dextrose for prevention of postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting (both in the postanesthesia care unit and within the first 24 h of surgery). Secondary outcomes included postoperative antiemetic administration and serum glucose level.

RESULTS:

Our search yielded a total of 10 randomized controlled trials (n = 987 patients) comparing the use of a perioperative dextrose infusion (n = 465) to control (n = 522). Perioperative dextrose infusion was not associated with a significant reduction in postoperative nausea and vomiting in the postanesthesia care unit (risk ratio = 0.91, 95% CI, 0.73–1.15; P = .44) or within the first 24 h (risk ratio = 0.76, 95% CI, 0.55–1.04; P = .09) of surgery. Although the use of dextrose was associated with a significant reduction in antiemetic administration within the first 24 h (risk ratio = 0.55, 95% CI, 0.45–0.69; P < .001), it also increased postoperative plasma glucose levels compared to controls.

CONCLUSIONS:

The use of perioperative dextrose did not result in a statistically significant association with postoperative nausea and vomiting. When utilized, plasma glucose monitoring is recommended to assess for postoperative hyperglycemia. Further prospective trials are necessary to examine the potential impact of timing of administration of a dextrose infusion on incidence of postoperative nausea and vomiting and rescue antiemetic requirements.
Speeding the Detection of Vessel Cannulation: An In-Vitro Stimulation Study
Authors: Muffly Matthew K. , Ku Andrew , Drover David R. , Rodriguez Samuel , Caruso Thomas J. , Ku Anne , Tsui Ban C. H.
Published: January 2019

BACKGROUND:

Some practitioners “prime” small IV angiocatheter needles with 0.9% sodium chloride—claiming this modification speeds visual detection of blood in the angiocatheter flash chamber on vessel cannulation.

METHODS:

We compared the time required for human blood to travel the length of saline-primed and saline-unprimed 24- and 22-gauge angiocatheter needles (Introcan Safety IV Catheter; B. Braun, Bethlehem, PA). A syringe pump (Medfusion 4000, Cary, NC) advanced each angiocatheter needle through the silicone membrane of an IV tubing “t-piece” (Microbore Extension Set, 5 Inch; Hospira, Lake Forest, IL) filled with freshly donated human blood. When the angiocatheter needle contacted the blood, an electrical circuit was completed, illuminating a light-emitting diode. We determined the time from light-emitting diode illumination to visual detection of blood in the flash chamber by video review. We tested 105 saline-primed angiocatheters and 105 unprimed angiocatheters in the 24- and 22-gauge angiocatheter sizes (420 catheters total). We analyzed the median time to visualize the flash using the nonparametric Wilcoxon rank sum test in R (http://www.R-project.org/). The Stanford University Administrative Panel on Human Subjects in Medical Research determined that this project did not meet the definition of human subjects research and did not require institutional review board oversight.

RESULTS:

In the 24-gauge angiocatheter group, the median (and interquartile range) time for blood to travel the length of the unprimed angiocatheter needle was 1.14 (0.61–1.47) seconds compared with 0.76 (0.41–1.20) seconds in the saline-primed group (P = 0.006). In the 22-gauge catheter group, the median (interquartile range) time for blood to travel the length of the unprimed angiocatheter needle was 1.80 (1.23–2.95) seconds compared with 1.46 (1.03–2.54) seconds in the saline-primed group (P = .046).

CONCLUSIONS:

These results support the notion that priming small angiocatheter needles, in particular 24-gauge catheters, with 0.9% sodium chloride may provide earlier detection of vessel cannulation than with the unprimed angiocatheter.
Cux2 refines the forelimb field by controlling expression ofRaldh2andHoxgenes
Authors: Ueda Shogo , Cordeiro Ingrid Rosenburg , Moriyama Yuuta , Nishimori Chika , Kai Kei-ichi , Yu Reiko , Nakato Ryoichiro , Shirahige Katsuhiko , Tanaka Mikiko
Published: January 2019

In vertebrates, two pairs of buds that give rise to the fore- and hindlimbs form at discrete positions along the rostral-caudal axis of the body. The mechanism responsible for the positioning of the limb buds is still largely unknown. Here we show a novel function for Cut homeobox transcription factor 2, Cux2, the ortholog of Drosophila cut, in refining the forelimb field during chick development. Cux2 is expressed in the forelimb field before the emergence of the limb buds. Knocking down the expression of Cux2 using small interfering RNA (siRNA) resulted in a caudal shift of the forelimb bud, whereas misexpression of Cux2 or the constitutively active Cux2-VP16 caused a rostral shift of the forelimb bud or reduction of the forelimb field along the anterior-posterior axis. Further functional analyses revealed that expression of Hoxb genes and retinaldehyde dehydrogenase 2 (Raldh2), which are involved in limb positioning, are directly activated by Cux2 in the lateral plate mesoderm. Our data suggest that Cux2 in the lateral plate mesoderm refines the forelimb field via regulation of Raldh2 and Hoxb genes in chicken embryos.
Women Experience the Same Ergogenic Response to Caffeine as Men
Authors: SKINNER TINA L. , DESBROW BEN , ARAPOVA JULIA , SCHAUMBERG MIA A. , OSBORNE JOHN , GRANT GARY D. , ANOOPKUMAR-DUKIE SHAILENDRA , LEVERITT MICHAEL D.
Published: January 2019

Purpose

This study aimed to determine whether 1) consumption of caffeine improves endurance cycling performance in women and 2) sex differences exist in the magnitude of the ergogenic and plasma responses to caffeine supplementation.

Methods

Twenty-seven (11 women and 16 men) endurance-trained cyclists and triathletes participated in this randomized, double-blind, placebo-controlled, crossover study. Participants completed an incremental exercise test to exhaustion, two familiarization trials, and two performance trials. Ninety minutes before the performance trials, participants ingested opaque capsules containing either 3 mg·kg−1 body mass of anhydrous caffeine or a placebo. They then completed a set amount of work (75% of peak sustainable power output) in the fastest possible time. Plasma was sampled at baseline, preexercise, and postexercise for caffeine. Strict standardization and verification of diet, hydration, training volume and intensity, and contraceptive hormone phase (for women) were implemented.

Results

Performance time was significantly improved after caffeine administration in women (placebo: 3863 ± 419 s, caffeine: 3757 ± 312 s; P = 0.03) and men (placebo: 3903 ± 341 s, caffeine: 3734 ± 287 s; P < 0.001). The magnitude of performance improvement was similar for women (mean = 4.3%, 95% CI = 0.4%–8.2%) and men (4.6%, 2.3%–6.8%). Plasma caffeine concentrations were similar between sexes before exercise, but significantly greater in women after exercise (P < 0.001).

Conclusions

Ingestion of 3 mg·kg−1 body mass of caffeine enhanced endurance exercise performance in women. The magnitude of the performance enhancement observed in women was similar to that of men, despite significantly greater plasma caffeine concentrations after exercise in women. These results suggest that the current recommendations for caffeine intake (i.e., 3–6 mg·kg−1 caffeine before exercise to enhance endurance performance), which are derived almost exclusively from studies on men, may also be applicable to women.