bluuebunny/crossref_metadata_2025 huggingface dataset:
Complications and risk factors for severe outcome in children with measles
Authors: Lo Vecchio Andrea , Krzysztofiak Andrzej , Montagnani Carlotta , Valentini Piero , Rossi Nadia , Garazzino Silvia , Raffaldi Irene , Di Gangi Maria , Esposito Susanna , Vecchi Barbara , Melzi Maria Luisa , Lanari Marcello , Zavarise Giorgio , Bosis Samantha , Valenzise Mariella , Cazzato Salvatore , Sacco Michele , Govoni Maria Rita , Mozzo Elena , Cambriglia Maria Donata , Bruzzese Eugenia , Di Camillo Chiara , Pata Davide , Graziosi Alessandro , Sala Debora , Magurano Fabio , Villani Alberto , Guarino Alfredo , Galli Luisa
Published: January 2019

Objective and design

Risk factors for severe measles are poorly investigated in high-income countries. The Italian Society for Paediatric Infectious Diseases conducted a retrospective study in children hospitalised for measles from January 2016 to August 2017 to investigate the risk factors for severe outcome defined by the presence of long-lasting sequelae, need of intensive care or death.

Results

Nineteen hospitals enrolled 249 children (median age 14.5 months): 207 (83%) children developed a complication and 3 (1%) died. Neutropaenia was more commonly reported in children with B3-genotype compared with other genotypes (29.5% vs 7.7%, p=0.01). Pancreatitis (adjusted OR [aOR] 9.19, p=0.01) and encephalitis (aOR 7.02, p=0.04) were related to severe outcome in multivariable analysis, as well as C reactive protein (CRP) (aOR 1.1, p=0.028), the increase of which predicted severe outcome (area under the receiver operating characteristic curve 0.67, 95% CI 0.52 to 0.82). CRP values >2 mg/dL were related to higher risk of complications (OR 2.0, 95% CI 1.15 to 3.7, p=0.01) or severe outcome (OR 4.13, 95% CI 1.43 to 11.8, p<0.01).

Conclusion

The risk of severe outcome in measles is independent of age and underlying conditions, but is related to the development of organ complications and may be predicted by CRP value.
Effect of time to primary repair on final visual outcome after open globe injury
Authors: Blanch Richard J , Bishop Jonathan , Javidi Hedayat , Murray Philip Ian
Published: January 2019

Background/Aim

Historic data suggest that open globe injuries should be repaired within 12–24 hours to reduce the risk of endophthalmitis. However, endophthalmitis is uncommon when systemic antibiotic prophylaxis is given. It is not clear whether delayed primary repair impacts visual outcomes in other ways or what is the optimum time to repair. We aimed to examine the effect of time to primary repair on visual outcomes.

Methods

This is a retrospective comparative case series including all open globe injuries presenting to the Birmingham Midland Eye Centre between 1 January 2014 and 15 March 2016. Presenting features, mechanism of injury, visual acuity at 6–12 months and demographic data were examined.

Results

56 open globe injuries were repaired, of which sufficient data for analysis were available on 52 cases. The mean time to primary repair was 1 day after injury (range 5 hours to 7 days). Final visual acuity at 6–12 months was related to the presenting visual acuity and the Ocular Trauma Score and to the time between injury and primary repair, with a reduction in predicted visual acuity of logarithm of the minimum angle of resolution of 0.37 for every 24 hours of delay (95% CI 0.14 to 0.6).

Discussion

Open globe injuries should be repaired promptly. Presenting visual acuity remains the strongest predictor of outcome; however, delay to primary repair also reduced final visual acuity, and any significant delay from injury to repair is likely to negatively impact final visual outcome.
Classifying signs and symptoms of dry eye disease according to underlying mechanism via the Delphi method: the DIDACTIC study
Authors: Labetoulle Marc , Bourcier Tristan , Doan Serge
Published: January 2019

Background/aims

Dry eye disease (DED) is categorised by pathophysiology as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE) or mixed. Treatment should be tailored to DED pathophysiology, but this is challenging to determine. This Delphi consultation aimed to categorise and weight signs and symptoms to help identify the evaporative or aqueous deficient DED origin.

Methods

A panel of French DED experts created an initial list of 77 DED signs and symptoms. In a Delphi consultation, experts categorised items by DED pathophysiology. Likert scoring was used to indicate whether items were strongly or moderately indicative of ADDE or EDE. Items could also be judged non-applicable to DED, with the opportunity to suggest alternative diagnoses.

Results

Experts attributed 19 items (of which 11 were strongly indicative) to a pathophysiology of EDE and 12 items (of which four were strongly indicative) to ADDE. Items scored strongly indicative with agreement >90% for EDE were previous chalazia, rosacea/rhinophyma, telangiectasias of eyelid margin and thick non-expressible meibomian gland secretions, and for ADDE were Sjögren syndrome or associated disease, and Schirmer <5 mm after 5 min (without anaesthesia). Seventeen items indicated neither pathophysiology and 18 items were found to be suggestive of alternative diagnoses.

Conclusions

This Delphi consultation categorised signs and symptoms, using an innovative weighting system to identify DED pathophysiology. An algorithm integrating the weighting of each sign and symptom of an individual patient would be valuable to help general ophthalmologists to classify the DED subtype and tailor treatment to DED underlying mechanism.
Healthcare professionals’ moral distress in adult palliative care: a systematic review
Authors: Maffoni Marina , Argentero Piergiorgio , Giorgi Ines , Hynes Julia , Giardini Anna
Published: January 2019

Objectives

Palliative care providers may be exposed to numerous detrimental psychological and existential challenges. Ethical issues in the healthcare arena are subject to continual debate, being fuelled with ongoing medical, technological and legal advancements. This work aims to systematically review studies addressing the moral distress experienced by healthcare professionals who provide adult palliative care.

Methods

A literature search was performed on PubMed, Scopus, Web of Science and PsycINFO databases, searching for the terms ‘moral distress’ AND ‘palliative care’. The review process has followed the international PRISMA statement guidelines.

Results

The initial search identified 248 papers and 10 of them were considered eligible. Four main areas were identified: (1) personal factors, (2) patients and caregivers, (3) colleagues and superiors and (4) environment and organisation. Managing emotions of self and others, witnessing sufferance and disability, caring for highly demanding patients and caregivers, as well as poor communication were identified as distressing. Moreover, the relationship with colleagues and superiors, and organisational constraints often led to actions which contravened personal values invoking moral distress. The authors also summarised some supportive and preventive recommendations including self-empowerment, communication improvement, management of emotions and specific educational programmes for palliative care providers. A holistic model of moral distress in adult palliative care (integrating emotional, cognitive, behavioural and organisational factors) was also proposed.

Conclusions

Cognisance of risk and protective factors associated with the moral distress phenomenon may help reframe palliative healthcare systems, enabling effective and tailored actions that safeguard the well-being of providers, and consequently enhance patient care.
Heart or heart-lung transplantation for patients with congenital heart disease in England
Authors: Dimopoulos Konstantinos , Muthiah Kavitha , Alonso-Gonzalez Rafael , Banner Nicholas Robert , Wort Stephen J , Swan Lorna , Constantine Andrew Harry , Gatzoulis Michael A , Diller Gerhard Paul , Kempny Aleksander
Published: January 2019

Background

Increased longevity in patients with congenital heart disease (CHD) is associated with late complications, mainly heart failure, which may not be amenable to redo surgery and become refractory to medical therapy and so, trigger referral for transplantation. We assessed the current role and future prospects of heart and heart-lung transplantation for patients with CHD in England.

Methods

We performed a retrospective analysis of hospital episodes for England for 1997–2015, identifying patients with a CHD code (ICD-10 ‘Q2xx.x’), who underwent heart or heart-lung transplantation.

Results

In total, 469 transplants (82.2% heart and 17.8% heart-lung) were performed in 444 patients. Half of patients transplanted had mild or moderate CHD complexity, this percentage increased with time (p=0.001). While overall, more transplantations were performed over the years, the proportion of heart-lung transplants declined (p<0.0001), whereas the proportion of transplants performed in adults remained static. Mortality was high during the first year, especially after heart-lung transplantation, but remained relatively low thereafter. Older age and heart-lung transplantation were strong predictors of death. While an increase in CHD transplants is anticipated, actual numbers in England seem to lag behind the increase in CHD patients with advanced heart failure.

Conclusions

The current and future predicted increase in the numbers of CHD transplants does not appear to parallel the expansion of the CHD population, especially in adults. Further investment and changes in policy should be made to enhance the number of donors and increase CHD transplant capacity to address the increasing numbers of potential CHD recipients and optimise transplantation outcomes in this growing population.
Monoclonal B-cell lymphocytosis and prostate cancer: Incidence and effects of radiotherapy
Authors: D'Auria Fiorella , Valvano Luciana , Rago Luciana , Statuto Teodora , Calice Giovanni , D'Arena Giovanni , Fusco Vincenzo , Musto Pellegrino
Published: January 2019

Monoclonal B-cells lymphocytosis (MBL) is a benign condition that may precede chronic lymphocytic leukemia (CLL), not rarely present in peripheral blood of healthy elderly people, among which there is also a male prevalence. Though CLL has been associated with various types of solid tumors, including prostate cancer (PC), no data exist about the relationship between PC and MBL. We studied the frequency of CLL-like MBL clones in a group of 48 patients affected by PC and followed them during and after whole-pelvis radiotherapy (WPRT) treatment. We found four MBL clones (8.3%), two of which (4.2%) had a B-cell clonal count >1000 cells/µL (‘clinical MBL’). A single case (1.8%) of ‘low-count’ MBL occurred in a control group of 54 healthy males. Notably, normal B-lymphocytes were consistently affected by WPRT, while MBL clones were less radiosensitive. Our results suggest a possible association between ‘clinical’ MBL and PC and show a different impact of the radiation on monoclonal respect to normal B-cells, which could also imply a greater risk of clonal transformation.
Implications of uninterrupted preoperative transdermal buprenorphine use on postoperative pain management
Authors: Martin Yvette N , Pearson Amy C S , Tranchida John R , Weingarten Toby N , Schulte Phillip J , Sprung Juraj
Published: January 2019

Background and objectives

Buprenorphine is a partial µ-receptor agonist resistant to displacement from receptors by conventional opioids, which can block the effect of conventional opioids and may interfere with postoperative pain management. We aimed to quantify perioperative opioid use in patients receiving transdermal buprenorphine (TdBUP).

Methods

We identified patients receiving TdBUP who underwent surgery between 2004 and 2016. To compare opioid requirements (intravenous morphine equivalents (IV-MEq)), we constructed a matched study, matching each TdBUP patient with two opioid-naive patients by sex, age, and type of anesthesia and procedure.

Results

Nineteen unique patients underwent 22 procedures while receiving TdBUP. Total (IQR) amounts of IV-MEq (intraoperative, recovery room, and 24 hours after recovery-room discharge) were 98 (63, 145) and 46 (30, 65) mg IV-MEq for TdBUP and opioid-naive patients, respectively (p<0.001). Postoperative IV-MEq requirements were 54 (38, 90) and 15 (3, 35) mg for TdBUP and opioid-naive patients, respectively (p<0.001). Among TdBUP patients, higher preoperative doses of TdBUP were associated with greater postoperative opioid requirements (p=0.02). Specifically, patients with a 20 µg/hour TdBUP patch required 133.8 mg IV-MEq more postoperatively than patients with a 5 µg/hour patch (p=0.002). Following discharge from the recovery room, 17 (77%) TdBUP patients and 15 (34%) opioid-naive patients reported severe pain (OR 6.6 (95% CI 2.0 to 21.3); p<0.001; adjusting for baseline pain score, 5.0 (95% CI, 1.4 to 17.8); p=0.01).

Conclusions

Analgesic management for patients receiving TdBUP therapy must account for increased opioid needs, and greater preoperative doses of TdBUP were associated with greater postoperative opioid requirements.
Salivary gland secretome: a novel tool towards molecular stratification of patients with primary Sjögren’s syndrome and non-autoimmune sicca
Authors: Blokland Sofie L M , Hillen Maarten R , van Vliet-Moret Fréderique M , Bikker Angela , de Jager Wilco , Pandit Aridaman , Kruize Aike A , Radstake Timothy R D J , van Roon Joel A G
Published: January 2019

Objective

To explore the potential of salivary gland biopsy supernatants (the secretome) as a novel tool to aid in stratification of patients with sicca syndrome and to study local immunopathology in Sjögren’s syndrome.

Methods

Labial salivary gland biopsies were incubated in saline for 1 hour. In these tissue supernatants from a discovery cohort (n=16) of patients with primary Sjögren’s syndrome (pSS) and non-Sjögren’s sicca (nSS), 101 inflammatory mediators were measured by Luminex. Results were validated in a replication cohort (n=57) encompassing patients with pSS, incomplete SS and nSS.

Results

The levels of 23 cytokines were significantly increased in patients with pSS versus nSS in the discovery cohort. These 23 and 3 additional cytokines were measured in a second cohort. Elevated concentrations of 11 cytokines were validated and the majority correlated with clinical parameters. Classification tree analysis indicated that the concentrations of CXCL13, IL-21, sIL-2R and sIL-7Rα could be used to classify 95.8% of patients with pSS correctly.

Conclusion

Labial salivary gland secretomes can be used to reliably assess mediators involved in immunopathology of patients with pSS, potentially contributing to patient classification. As such, this method represents a novel tool to identify therapeutic targets and markers for diagnosis, prognosis and treatment response.
Tofacitinib or adalimumab versus placebo: patient-reported outcomes from OPAL Broaden—a phase III study of active psoriatic arthritis in patients with an inadequate response to conventional synthetic disease-modifying antirheumatic drugs
Authors: Strand Vibeke , de Vlam Kurt , Covarrubias-Cobos Jose A , Mease Philip J , Gladman Dafna D , Graham Daniela , Wang Cunshan , Cappelleri Joseph C , Hendrikx Thijs , Hsu Ming-Ann
Published: January 2019

Objectives

Tofacitinib is an oral Janus kinase inhibitor for treatment of psoriatic arthritis (PsA). We evaluated patient-reported outcomes (PROs) in patients with PsA refractory to ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD-IR) and tumour necrosis factor inhibitor-naïve in a 12-month, phase III randomised controlled trial (OPAL Broaden [NCT01877668]).

Methods

Patients (N=422) received tofacitinib 5 mg or 10 mg twice daily, adalimumab 40 mg subcutaneously every 2 weeks or placebo advancing to tofacitinib 5 mg or 10 mg twice daily at month 3. Least squares mean changes from baseline and percentages of patients reporting improvements ≥minimum clinically important differences (MCID); and scores ≥normative values in: Patient Global Assessment of disease activity (PtGA), Pain, Patient Global Joint and Skin Assessment (PGJS), Short Form-36 Health Survey version 2 (SF-36v2), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), EuroQol 5-Dimensions-3-level questionnaire (EQ-5D-3L) and Ankylosing Spondylitis Quality of Life (ASQoL) were determined. Nominal p values were cited without multiple comparison adjustments.

Results

At month 3, PtGA, Pain, PGJS, FACIT-Fatigue, EQ-5D-3L, ASQoL and SF-36v2 Physical Component Summary (PCS), physical functioning (PF), bodily pain (BP) and vitality domain scores exceeded placebo with both tofacitinib doses (p≤0.05); SF-36v2 social functioning with 5 mg twice daily (p≤0.05). Percentages reporting improvements ≥MCID in PtGA, Pain, PGJS, FACIT-Fatigue, ASQoL and SF-36v2 PCS, PF, BP and general health scores exceeded placebo with both tofacitinib doses (p≤0.05) and were similar with adalimumab.

Conclusion

csDMARD-IR patients with active PsA reported statistically and clinically meaningful improvements in PROs with tofacitinib compared with placebo at Month 3.
Effect of tofacitinib on patient-reported outcomes in patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors in the phase III, randomised controlled trial: OPAL Beyond
Authors: Strand Vibeke , de Vlam Kurt , Covarrubias-Cobos Jose A , Mease Philip J , Gladman Dafna D , Chen Linda , Kudlacz Elizabeth , Wu Joseph , Cappelleri Joseph C , Hendrikx Thijs , Hsu Ming-Ann
Published: January 2019

Objectives

Tofacitinib is an oral Janus kinase inhibitor for treatment of psoriatic arthritis (PsA). Patient-reported outcomes (PROs) were evaluated in patients with PsA with inadequate responses to tumour necrosis factor inhibitors (TNFi-IR) in a 6-month, phase III randomised controlled trial (OPAL Beyond [NCT01882439]).

Methods

Patients (N=394) received tofacitinib 5 or 10 mg twice daily or placebo (advancing to tofacitinib 5 or 10 mg twice daily at month 3). Least squares mean changes from baseline and percentages of patients reporting improvements ≥minimum clinically important differences and scores ≥normative values were determined in Patient Global Assessment of disease activity (PtGA), Pain, Patient Global Joint and Skin Assessment (PGJS), Short Form-36 Health Survey version 2 (SF-36v2), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), EuroQol 5-Dimensions-3-level (EQ-5D-3L), EQ-VAS and Ankylosing Spondylitis Quality of Life (ASQoL). Nominal p values are without multiple comparison adjustments.

Results

At month 3, PtGA, Pain, PGJS, SF-36v2 Physical Component Summary (PCS), physical functioning (PF), bodily pain (BP), vitality and social functioning (SF) domains, FACIT-Fatigue Total score, EQ-5D-3L pain/discomfort, EQ-VAS and ASQoL scores exceeded placebo with both tofacitinib doses (role physical [RP] with 10 mg twice daily only; p≤0.05). Patients reporting improvements ≥MCID (%) in PtGA, PGJS, Pain, ASQoL and SF-36v2 PCS, PF, RP, BP, SF (both tofacitinib doses) exceeded placebo (p≤0.05).

Conclusion

TNFi-IR patients with PsA receiving tofacitinib reported statistically and clinically meaningful improvements in PROs versus placebo over 3 months, which were maintained to month 6. Despite lower baseline scores, these improvements were similar to the csDMARD-IR TNFi-naive OPAL Broaden trial.
Circulating Biomarkers Predicting Longitudinal Changes in Left Ventricular Structure and Function in a General Population
Authors: Cauwenberghs Nicholas , Ravassa Susana , Thijs Lutgarde , Haddad Francois , Yang Wen‐Yi , Wei Fang‐Fei , López Begoña , González Arantxa , Díez Javier , Staessen Jan A. , Kuznetsova Tatiana
Published: January 2019

Background

Serial imaging studies in the general population remain important to evaluate the usefulness of pathophysiologically relevant biomarkers in predicting progression of left ventricular (LV) remodeling and dysfunction. Here, we assessed in a general population whether these circulating biomarkers at baseline predict longitudinal changes in
LV
structure and function.

Methods and Results

In 592 participants (mean age, 50.8 years; 51.4% women; 40.5% hypertensive), we derived echocardiographic indexes reflecting
LV
structure and function at baseline and after 4.7 years. At baseline, we measured alkaline phosphatase, markers of collagen turnover (procollagen type I, C‐terminal telopeptide, matrix metalloproteinase‐1) and high‐sensitivity cardiac troponin T. We regressed longitudinal changes in
LV
indexes on baseline biomarker levels and reported standardized effect sizes as a fraction of the standard deviation of
LV
change. After full adjustment, a decline in
LV
longitudinal strain (−14.2%) and increase in E/e′ ratio over time (+18.9%;
P
≤0.019) was associated with higher alkaline phosphatase activity at baseline. Furthermore, longitudinal strain decreased with higher levels of collagen I production and degradation at baseline (procollagen type I, −14.2%; C‐terminal telopeptide, −16.4%;
P
≤0.029). An increase in E/e′ ratio over time was borderline associated with lower matrix metalloproteinase‐1 (+9.8%) and lower matrix metalloproteinase‐1/tissue inhibitor of metalloproteinase‐1 ratio (+11.9%;
P
≤0.041). Higher high‐sensitivity cardiac troponin T levels at baseline correlated significantly with an increase in relative wall thickness (+23.1%) and
LV
mass index (+18.3%) during follow‐up (
P
≤0.035).

Conclusions

We identified a set of biomarkers predicting adverse changes in
LV
structure and function over time. Circulating biomarkers reflecting
LV
stiffness, injury, and collagen composition might improve the identification of subjects at risk for subclinical cardiac maladaptation.
Increased Expression of MicroRNA‐206 Inhibits Potassium Voltage‐Gated Channel Subfamily A Member 5 in Pulmonary Arterial Smooth Muscle Cells and Is Related to Exaggerated Pulmonary Artery Hypertension Following Intrauterine Growth Retardation in Rats
Authors: Lv Ying , Fu Linchen , Zhang Ziming , Gu Weizhong , Luo Xiaofei , Zhong Ying , Xu Shanshan , Wang Yu , Yan Lingling , Li Min , Du Lizhong
Published: January 2019

Background

Intrauterine growth retardation (
IUGR
) is related to pulmonary artery hypertension in adults, and mi
croRNA
‐206 (miR‐206) is proposed to affect the proliferation and apoptosis of pulmonary artery smooth muscle cells (
PASMC
s) via post‐transcriptional regulation.

Methods and Results

In an
IUGR
rat model, we found that the expression and function of potassium voltage‐gated channel subfamily A member 5 (Kv1.5) in
PASMC
s was inhibited, and pulmonary artery hypertension was exaggerated after chronic hypoxia (
CH
) treatment as adults. micro
RNA
expression was investigated in
PASMC
s from 12‐week‐old male
IUGR
rats with
CH
by microarray, polymerase chain reaction, and in situ hybridization. The expression levels of Kv1.5 in primary cultured
PASMC
s and pulmonary artery smooth muscle from
IUGR
or control rats were evaluated with and without application of an miR‐206 inhibitor. Right ventricular systolic pressure, cell proliferation, luciferase reporter assay, and

I
K

v
were also calculated. We found increased expression of miR‐206 in resistance pulmonary arteries of
IUGR
rats at 12 weeks compared with newborns. Application of an miR‐206 inhibitor in vivo or in vitro increased expression of Kv1.5 α‐protein and
KCNA
5. Also, decreased right ventricular systolic pressure and cell proliferation were observed in
PASMC
s from 12‐week‐old control and
IUGR
rats after
CH
, while inhibitor did not significantly affect control and
IUGR
rats.

Conclusions

These results suggest that expression of Kv1.5 and 4‐aminopyridine (Kv channel special inhibitor)‐sensitive Kv current were correlated with the inhibition of miR‐206 in
PA
rings of
IUGR
‐
CH
rats and cultured
IUGR PASMC
s exposed to hypoxia. Thus, miR‐206 may be a trigger for induction of exaggerated CH–pulmonary artery hypertension of
IUGR
via Kv1.5.
Association of Obstructive Sleep Apnea With Cardiovascular Outcomes in Patients With Acute Coronary Syndrome
Authors: Fan Jingyao , Wang Xiao , Ma Xinliang , Somers Virend K. , Nie Shaoping , Wei Yongxiang
Published: January 2019

Background

The prognostic significance of obstructive sleep apnea (
OSA
) in patients with acute coronary syndrome (
ACS
) in the contemporary era is unclear. We performed a large, prospective cohort study and did a landmark analysis to delineate the association of
OSA
with subsequent cardiovascular events after
ACS
onset.

Methods and Results

Between June 2015 and May 2017, consecutive eligible patients admitted for
ACS
underwent cardiorespiratory polygraphy during hospitalization.
OSA
was defined as an apnea‐hypopnea index ≥15 events·h
−1
. The primary end point was major adverse cardiovascular and cerebrovascular event (
MACCE
), including cardiovascular death, myocardial infarction, stroke, ischemia‐driven revascularization, or hospitalization for unstable angina or heart failure.
OSA
was present in 403 of 804 (50.1%) patients. During median follow‐up of 1 year, cumulative incidence of
MACCE
was significantly higher in the
OSA
group than in the non‐
OSA
group (log‐rank,
P
=0.041). Multivariate analysis showed that
OSA
was nominally associated with incidence of
MACCE
(adjusted hazard ratio, 1.55; 95% CI, 0.94–2.57;
P
=0.085). In the landmark analysis, patients with
OSA
had 3.9 times the risk of incurring a
MACCE
after 1 year (adjusted hazard ratio, 3.87; 95% CI, 1.20–12.46;
P
=0.023), but no increased risk was found within 1‐year follow‐up (adjusted hazard ratio, 1.18; 95% CI, 0.67–2.09;
P
=0.575). No significant differences were found in the incidence of cardiovascular death, myocardial infarction, and ischemia‐driven revascularization, except for a higher rate of hospitalization for unstable angina in the
OSA
group than in the non‐
OSA
group (adjusted hazard ratio, 2.10; 95% CI, 1.09–4.05;
P
=0.027).

Conclusions

There was no independent correlation between
OSA
and 1‐year
MACCE
after
ACS
. The increased risk associated with
OSA
was only observed after 1‐year follow‐up. Efficacy of
OSA
treatment as secondary prevention after
ACS
requires further investigation.
Lymph Vessel Proliferation on Cardiac Biopsy May Help in the Diagnosis of Cardiac Sarcoidosis
Authors: Oe Yukiko , Ishibashi‐Ueda Hatsue , Matsuyama Taka‐aki , Kuo Yen‐Hong , Nagai Toshiyuki , Ikeda Yoshihiko , Ohta‐Ogo Keiko , Noguchi Teruo , Anzai Toshihisa
Published: January 2019

Background

The diagnosis of cardiac sarcoidosis (
CS
) is challenging because endomyocardial biopsy has only a 20% to 30% sensitivity rate for diagnosis and it presents with similar clinical features of idiopathic dilated cardiomyopathy (
DCM
). Lymphatic vessel proliferation in pulmonary sarcoidosis has been previously demonstrated. In this study, we compared endomyocardial biopsy samples obtained from patients with
CS
and
DCM
to determine whether lymph vessel counts using D2‐40 immunostaining can be utilized as a complementary tool to distinguish
CS
from
DCM
.

Methods and Results

Endomyocardial biopsy tissues were obtained from 62 patients with
CS
(30 patients with a diagnosis made histologically, 32 patients with a diagnosis made clinically), and hematoxylin/eosin, Masson trichrome, and D2‐40 immunostaining were performed. Their results were compared with those from 53 patients with DCM. The histological
CS
group showed significantly increased lymphatic vessels (12.0 [4.0–40.0] versus 2.6 [1.9–3.4],
P
<0.0001) and more severe mosaic fibrosis (
P
<0.0001) compared with the
DCM
group. The optimal threshold was 7.5 lymphatic vessels, and this resulted in a sensitivity of 0.67 and specificity of 0.96. The clinical
CS
group diagnosed according to Japanese Circulation Society 2016 criteria showed increased lymphatic vessels (4.0 [3.3–9.0] versus 2.6 [1.9–3.4],
P
<0.0001), more severe mosaic fibrosis (
P
<0.0001), more inflammatory cell infiltration (53% versus 0%,
P
<0.0001), and fatty infiltration within fibroblasts (50% versus 17%,
P
=0.0012) compared with the
DCM
group. The optimal threshold of lymphatic vessels was 3.5, which resulted in a sensitivity of 0.75 and specificity of 0.68.

Conclusions

Lymphatic vessel counts using D2‐40 immunostaining may help to distinguish clinical
CS
without granuloma from
DCM
.
Understanding the characteristics of nano mineral oil under nonstandard oscillatory impulse voltage
Authors: Sivakamasundari N , Bharathi N
Published: January 2019

This paper illustrates the breakdown strength of oscillatory impulse voltage for different barrier electrode gap with the dispersed titania (Tio2) nanoparticles in the mineral oil. The breakdown strength varies with addition of surfactant added in the nanoparticles and with different frequencies. Comparison is done by undergoing breakdown tests using alternating current (AC), direct current (DC), and lightning impulse voltages. Tests are to be done to prove that sin bidirectional oscillatory impulse voltage (SBOIV) provides higher breakdown strength when titania is dispersed in mineral oil and higher than other standard voltages.
Development of a lab module for multi-interface solar photovoltaic inverter for three-phase loads
Authors: Jabavathi Deepa Jayasheela , Sait Habeebullah , Ehsan Muhammad
Published: January 2019

This paper presents the design and development of a laboratory module to aid solar photovoltaic courses in the Electrical Engineering and Power systems programs. This hardware-based system is modeled for three-phase solar photovoltaic power system with multiple interfaces such as solar, battery and utility power. This system employs a photovoltaic power as the main input and an electrical storage system as secondary input. The system is supported by the utility grid in the case of deficiency or absence of photovoltaic power. The power flow control from the two sources is tailored for maximum utilization of solar photovoltaic power while maintaining required level of constant power for the industrial application. A microcontroller is programmed to operate the changeovers between sources for uninterrupted and constant level of power for the load. The complete design and experimentation of the proposed system are explained in this paper along with techno-economic analysis to make this more meaningful for power engineering graduates to apply them in real life situations.
Rethinking the Cooling Out Hypothesis for the 21st Century: The Impact of Financial Aid on Students’ Educational Goals
Authors: Broton Katharine M.
Published: January 2019

Background:

Most community college students from low-income families have ambitious educational degree goals, but only a small fraction attains them. For many decades, sociologists have primarily attributed this problem to a cooling out process in which college practitioners diminish students’ educational ambitions using academic reorientation processes that encourage the least-promising students to lower their degree goals. The cooling out explanation focuses exclusively on the actions of institutional community college actors rather than other factors affecting student decisions and thus has been used to vilify community colleges as engines of inequality.

Objective:

This article addresses an alternative hypothesis, considering whether student financial aid, the ubiquitous and multifaceted system that community college actors mainly do not control, influences students’ educational goals.

Method and Results:

Using data from an experimental study of need-based financial aid in Wisconsin, I find that a private grant program, which triggered a repackaging of students’ financial aid awards, decreased the educational degree aspirations and expectations of 2-year college students, on average.

Contributions and Implications:

Although counterintuitive, this finding is consistent with the idea that the complex manner in which aid is delivered creates confusion and uncertainty about the actual costs of college. While these lowered degree goals persisted over time, they did not affect degree attainment rates, suggesting students’ expectations may be more malleable and less consequential than prior research suggests. This article demonstrates that the observed cooling out phenomenon is not necessarily the result of a meritocratic sorting system and involves processes previously neglected by sociological theory. A more robust model of college choices is needed.
Active labour market policy in the UK: At a (local) crossroads?
Authors: Orton Michael , Green Anne E
Published: January 2019

Active labour market policy has developed into a widely used and seemingly embedded approach to addressing worklessness, both in the UK and internationally. But the future of UK active labour market policy looks far from certain. Some recent developments suggest demise and diminution. But at the same time there is also evidence of more positive points, including increasing recognition of the importance of employer involvement and activity at local level. Possible future trajectories are considered in the light of emerging developments, and two potential scenarios for future UK active labour market policy are posited: ‘less support, more sticks’ and an ‘active local labour markets approach’.
Smoke emission and temperature characteristics of the long-term overloaded wire in space
Authors: Xue Shao , Kong Wenjun
Published: January 2019

We developed an experimental payload to study the overloaded characteristics of wire insulations on board the China’s SJ-10 satellite. In 2-week microgravity experiments provided by the orbital flight, the smoke emissions of overloaded wire insulations were observed in space for the first time. Two smoke emission modes, namely the end smoke jet and the bubbling smoke jet, were identified with polyethylene insulations. The results showed that the geometry of the pyrolysis front dominated the direction and the range of the end smoke jet. The non-oxidative pyrolysis that occurred between the wire core and the insulation produced the high-temperature smoke and caused the bubbling smoke jet. The bubbling jet has a significant impact on the temperatures of adjacent wires, revealing an additional fire risk in microgravity. The effects of insulation thickness and excess current on the temperature rise were also discussed.
Service innovation through resource integration: An empirical examination of co-created value using telehealth services
Authors: Go Jefferies Josephine , Bishop Simon , Hibbert Sally
Published: January 2019

Scholars, policymakers and practitioners recognise the potential to improve public services through active citizen involvement and much research has examined the formal opportunities to ‘co-produce’ changes in the structures and cultures of public services. Yet scholars have devoted little attention to the opportunities for service and social innovation that emerge from the everyday activities of service users and their phenomenological experiences of realising value from service interactions. This qualitative study of telehealth users explores how and why public service beneficiaries co-create value. It argues that understanding citizens’ approaches to co-create phenomenological value is a vital component of the collaborative processes that generate social benefit.
Efficiency of nanoparticle reinforcement using finite element analysis of titanium alloy mandible plate
Authors: Jindal Prashant , Worcester Frank , Gupta Anand , Breedon Philip
Published: January 2019

Nanoparticles in the form nanotubes and nanoplatelets have been compared for von Mises stresses by using them as low-composition reinforcements in titanium alloy–based mandible plate for different compositions and orientations. A finite element model has been designed to reconstruct a fractured human mandible with a titanium alloy mandible plate. A 500 N compressive force was applied on the mandible, and stress distribution across the plate sections was analysed for aligned two-dimensional random and three-dimensional random orientations for both tubes and platelets. Carbon material as graphene has been used for tube and platelet in the form of nanotubes and nanoplatelets, respectively. Using properties of graphene as the filler in titanium alloy plate, for both nanoplatelets and nanotubes, the stresses reduced between 5% and 25% for nanoplatelets and nanotubes graphene–titanium composite plates in comparison to non-reinforced plates, at critically stressed sections. Nanotubes exhibited stress reduction of nearly 23.4% for aligned configurations, while nanoplatelets exhibited stress reduction up to 21.2% for two-dimensional and three-dinemsional random configurations in comparison to non-reinforced titanium plates. Hence, it has been suggested that nanotubes exhibited superior mechanical reinforcement potential beyond that of aligned nanoplatelets, while nanoplatelets provided enhanced mechanical reinforcements for random configurations. Therefore, for biomedical implant applications nanocomposite materials can be designed with the same dimensional form but with lower compositions of filler materials by simply manipulating the appropriate orientations.
Sequence of practices in personal and societal rhythms – Showering as a case
Authors: Gram-Hanssen Kirsten , Christensen Toke Haunstrup , Madsen Line Valdorff , do Carmo Carolina
Published: January 2019

This paper explores methodologically and theoretically how to understand variations in the temporal performances of showering as a practice-as-entity. Time-based data on domestic hot water consumption in 134 Danish households show distinctly different patterns, where some households exhibit highest consumption in the morning and others in the evening. This temporal pattern of showering is analysed based on an innovative combination of statistical cluster analysis and qualitative interviews. Focus is on the timing of showering related to sequences of other everyday practices, and to the rules, meanings and dispositions guiding this practice. From a sustainability perspective, the consumption of water and energy entailed by showering is problematic, and with increasingly intermittent renewable energy production, the timing of showering also becomes an issue. The study demonstrates that the time of showering is closely related to sequences of different practices, that dispositions and socio-demographics influence the order of sequences, and that meanings of showering may vary accordingly. However, there are also common meanings and rules related to showering across these variations, which contribute to the formation of showering as a practice-as-entity.
Controlling the differential mobile robot with system uncertainty: Constraint-following and the adaptive robust method
Authors: Sun Hao , Chen Ye-Hwa , Huang Kang , Qiu Mingming
Published: January 2019

We aim to control the differential mobile robot system to follow a class of pre-specified constraints sufficiently closely in the presence of system uncertainties. The mass and the moment of inertia of the differential mobile robot are considered as the uncertain parameters, which are (possibly) fast time-varying. In the first step, based on Udwadia and Kalaba’s approach, an adaptive robust control scheme is proposed to deal with the system uncertainties. The adaptive law is of leakage type, which can adjust itself based on the tracking error. Using this adaptive robust control scheme, we can obtain the desired armature currents of the two direct current (DC) motors, which are not the real control inputs. In the second step, taking the motor dynamics into account, a Lyapunov Minimax approach for the required actual control inputs (i.e., the input voltages of the two DC motors) is proposed to generate the desired armature currents. This two-step control methodology guarantees uniform boundedness and uniform ultimate boundedness, and renders the system to follow a class of pre-specified constraints approximately.
Safety and efficacy of a urine alkalinization protocol developed for high-dose methotrexate patients during intravenous bicarbonate shortage
Authors: Roy Amanda M , Lei Matthew , Lou Uvette
Published: January 2019

Purpose

Urinary alkalinization with intravenous sodium bicarbonate is standard during high-dose methotrexate administration. Due to a national intravenous sodium bicarbonate shortage, a urinary alkalinization protocol involving hyperhydration with intravenous fluids, oral bicarbonate, and intravenous or oral acetazolamide was utilized from 10 April to 30 May 2017 (“shortage protocol”). This study compared outcomes between protocols.

Methods

A single-center, retrospective chart review was conducted for adults who received methotrexate ≥500 mg/m2 on ≥ two occasions, at least once during each protocol, between 19 February and 19 July 2017.

Results

Eighteen patients (50% male), median age 65 years, received 76 total high-dose methotrexate cycles. Shortage protocol was used in 37 cycles (48.7%). Mean time to methotrexate clearance did not differ between groups (p = ns). Mean time to urinary alkalinization and duration of hospitalization were not statistically different (p = 0.49 and 0.23, respectively). Average total bicarbonate administered per 24 hours was higher in standard protocol (p < 0.05), but hydration rates were similar (p = 0.73). Creatinine clearance and urine output on days 1 and 2 post-high-dose methotrexate did not significantly differ (creatinine clearance day 1, p = 0.27; creatinine clearance day 2, p = 0.55; urine output day 1, p = 0.62; urine output day 2, p = 0.60). Interruptions in alkalinization were significantly higher during shortage (0.41 ± 0.75 instances of urine pH < 7 during standard vs. 1.3 ± 1.7 under shortage, p < 0.05).
Person-centred creative dance intervention for persons with dementia living in the community in Singapore
Authors: Koh Wei Ling Elain , Low Felicia , Kam Jia Wen , Rahim Sahnan , Ng Wei Fern , Ng Li Ling
Published: January 2019

This paper examines the efficacy of the use of creative dance intervention for persons with mild to moderate dementia, living in the community. Pre- and post-intervention data were collected on the sample of 35 older people to track the impact of the intervention on the domains of function, quality of life and well-being and caregiving stress through the use of the gait speed test, CONFbal scale, Functional Independence Measure, Quality of Life-AD, Dementia Care Mapping and Zarit Burden Interview. There was an overall improvement in all the domains. Statistically significant improvement was found in the Quality of Life reports ( p = 0.002) and well-being as measured by Dementia Care Mapping ( p < 0.001). The findings assert the positive contributions of person-centred creative dance towards an approach and environment that promotes dementia care. Future studies on determining sustainability of such intervention are recommended.
Research Ethics in Correspondence Testing: An Update
Authors: Zschirnt Eva
Published: January 2019

Correspondence testing to research discrimination in the marketplace has become common and the use of internet applications has allowed researchers to send greater numbers of applications. While questions of research ethics always arise when planning a correspondence test, the issue receives relatively little attention in published correspondence tests. This paper addresses the question of ethics in correspondence testing in the age of ready internet access. It focusses on the ethical issues that arise in correspondence testing, looking at potential problems (regarding voluntary participation, informed consent, deception, entrapment of employers, employers’ rights) and possible solutions, and technical challenges. European country examples show that the ethical questions raised in correspondence testing have to be renegotiated depending on the national context. The paper argues that correspondence testing, if planned carefully and executed responsibly, can meet most of the ethical requirements of Social Science ethics guidelines.
The impact of the Glasgow Prognostic Score on survival in second-line chemotherapy for metastatic colorectal cancer patients with BRAF V600E mutation
Authors: Mitani Seiichiro , Taniguchi Hiroya , Sugiyama Keiji , Masuishi Toshiki , Honda Kazunori , Narita Yukiya , Kadowaki Shigenori , Ura Takashi , Ando Masashi , Tajika Masahiro , Yatabe Yasushi , Muro Kei
Published: January 2019

Background:

BRAF (v-raf murine sarcoma viral oncogene homolog B1) V600E mutant colorectal cancer is associated with short survival. Recently, clinical trials have been conducted to improve outcomes of second or later lines of chemotherapy. However, there is a paucity of reference data pertaining to outcomes of second-line chemotherapy and prognostic factors that are relevant only to BRAF mutant patients.

Patients and methods:

We retrospectively reviewed metastatic colorectal cancer patients with BRAF V600E mutation who underwent second-line chemotherapy between January 2007 and March 2017. We evaluated treatment outcomes and performed prognostic analyses.

Results:

A total of 52 patients were included. The median progression-free survival and overall survival (OS) were 2.5 [95% confidence interval (CI) = 1.91–4.11] and 6.5 (95% CI = 4.30–9.63) months, respectively. Overall response and disease control rates were 7% and 48%, respectively. All the regimens which elicited a partial response included BRAF inhibitors in combination with anti-epidermal growth factor receptor (EGFR) antibodies. Therefore, the overall response was 0% after exclusion of patients treated with study drugs. Multivariate analysis for OS revealed that the Glasgow Prognostic Score (GPS), elevated lactate dehydrogenase, and poor performance status were independent prognostic factors. In particular, survival curves according to the GPS stratified the patients into distinct risk groups. The median OSs in patients with GPS of 0, 1, and 2 were 9.9, 5.0, and 1.9 months, respectively.

Conclusions:

Outcomes of second-line chemotherapy for metastatic colorectal cancer patients with BRAF V600E mutation were extremely poor. GPS may be useful in future clinical trials.
C-MAC® video-laryngoscope assisted removal of pediatric upper airway foreign body via apneic technique: Two case reports
Authors: Punnoose Seema Elina , Victor John , Hazarika Produl , SS Marla
Published: January 2019

C-MAC® video-laryngoscope is often used by anesthetists in difficult intubation scenarios primarily in adults. Using this C-MAC® device in two of our pediatric cases, we successfully removed the laryngeal foreign body, while the anesthetist provided the apneic technique. A systematic review of PubMed and Google Scholar for similar cases was conducted. We found only one such case report of pediatric airway foreign body removal via video-laryngoscope in the English literature. The use of this high-quality, magnified video-laryngoscope in children in an emergency scenario is often not adequately applied. This procedure provides continuous real-time visualization to both the operating surgeon as well as the anesthetist in respect to the airway and thereby reduces the chance of any untoward complications. Here, we present two interesting case reports of C-MAC® video-laryngoscope assisted removal of laryngeal foreign body via apneic technique with spontaneous ventilation performed on two different children in our facility. Both these children had clinical symptoms of upper airway obstruction with fluctuating stridor simulating croup or asthma.
Purple urine bag syndrome: An unusual but important manifestation of urinary tract infection. Case report and literature review
Authors: Worku Dominic Adam
Published: January 2019

Purple urine bag syndrome is a rare albeit alarming purple discolouration of the urine typically seen in elderly ladies with constipation, urinary tract infection and concurrent urinary catheterisation. In this concise review, we report the pathophysiology of this condition and the case of one patient who developed this interesting phenomenon.