bluuebunny/crossref_metadata_2025 huggingface dataset:
Are single‐injection erector spinae plane block and multiple‐injection costotransverse block equivalent to thoracic paravertebral block?
Authors: Nielsen Martin V. , Moriggl Bernhard , Hoermann Romed , Nielsen Thomas D. , Bendtsen Thomas F. , Børglum Jens
Published: July 2019

Background

Thoracic paravertebral block (TPVB) is considered the gold standard for hemithoracic regional anaesthesia. Erector spinae plane block (ESPB) is a new posterior thoracic wall block. Multiple‐injection costotransverse block (MICB) mimics TPVB but with injection points within the thoracic intertransverse tissue complex and posterior to the superior costotransverse ligament. We aimed to compare the spread of injectate into the thoracic paravertebral space (TPVS) resulting from single‐injection ESPB and MICB, respectively, with TPVB.

Methods

Ten soft‐embalmed cadavers were utilised. In five cadavers, the right hemithorax was randomly allocated either to ultrasound‐guided single‐injection ESPB or single‐injection TPVB; vice versa on the other side. In another five cadavers, the right hemithorax was randomly allocated either to ultrasound‐guided MICB or multiple‐injection TPVB. About 20 mL of dye was injected in each hemithorax with all techniques.

Results

With TPVB, the dye was consistently present in the TPVS with concomitant epidural spread in the majority of cases. The injectate spread into the TPVS with ESPB (60%) and MICB (100%). MICB consistently stained the ventral rami (T1‐7), communicating rami and thoracic sympathetic trunk without epidural spread. Dissection after MICB revealed dye spread into the TPVS via the costotransverse foramina and along the dorsal branches of the posterior intercostal veins.

Conclusions

Consistent spread of dye into the TPVS colouring the ventral rami, the communicating rami, and the sympathetic trunk was observed with MICB; in this respect equivalent to TPVB. ESPB exhibited only partial success and was not equivalent to TPVB. No epidural spread was found with neither MICB nor ESPB.
Mechanisms of Persistent Neurobiological Changes Following Adolescent Alcohol Exposure: NADIA Consortium Findings
Authors: Crews Fulton T. , Robinson Donita L. , Chandler L. Judson , Ehlers Cindy L. , Mulholland Patrick J. , Pandey Subhash C. , Rodd Zachary A. , Spear Linda P. , Swartzwelder H. Scott , Vetreno Ryan P.
Published: July 2019

The Neurobiology of Adolescent Drinking in Adulthood (NADIA) Consortium has focused on the impact of adolescent binge drinking on brain development, particularly on effects that persist into adulthood. Adolescent binge drinking is common, and while many factors contribute to human brain development and alcohol use during adolescence, animal models are critical for understanding the specific consequences of alcohol exposure during this developmental period and the underlying mechanisms. Using adolescent intermittent ethanol (AIE) exposure models, NADIA investigators identified long‐lasting AIE‐induced changes in adult behavior that are consistent with observations in humans, such as increased alcohol drinking, increased anxiety (particularly social anxiety), increased impulsivity, reduced behavioral flexibility, impaired memory, disrupted sleep, and altered responses to alcohol. These behavioral changes are associated with multiple molecular, cellular, and physiological alterations in the brain that persist long after AIE exposure. At the molecular level, AIE results in long‐lasting changes in neuroimmune/trophic factor balance and epigenetic–microRNA (miRNA) signaling across glia and neurons. At the cellular level, AIE history is associated in adulthood with reduced expression of cholinergic, serotonergic, and dopaminergic neuron markers, attenuated cortical thickness, decreased neurogenesis, and altered dendritic spine and glial morphology. This constellation of molecular and cellular adaptations to AIE likely contributes to observed alterations in neurophysiology, measured by synaptic physiology, EEG patterns, and functional connectivity. Many of these AIE‐induced brain changes replicate findings seen in postmortem brains of humans with alcohol use disorder (AUD). NADIA researchers are now elucidating mechanisms of these adaptations. Emerging data demonstrate that exercise, antiinflammatory drugs, anticholinesterases, histone deacetylase inhibitors, and other pharmacological compounds are able to prevent (administered during AIE) and/or reverse (given after AIE) AIE‐induced pathology in adulthood. These studies support hypotheses that adolescent binge drinking increases risk of adult hazardous drinking and influences brain development, and may provide insight into novel therapeutic targets for AIE‐induced neuropathology and AUDs.
Clinical outcomes of external beam radiotherapy in patients with localized prostate cancer: Does dose escalation matter?
Authors: Lee Chia Ching , Lim Keith HC , Chia David WT , Chong Yew Lam , Png Keng Siang , Chong Kian Tai , Soon Yu Yang , Tey Jeremy CS
Published: July 2019

Background

To report outcomes of localized prostate cancer treated with radical external beam radiation therapy (EBRT) in our institution over a 14‐year period, and to determine the impact of dose escalation of prostate cancer outcomes.

Methods

Patients with T1–T4 N0 M0 prostate cancer who received radical EBRT between January 2002 and December 2015 were reviewed retrospectively. Clinical data were obtained via the institutional electronic medical records. The primary endpoint was 5‐year overall survival (OS). The secondary endpoints were 5‐year freedom from biochemical failure (FFBF) and treatment toxicities.

Results

A total of 200 eligible patients were identified. Median follow‐up duration was 48 months. 13%, 36% and 51% of patients had low‐, intermediate‐ and high‐risk disease. Median dose was 79.2 Gy. The 5‐year OS were 90%, 87% and 78% and FFBF were 94%, 100% and 81% for low‐, intermediate‐ and high‐risk patients, respectively. Multivariable analysis showed that Eastern Cooperate Oncology Group performance status 2 and Gleason grade group 5 were independent predictors of worse OS. The incidence of grade ≥2 proctitis was 24.5%. Dose escalation was significantly associated with increased incidence of grade ≥2 proctitis (odd ratio, 4.42; 95% confidence interval, 1.95–10.08; P < 0.01).

Conclusion

Men with localized prostate cancer treated with EBRT in our population had excellent 5‐year OS and biochemical outcomes. Dose escalation did not significantly improve these outcomes but was associated with significantly increased risk of grade ≥2 proctitis in our population. Future studies should be performed to identify patients who will benefit the most from dose‐escalated EBRT.
Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta‐analysis
Authors: Tong Felice , Dannaway Jasan , Enke Oliver , Eslick Guy
Published: July 2019

Background

Orthopaedic surgery is largely successful; however, a proportion of patients are dissatisfied and report pain and poor function. Psychological factors have been shown to influence orthopaedic surgical outcomes. This systematic review and meta‐analysis investigates the types and effectiveness of preoperative psychological interventions in elective orthopaedic surgery.

Methods

A registered systematic review (PROSPERO CRD42017073833) was performed on literature (1960–January 2018) using eight databases. Prospective controlled clinical trials involving adult and adolescent elective orthopaedic surgery were included. Interventions examined included relaxation, cognitive behavioural therapy, hypnosis, emotional counselling and mixed psychotherapies; general procedural education was excluded. Outcomes extracted included pain, anxiety, quality of life and disability.

Results

A total of 19 studies met the inclusion criteria (n= 1893 patients). Meta‐analyses were performed for pain, anxiety and quality of life. Analysis did not find enough evidence to confirm reduction in post‐operative pain (seven studies, 666 patients;g= −0.15 (95% CI −0.42, 0.13),P= 0.305). Pooled data from six studies on acute post‐operative anxiety (589 patients) showed a moderate statistically significant benefit (g= −0.26 (−0.49, −0.03),P= 0.024). There was an improved quality of life (mental component) at longer term follow‐up (g= 0.25 (0.02, 0.49),P= 0.034).

Conclusions

These studies provide evidence that psychological interventions have a positive effect on anxiety in the acute post‐operative period, and on mental components of quality of life at longer term follow‐up.
Systematic mediastinal lymph node dissection outcomes and conversion rates of uniportal video‐assisted thoracoscopic lobectomy for lung cancer
Authors: Wu Han‐Ran , Liu Chang‐Qing , Xu Mei‐Qing , Xu Guang‐Wen , Xiong Ran , Li Cai‐Wei , Xie Ming‐Ran
Published: July 2019

Background

To evaluate the systematic mediastinal lymph node (LN) dissection outcomes and conversion rates of uniportal video‐assisted thoracoscopic surgery (UVATS).

Methods

Patients with non‐small‐cell lung cancer who underwent video‐assisted thoracoscopic surgery (VATS) and systematic mediastinal LN dissection between January 2015 and January 2017 were retrospectively reviewed. We categorized the patients into two groups according to the different surgical approaches. Patients' clinical data were collected and compared. The index of estimated benefit from LN dissection was used to evaluate the therapeutic value of LN dissection for each station.

Results

A total of 453 patients underwent VATS, including 197 patients in the UVATS group and 256 patients in the triportal VATS (TVATS) group. There were no significant differences in the 1‐, 2‐ and 3‐year survival rates of these two groups (P > 0.05). There were no statistically significant differences in the operative time, numbers and stations of LNs, numbers and stations of N2 LNs, conversion rate or postoperative complications. The UVATS group had less intraoperative blood loss, a shorter duration of hospital stay, less chest tube drainage and a shorter duration of chest tube drainage than the TVATS group (P < 0.05). The conversion rates in the UVATS and TVATS groups were 5.1% and 4.3%, respectively, and the difference was not significant. The same degree of LN sampling was achieved in both groups.

Conclusion

UVATS permits the same degree of LN sampling as TVATS without a difference in the conversion rate.
Topiramate pharmacokinetics in neonates undergoing therapeutic hypothermia and proposal of an optimised dosing schedule
Authors: Marques María Remedios , Garcia‐Robles Ana , Usach Iris , Vento Maximo , Poveda José Luis , Peris José Esteban , Mangas‐Sanjuan Victor
Published: July 2019

Aim

The adequate dosing of topiramate in neonates undergoing therapeutic hypothermia has not been established. The aim of this study was to design a dosing schedule capable of providing topiramate serum concentrations within the accepted therapeutic range.

Methods

Neonates (n = 52) with hypoxic ischaemic encephalopathy and subjected to therapeutic hypothermia were dosed with topiramate, 5 mg/kg on day one and 3 mg/kg on days two to five, to decrease seizure events. A total of 451 topiramate serum concentrations obtained in the patients were used to develop a population pharmacokinetic model using a non‐linear mixed‐effects modelling approach.

Results

A one‐compartment model with first‐order absorption and two different clearance terms, one for the cooling period and another for the post‐warming period, were used to describe the concentration‐time topiramate data. The probability of no‐seizure events could not be related to topiramate concentrations, which was attributed to excessively low topiramate concentrations. A modified dosage schedule was designed with the aim of obtaining more than 90% of patients with topiramate concentrations within the therapeutic range after the first dose.

Conclusion

The dosage schedule of topiramate in these patients should be modified with the aim of decreasing the frequency of seizure events.
Urinary extracellular vesicles: Origin, role as intercellular messengers and biomarkers; efficient sorting and potential treatment options
Authors: Svenningsen Per , Sabaratnam Rugivan , Jensen Boye L.
Published: July 2019

Urinary extracellular vesicles (uEVs) are a heterogenous group of vesicles consisting mainly of microvesicles and exosomes that originate predominantly (99.96%) from kidney, the urinary tract epithelium and the male reproductive tract. Secreted EVs contain molecular cargo from parental cells and provide an attractive source for biomarkers, a potential readout of physiological and pathophysiological mechanisms, and events associated with the urinary system. uEVs are readily enriched and isolated from urine samples and we review 6 standard methods that allow for downstream analysis of the uEV cargo. Although the use of uEVs as a surrogate readout for physiological changes in tissue protein levels is widespread, the protein abundance in uEVs is affected significantly by mechanisms that regulate protein sorting and secretion in uEVs. Data suggest that baseline kidney tissue and uEV levels of apical membrane‐associated electrolyte transport proteins are not directly related in human patients. Recent evidence indicates that EVs may contribute to physiological and pathophysiological intercellular signalling and EVs confer protection against renal ischemia‐reperfusion injury. The therapeutic use of EVs as information carriers has mainly been explored in vitro and a major hurdle lies in the translation of the in vitro findings into an in vivo setting. Thus, the EV research field is moving from a technical focus to a more physiological focus, allowing for a deeper understanding of human physiology, development of diagnostic tools and potential treatment strategies for precision medicine.
Effects of Two Web‐Based Interventions and Mediating Mechanisms on Stage of Change Regarding Physical Activity in Older Adults
Authors: Ratz Tiara , Lippke Sonia , Muellmann Saskia , Peters Manuela , Pischke Claudia R. , Meyer Jochen , Bragina Inna , Voelcker‐Rehage Claudia
Published: July 2019

Background

Web‐based, theory‐driven interventions effectively promote older adults’ physical activity. Social‐cognitive mechanisms of their effect on stage of change need to be further researched.

Methods

Older adults were randomly allocated to intervention group 1 (10‐week online physical activity program), intervention group 2 (same program plus activity tracker), or delayed intervention control group; n = 351 were analyzed (59.6% of originally allocated individuals). Stages of change for recommended endurance and strength training and social‐cognitive predictors of physical activity were assessed using questionnaires at baseline and follow‐up. Intervention effects and mediation were investigated using mixed‐effects ANOVA and ordinal least squares regression.

Results

Direct effects on stage of change were found for intervention group 1 regarding endurance training (bintervention group 1 = 0.44, 95% confidence interval [0.15, 0.73]), and both groups regarding strength training (bintervention group 1 = 1.02, [0.71, 1.33], bintervention group 2 = 1.24, [0.92, 1.56]). Social‐cognitive predictor changes in task self‐efficacy, intention, and action planning explained intervention effect on stage of change, but not to the full extent.

Conclusions

The results indicate significant web‐based intervention effects on physical activity stage, partly mediated by changes in task self‐efficacy, intention, and action planning.
Resettlement and the environment in Vietnam: Implications for climate change adaptation planning
Authors: Miller Fiona , Dun Olivia
Published: July 2019

Increasingly the environment, and climate risks in particular, are influencing migration and planned resettlement in Vietnam, raising the spectre of increased displacement in a country already confronting serious challenges around sustainable land and water use as well as urbanisation. Planned resettlement has emerged as part of a suite of measures being pursued as part of disaster risk reduction and climate change adaptation strategies. This paper provides an historical, political, legal and environmental overview of resettlement in Vietnam identifying key challenges for framing resettlement as climate change adaptation. The paper outlines the scale of past resettlement in Vietnam, identifying the drivers and implications for vulnerability. Detailed case studies of resettlement are reviewed. Through this review, the paper reflects on the growing threat of climate change and the likelihood of increased displacement associated with worsening climate risks to identify some critical considerations for planned resettlement in climate change adaptation planning.
Thoracoscopic subtotal esophagectomy via a right thoracic cavity approach to treat an intractable fistula after 20 months from onset of an idiopathic esophageal rupture: A case report
Authors: Imai Takeharu , Tanaka Yoshihiro , Adachi Takahito , Suetsugu Tomonari , Fukada Masahiro , Tanahashi Toshiyuki , Matsui Satoshi , Imai Hisashi , Kato Takazumi , Matsuhashi Nobuhisa , Takahashi Takao , Yamaguchi Kazuya , Shiroko Takashi , Yoshida Kazuhiro
Published: July 2019

An intractable fistula caused by idiopathic esophageal rupture is a rare but severe condition. In the present case, a 69‐year‐old man had been treated conservatively at another hospital for esophageal rupture but had developed an abscess in the left thoracic cavity due to an intractable fistula at the rupture site. He was referred to our hospital for treatment 19 months after the esophageal rupture. On admission, the intractable fistula was found to be continuous with an abscess in the left thoracic cavity. Preoperative continuous enteral nutrition was administered to improve the patient's nutritional status, and drainage was performed to reduce the size of the abscess. Then, to minimize the invasion of the intractable fistula, thoracoscopic subtotal esophagectomy was performed via a right thoracic cavity approach 20 months after the esophageal rupture. Preoperative management and thoracoscopic surgery via an opposite chest cavity approach was found to be safe and feasible for the intractable fistula caused by idiopathic esophageal rupture.
Laparoscopic transabdominal preperitoneal hernioplasty for recurrent obturator hernia: A case report
Authors: Amiki Manabu , Goto Manabu , Tomizawa Yuki , Sugiyama Atsuhiko , Sakon Ryota , Inoue Takahiro , Ito Shingo , Oneyama Masataka , Shimojima Reiko , Hara Yoshiaki , Narita Kazuhiro , Tachimori Yuji , Sekikawa Koji
Published: July 2019

Reports of recurrence after obturator hernia repair are few. We describe the case of an 89‐year‐old woman who presented to us with a thrice recurrent obturator hernia. She had undergone open non‐mesh repair twice and then laparoscopic non‐mesh repair. She was readmitted to our hospital 6 months after the laparoscopic repair. Manual reduction was successful, paving the way for elective transabdominal preperitoneal repair. During the endoscopic repair, surgical mesh was placed extraperitoneally over the hernia defect and then fixed to Cooper's ligament with absorbable tacks. The patient was discharged on postoperative day 2 without complications. In the 2 months that have passed since the surgery there has been no sign of recurrence, but the patient will be carefully followed up. Repair of a recurrent obturator hernia is technically challenging; however, the transabdominal preperitoneal approach seems to be reliable and safe.
The competitive endogenous RNA regulatory network reveals potential prognostic biomarkers for overall survival in hepatocellular carcinoma
Authors: Zhang Zhiqiao , Li Jing , He Tingshan , Ouyang Yanling , Huang Yiyan , Liu Qingbo , Wang Peng , Ding Jianqiang
Published: July 2019

The aim of the present study is to construct a competitive endogenous RNA (ceRNA) regulatory network by using differentially expressed long noncoding RNAs (lncRNAs), microRNAs (miRNAs), and mRNAs in patients with hepatocellular carcinoma (HCC), and to construct a prognostic model for predicting overall survival (OS) of HCC patients. Differentially expressed lncRNAs, miRNAs, and mRNAs were explored between HCC tissues and normal liver tissues. A prognostic model was built for predicting OS of HCC patients and receiver operating characteristic curves were used to evaluate the performance of the prognostic model. There were 455 differentially expressed lncRNAs, 181 differentially expressed miRNAs, and 5035 differentially expressed mRNAs. A ceRNA regulatory network was constructed based on 43 lncRNAs, 37 miRNAs, and 105 mRNAs. Eight mRNA biomarkers (H2AFX, SQSTM1, ITM2A, PFKP, TPD52L1, ACSL4, STRN3, and CPEB3) were identified as independent risk factors by multivariate Cox regression and were used to develop a prognostic model for OS. The C‐indexes in the model group were 0.776 (95% confidence interval [CI], 0.730‐0.822), 0.745 (95% CI, 0.699‐0.791), and 0.789 (95% CI, 0.743‐0.835) for 1‐, 3‐, and 5‐year OS, respectively. The current study revealed potential molecular biological regulation pathways and prognostic biomarkers by the ceRNA regulatory network. A prognostic model based on prognostic mRNAs in the ceRNA network might be helpful to predict the individual mortality risk for HCC patients. The individual mortality risk calculator can be used by visiting the following URL: https://zhangzhiqiao.shinyapps.io/Smart_cancer_predictive_system_HCC/.
Role of timing of exposure to pets and dampness or mould on asthma and sensitization in adolescence
Authors: Milanzi Edith B. , Koppelman Gerard H. , Smit Henriette A. , Wijga Alet H. , Vonk Judith M. , Brunekreef Bert , Gehring Ulrike
Published: July 2019

Background

Pet and dampness or mould exposure are considered risk factors for asthma and sensitization. It is unclear whether timing of exposure to these factors is differentially associated with asthma risk and sensitization in adolescence.

Objective

We investigated the role of timing of pet and dampness or mould exposure in asthma and sensitization in adolescence. Understanding this role is essential to build targeted prevention strategies.

Methods

We used data from 1871 participants of the Dutch Prevention and Incidence of Asthma and Mite Allergy (PIAMA) cohort. Residential exposure to pets, dampness or mould was assessed by repeated parental questionnaires. We used asthma data from the 17‐year questionnaire and sensitization data from the 16‐year medical examination. We characterized timing using longitudinal exposure patterns from pregnancy till age 17 using longitudinal latent class growth modelling. We used logistic regression models to analyse associations of exposure patterns with asthma at age 17 and sensitization at age 16.

Results

For none of the time windows, exposure to pets and dampness or mould was associated with asthma at age 17, but a lower sensitization risk at age 16 was suggested, for example the odds ratio (95% confidence interval) for sensitization was 0.63 (0.35‐1.11) and 0.69 (0.44‐1.08) for early life and persistently high pet exposure, respectively, compared with very low exposure. An inverse association was also suggested for sensitization and moderate early childhood dampness or mould exposure (0.71 [0.42‐1.19]).

Conclusion and clinical relevance

Different timing of pet and dampness or mould exposure was not associated with asthma, but lower risk of sensitization in adolescence was suggested, which could be partly attributable to reversed causation. Current findings are not sufficient to recommend pet avoidance to prevent allergic disease. More prospective studies are needed to obtain insights that can be used in clinical practice.
Mechanism of dorsal root ganglion stimulation for pain relief in painful diabetic polyneuropathy is not dependent on GABA release in the dorsal horn of the spinal cord
Authors: Koetsier Eva , Franken Glenn , Debets Jacques , Heijmans Lonne , van Kuijk Sander M.J. , Linderoth Bengt , Joosten Elbert A. , Maino Paolo
Published: July 2019

Aims

It is hypothesized that dorsal root ganglion stimulation (DRGS), sharing some of the mechanisms of traditional spinal cord stimulation (SCS) of the dorsal columns, induces γ‐aminobutyric acid (GABA) release from interneurons in the spinal dorsal horn.

Methods

We used quantitative immunohistochemical analysis in order to investigate the effect of DRGS on intensity of intracellular GABA‐staining levels in the L4‐L6 spinal dorsal horn of painful diabetic polyneuropathy (PDPN) animals. To establish the maximal pain relieving effect, we tested for mechanical hypersensitivity to von Frey filaments and animals received 30 minutes of DRGS at day 3 after implantation of the electrode. One day later, 4 Sham‐DRGS animals and four responders‐to‐DRGS received again 30 minutes of DRGS and were perfused at the peak of DRGS‐induced pain relief.

Results

No significant difference in GABA‐immunoreactivity was observed between DRGS and Sham‐DRGS in lamina 1‐3 of the spinal levels L4‐6 neither ipsilaterally nor contralaterally.

Conclusions

Dorsal root ganglion stimulation does not induce GABA release from the spinal dorsal horn cells, suggesting that the mechanisms underlying DRGS in pain relief are different from those of conventional SCS. The modulation of a GABA‐mediated “Gate Control” in the DRG itself, functioning as a prime Gate of nociception, is suggested and discussed.
Object‐Label‐Order Effect When Learning From an Inconsistent Source
Authors: Ma Timmy , Komarova Natalia L.
Published: July 2019

Learning in natural environments is often characterized by a degree of inconsistency from an input. These inconsistencies occur, for example, when learning from more than one source, or when the presence of environmental noise distorts incoming information; as a result, the task faced by the learner becomes ambiguous. In this study, we investigate how learners handle such situations. We focus on the setting where a learner receives and processes a sequence of utterances to master associations between objects and their labels, where the source is inconsistent by design: It uses both “correct” and “incorrect” object‐label pairings. We hypothesize that depending on the order of presentation, the result of the learning may be different. To this end, we consider two types of symbolic learning procedures: the Object‐Label (OL) and the Label‐Object (LO) process. In theOLprocess, the learner is first exposed to the object, and then the label. In theLOprocess, this order is reversed. We perform experiments with human subjects, and also construct a computational model that is based on a nonlinear stochastic reinforcement learning algorithm. It is observed experimentally thatOLlearners are generally better at processing inconsistent input compared toLOlearners. We show that the patterns observed in the learning experiments can be reproduced in the simulations if the model includes (a) an ability to regularize the input (and also to do the opposite, i.e., undermatch) and (b) an ability to take account of implicit negative evidence (i.e., interactions among different objects/labels). The model suggests that while both types of learners utilize implicit negative evidence in a similar way, there is a difference in regularization patterns:OLlearners regularize the input, whereasLOlearners undermatch. As a result,OLlearners are able to form a more consistent system of image‐utterance associations, despite the ambiguous learning task.
Addressing bone quality and bone density after renal transplantation: A prospective evaluation of the evolution of trabecular bone score and bone mineral density over the first 5 years following renal transplantation in Asian patients
Authors: Chandran Manju , Hao Ying , Kwee Ann Kerwen , Swee Du Soon , Ng David Chee Eng , Kee Terence Yi Shern , Bharadwaj Pushan
Published: July 2019

The evolution of trabecular bone score (TBS) and bone mineral density (BMD) over the first 5 years after renal transplantation was prospectively evaluated in 164 patients. Dual energy X‐ray absorptiometry (DXA) scans were performed at 0, 6, 12, 24, and 60 months. Cumulative steroid dose, serum 25(OH)D, calcium, parathyroid hormone, and total ALP levels at these time points were checked. Incident fractures were identified from X‐rays/vertebral fracture assessments. Mean (SD) age, TBS, and lumbar spine BMD at baseline were 47.11 (9.53), 1.424 (0.097), and 0.935 (0.183) gm/cm2, respectively. Baseline TBS was lower in tertiary 1.38 (0.07) vs secondary hyperparathyroidism 1.43 (0.01) vs post‐parathyroidectomy 1.46 (0.11); P = .035. Trabecular bone score and BMD significantly decreased from baseline‐>6 months, changes after that at consecutive time points were non‐significant. 11% had incident fractures during the follow‐up period, majority being metatarsal with no vertebral or hip fractures noted. This first prospective evaluation of TBS and BMD evolution at multiple time points over 5 years suggest that microarchitectural and bone density deteriorations post‐renal transplantation stabilize after 6 months. Stabilization of these parameters could partially account for the absence of major fractures noted in this Asian population. Possible genetic and ethnic differences in fracture risk between Asian and Caucasian renal transplant patients have to be explored through large population‐based studies.
The Antinomies of Successful Mobilization: Colombian Recyclers Manoeuvre between Dispossession and Exploitation
Authors: Rosaldo Manuel
Published: July 2019

Long dismissed as too weak and fragmented to collectively organize, millions of informal workers have begun mobilizing for labour rights over the past 40 years. As informal workers gain a measure of power to reshape the structure and conditions of their work, but continue to face constraints due to their subordinated positions in the broader political economy, tensions may emerge between the imperatives of combatting exploitation and dispossession. Recent conflicts over recycler rights policy in Bogotá, Colombia are illustrative of this dilemma. For the first 25 years of its existence, the recycler rights movement experienced little tension between these two imperatives, as it had little capacity to do either. In recent years, however, recyclers have become powerful political agents, and since 2012 conflicts have erupted among recyclers and state officials over how to navigate the twin threat. Drawing on 12 months of ethnographic fieldwork, this article exposes both potentials and constraints of state‐led interventions to improve informal livelihoods. Such interventions are likely to entail thorny tradeoffs as long as they occur within a broader system of social relations that is based on exploitation and exclusion.
Addition of low‐dose liraglutide to insulin therapy is useful for glycaemic control during the peri‐operative period: effect of glucagon‐like peptide‐1 receptor agonist therapy on glycaemic control in patients undergoing cardiac surgery (GLOLIA study)
Authors: Makino H. , Tanaka A. , Asakura K. , Koezuka R. , Tochiya M. , Ohata Y. , Tamanaha T. , Son C. , Shimabara Y. , Fujita T. , Miyamoto Y. , Kobayashi J. , Hosoda K.
Published: July 2019

Aim

To test the hypothesis that the addition of a glucagon‐like peptide‐1 receptor agonist that can decrease glucose levels without increasing the hypoglycaemia risk will achieve appropriate glycaemic control during the peri‐operative period.

Methods

We studied 70 people with Type 2 diabetes who underwent elective cardiac surgery. Participants were randomized to either an insulin‐alone or an insulin plus liraglutide 0.6 mg/day group. We evaluated average M values, which indicated the proximity index of the target glucose level from day 1 to day 10.

Results

The average M value in the liraglutide plus insulin group was significantly lower than that in the insulin‐alone group (liraglutide plus insulin 5.8 vs insulin‐alone 12.3; P < 0.001). The frequency of insulin dose modification in the liraglutide plus insulin group was significantly lower than that in the insulin‐alone group (odds ratio 0.19, 95% CI 0.08–0.49; P < 0.001). The frequency of hypoglycaemia in the liraglutide plus insulin group tended to be lower than that in the insulin‐alone group (odds ratio 0.57, 95% CI 0.15–2.23; P = 0.21).

Conclusions

The results of this study showed that the addition of low‐dose liraglutide to insulin achieved lower M values than insulin alone, suggesting that the addition of low‐dose liraglutide may achieve better glycaemic control during the peri‐operative period. (Clinical trials registry no.: UMIN 000008003)
Performance of the Freestyle Libre flash glucose monitoring (flash GM) system in individuals with type 1 diabetes: A secondary outcome analysis of a randomized crossover trial
Authors: Moser Othmar , Eckstein Max L. , McCarthy Olivia , Deere Rachel , Pitt Jason , Williams David M. , Hayes Jennifer , Sourij Harald , Bain Stephen C. , Bracken Richard M.
Published: July 2019

Aims

The efficacy of flash glucose monitoring (flash GM) systems has been demonstrated by improvements in glycaemia; however, during high rates of glucose flux, the performance of continuous glucose monitoring systems was impaired, as detailed in previous studies. This study aimed to determine the performance of the flash GM system during daily‐life glycaemic challenges such as carbohydrate‐rich meals, bolus insulin‐induced glycaemic disturbances and acute physical exercise in individuals with type 1 diabetes.

Materials and methods

This study comprised four randomized trial visits with alternating pre‐ and post‐exercise bolus insulin doses. Throughout the four 14‐hour inpatient phases, 19 participants received three carbohydrate‐rich meals and performed moderate‐intensity exercise. Venous blood glucose and capillary blood glucose during exercise was compared to interstitial glucose concentrations. Flash GM accuracy was assessed by median absolute relative difference (MARD) (interquartile range [IQR]) using the Bland–Altman method and Clark error grid, as well as according to guidelines for integrated CGM approvals (Class II–510(K)).

Results

The overall MARD (IQR) during inpatient phases was 14.3% (6.9%–22.8%), during hypoglycaemia (≤3.9 mmol/L) was 31.6% (16.2%–46.8%), during euglycaemia (4.0 mmol/L − 9.9 mmol/L) was 16.0% (8.5%–24.0%) and during hyperglycaemia (≥10 mmol/L) was 9.4% (5.1%–15.7%). Overall Bland–Altman analysis showed a bias (95% LoA) of 1.26 mmol/L (−1.67 to 4.19 mmol/L). The overall MARD during acute exercise was 29.8% (17.5%–39.8%), during hypoglycaemia was 45.1% (35.2%–51.1%), during euglycaemia was 30.7% (18.7%–39.2%) and during hyperglycaemia was 16.3% (10.0%–22.8%).

Conclusion

Flash GM interstitial glucose readings were not sufficiently accurate within the hypoglycaemic range and during acute exercise and require confirmatory blood glucose measurements.
Choosing Among Computational Software Tools to Enhance Learning in Introductory Business Statistics
Authors: Johnson Marina E. , Berenson Mark L.
Published: July 2019

AACSB has now mandated that analytics be integrated into the undergraduate business curriculum. Given that the subject of statistics provides the underpinnings of the developing discipline of business analytics, this article focuses on effective course delivery aimed at enhancing the learning of introductory business statistics in the modern world of big data. To this end, the choice and use of computational software tools are essential to the successful delivery of the course. A set of seven competing tools are compared and contrasted, their advantages and disadvantages are discussed, and a link is provided to show demonstrations of needed instructions and resulting output.
Thermal plasticity and microevolution enhance establishment success and persistence of a water hyacinth biological control agent
Authors: Griffith Tamzin C. , Paterson Iain D. , Owen Candice A. , Coetzee Julie A.
Published: July 2019

Aspects of the thermal physiology of the water hyacinth biological control agent Eccritotarsus catarinensis Carvalho (Hemiptera: Miridae) have been extensively investigated over the past 20 years to understand and improve post‐release establishment in the field. Thermal physiology studies predicted that the agent would not establish at a number of cold sites in South Africa, where it has nonetheless subsequently established and thrived. Recently, studies have begun to incorporate the plastic nature of insect thermal physiology into models of agent establishment. This study determined whether season and locality influenced the thermal physiology of two field populations of E. catarinensis, one collected from the hottest site where the agent has established in South Africa, and one from the coldest site. The thermal physiology of E. catarinensis was significantly influenced by season and site, demonstrating a degree of phenotypic plasticity, and that some post‐release local adaptation to climatic conditions has occurred through microevolution. We then determined whether cold acclimation under laboratory conditions was possible. Successfully cold‐acclimated E. catarinensis had a significantly lower critical thermal minimum (CTmin) compared to the field cold‐acclimated population. This suggests that cold acclimation of agents could be conducted in the laboratory before future releases to improve their cold tolerance, thereby increasing their chance of establishment at cold sites and allowing further adaptation to colder climates to occur in the field. Although the thermal tolerance of E. catarinensis is limited by local adaptations to climatic conditions in the native range, the plastic nature of the insect's thermal physiology has allowed it to survive in the very different climatic conditions of the introduced range, and there has been some adaptive change to the insect's thermal tolerance since establishment. This study highlights the importance of plasticity and microevolutionary processes in the success of biological control agents under the novel climatic conditions in the introduced range.
Risk factors and implications of oral mucositis in recipients of allogeneic hematopoietic stem cell transplantation
Authors: Shouval Roni , Kouniavski Elizaveta , Fein Joshua , Danylesko Ivetta , Shem‐Tov Noga , Geva Mika , Yerushalmi Ronit , Shimoni Avichai , Nagler Arnon
Published: July 2019

Background

Oral mucositis (OM) is a common toxicity of stem cell transplantation (SCT). We sought to evaluate OM burden, risk factors, and implications in a cohort of allogeneic‐SCT recipients.

Methods

This was a single‐center study including 115 adult allogeneic‐SCT transplanted between 2016 and 2018 for various hematological conditions. Conditioning intensity was categorized as myeloablative (MAC, 39%), reduced intensity (34%), or reduced toxicity (RTC, 27%) in patients conditioned with fludarabine‐treosulfan. OM was prospectively graded using the Common Terminology Criteria for Adverse Events (v.4.0) system.

Results

Moderate‐to‐severe OM (grade 2‐4) was experienced by 60% of patients. In a univariate analysis, younger age (P = .023), lower body mass index (P = .01), recent smoking (P = .08), recent antibiotics exposure (P = .018), MAC (P < .001), and methotrexate (P = .009) were associated with moderate‐to‐severe OM. In a multivariable logistic regression model, conditioning and graft‐versus‐host disease prophylaxis remained significant. OM risk was lowest with RTC (RTC vs MAC: odd ratio [OR] 0.05, P < .001), and recent antibiotic exposure trended toward increased risk (OR 1.88, P = .168). OM was associated with longer hospitalization, delayed neutrophil engraftment, and gastrointestinal‐related infections.

Conclusion

Oral mucositis remains a leading SCT complication. Treosulfan‐based conditioning has low mucosal toxicity and is appealing given previous reports on its high efficacy.
Decadal plant composition changes in grazed native grassland
Authors: Farmilo Brad J. , Moxham Claire
Published: July 2019

Most high value grasslands of south‐eastern Australia are restricted to small fragmented areas of public land. However, a significant proportion of native grassland is privately owned, managed with grazing rather than fire and is rarely monitored. Hence, a better understanding of grassland management and conservation on the private estate is required. Eco‐markets are policy instruments that incentivise private landholders to effectively manage and conserve native vegetation. However, short funding cycles restrict the capacity of monitoring programs to assess long‐term vegetation changes. In this study, 17 native grassland remnants on private land managed with livestock grazing were monitored before and during a 4‐year eco‐market and 6 years after it ended to determine how composition had changed over 10 years of monitoring. Numerous grassland attributes were either maintained or improved over the 10‐year period, which coincided with one of the most severe and long‐lasting droughts in recent history (i.e. the Millennium drought). In addition, several threatened species were identified as part of the program. A decline in exotic forb richness, native grass cover and native forb richness suggests there is also some impact of the Millennium drought on plant mortality as evidenced by altered litter dynamics. Inherent variability year‐to‐year for most measures of grassland attributes over the monitoring period indicates that climatic conditions have a strong influence on grassland dynamics. Our ability to determine the driver(s) of grassland composition was limited by monitoring program design. Future eco‐market monitoring programs should have adequate resources allocated to enable effective monitoring designs, that incorporate reference information and control sites, and should aim to be long‐term (i.e. >10 years). This will provide clearer insights into the drivers of grassland dynamics and allow for refinement of management options for conservation of this threatened community.
Cognitive deficits in a rat model of temporal lobe epilepsy using touchscreen‐based translational tools
Authors: Carron Simone , Dezsi Gabi , Ozturk Ezgi , Nithianantharajah Jess , Jones Nigel C.
Published: July 2019

Objective

Cognitive deficits are commonly observed in people with epilepsy, but the biologic causation of these is challenging to identify. Animal models of epilepsy can be used to explore pathophysiologic mechanisms leading to cognitive problems, as well as to test novel therapeutics. We utilized a well‐validated animal model of epilepsy to explore cognitive deficits using novel translational assessment tools/automated rodent touchscreen assays.

Methods

To induce epilepsy, adult Wistar rats were subjected to kainic acid–induced status epilepticus or sham control (n = 12/group). Two months following induction, animals underwent the Pairwise Discrimination and Reversal learning touchscreen tasks, novel object recognition, and the Y maze test of spatial memory.

Results

In the Pairwise Discrimination paradigm, only 40% of epilepsy animals acquired the discrimination learning criterion, compared to 100% of sham animals (P = 0.003). Epilepsy and sham animals that successfully acquired the discrimination progressed onto the reversal phase, which measures cognitive flexibility. Of interest, there were no differences in the rate of reversal learning; however, on the first reversal session, epilepsy rats committed more perseverative errors than shams (mean ± SEM: 6.3 ± 0.9 vs 1.8 ± 0.5, P < 0.0001). Additional behavioral analysis revealed that epilepsy rats were significantly impaired in novel object recognition and short‐term spatial learning and memory.

Significance

Using translationally relevant behavioral tools in combination with traditional assays to measure cognition in animal models, here we identify impairments in learning and memory, and enhanced perseverative behaviors in rats with epilepsy. These tools can be used in future research to explore biologic mechanisms and treatments for cognitive deficits associated with epilepsy.
Love in Action: An Integrative Approach to Last Chance Couple Therapy
Authors: Fraenkel Peter
Published: July 2019

This article presents an integrative approach to the special challenges of therapy with couples on the brink of dissolution or divorce—who often describe this therapy as their “last chance.” In some, one partner is considering ending the relationship, and in others, both partners are considering ending it. Often, these couples have had prior dissatisfying experiences in couple therapy. Four types of last chance couples are described: high‐conflict couples; couples in which partners have differing goals for their lives or different timelines for reaching shared goals; couples in which one or both partners have acted in a manner that violates the values, expectations, emotional comfort, or safety of the other; and couples in which there has been a gradual loss of intimacy. The Therapeutic Palette, a multiperspectival, theoretically eclectic integrative approach, is enlisted as a general framework for selecting and sequencing use of particular theories and their associated practices, based on the three “primary colors” of couple therapy: time frame/focus, level of directiveness, and change entry point. An additional complementary framework, the creative relational movement approach, is proposed to provide an integrative frame encompassing both language‐based and action‐based practices, suggesting that meaning is held and expressed as much through interaction or “relational motion” as it is through language. Principles of change are described. Due to the couple's level of crisis and desire for immediate evidence of possible improvement, priority is given to action‐based interventions in early stages of therapy, by engaging couples in “experiments in possibility.” Typical action approaches are described. An extended vignette follows.
The effect of a pre‐existing crack on a running crack in brittle material under dynamic loads
Authors: Zhou Qin , Zhu Zheming , Wang Xiong , Zhou Jiali , Lang Lin , Zhang Xianshang
Published: July 2019

Brittle material usually contains plenty of cracks or micro‐cracks, which raises a question that how a pre‐existing crack affects a running crack as they are approaching. In order to investigate such issue, impact experiments were conducted by using double crack semi‐circle (DCSC) specimens. Polymethyl methacrylate (PMMA) was selected to make the DCSC specimens, and a modified SHPB system was used to perform the impact tests. The finite difference code AUTODYN was employed to simulate the crack propagation behavior and propagation path, and the simulated crack paths agree well with the impact test results. Meanwhile the stresses around the crack tips were analyzed and the crack propagation direction was investigated. To calculate the crack dynamic stress intensity factors (DSIFs), finite element code ABAQUS was employed. The results show that the spacing D between the vertical crack tip and the inclined crack center affects the stress distribution and fracture behavior of the vertical crack largely. As the vertical crack approaches the inclined crack, the crack speed is slow down, and tensile stress appears at the inclined crack tip. As the spacing D is small than 50 mm, the vertical crack connects with the middle area of the inclined crack. As the spacing D is 50 mm, the vertical crack connects with either the middle area or the upper tip of the inclined crack. As the spacing D is larger than 50 mm, the vertical crack coalesces with the upper crack tip.