bluuebunny/crossref_metadata_2025 huggingface dataset:
ED50 and ED95 of intrathecal hyperbaric ropivacaine for parturients undergoing cesarean section with prophylactic infusion of phenylephrine
Authors: Xu Wenping , Xiao Fei , Zhang Yinfa , Liu Lin , Chang Xiangyang
Published: December 2018

Background:

Studies have reported that the ED50 of intrathecal ropivacaine was increased when using prophylactic infusion of phenylephrine to prevent spinal-induced hypotension. However, ED95 is more meaningful to clinical practice than ED50. Therefore, we conducted this study to determine the 95% effective dose (ED95) of intrathecal hyperbaric ropivacaine for cesarean section in parturients receiving prophylactic infusion of phenylephrine to prevent spinal-induced hypotension.

Methods:

A hundred of healthy parturients undergoing elective cesarean section under combined spinal-epidural anesthesia (CSEA) were enrolled in this randomized, double-blinded, dose-ranging study. Patients were randomly assigned to receive 7, 9, 11, 13 or 15 mg intrathecal hyperbaric ropivacaine respectively. The prophylactic phenylephrine infusion (50 μg/min) was initiated immediately at the same time of spinal injection. Successful spinal anesthesia was defined as a T5 sensory level achieved within 10 min after intrathecal drug administration and no epidural supplement was required during the surgery. The ED95 was calculated with Probit analysis.

Results:

The ED95 of intrathecal ropivacaine with 5 μg sufentanil for successful anesthesia was 15.2 mg (95%CI, 13.5–18.8 mg), when receiving prophylactic infusion of phenylephrine.

Conclusion:

Under the conditions of the present study, the ED95 of intrathecal hyperbaric ropivacaine for successful spinal anesthesia for cesarean section in healthy parturient receiving prophylactic infusion of phenylephrine was 15.2 mg.
Nivolumab therapy for lung cancer with tracheo-parenchymal fistula
Authors: Yamasaki Masahiro , Daido Wakako , Funaishi Kunihiko , Kawamoto Kazuma , Matsumoto Yu , Matsumoto Naoko , Taniwaki Masaya , Ohashi Nobuyuki , Hattori Noboru
Published: December 2018

Rationale:

Tracheobronchial fistulas are rare complications in lung cancer patients. These lesions are associated with a high rate of mortality caused by infection and bleeding, and there is no consensus on a definitive optimal therapy.

Patient concerns and diagnoses:

The patient was a 59-year-old man with a right lung mass showing mediastinal invasion and tracheal compression, diagnosed with adenocarcinoma, cT4N0M0, stage IIIA. He was treated with concurrent chemoradiotherapy with carboplatin and paclitaxel, and the lesion markedly shrunk. Eleven months later, the lesion showed regrowth, and he underwent repeated chemotherapy for stabilization of the lesion. Thirty-six months after the first regrowth, the tumor showed regrowth again. The patient was then administered docetaxel and bevacizumab as fifth-line therapy. After 11 cycles of docetaxel and bevacizumab therapy, a tracheo-parenchymal fistula appeared.

Interventions and outcomes:

Docetaxel and bevacizumab therapy was stopped, and nivolumab therapy was initiated. Subsequently, the fistula and cavity became stable with slight shrinkage. To date, the patient is alive with no complaints and no disease progression and has continued nivolumab for a total of 28 months.

Lessons:

Immune-checkpoint inhibitor therapy involving nivolumab therapy might be a useful alternative for the treatment of lung cancer involving a tracheobronchial fistula.
A highly aggressive invasive ductal carcinoma from a complex cystic breast mass and BI-RADS assessment
Authors: Li Yixuan , Peng Yulan , He Xin
Published: December 2018

Rationale:

The term cystic breast lesions is a sonographic diagnosis, which can be categorized as simple, complicated or complex. The complex cysts are deemed as having a low risk of breast cancer. The highly aggressive invasive ductal carcinomas among complex cysts, in particular, are infrequent reported.

Patient concerns:

A 56-year-old female with a breast complex cyst who, after fine-needle aspiration, complained about oozing with fluid as well as skin ulceration that did not heal.

Diagnoses:

An advanced HER-2-enriched invasive ductal carcinoma was diagnosed.

Interventions:

The patient received neoadjuvant chemotherapy of anti-HER-2 target drug, palliative surgery and following postoperative chemotherapy.

Outcomes:

The patient was in good general condition at 6 months follow-up after surgery.

Lessons:

Meticulous ultrasound evaluation of Breast Imaging Reporting and Data System (BI-RADS) category is crucial and indispensable when a complex cyst is found. The radiologist and clinician should be fully awake to its possibility of malignancy, especially fast-growing one in post-menopausal women. Excision biopsy may be preferred for diagnosis.
The prognostic value of proliferating cell nuclear antigen expression in colorectal cancer
Authors: Zhou He , Huang Tao , Xiong Yongfu , Peng Linglong , Wang Rong , Zhang Guang jun
Published: December 2018

Background:

A number of studies have attempted to determine the prognostic significance of proliferating cell nuclear antigen (PCNA) in patients with colorectal cancer (CRC), but the reports are controversial and inconsistent. Thus, we conducted a meta-analysis to clarify the value of PCNA in CRC prognosis.

Methods:

A systematic search of relevant studies was performed in 4 electronic databases including PubMed, Cochrane Library, Embase, and Web of Science until February 2018. Hazard ratios (HRs) combined with 95% confidence intervals (95% CIs) were used to evaluate the relationship of PCNA expression with overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).

Results:

A total of 1372 CRC patients in 14 studies were identified eventually in our meta-analysis. The pooled HRs demonstrated that CRC patients with high PCNA expression was significantly correlated with poor OS (HR = 1.81; 95% CI: 1.51–2.17; P = .000), CSS (HR = 1.99; 95% CI: 1.04–3.79; P = .037); but not significantly with DFS (HR = 2.48; 95% CI: 0.98–6.26; P = .055). Sensitivity analysis showed the pooled HRs for OS, CSS, and DFS were stable when the included studies were removed one by one.

Conclusion:

Our meta-analysis suggested that high PCNA expression was associated with poor prognosis, and it could serve as a reliable and prognostic biomarker in CRC patients. More large-scale studies are needed to further support the conclusion.
Improving Patient Experience and Treatment Adherence in the Adult, Outpatient Hemodialysis Population
Authors: Saunders Jessica , Ahmadzadeh Shahram , Bush Margaret , Wright Robin , Granger Bradi
Published: December 2018

Background:

The commonly employed medication reconciliation process leaves room for mismanagement of medications in the complex end-stage renal disease patient population.

Purpose:

The purpose of this quality improvement project was to implement and evaluate a multidisciplinary education and feedback intervention designed to improve self-management for adults with end-stage renal disease.

Methods:

A pre-post, same subject repeated measures design was used to evaluate the intervention. Laboratory values, vital signs, interdialytic weight gains, dialysis attendance, and questionnaires were used to assess regimen adherence.

Results:

We observed improvements in patient outcomes including laboratory values, vital signs, and interdialytic weight gains. Significant improvements in process outcomes were also seen, including accuracy of medication lists, dialysis attendance, and use of remote pharmacy services.

Conclusions:

A comprehensive medication review, with concurrent pharmacist access, represents a time-effective approach to improved self-management and end-stage renal disease outcomes.
Pregnancy in Women With a History of Uterine Rupture
Authors: Frank Zoë C. , Caughey Aaron B.
Published: December 2018

Importance

With increased rates of primary and repeat cesarean deliveries, the potential for uterine rupture and management of women with a history of uterine rupture has also increased. Taking care of a pregnant woman with a prior uterine rupture requires understanding of the risks, the need for additional surveillance, and the limitations of our knowledge about how rupture affects subsequent pregnancies.

Objective

The aims of this study were to review the literature on pregnancy after uterine rupture and to summarize the evidence to help the obstetrician care for a pregnant woman with a history of uterine rupture.

Evidence Acquisition

Evidence for this review was acquired using PubMed.

Conclusions

Pregnancy after uterine rupture carries a risk of spontaneous repeat rupture before the onset of labor and of repeat rupture during early labor. Elective cesarean delivery before the onset of labor is the safest strategy to prevent maternal and neonatal morbidity and mortality. However, more research is needed to better inform risk estimates and to guide management of pregnant women with a history of uterine rupture.

Relevance

Obstetricians will increasingly be caring for women who have experienced uterine rupture and subsequently become pregnant.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After participating in this activity, the learner should be better able to summarize the evidence regarding risk of spontaneous recurrent rupture and of recurrent rupture in labor in women pregnant after a prior uterine rupture; formulate an evidence-based plan for the care of a patient pregnant after a prior uterine rupture; and recognize factors that may modify the risk of rupture recurrence and interpret the evidence regarding their interaction with risk.
Current Practices in the Processing, Diagnosis, and Reporting of Endometrial Carcinoma: Results of a Web-based Survey by the International Society of Gynecological Pathologists (ISGyP)
Authors: Parkash Vinita , Matias-Guiu Xavier , Oliva Esther , Malpica Anais , McCluggage W. Glenn
Published: December 2018

There have been significant advances in our understanding of the biology and classification of endometrial carcinoma, over the last few years, and the new prediction models proposed for prognostication. To accurately diagnose and stage tumors and apply these prediction models, it is necessary that there be standardized processing of specimens, and a common understanding and usage of the diagnostic terminology of endometrial carcinoma. The International Society of Gynecological Pathologists embarked on an ambitious project to achieve this goal in 2015. An early step in the process was to collect baseline information on existing practices with regard to the processing, diagnosis, and reporting of endometrial carcinomas among the members of the society. This was carried out using a web-based survey comprising 112 questions. The results are presented herein and reveal areas of uniformity but also areas of substantial variation among pathologists. The results of the survey assisted in developing the subsequent recommendations that follow as separate articles in this issue of the journal with regard to processing, diagnosis, and reporting of endometrial carcinomas.
Guidelines to Aid in the Distinction of Endometrial and Endocervical Carcinomas, and the Distinction of Independent Primary Carcinomas of the Endometrium and Adnexa From Metastatic Spread Between These and Other Sites
Authors: Stewart Colin J.R. , Crum Christopher P. , McCluggage W. Glenn , Park Kay J. , Rutgers Joanne K. , Oliva Esther , Malpica Anais , Parkash Vinita , Matias-Guiu Xavier , Ronnett Brigitte M.
Published: December 2018

In most cases of suspected endometrial neoplasia tumor origin can be correctly assigned according to a combination of clinical, radiologic, and pathologic features, even when the latter are based upon the examination of relatively small biopsy samples. However there are well-recognized exceptions to this rule which continue to create diagnostic difficulty, and sometimes difficulties persist even after the detailed examination of resection specimens. Among the most common problems encountered in practice are the distinction of primary endometrial and primary endocervical adenocarcinomas, and the determination of tumor origin when there is synchronous, multifocal involvement of gynecologic tract sites, for example the endometrium and the ovary. However, accurate diagnosis in these cases is important because this has significant staging, management and prognostic implications. In this review we discuss the value and limitations of key morphologic, immunophenotypic and molecular findings in these diagnostic scenarios.
Effect of Macrolide Prophylactic Therapy on AIDS-Defining Conditions and HIV-Associated Mortality
Authors: Pasayan Mark Kristoffer U. , S. Mationg Mary Lorraine , Boettiger David , Lam Wilson , Zhang Fujie , Ku Stephane Wen-Wei , Merati Tuti Parwati , Chaiwarith Romanee , Cuong Do Duy , Yunihastuti Evy , Kiertiburanakul Sasisopin , Van Kinh Nguyen , Avihingsanon Anchalee , Sun Ly Penh , Kamarulzaman Adeeba , Kantipong Pacharee , Kumarasamy Nagalingeswaran , Pujari Sanjay , Heng Sim Benedict Lim , Ng Oon Tek , Choi Jun Yong , Tanuma Junko , Ross Jeremy , A. Ditangco Rossana ,   on behalf of the TREAT Asia HIV Observational Database (TAHOD) of IeDEA Asia-Pacific
Published: December 2018

Background:

Mycobacterium avium complex prophylaxis is recommended for patients with advanced HIV infection. With the decrease in incidence of disseminated Mycobacterium avium complex infection and the availability of antiretroviral therapy (ART), the benefits of macrolide prophylaxis were investigated. This study examined the impact of macrolide prophylaxis on AIDS-defining conditions and HIV-associated mortality in a cohort of HIV-infected patients on ART.

Methods:

Patients from TREAT Asia HIV Observational Database (September 2015 data transfer) aged 18 years and older with a CD4 count <50 cells/mm3 at ART initiation were included. The effect of macrolide prophylaxis on HIV-associated mortality or AIDS-defining conditions (as a combined outcome) and HIV-associated mortality alone were evaluated using competing risk regression. Sensitivity analysis was conducted in patients with a CD4 <100 cells/mm3 at ART initiation.

Results:

Of 1345 eligible patients, 10.6% received macrolide prophylaxis. The rate of the combined outcome was 7.35 [95% confidence interval (CI): 6.04 to 8.95] per 100 patient-years, whereas the rate of HIV-associated mortality was 3.14 (95% CI: 2.35 to 4.19) per 100 patient-years. Macrolide use was associated with a significantly decreased risk of HIV-associated mortality (hazard ratio 0.10, 95% CI: 0.01 to 0.80, P = 0.031) but not with the combined outcome (hazard ratio 0.86, 95% CI: 0.32 to 2.229, P = 0.764). Sensitivity analyses showed consistent results among patients with a CD4 <100 cells/mm3 at ART initiation.

Conclusions:

Macrolide prophylaxis is associated with improved survival among Asian HIV-infected patients with low CD4 cell counts and on ART. This study suggests the increased usage and coverage of macrolide prophylaxis among people living with HIV in Asia.
Tonotopy of the mammalian cochlea is associated with stiffness and tension gradients of the hair cell’s tip-link complex
Authors: Tobin Mélanie , Michel Vincent , Michalski Nicolas , Martin Pascal
Published: December 2018

Frequency analysis of sound by the cochlea relies on sharp frequency tuning of mechanosensory hair cells along a tonotopic axis. To clarify the underlying biophysical mechanism, we have investigated the micromechanical properties of the hair cell’s mechanoreceptive hair bundle in the rat cochlea. We studied both inner and outer hair cells, which send nervous signals to the brain and amplify cochlear vibrations, respectively. We find that tonotopy is associated with gradients of stiffness and resting mechanical tension, with steeper gradients for outer hair cells, emphasizing the division of labor between the two hair-cell types. We demonstrate that tension in the tip links that convey force to the mechano-electrical transduction channels increases at reduced Ca2+. Finally, we reveal tonotopic gradients in stiffness and tension at the level of a single tip link. We conclude that intrinsic mechanical gradients of the tip-link complex help specify the characteristic frequency of the hair cell.
Id proteins promote a cancer stem cell phenotype in triple negative breast cancer via negative regulation of Robo1
Authors: Teo Wee S. , Holliday Holly , Karthikeyan Nitheesh , Cazet Aurélie S. , Roden Daniel L. , Harvey Kate , Konrad Christina Valbirk , Murali Reshma , Varghese Binitha Anu , P. T. Archana , Chan Chia-Ling , McFarland Andrea , Junankar Simon , Ye Sunny , Yang Jessica , Nikolic Iva , Shah Jaynish S. , Baker Laura A. , Millar Ewan K.A. , Naylor Mathew J. , Ormandy Christopher J. , Lakhani Sunil R. , Kaplan Warren , Mellick Albert S. , O’Toole Sandra A. , Swarbrick Alexander , Nair Radhika
Published: December 2018

Breast cancers display phenotypic and functional heterogeneity and several lines of evidence support the existence of cancer stem cells (CSCs) in certain breast cancers, a minor population of cells capable of tumor initiation and metastatic dissemination. Identifying factors that regulate the CSC phenotype is therefore important for developing strategies to treat metastatic disease. The Inhibitor of Differentiation Protein 1 (Id1) and its closely related family member Inhibitor of Differentiation 3 (Id3) (collectively termed Id) are expressed by a diversity of stem cells and are required for metastatic dissemination in experimental models of breast cancer. In this study, we show that ID1 is expressed in rare neoplastic cells within ER-negative breast cancers. To address the function of Id1 expressing cells within tumors, we developed two independent murine models of Triple Negative Breast Cancer (TNBC) in which a genetic reporter permitted the prospective isolation of Id1+cells. Id1+cells are enriched for self-renewal in tumorsphere assaysin vitroand for tumor initiationin vivo. Conversely, depletion of Id1 and Id3 in the 4T1 murine model of TNBC demonstrates that Id1/3 are required for cell proliferation and self-renewalin vitro, as well as primary tumor growth and metastatic colonization of the lungin vivo. Using combined bioinformatic analysis, we have defined a novel mechanism of Id protein function via negative regulation of the Roundabout Axon Guidance Receptor Homolog 1 (Robo1) leading to activation of a Myc transcriptional programme.
Migration of gastric cancer is suppressed by rabies virus glycoprotein via regulating α7-nicotinic acetylcholine receptors/ERK-EMT
Authors: Bu Xuefeng , Zhang Anwei , Chen Zhengwei , Yin Chaoyun , Zhang Xuanfeng , Zhang Riting , Zhang Yao , Zhang Jie , Yan YuLan
Published: December 2018

Nicotinic acetylcholine receptors (nAChRs) have been reported to be overexpressed in malignancies in humans and is associated with tumorigenesis and cell migration. In previous studies of gastric cancer, alpha7 nicotinic acetylcholine receptor (α7-nAChR) overexpression can induce epithelial-mesenchymal transition (EMT) and promote migration of gastric cancer cells. Recombinant avirulent Newcastle disease virus (NDV) LaSota strain expressing the rabies virus glycoprotein (rL-RVG) may promote apoptosis of gastric cancer cells and reduces migration of lung cancer metastasis. However, whether rL-RVG inhibits migration of gastric cancer cells and what the underlying functional mechanism is remains unknown. our findings demonstrate that rL-RVG suppressed migration and reduced EMT of gastric cancer cells via α7-nAChR in vitro. Furthermore rL-RVG decreased the phosphorylation levels of the MEK/ERK signaling pathway such as down-regulating the expression of P-MEK and P-ERK. Additionally, rL-RVG also reduced the expression level of mesenchymal markers N-cadherin and Vimentin and enhanced the expression of the epithelial marker E-cadherin. Lastly, rL-RVG together with nicotinic acetylcholine receptors (nAChRs) inhibited gastric cancer epithelial to mesenchymal transition (EMT) which suppressed gastric cancer cell migration. We also found rL-RVG suppresses the growth of gastric cancer subcutaneous tumor cells in vivo. Thus, rL-RVG inhibits α7-nAChR-MEK/ERK-EMT to suppress migration of gastric cancer cells.
Emergent wetland vegetation data recording: Does an optimal period exist?
Authors: Jenačković Dragana D. , Lakušić Dmitar , Zlatković Ivana , Jušković Marina , Ranđelović N. Vladimir
Published: December 2018

Aims

Certain parts of the growing season have been proposed as optimal for recording relevant relevés of forests and dry grasslands and so the monitoring of these vegetation types has become more time‐ and cost‐effective. We investigated whether it is possible to propose an optimal period during the year for making relevant relevés of emergent wetland vegetation.

Location

Marshlands of the central Balkan Peninsula.

Methods

One hundred and eighty‐five permanent vegetation plots were investigated in three distinct time periods: spring, summer and autumn. In order to identify the communities, cluster analyses were carried out, and diagnostic species for each cluster were determined. The potential for temporal change of the communities regarding the species and life form composition was assessed using PERMANOVA and NMDS analyses. The Friedman test was used to assess the significance of seasonal change in the communities regarding their species richness, recordability and Shannon diversity.

Results

The level of floristic similarity among the 11 phytocoenoses analyzed significantly varied over the growing season while the composition in terms of their diagnostic species remained unchanged. The majority of the communities showed statistically significant seasonal changes in the qualitative and quantitative characteristics of the vegetation, life form composition and cover. Although different communities expressed significant modifications in these parameters between different pairs of seasons, all of them showed changes in the mentioned parameters between spring and autumn. The degree of intra‐annual variation in the species richness, species recordability and Shannon diversity was low in almost all phytocoenoses.

Conclusions

Summer is the optimal period for recording most of the species from the total list of the communities developed on hydrologically stable habitats, while spring is more appropriate for making relevés on periodically inundated habitats. The sampling time has negligible impact on the classification of associations but it could have important implications for the classification of higher‐ranked syntaxonomic units of the class Phragmito‐Magnocaricetea.
Clustered shareholder activism
Authors: Artiga González Tanja , Calluzzo Paul
Published: December 2018

Research Question/Issue

This study examines activism campaigns where multiple activists simultaneously target the same firm—which we term clustered shareholder activism. Despite the growing influence of shareholder activism on corporate governance, the clustered activism phenomenon has previously only been addressed indirectly, anecdotally, or with limited data. We consider cost sharing motives for clustered activism and whether the phenomenon exerts a positive or negative impact on the performance of the target firm.

Research Findings/Insights

Using a large dataset of shareholder activism events at U.S. firms, we find that clustered activism campaigns are more common at larger firms and among geographically proximate activists, which is consistent with our prediction that activists cluster to reduce the costs associated with activism campaigns. Furthermore, we find that clustered activism produces elevated profitability and abnormal returns, which is consistent with our prediction that activists cluster to address principal–agency costs.

Theoretical/Academic Implications

Our study provides some of the first theoretical and empirical evidence on the clustered activism phenomenon. We contribute to the understanding of the role of shareholder activism by considering their effect on principal–agency and principal–principal problems. Our results also contribute to the literature that examines factors relating to the success of shareholder activism by documenting the effect of clustered activism on activism costs and target firm performance.

Practitioner/Policy Implications

Our study adds to the debate among practitioners and regulators on the merits (or lack thereof) of clustered activism. Our findings suggest that a regulatory approach that encourages clustered activism can benefit shareholders.

Video Abstract

https://onlinelibrary.wiley.com/page/journal/14678683/homepage/videoabstracts.html

youtube

https://www.youtube.com/watch?time_continue=1&v=0_D-6Pw9sYo
First report of Phytophthora cinnamomi in forest stands in Germany
Authors: Peters Franziska S. , Wunderlich Linda , Metzler Berthold
Published: December 2018

Phytophthora cinnamomi was repeatedly isolated from the rhizosphere of recently dead sweet chestnut trees in the upper Rhine valley. Identification was genetically confirmed by RFLP and sequencing of the ITS‐region. This is the first record of P. cinnamomi on forest land in Germany. Mode of introduction of this invasive species and potential factors favouring establishment are discussed.
Tumor necrosis factor‐related apoptosis‐inducing ligand reduces the expression of the neuroprotective Na+/Ca2+ exchanger isoform NCX3 in human neuroblastoma SH‐SY5Y cells
Authors: Di Benedetto Giulia , Valerio Oriana , Lariccia Vincenzo , Burgaletto Chiara , Lempereur Laurence , Parenti Carmela , Zanghì Guido Nicola , Matteucci Alessandra , Amoroso Salvatore , Bernardini Renato , Cantarella Giuseppina
Published: December 2018

Tumor necrosis factor‐related apoptosis‐inducing ligand (TRAIL), a cytokine belonging to the TNF superfamily, is regarded as a mediator of neurotoxicity. The constitutively expressed ion exchanger Na+/Ca2+ exchanger isoform‐3 (NCX3) has been shown to protect neurons from injury. Its expression is induced by nerve growth factor (NGF) through activation of its tyrosine kinase receptor trkA. The latter, in turn, activates downstream kinases, such as extracellular signal‐regulated kinase (ERK) and the survival‐related kinase protein kinase B (AKT). Here, we verified whether TRAIL could influence the expression of NCX3 via modulation of the NGF/trkA system. Differentiated human neuroblastoma SH‐SY5Y cells were incubated with TRAIL and, subsequently, the expression of the NCX3 protein was studied at different times by means of western blot analysis. Then, the expression of the phosphorylated forms of either trkA, ERK or AKT was analyzed at identical intervals. Western blot analysis revealed that the expression of NCX3 protein decreased in a time‐dependent fashion in SH‐SY5Y cells treated with TRAIL, to reach its minimum at 48 h. On the other hand, p‐trkA, p‐ERK, and p‐AKT expression was increased in cells treated with TRAIL after 6 and 16 h; then it declined to nearly undetectable levels after 48 h. Results indicate that the increase in TRAIL expression occurring during neuronal damage may be responsible of NCX3 down‐regulation and weakens its neuroprotective effects. The TRAIL system could thus represent a potential target for treatment of neuronal damage characterized by NCX3 function impairment.
A vintage model with endogenous growth and human capital
Authors: Benhabib Jess
Published: December 2018

We develop an endogenous growth model with vintages of physical capital where human capital is endogenously produced. Under some simplifying assumptions, we can solve the model analytically and study its dynamics. We provide conditions under which a balanced growth path, in the ratio of capital to human capital, exists and is stable, with the transition dynamics exhibiting oscillatory echo effects associated with vintages.
Calcitriol loading before total parathyroidectomy with autotransplant in patients with end‐stage kidney disease: does it prevent postoperative hypocalcaemia?
Authors: Ferreira David , Vilayur Eswari , Gao Michael , Sankoorikal Christy , Bendinelli Cino
Published: December 2018

Background

Hungry bone syndrome (HBS) is one of the most serious complications following parathyroidectomy for severe hyperparathyroidism. There is a lack of literature informing the treatment and risk factors for this condition and the ideal pre‐operative strategy for prevention.

Aims

The primary aims were to examine the incidence of HBS with pre‐operative calcitriol loading for 10 days and to determine the risk factors for HBS. The secondary aims were to determine the rate of intravenous calcium replacement in those with HBS and to assess whether cinacalcet removal has increased rates of parathyroidectomy in the end‐stage kidney disease population.

Methods

We performed a retrospective study from 2011 to 2018 on 45 patients with end‐stage kidney disease undergoing total parathyroidectomy with autotransplantation for severe hyperparathyroidism. This was based at the John Hunter and Newcastle Private Hospitals in New South Wales.

Results

28.3% of patients with calcitriol loading undergoing parathyroidectomy fulfilled criteria for HBS. Pre‐operative variables that were associated with HBS were elevated parathyroid hormone (P = 0.028) and longer duration of renal replacement therapy (P = 0.033). Rates of total parathyroidectomy were higher after the removal of calcimimetics from the Pharmaceutical Benefits Scheme (P = 0.0024).

Conclusions

HBS remains a common complication of parathyroidectomy, even with prolonged high‐dose calcitriol loading. This emphasises the need for further trials investigating other targeted therapies, such as bisphosphonates, to prevent HBS. Those most at risk of HBS are patients with high bone turnover and prolonged renal replacement therapy.
Developmental origins of murine γδ T‐cell subsets
Authors: Sumaria Nital , Martin Stefania , Pennington Daniel J.
Published: December 2018

Murine γδ T cells display diverse responses to pathogens and tumours through early provision of pro‐inflammatory cytokines such as interleukin‐17A (IL‐17) and interferon‐γ (IFN‐γ). Although it is now clear that acquisition of these cytokine‐secreting effector fates is to a great extent developmentally pre‐programmed in the thymus, the stages through which γδ progenitor cells transition, and the underlying mechanistic processes that govern these commitment events, are still largely unclear. Here, we review recent progress in the field, with particular consideration of how TCR‐γδ signalling impacts on developmental programmes initiated before TCR‐γδ expression.
Inflammatory response under zinc deficiency is exacerbated by dysfunction of the T helper type 2 lymphocyte–M2 macrophage pathway
Authors: Kido Takamasa , Ishiwata Kenji , Suka Machi , Yanagisawa Hiroyuki
Published: December 2018

Nutritional zinc deficiency leads to immune dysfunction and aggravates inflammation. However, the underlying mechanism remains unknown. In this study, the relationship between macrophage subtypes (M1 and M2) and helper T lymphocytes (Th1 and Th2) was investigated using the spleen from rats fed zinc‐deficient or standard diet. In experiment I, 5‐week‐old male Sprague‐Dawley rats were fed a zinc‐deficient diet (without zinc additives) or a standard diet (containing 0·01% zinc) for 6 weeks. In experiment II, the rats were divided into four groups: one group was fed a standard diet for 6 weeks; two groups were fed zinc‐deficient diets and were injected three times a week with either saline or interleukin‐4 (IL‐4) (zinc‐deficient/IL‐4 i.p.); a fourth group (zinc‐deficient/standard) was fed a zinc‐deficient diet for 6 weeks followed by a standard diet for 4 weeks. In experiment I; GATA‐binding protein 3 (GATA‐3) protein level, M2 macrophage, CD3+ CD8+ cells, and IL‐4/IL‐13‐positive cells significantly decreased in the spleens of the zinc‐deficient group. Additionally, IL‐1β and macrophage inflammatory protein‐1α (MIP‐1α) mRNA levels significantly increased in the splenic macrophages of the zinc‐deficient group. In experiment II; M2 macrophages, CD3+ CD8+ cells, IL‐4/IL‐13‐positive cells, and GATA‐3 protein levels significantly increased in the spleens of the zinc‐deficient/IL‐4 i.p. and zinc‐deficient/standard groups. Furthermore, IL‐1β and MIP‐1α mRNA levels decreased in the splenic macrophages of the zinc‐deficient/IL‐4 i.p. and zinc‐deficient/standard groups. Zinc deficiency‐induced aggravated inflammation is related to Th2 lymphocytes and followed by the association with loss of GATA‐3, IL‐4 and anti‐inflammatory M2 macrophages. Importantly, IL‐4 injection or zinc supplementation can reverse the effects of zinc deficiency on immune function.
Compositional control of radionuclide retention in hollandite‐based ceramic waste forms for Cs‐immobilization
Authors: Zhao Mingyang , Xu Yun , Shuller‐Nickles Lindsay , Amoroso Jake , Frenkel Anatoly I. , Li Yuanyuan , Gong Weiping , Lilova Kristina , Navrotsky Alexandra , Brinkman Kyle S.
Published: December 2018

Hollandite materials, as a class of crystalline nuclear waste forms, are promising candidates for the immobilization of radioactive elements, such as Cs, Ba, as well as a variety of lanthanide and transition‐metal fission products. In this study, three Ga‐doped titanate hollandite‐type phases, Ba1.33Ga2.67Ti5.33O16, Ba0.667Cs0.667Ga2Ti6O16, and Cs1.33Ga1.33Ti6.67O16, were synthesized using a solid‐state reaction route. All synthesized phases adopted a single phase tetragonal structure, as determined by powder X‐ray diffraction (XRD), and elemental analysis confirmed the measured stoichiometries were close to targeted compositions. Extended X‐ray absorption fine structure spectroscopy (EXAFS) was used to determine the local structural features for the framework of octahedrally coordinated cations. EXAFS data indicated that Cs1.33Ga1.33Ti6.67O16 possessed the most disordered local structure centered around the Ga dopant. The enthalpies of formation of all three hollandite phases measured using high‐temperature oxide melt solution calorimetry were found to be negative, indicating enthalpies of formation of these hollandites from oxides are thermodynamically stable with respect to their constituent oxides. Furthermore, the formation enthalpies were more negative and hence more favorable with increased Cs content. Finally, aqueous leaching tests revealed that high Cs content hollandite phases exhibited greater Cs retention as compared to low Cs content hollandite. While preliminary in nature, this work draws attention to the links between the capacity for radionuclide retention, atomistic level structural features and bulk thermodynamic properties of materials.
Extracorporeal shock wave lithotripsy is safe and effective for geriatric patients with chronic pancreatitis
Authors: Hao Lu , Liu Yu , Wang Teng , Guo Hong‐Lei , Wang Dan , Bi Ya‐Wei , Xin Lei , He Lin , Lin Jin‐Huan , Zhang Di , Zeng Xiang‐Peng , Zou Wen‐Bin , Chen Hui , Xie Ting , Li Bai‐Rong , Cong Zhi‐Jie , Wang Li‐Sheng , Liao Zhuan , Xu Zheng‐Lei , Li Zhao‐Shen , Hu Liang‐Hao
Published: December 2018

Background and Aim

Pancreatic extracorporeal shock wave lithotripsy (P‐ESWL) is a first‐line treatment for chronic pancreatitis (CP) patients with pancreatic stones. However, the performance of P‐EWSL in geriatric patients remains unclear. We aimed to evaluate the safety and efficacy of P‐ESWL for them.

Methods

This prospective study was conducted in painful CP patients who underwent P‐ESWL. Patients aged over 65 years were included in geriatric group; patients aged under 65 years were assigned to control group. For the long‐term follow‐up investigation, geriatric patients were matched with patients from the control group in a 1:1 ratio. Primary outcomes were complications of P‐ESWL and pain relief. Secondary outcomes included stone clearance, physical and mental health, quality of life score, changes in exocrine and endocrine pancreatic function, and survival.

Results

From March 2011 to March 2016, P‐ESWL was performed in 1404 patients (72 in the geriatric group and 1332 in the control group). No significant differences were observed in complications of P‐ESWL between the two groups (P = 0.364). Among the 67 (67/72, 93.1%) geriatric patients who underwent follow up for 4.02 years, complete pain relief was achieved in 53 patients, which was not significantly different from that of matched controls (54/70; P = 0.920). The death in the geriatrics was significantly higher (P = 0.007), but none of them were correlated with P‐ESWL.

Conclusions

P‐ESWL is safe and effective for geriatric CP patients with pancreatic stones. It can promote significant pain relief and stone clearance and improve quality of life and mental and physical health.
Histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens in superficial esophageal squamous neoplasms
Authors: Park Young Joo , Kim Gwang Ha , Park Do Youn , Lee Sojeong , Lee Moon Won , Lee Bong Eun , Song Geun Am
Published: December 2018

Background and Aim

Endoscopic forceps biopsy results that reflect the final pathologic results of an entire lesion are essential for making accurate diagnoses and appropriate therapeutic decisions for patients with superficial esophageal squamous neoplasms (SESNs). This study investigated the histopathologic discrepancies between endoscopic forceps biopsy and endoscopic resection specimens to elucidate the factors contributing to such discrepancies.

Methods

This retrospective observational study involved 77 patients (84 lesions) who underwent endoscopic resections for SESNs, between January 2005 and August 2017, at the Pusan National University Hospital. The SESNs were classified as low‐grade intraepithelial neoplasms (LGINs), high‐grade intraepithelial neoplasms (HGINs), or squamous cell carcinomas (SCCs). Following slide reviews, the histopathologic concordance between endoscopic forceps biopsy and endoscopic resection specimens was assessed, in each case.

Results

The histopathologic discrepancy rate between the endoscopic forceps biopsy and endoscopic resection specimens was 34.5% (29/84 lesions). Among the 29 diagnostically discordant lesions, upgrades and downgrades of the histopathologic diagnoses occurred for 27 and 2 lesions, respectively. The predominant discrepancies results in lesion upgrades from HGIN to SCC (n = 21) and from LGIN to SCC (n = 5). The two downgraded cases included one from SCC to HGIN and one from HGIN to LGIN. Multivariate analyses identified two factors that were significantly associated with the histopathologic discrepancies: upper esophageal location (odds ratio, 7.743; 95% confidence interval, 1.031–58.174; P = 0.047) and tumor area per biopsy ≥ 158.6 mm2/biopsy (odds ratio, 5.933; 95% confidence interval, 1.051–44.483; P = 0.044).

Conclusion

Histopathologic discrepancies were observed between endoscopic forceps biopsy and endoscopic resection specimens in patients with SESNs. Tumor location and tumor area/biopsy were both significantly associated with the discrepancies.
Percutaneous endoscopic gastrostomy in older patients with and without dementia: Survival and ethical considerations
Authors: van Bruchem‐Visser Rozemarijn Lidewij , Mattace‐Raso Francesco Umberto Salvatore , de Beaufort Inez Duconia , Kuipers Ernst Johan
Published: December 2018

Background and Aim

Notwithstanding multiple recommendations in guidelines, percutaneous endoscopic gastrostomy (PEG)‐tube placement is still performed in patients with dementia. In this study, we aim to investigate survival in patients with and without dementia after PEG‐tube placement.

Methods

We conducted a retrospective multicenter study in four different hospitals in the Netherlands. Furthermore, we explored the ethical considerations that may play a role in the decision whether or not to insert a PEG tube in a patient with dementia.

Results

Three‐hundred‐and‐three patients were included, mean age of 77.4 years. Forty‐two (13.9%) patients had dementia. Short‐term complications did not differ between patients with and without cognitive disorders (P 0.224). However, patients with dementia survived significantly shorter after PEG placement than did patients without dementia. Adjusted for age and sex, patients with dementia had a 49% increased risk of mortality (hazard ratio 1.49, 95% confidence interval 1.01–2.19). In our exploratory literature search, we found that several ethical concerns and considerations play a role in the decision process of PEG placement. These considerations are both medical and nonmedical and include beliefs regarding the benefits of a PEG tube, a lack of knowledge about the natural course of dementia in both professionals and family of patients, and a fear of letting a patient die hungry.

Conclusions

Patients with dementia had higher mortality rates after PEG placement than patients without dementia. Although multiple ethical concerns and considerations play a role, insertion of a PEG tube in patients with dementia is not appropriate.
Unit Leadership and Climates for Evidence‐Based Practice Implementation in Acute Care: A Cross‐Sectional Descriptive Study
Authors: Shuman Clayton J. , Powers Katherine , Banaszak‐Holl Jane , Titler Marita G.
Published: December 2018

Purpose

The purposes of this study were to (a) describe nurse manager (NM) leadership behaviors for evidence‐based practice, NM evidence‐based practice competencies, and unit climates for evidence‐based practice implementation in acute care, and (b) test for differences in NMs’ and staff nurses’ (RNs’) perceptions.

Design

A multisite cross‐sectional design was used to collect data from a sample of 24 NMs and 553 RNs from 24 adult medical‐surgical units in seven U.S. community hospitals.

Methods

Responses were collected using electronic questionnaires, inclusive of the Nurse Manager Evidence‐Based Practice Competency Scale (NM only), Implementation Leadership Scale, and Implementation Climate Scale. E‐mail reminders and gift card lottery drawings encouraged response. Descriptive statistics described total and subscale scores by role. Differences in perceptions were evaluated using independent t‐tests with Bonferroni correction (α = .05).

Findings

23 NMs and 287 RNs responded (95.8% and 51.9% response rates, respectively). NMs reported they were “somewhat competent” in evidence‐based practice (M = 1.62 [SD = 0.5]; 0–3 scale). NMs and RNs perceived leadership behaviors (NM: M = 2.73 [SD = 0.46]; RN: M = 2.88 [SD = 0.78]; 0–4 scale) and unit climates for evidence‐based practice implementation (NM: M = 2.16 [SD = 0.67]; RN: M = 2.24 [SD = 0.74]; 0–4 scale) as evident to a “moderate extent.” RN and NM perceptions differed significantly on the Proactive (p = .01) and Knowledgeable (p < .001) leadership subscales.

Conclusions

Evidence‐based practice competencies and leadership behaviors of NMs, and unit climates for evidence‐based practice were modest at best and interventions are needed. To close the research to practice gap, future studies should investigate the interplay between social dynamic context factors and implementation strategies to promote uptake of evidence‐based practices.

Clinical Relevance

Critical attention is needed to build organizational capacity for evidence‐based practices through development of unit leadership and climate for evidence‐based practice to accelerate routine use of evidence‐based practices for improving care delivery and patient outcomes. The three instruments described herein provide a foundation for nurse leaders to assess these dynamic context factors and design interventions or programs where there is opportunity for improvement.
Newly graduated nurses' experiences of a trainee programme regarding the introduction process and leadership in a hospital setting—A qualitative interview study
Authors: Gellerstedt Linda , Moquist Annelie , Roos Anette , Karin Bergkvist , Craftman Åsa Gransjön
Published: December 2018

Aim and objectives

This study aimed to describe newly graduated nurses' experiences of introduction processes and leadership within a hospital trainee programme.

Background

For many, being a newly graduated nurse is associated with stress, influenced by the challenge of the transition to independent nurse, coupled with the loss of mentorship due to nurse turnover and rapidly changing demands.

Methods

A qualitative design with an inductive approach was chosen, and four focus groups were convened. A total of nineteen nurses were included in the study. Data were analysed using qualitative content analysis. COREQ was used as EQUATOR checklist.

Findings

The analysis resulted in three themes: Need for an introduction when facing a complex reality, Striving to stand on my own and The importance of having an accessible and multiskilled manager. The transition is a complex, dynamic and demanding process.

Conclusions

The orientation process from student to becoming an independent nurse is a challenging period. A flexible manager and a readily accessible leadership facilitate the newly graduated nurse's striving to become an independent nurse. The study demonstrates that a trainee programme and support are essential in this process. There are indications that today's newly graduated nurses have high expectations of coaching from the manager during the orientation process.

Relevance to clinical practice

The hospital setting and its organisation are rapidly changing in relation to the increasing number of patients and their health status. In addition, there is a need for newly graduated nurses to secure regrowth, to fill the ranks of experienced nurses leaving the field. Newly graduated nurses increasingly perceive a gap between their training and clinical realities, thus necessitating changes in tutoring and their introduction to the work.
Parents’ experiences of donation to their child before kidney transplantation: A qualitative study
Authors: Agerskov Hanne , Thiesson Helle , Specht Kirsten , D. Pedersen Birthe
Published: December 2018

Aim and objectives

To explore parents’ experiences of donation to their child before kidney transplantation.

Background

Transplantation is the treatment of choice for paediatric patients with end‐stage renal disease. Living donor kidney transplantation has shown a higher long‐term transplant survival compared to deceased donor transplantation and entails a more controllable process, with shorter waiting time. Besides complex care and treatment of their child, parents must reflect on the prospects of being a donor for their child. However, little is known about the parent donor and parent caregiver perspective.

Design

A qualitative exploratory study taking a phenomenological‐hermeneutic approach.

Method

The study was conducted in a Danish university hospital. Interviews were conducted with the parents of seven children, aged between 5–15 years, with end‐stage renal disease in the period before kidney transplantation. Data were analysed with inspiration from Ricoeur's theory of interpretation on three levels: naïve reading, structural analysis and critical interpretation and discussion.

Results

The decision about donation was experienced as a matter of course and commitment. There were preferences for a kidney from a living donor, including the hope of being accepted as a donor. Being refused as a donor revealed feelings of powerlessness. However, transformation was performed into having a new role providing care and comfort to the child during the transplant process. Asking family and friends about donation could feel like crossing a line.

Conclusion

The prospect of donating to one's child had an impact on the well‐being of the entire family. Parents were in a vulnerable situation and in need of support, regarding both living and deceased donation. Waiting time included hopeful thoughts and reflections on a new caregiver role for the child during transplantation.

Relevance to clinical practice

Health professionals’ attention, engagement and dialogue are essential in order to gain extensive and varied knowledge about the individual parent's experiences and the well‐being of the entire family to provide care and support before, during and after the donation and transplantation process.