bluuebunny/crossref_metadata_2025 huggingface dataset:
Multidisciplinary team training reduces the decision‐to‐delivery interval for emergency Caesarean section
Authors: Fuhrmann L. , Pedersen T. H. , Atke A. , Møller A. M. , Østergaard D.
Published: June 2015

Background

Emergency Caesarean section is performed when the life of the pregnant woman and/or the foetus is considered at risk. A 30‐min standard for the decision‐to‐delivery interval (DDI) is a common practice and is supported by national organisations including The Danish Society of Obstetrics and Gynaecology. Danish obstetric departments report the DDI to a national database. A national arbitrarily set standard recommends that 95% of ECSs should be achieved within the 30‐min DDI standard. In 2011, 34.4% of ECSs, performed at our hospital, were achieved within the 30‐min time frame. This study aims to evaluate the effect of a simulation‐based team training programme on the proportion of ECSs achieved within a 30‐min time frame.

Method

We performed an interventional before‐and‐after study. We evaluated a total of one hundred 30‐min ECSs before and after the intervention. The primary outcome of interest was the proportion of 30‐min ECSs achieved within a 30‐min time frame.

Results

A total of 20 team training courses were held during May/June 2013. These courses trained 239 of 252 team members (comprised of: 36 obstetricians, 45 scrub nurses, 83 midwifes, 38 anaesthesiologists, 37 nurse anaesthetists) in handling of 30‐min ECS. This corresponds to 95% of staff. The proportion of 30‐min ECSs achieved within a 30‐min time frame was higher after team training (87.5%, 95% CI 79.2–93.4%) compared with before training (74.0%, 95% CI 64.0–82.4%) (P = 0.017).

Conclusion

Team training may contribute positively to an increase in the proportion of ECSs achieved within a 30‐min time frame.
Effect‐site concentration of remifentanil for attenuating QTc interval prolongation following intubation in hypertensive female patients
Authors: Kim E. J. , Han D. W. , Song M. K. , Choi S. Y. , Kim S. Y.
Published: June 2015

Background

Haemodynamic changes after sympathetic stimuli like tracheal intubation are more pronounced in hypertensive patients than in normotensive patients. Heart rate (HR)‐corrected QT (QTc) interval changes related to intubation may also be more prominent in hypertensive patients. We hypothesised that there would be a difference in the effect‐site concentration (Ce) of remifentanil to attenuate QTc interval prolongation in normotensive and hypertensive patients following intubation.

Methods

Twenty‐two normotensive and 22 hypertensive female patients (≥ 50 year) were enrolled and anaesthesised with remifentanil and propofol using a target‐controlled infusion. All hypertensive patients received oral antihypertensive medications for > 6 months and took the medications in the morning of the surgery. The effective concentration of remifentanil Ce in 50% (EC50) and 95% of the population (EC95) required to maintain QTc interval prolongation < 15 ms following intubation was calculated using the isotonic regression and a bootstrapping approach following the Dixon's up‐and‐down method.

Results

Median duration of hypertension was 6 years. Isotonic regression revealed that the EC50 (83% confidence interval) of remifentanil Ce for reducing QTc interval prolongation following intubation was 3.8 (3.5‐4.1) ng/ml in normotensive and 6.1 (5.8–6.2) ng/ml in hypertensive female patients. The EC95 (95% confidence interval) of remifentanil Ce was 4.4 (4.3–4.5) ng/ml in normotensive and 6.5 (6.4–6.5) ng/ml in hypertensive female patients.

Conclusion

The Ce of remifentanil required to attenuate QTc interval prolongation following intubation was significantly higher in hypertensive patients than it was in normotensive patients. Thus, more caution should be taken related to QTc interval prolongation when intubating hypertensive patients.
Investigating rehabilitation needs of visually impaired young adults according to the International Classification of Functioning, Disability and Health
Authors: van Leeuwen Lisette M. , Rainey Linda , Kef Sabina , van Rens Ger H. M. B. , van Nispen Ruth M. A.
Published: June 2015

Purpose

To gain qualitative insight into the rehabilitation needs of visually impaired young adults (18–25 years) and how these needs relate to the International Classification of Functioning, Disability and Health (ICF) and patient characteristics.

Methods

Rehabilitation needs and patient characteristics of young adults (N = 392) who applied for multidisciplinary services in 2012 and 2013 were obtained from structured and semi‐structured intake records. Linking rules were used to assess how the needs related to Environmental Factors, Body Functions, Body Structures, and Activity and Participation (A&P) ICF components. The relationship between the type of rehabilitation goal and patient characteristics was assessed using multivariate logistic regression analyses.

Results

Most rehabilitation needs (67.6%; N = 510) were found on the A&P component of the ICF. Most prevalent needs were related to ‘major life areas’ (e.g. finding internship or job), followed by the chapters: ‘mobility’ (e.g. self‐reliance in travelling), ‘communication’ (e.g. using communication devices and techniques), ‘general tasks and demands’ (e.g. psychological aspects of vision loss) and ‘domestic life’ (e.g. household tasks). Patients in one of the multidisciplinary rehabilitation centres (odds ratio (OR) = 7.07; 95% confidence interval (CI) [2.97–16.83]) and patients with comorbidity (OR = 3.82; 95% CI [1.62–9.02]) were more likely to report rehabilitation needs related to chapter E3 ‘support and relationships’.

Conclusion

‘Major life areas’ prevail in the content of rehabilitation needs, but tend to overshadow topics regarding peer interaction and social, community and civic life. A suitable survey method for young adults with visual impairments is required that contains rehabilitation domains and goals relevant to their lives and development.
Clinical application of 3D display device in ophthalmology: measurement of metamorphopsia
Authors: Kim Ji Won , Kim Yun Taek
Published: June 2015

Purpose

To develop a new tool for detecting metamorphopsia.

Method

Evaluation of diagnostic test. Novel tool for measuring metamorphopsia was developed using commercial 3D display. Fifty‐eight patients diagnosed with macular disease, which included epiretinal membrane, age‐related macular degeneration, central serous chorioretinopathy and macular hole, as confirmed by macular optical coherence tomography were tested with Amsler grid and novel method. The subjective perception of metamorphopsia and its effect on the lives of the participants with macular disease was also evaluated using a brief questionnaire. The sensitivity and specificity to subjective perception of metamorphopsia were compared.

Results

The sensitivity and specificity were 66.7% and 97.7%, respectively, using the Amsler grid test, and 100% and 90.7%, respectively, using the 3D novel metamorphopsia test developed for this study.

Conclusions

The detection rate of metamorphopsia in macular disease using novel metamorphopsia test was significantly higher than that using the Amsler grid test. This novel approach to detecting for metamorphopsia can also be used at home for self‐assessment.
Macrolides do not affect the incidence of moderate and severe bronchopulmonary dysplasia in symptomatic ureaplasma‐positive infants
Authors: Anbu Chakkarapani Aravanan , Paes Bosco , Shivananda Sandesh
Published: June 2015

Aim

The aim of this study was to compare the incidence of bronchopulmonary dysplasia (BPD) in symptomatic ureaplasma‐positive treated preterm infants and asymptomatic preterm infants not tested or treated for ureaplasma.

Methods

A retrospective matched cohort study was conducted in a tertiary, neonatal unit between January 2007 and December 2012. Infants ≤29 completed weeks with signs and symptoms suggesting ureaplasma pneumonia who received macrolides comprised the study group. Infants ≤29 weeks without signs and symptoms not tested or treated with macrolides were the controls. Infants were mandatorily matched for gestational age ± one week or birthweight ± 100 grams.

Results

There were 31 infants in the study group and 62 in the control group. The baseline demographic data of both groups were similar on the whole. The incidence of moderate and severe BPD, defined by oxygen dependency or the need for continuous positive airway pressure at 36 weeks of postconceptual age, was 45.2% in the study group and 40.3% in the controls (p = 0.65). There was no significant difference in morbidities or mortality between the groups.

Conclusion

A selective approach of treating symptomatic ureaplasma‐positive preterm infants with macrolides did not affect the incidence of moderate and severe BPD.
Randomised clinical trial: gut microbiome biomarkers are associated with clinical response to a low FODMAP diet in children with the irritable bowel syndrome
Authors: Chumpitazi B. P. , Cope J. L. , Hollister E. B. , Tsai C. M. , McMeans A. R. , Luna R. A. , Versalovic J. , Shulman R. J.
Published: June 2015

Background

A low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet can ameliorate symptoms in adult irritable bowel syndrome (IBS) within 48 h.

Aim

To determine the efficacy of a low FODMAP diet in childhood IBS and whether gut microbial composition and/or metabolic capacity are associated with its efficacy.

Methods

In a double‐blind, crossover trial, children with Rome III IBS completed a 1‐week baseline period. They then were randomised to a low FODMAP diet or typical American childhood diet (TACD), followed by a 5‐day washout period before crossing over to the other diet. GI symptoms were assessed with abdominal pain frequency being the primary outcome. Baseline gut microbial composition (16S rRNA sequencing) and metabolic capacity (PICRUSt) were determined. Metagenomic biomarker discovery (LEfSe) compared Responders (≥50% decrease in abdominal pain frequency on low FODMAP diet only) vs. Nonresponders (no improvement during either intervention).

Results

Thirty‐three children completed the study. Less abdominal pain occurred during the low FODMAP diet vs. TACD [1.1 ± 0.2 (SEM) episodes/day vs. 1.7 ± 0.4, P < 0.05]. Compared to baseline (1.4 ± 0.2), children had fewer daily abdominal pain episodes during the low FODMAP diet (P < 0.01) but more episodes during the TACD (P < 0.01). Responders were enriched at baseline in taxa with known greater saccharolytic metabolic capacity (e.g. Bacteroides, Ruminococcaceae, Faecalibacterium prausnitzii) and three Kyoto Encyclopedia of Genes and Genomes orthologues, of which two relate to carbohydrate metabolism.

Conclusions

In childhood IBS, a low FODMAP diet decreases abdominal pain frequency. Gut microbiome biomarkers may be associated with low FODMAP diet efficacy.

ClinicalTrials.gov identifier: NCT01339117.
Why is Pain Still Under‐Treated in the Emergency Department? Two New Hypotheses
Authors: Carter Drew , Sendziuk Paul , Eliott Jaklin A. , Braunack‐Mayer Annette
Published: June 2015

Across the world, pain is under‐treated in emergency departments (EDs). We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain's under‐treatment in the ED is due partly to (1) an epistemic preference for signs over symptoms on the part of some practitioners, and (2) some ED practices that themselves worsen pain by increasing patients' anxiety and fear. Our argument includes the following logic. Some ED practitioners depart from formal guidance in basing their acute pain assessments on observable features rather than on patient reports of pain. This is potentially due to an epistemic preference for signs over symptoms which aims to circumvent intentional and/or unintentional misrepresentation on the part of patients. However, conducting pain assessments in line with this epistemic preference contributes to the under‐treatment of pain in at least three respects, which we detail. Moreover, it may do little to help the practitioner circumvent any intentional misrepresentation on the part of the patient, as we explain. Second, we examine at least four ED practices that may be contributing to the under‐treatment of pain by increasing patient anxiety and fear, which can worsen pain. These practices include failing to provide orienting information and partially objectifying patients so as to problem‐solve along lines pre‐established by modern medical science. We conclude by touching on some potential solutions for ED practice.
Risks, severity and timing of infections in patients with multiple myeloma: a longitudinal cohort study in the era of immunomodulatory drug therapy
Authors: Teh Benjamin W. , Harrison Simon J. , Worth Leon J. , Spelman Tim , Thursky Karin A. , Slavin Monica A.
Published: June 2015

We defined the epidemiology and clinical predictors of infection in patients with multiple myeloma (MM) receiving immunomodulatory drugs (IMiDs), proteasome inhibitors (PI) and autologous haematopoietic stem cell transplant (ASCT) in a large longitudinal cohort study. Clinical and microbiology records of patients with MM diagnosed between January 2008 and December 2012 were reviewed to capture patient demographics, characteristics of myeloma and infections (type, severity, outcomes). Conditional risk set modelling was used to determine clinical predictors of infection. One hundred and ninety‐nine patients with MM with 771 episodes of infection were identified. 44·6% of infections were clinically defined, 35·5% were microbiologically defined and 19·9% were fever of unknown focus. There was a bimodal peak in incidence of bacterial (4–6 and 70–72 months) and viral infections (7–9 and 52–54 months) following disease diagnosis. Chemotherapy regimens high‐dose melphalan [hazard ratio (HR) = 2·07], intravenous cyclophosphamide (HR = 1·96) and intensive combination systemic chemotherapy (HR = 1·86) and cumulative doses of corticosteroid (HR = 3·06 at highest dose) were independently associated with increased risk of infection overall (P < 0·05). IMiDs and PI and other clinical factors were not independently associated with increased risk of infection. New approaches to prevention and treatment of infection should focus upon identified periods of risk and treatment‐related risk factors.
HbA2: biology, clinical relevance and a possible target for ameliorating sickle cell disease
Authors: Steinberg Martin H. , Rodgers Griffin P.
Published: June 2015

HbA2, a tetramer of α‐ and δ‐globin chains, provides a diagnostic clue to the presence of β‐thalassaemia trait. This minor haemoglobin, which forms about 2–3% of the total, has no known physiological role, but has the interesting property of preventing polymerization of deoxy‐sickle haemoglobin. If it were possible to increase the level of HbA2 sufficiently it could have a benefit in sickle cell disease similar to that of foetal haemoglobin. Moreover, HbA2 is present in all erythrocytes, an advantage not found with foetal haemoglobin, which is heterocellularly expressed. The molecular basis of HbA2 gene (HBD) expression is partially understood, and with new molecular tools, it might be possible to induce levels of HbA2 that could be clinically important. However, high concentrations of this positively charged haemoglobin might damage the erythrocyte membrane; also, the reciprocal relationship of δ‐ and γ‐globin gene (HBD and HBG1/2, respectively) expression might negate any benefit of increasing transcription of the former.
RNAi Silencing of IL‐1β and TNF‐α in the Treatment of Post‐traumatic Arthritis in Rabbits
Authors: Tang Qiang , Hao Liang , Peng Yuanxiang , Zheng Yating , Sun Kuo , Cai Feng , Liu Chunlong , Liao Qi
Published: June 2015

Post‐traumatic arthritis is a secondary complication to severe joint trauma. With the disease progression, it may eventually lead to osteoarthritis in patients whose age is considerably younger than patients with traditional bone arthritis. The main objective of this study was to explore the feasibility of using lentiviral‐mediated RNA interference silencing of IL‐1β and TNF‐α to treat post‐traumatic arthritis in rabbits. About 48 New Zealand rabbits underwent bilateral knee joint surgery to stimulate traumatic arthritis. They were then randomly divided into four groups of 12 rabbits each. The histopathology of the cartilage was observed, and the changes were assessed by Mankin scoring. ELISA was used to detect the expression of IL‐1β and TNF‐α in the synovial fluid. (i) Compared with the control group, the transfection and co‐transfected groups displayed reduced cartilage damage and speed of degeneration. The co‐transfected group showed the greatest alleviation of symptoms. The Mankin score was statistically different (p < 0.01). (ii) Compared with the control group, the expression of IL‐1β or TNF‐α was reduced in the respective transfection groups (p < 0.01 in both groups) and IL‐1β and TNF‐α were reduced in the co‐transfected group (p < 0.01). The co‐transfected group showed the lowest expression of the three experimental groups of both IL‐1β and TNF‐α (p < 0.01). Lentivirus‐mediated RNA interference can knock down the expression of IL‐1β and TNF‐α in joint fluids and, in a synergistic effect when two siRNAs are co‐transfected, ease cartilage degeneration.
Fetal outcome of trisomy 18 diagnosed after 22 weeks of gestation: Experience of 123 cases at a single perinatal center
Authors: Nagase Hiromi , Ishikawa Hiroshi , Toyoshima Katsuaki , Itani Yasufumi , Furuya Noritaka , Kurosawa Kenji , Hirahara Fumiki , Yamanaka Michiko
Published: June 2015

To investigate the pregnancy outcome of the fetuses with trisomy 18, we studied 123 cases of trisomy 18 who were born at our hospital from 1993 to 2009. Among them, 95.9% were diagnosed with trisomy 18 prenatally. Prenatal ultrasound findings showed fetal growth restriction in 77.2%, polyhydramnios in 63.4% and congenital heart defects in 95.1%. For 18 cases, cesarean section (C‐section) was chosen, and for 75 cases, transvaginal delivery was chosen. Premature delivery occurred in 35.5%. Stillbirths occurred in 50 cases (40.7%). Fetal demise before onset of labor occurred in 30 cases and fetal demise during labor occurred in 20 cases which was 26.7% of vaginal deliveries. Among the 73 live‐born infants, the survival rate for 24 h, 1 week, 1 month and 1 year were 63%, 43%, 33% and 3%. The median survival time was 3.5 days. There was no significant difference between the survival time of C‐section and that of vaginal delivery. However, for the births involving breech presentation, the survival time of C‐section was significantly longer than that of vaginal delivery. When the fetus is diagnosed with trisomy 18, the parents have to make many choices. These findings constitute critical information in prenatal counseling to the couples whose fetuses have been found to have trisomy 18, especially when they choose palliative approaches in the perinatal management.
Diabetes telemonitoring reduces the risk of hypoglycaemia during Ramadan: a pilot randomized controlled study
Authors: Lee J. Y. , Lee S. W. H. , Nasir N. H. , How S. , Tan C. S. S. , Wong C. P.
Published: June 2015

Aim

This pilot study evaluated the short‐term benefits of a telemonitoring‐supplemented focused diabetic education compared with education alone in participants with Type 2 diabetes who were fasting during Ramadan.

Methods

In this pilot mixed‐method study, we identified 37 participants and randomly allocated them to either a telemonitoring group (n = 18) or a group receiving Ramadan‐focused pre‐education only (usual care; n = 19). The telemonitoring group received goal‐setting and personalized feedback.

Results

The telemonitoring group was less likely to experience hypoglycaemia than the usual care group (odds ratio: 0.1273; 95% confidence interval: 0.0267–0.6059). No significant differences were noted in glycaemic control at the end of study. Participants viewed telemedicine as a more convenient alternative although technological barriers remain a concern.

Conclusions

The results of this study reinforce the need for monitoring as well as educational initiatives for Muslims with diabetes who fast during Ramadan. Telemonitoring offers an attractive option requiring further research. (Clinical Trial Registry No. NCT02189135)
Efficacy and safety of antihyperglycaemic drug regimens added to metformin and sulphonylurea therapy in Type 2 diabetes: a network meta‐analysis
Authors: Mearns E. S. , Saulsberry W. J. , White C. M. , Kohn C. G. , Lemieux S. , Sihabout A. , Salamucha I. , Coleman C. I.
Published: June 2015

Aim

To assess the efficacy and safety of third‐line adjuvant antihyperglycaemic agents in people with Type 2 diabetes mellitus failing metformin and sulphonylurea combination therapy.

Methods

We searched MEDLINE, CENTRAL, clinicaltrials.gov and regulatory websites, and conducted a manual search of references in the identified studies. Randomized trials evaluating antihyperglycaemic agents in adults with Type 2 diabetes experiencing poor glycaemic control despite optimized metformin and sulphonylurea therapy (≥ 1500 mg metformin or maximum tolerated dose; ≥ 50% of maximum sulphonylurea dose for ≥ 3 weeks) were included. Data extraction included: study characteristics; change in HbA1c concentration; weight; systolic blood pressure; and relative risk of hypoglycaemia, urinary tract infections; and genital tract infections. A network meta‐analysis was performed.

Results

A total of 20 trials evaluating 13 antihyperglycaemic agents were included. Compared with placebo/control, all antihyperglycaemic agents reduced HbA1c levels, albeit by differing magnitudes [range 7 mmol/mol (0.6%) for acarbose to 13 mmol/mol (1.20%) for liraglutide]. Sodium glucose cotransporter‐2 inhibitors reduced weight (1.43–2.07 kg) whereas thiazolidinediones, glargine and sitagliptin caused weight gain (1.48–3.62 kg) compared with placebo/control. Sodium glucose cotransporter‐2 inhibitors, rosiglitazone and liraglutide decreased systolic blood pressure compared with placebo/control, pioglitazone, glargine and sitagliptin (2.41–8.88 mm Hg). Glargine, thiazolidinediones, liraglutide, sitagliptin and canagliflozin increased hypoglycaemia risk compared with placebo/control (relative risk 1.92–7.47), while glargine and rosiglitazone increased hypoglycaemia compared with most antihyperglycaemic agents (relative risk 2.81–7.47). No antihyperglycaemic agent increased the risk of urinary tract infection, but canagliflozin increased the risk of genital tract infection by 3.9‐fold compared with placebo/control.

Conclusions

When added to metformin and a sulphonylurea, antihyperglycaemic agents had varying effects on efficacy and safety endpoints. These conclusions should be considered when clinicians choose between possible adjunctive agents.
Resistance exercise training increases lower limb speed of strength generation during stair ascent and descent in people with diabetic peripheral neuropathy
Authors: Handsaker J. C. , Brown S. J. , Bowling F. L. , Maganaris C. N. , Boulton A. J. M. , Reeves N. D.
Published: June 2015

Aim

To examine the effects of a 16‐week resistance exercise training intervention on the speed of ankle and knee strength generation during stair ascent and descent, in people with neuropathy.

Methods

A total of 43 people: nine with diabetic peripheral neuropathy, 13 with diabetes but no neuropathy and 21 healthy control subjects ascended and descended a custom‐built staircase. The speed at which ankle and knee strength were generated, and muscle activation patterns of the ankle and knee extensor muscles were analysed before and after a 16‐week intervention period.

Results

Ankle and knee strength generation during both stair ascent and descent were significantly higher after the intervention than before the intervention in the people with diabetes who undertook the resistance exercise intervention (P < 0.05). Although muscle activations were altered by the intervention, there were no observable patterns that underpinned the observed changes.

Conclusions

The increased speed of ankle and knee strength generation observed after the intervention would be expected to improve stability during the crucial weight acceptance phase of stair ascent and descent, and ultimately contribute towards reducing the risk of falling. Improvements in muscle strength as a result of the resistance exercise training intervention are likely to be the most influential factor for increasing the speed of strength generation. It is recommended that these exercises could be incorporated into a multi‐faceted exercise programme to improve safety in people with diabetes and neuropathy.
Rate and pattern of interproximal dental attrition
Authors: Sarig Rachel , Hershkovitz Israel , Shpack Nir , May Hila , Vardimon Alexander D.
Published: June 2015

Although occlusal and interproximal attrition occur because of diverse etiology and present dissimilar features, both progress with age. The objectives of this study were to reveal the rate and pattern of development of interproximal attrition facets (PAF) with age and to compare those with occlusal attrition (OA) changes. Five‐hundred and ninety‐four teeth were collected from 198 skulls (of adults, 20–71 yr of age). Three mandibular teeth [first premolar (P1), second premolar (P2), and first molar (M1)] were examined for PAF size and OA rate. Interproximal attrition and OA followed similar patterns of development until subjects reached 40–45 yr of age, after which they took different paths: PAF did not increase in size and were not as large as in younger groups, regardless of facet location, whereas OA continued to progress. The PAF changes with age differed between premolars and molars, unlike OA, which presented a similar rate for all teeth studied. Although OA scores presented significantly moderate correlations with age, PAF area size demonstrated low correlations with age. Low, but significant, correlations were found between the rate of OA and that of PAF. However, PAF and OA exhibited different patterns of development with age. Premolars and molars presented dissimilar development of PAF, which is probably caused by a unique attrition pattern in the molar teeth, different morphology, and force vectors.
The status of supergenes in the 21st century: recombination suppression in Batesian mimicry and sex chromosomes and other complex adaptations
Authors: Charlesworth Deborah
Published: June 2015

I review theoretical models for the evolution of supergenes in the cases of Batesian mimicry in butterflies, distylous plants and sex chromosomes. For each of these systems, I outline the genetic evidence that led to the proposal that they involve multiple genes that interact during ‘complex adaptations’, and at which the mutations involved are not unconditionally advantageous, but show advantages that trade‐off against some disadvantages. I describe recent molecular genetic studies of these systems and questions they raise about the evolution of suppressed recombination. Nonrecombining regions of sex chromosomes have long been known, but it is not yet fully understood why recombination suppression repeatedly evolved in systems in distantly related taxa, but does not always evolve. Recent studies of distylous plants are tending to support the existence of recombination‐suppressed genome regions, which may include modest numbers of genes and resemble recently evolved sex‐linked regions. For Batesian mimicry, however, molecular genetic work in two butterfly species suggests a new supergene scenario, with a single gene mutating to produce initial adaptive phenotypes, perhaps followed by modifiers specifically refining and perfecting the new phenotype.
Diversification, Organization, and Value of the Firm
Authors: Ushijima Tatsuo
Published: June 2015

Because corporate diversification coevolves with organizational structure, a discount for diversification, which is widely documented in the literature, can be caused by organizational structure rather than by the industrial scope of the firm. I examine this possibility based on a large sample of Japanese firms for which the legal (parent–subsidiary) structure of the organization is easily observable. I identify a significant discount for diversified firms with and without control over the organizational structure. I also find that firms with a legally segmented structure (e.g., holding companies) are deeply discounted. My results suggest that diversification and organization are both important determinants of firm value.
Development of resources to promote best practice in the humane dispatch of finfish caught by recreational fishers
Authors: Diggles B. K.
Published: June 2015

Dispatch of finfish using the ikijime method (also known as ikejime or brain spiking) is the fastest and most humane way to kill fish. However, fish brains are small and vary in location between species groups. Without guidance, recreational fishers can find it difficult to pith the brain of a live fish accurately, potentially resulting in unnecessary stress. A lack of information on how to perform ikijime was considered a barrier to the widespread uptake of this method. This project filled the information gap by developing resources that provide accurate information on the ikijime procedure and pinpoint the location of the brain of fish commonly captured by recreational fishers. To assist with communicating this information to recreational fishers and the broader community, a new website www.ikijime.com was developed, together with the Ikijime Tool series of phone apps, which provide access to interactive photograph/radiograph overlays revealing the brain location of 100 species of fish from 38 families. These resources raise awareness of fish welfare issues and improve the ability of recreational fishers to dispatch fish humanely using best practice methods.
Efficacy of losartan for improving insulin resistance and vascular remodeling in hemodialysis patients
Authors: Sun Fang , Song Yan , Liu Jing , Ma Li‐Jie , Shen Yang , Huang Jing , Zhou Yi‐Lun
Published: June 2015

Insulin resistance and vascular remodeling are prevalent and predict cardiovascular mortality in hemodialysis patients. Angiotensin II (Ang II) may be involved in both pathogenesis. In the present study, we investigated the effects of the Ang II receptor blocker losartan on insulin resistance, arterial stiffness, and carotid artery structure in hemodialysis patients. Seventy‐two hemodialysis patients were randomly assigned to receive either losartan 50 mg qd (n = 36) or β‐blocker bisoprolol 5 mg qd (n = 36). At the start and at month 12, ambulatory blood pressure (BP) monitoring, aortic pulse wave velocity (PWV) measurements, and carotid artery ultrasound were performed, and homeostasis model assessment index of insulin resistance (HOMA‐IR) was determined. During the study period, bioimpedance method was used to evaluate volume status every 3 months. Home‐monitored BPs were measured at least monthly. Ambulatory BP decreased significantly and similarly by either losartan or bisoprolol. Decreases in PWVs in losartan group at the end of month 12 were significantly greater than changes in PWV in bisoprolol group (0.9 ± 0.3 vs. 0.4 ± 0.5 m/s, P = 0.021). Common carotid artery intima‐media cross‐sectional area decreased significantly only in patients treated with losartan (20.3 ± 4.9 vs. 19.1 ± 5.1 mm2, P = 0.001), and HOMA‐IR was also reduced in losartan group only (1.9 ± 1.0 vs. 1.7 ± 0.8, P = 0.003). Multiple regression analysis showed significant correlations between changes in PWV and changes in HOMA‐IR. With comparable BP‐lowering efficacy, losartan achieved better improvement in insulin sensitivity, arterial stiffness, and carotid artery hypertrophy in hemodialysis patients. The regression of arterial stiffness may be in part through attenuation in insulin resistance.
Effect of high‐protein supplemental therapy on subjective global assessment of CKD‐5D patients
Authors: Yuvaraj Anand , Vijayan Madhusudan , Alex Marina , Abraham Georgi , Nair Sanjeev
Published: June 2015

Adequate nutrition in patients on hemodialysis is an important step for improving the quality of life. This prospective study was undertaken to monitor the nutritional status of patients who were given high‐protein supplements on malnutrition inflammation score (MIS) and to correlate with biochemical parameters in maintenance hemodialysis (MHD) patients. This prospective study was conducted on 55 chronic kidney disease patients on MHD (37 women, 18 men), aged between 21 and 67 years. Of the 55 patients, 26 patients received high‐protein commercial nutritional supplements, whereas 29 patients received high‐protein kitchen feeding. Every patient had their MIS, 24‐hour dietary recall, hand grip, mid arm circumference, triceps skin‐fold thickness at 0, 3, and 6 months. Each of the above parameters was compared between the high‐protein commercial nutritional supplement cohort and high‐protein kitchen feeding cohort, and the data were analyzed. Of the 55 patients, 82.61% of patients on high‐protein kitchen feeding group and 66.67% in high‐protein commercial nutritional supplement group were nonvegetarian (P = 0.021). According to the MIS, improvement was observed in malnutrition status from 3‐ to 6‐month period in 38.1% of patients in high‐protein commercial supplement group, whereas only in 8.7% in high‐protein kitchen feeding group (P = 0.04). Assessment showed improvement in malnutrition status with high‐protein commercial nutritional supplement, which was marked in patients with age group >65 years (P = 0.03) and in those in whom serum albumin is <35 g/L (P = 0.02). Both high‐protein kitchen feeding and high‐protein commercial nutritional supplement cohorts were observed to have improvement in overall nutritional status. Older patients >65 years with lower serum albumin levels (<3.5 g/dL) were observed to have significant improvement in nutritional status with high‐protein commercial nutritional supplements.
Tailored versus Triple plus Bismuth or Concomitant Therapy as Initial Helicobacter pylori Treatment: A Randomized Trial
Authors: Zhou Liya , Zhang Jianzhong , Song Zhiqiang , He Lihua , Li Yanqing , Qian Jiaming , Bai Peng , Xue Yan , Wang Ye , Lin Sanren
Published: June 2015

Background

With markedly increased antibiotic resistance and unsatisfactory efficacies of common empiric eradication regimens in the mainland of China, tailored therapy may be the best choice to achieve good efficacy. This study compared the eradication rates, safety, and compliance of tailored therapy to those of triple therapy plus bismuth and concomitant therapy in the naïve patients with Helicobacter pylori infection.

Materials and Methods

Between September 2013 and April 2014, 1050 patients with H. pylori infection at three tertiary hospitals were randomly assigned to 10‐day treatment with tailored, triple plus bismuth, or concomitant regimens. In tailored therapy, medications were adjusted according to clarithromycin sensitivity and cytochrome P450 isoenzyme 2C19 genotype. The antimicrobial susceptibility testing (E test) was performed. Eradication status was assessed 4–12 weeks after treatment.

Results

The eradication rate was significantly higher in tailored group than in triple plus bismuth and concomitant groups in both intention‐to‐treat (88.7 vs 77.4 vs 78.3%, p < .001) and per‐protocol (93.3 vs 87.0 vs 87.4%, p = .021) analyses in a setting with high antibiotic resistance (clarithromycin 48.8%, metronidazole 65.7%, and dual resistance 35.3%). Significantly, fewer adverse effects occurred in tailored group than in concomitant group (22.0 vs 31.7%, p = .018). The eradication rates of dual clarithromycin and metronidazole resistance, isolated clarithromycin resistance, isolated metronidazole resistance, and dual susceptible were 78.7, 82.4, 94.8, and 94.4% in triple therapy plus bismuth and 75.9, 87.2, 92.9, and 95.2% in concomitant therapy, respectively.

Conclusions

First‐line tailored therapy achieves significantly higher eradication rates and fewer side effects, compared to triple therapy plus bismuth and concomitant therapy in a setting with high rates of clarithromycin and metronidazole resistance.
The ability of Schisandra chinensis fruit to inhibit the growth of foodborne pathogenic bacteria and the viability and heat resistance of Bacillus cereus spores
Authors: Bai Xuezhi , Park Il Beom , Hwang Han‐Joon , Mah Jae‐Hyung
Published: June 2015

The objective of this study was to investigate the influence of Schisandra chinensis fruit on the growth of spoilage and pathogenic bacteria and on the viability and heat resistance of Bacillus cereus spores. Schisandra chinensis fruit was extracted with one of three different solvents (50% ethanol, 100% ethanol and distilled water), and the extracts exhibited antimicrobial activity against all the bacteria tested. Particularly, the ethanol extracts of S. chinensis fruit had the strongest activity, in a concentration‐dependent manner. Fractionation of extracts by ion chromatography revealed that the antimicrobial activity of S. chinensis fruit is mainly due to organic acids such as citric acid and malic acid. Meanwhile, S. chinensis fruit extract (10%) significantly reduced the viability and heat resistance of B. cereus spores. Therefore, this study suggests that S. chinensis fruit extract has potential as a natural food preservative and/or sanitising agent for the reduction of spoilage and pathogenic contamination.
Internal Quality Control Practices in Coagulation Laboratories: recommendations based on a patterns‐of‐practice survey
Authors: McFarlane A. , Aslan B. , Raby A. , Moffat K. A. , Selby R. , Padmore R.
Published: June 2015

Introduction

Internal quality control (IQC) procedures are crucial for ensuring accurate patient test results. The IQMH Centre for Proficiency Testing conducted a web‐based survey to gather information on the current IQC practices in coagulation testing.

Methods

A questionnaire was distributed to 174 Ontario laboratories licensed to perform prothrombin time (PT) and activated partial thromboplastin time (APTT).

Results

All laboratories reported using two levels of commercial QC (CQC); 12% incorporate pooled patient plasma into their IQC program; >68% run CQC at the beginning of each shift; 56% following maintenance, with reagent changes, during a shift, or with every repeat sample; 6% only run CQC at the beginning of the day and 25% when the instruments have been idle for a defined period of time. IQC run frequency was determined by manufacturer recommendations (71%) but also influenced by the stability of test (27%), clinical impact of an incorrect test result (25%), and sample's batch number (10%). IQC was monitored using preset limits based on standard deviation (66%), precision goals (46%), or allowable performance limits (36%). 95% use multirules. Failure actions include repeating the IQC (90%) and reporting patient results; if repeat passes, 42% perform repeat analysis of all patient samples from last acceptable IQC.

Conclusion

Variability exists in coagulation IQC practices among Ontario clinical laboratories. The recommendations presented here would be useful in encouraging standardized IQC practices.
Production and Certification of Synthetic Selenium Isotopic Reference Materials
Authors: Ren Tongxiang , Wang Jun , Lu Hai , Zhou Tao , Zhou Yuanjing
Published: June 2015

Due to intensive research into selenium isotopes in recent years, the increasing requirement for reliable and comparable measurement results has created a strong demand for selenium isotopic certified reference materials (iCRM) that were previously not available. To address this, eleven selenium iCRMs were developed, including ten synthetic iCRMs (GBW 04447–GBW 04456) and one natural iCRM (GBW 04457). The synthetic iCRMs were prepared with 76Se, 78Se, 80Se and 82Se solutions and a natural selenium solution; the natural iCRM was prepared with highly pure selenium material. The property values of isotope ratios in these iCRMs were certified by calibrated mass spectrometry with a collision cell multi‐collector ICP‐MS. The mass discrimination effect of the instrument was corrected with corresponding 78Se/76Se isotope mixtures and 82Se/76Se isotope mixtures, which were gravimetrically prepared with purified, isotopically enriched selenium materials. Homogeneity and stability tests were performed, and no significant influences were found. The uncertainty of the property values of the iCRMs was evaluated according to the Guide to the Expression of Uncertainty in Measurement (GUM) of ISO/BIPM and ISO Guide 35. The δ82/76Se value of GBW 04457 relative to NIST SRM 3149 was also calculated. These iCRMs are intended for use in calibration of instruments and evaluation of methods for the determination of selenium isotope ratios.
THE GODDESS OPS IN ARCHAIC ROME
Authors: MIANO DANIELE
Published: June 2015

This article analyses the evidence on the goddess Ops in Archaic Rome, focussing on her two festivals in the archaic feriale, and on her connection with the god Consus. It contends that Ops was related to a nuanced concept of abundance, which included associations with sovereignty. At the same time, it questions the theory that Ops and Consus were associated with agriculture and granaries. It also considers the developing roles of Ops in Republican Rome, to verify if, and to what extent, they show continuity with the archaic period.
Modeling the Microstructural Evolution During Constrained Sintering
Authors: Bjørk Rasmus , Frandsen Hendrik Lund , Pryds Nini
Published: June 2015

A numerical model able to simulate solid‐state constrained sintering is presented. The model couples an existing kinetic Monte Carlo model for free sintering with a finite element model (FEM) for calculating stresses on a microstructural level. The microstructural response to the local stress as well as the FEM calculation of the stress field from the microstructural evolution is discussed. The sintering behavior of a sample constrained by a rigid substrate is simulated. The constrained sintering results in a larger number of pores near the substrate, as well as anisotropic sintering shrinkage, with significantly enhanced strain in the central upper part of the sample surface, and minimal strain at the edges near the substrate. All these features have also previously been observed experimentally.
Patients With Newly Diagnosed Hypertension Treated With the Renin Angiotensin Receptor Blocker Azilsartan Medoxomil vs Angiotensin‐Converting Enzyme Inhibitors: The Prospective EARLY Registry
Authors: Schmieder Roland E. , Potthoff Sebastian A. , Bramlage Peter , Baumgart Peter , Mahfoud Felix , Buhck Hartmut , Ouarrak Taoufik , Ehmen Martina , Senges Jochen , Gitt Anselm K. ,   the EARLY Registry Group
Published: June 2015

For patients with newly diagnosed hypertension, angiotensin‐converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) are usually the first‐line therapies. There is, however, no real‐life data regarding the relative clinical effectiveness and tolerability of either drug class. The prospective registry, Treatment With Azilsartan Compared to ACE Inhibitors in Antihypertensive Therapy (EARLY), was conducted to evaluate the effectiveness of the ARB azilsartan medoxomil (AZL‐M) vs ACE inhibitors in real‐world patients. Of the 1153 patients with newly diagnosed hypertension who were included in the registry, 789 were prescribed AZL‐M and 364 were prescribed an ACE inhibitor. After multivariate adjustment, AZL‐M was found to provide superior blood pressure reduction and better target blood pressure (<140/90 mm Hg) achievement. The proportion of patients with adverse events was not statistically different between groups. The authors conclude that in newly diagnosed hypertensive patients, AZL‐M provides superior blood pressure control with a similar safety profile compared with ACE inhibitors.
Protease-activated receptors and their biological role—focused on skin inflammation
Authors: Guenther Florian , Melzig Matthias F.
Published: June 2015

Objectives

For several years, protease-activated receptors (PARs) are targets of science regarding to various diseases and platelet aggregation. In the past, a number of publications related to PARs have been published, which refer to a variety of aspects. An important point of view is the inflammation of the skin, which has not been reported in detail yet. This review will provide an overview of the current knowledge on PARs, and in particular, on the involvement of PARs in terms of skin inflammation.

Key Findings

Wound healing is an important step after skin injury and is connected with involvement of PARs and inflammation. An important point in skin inflammation is the coagulation-dependent skin inflammation.

PARs are a special kind of receptors, being activated by proteolytic cleavage or chemical agonists. They may play an important role in various physiological processes. It is shown that the proteases are involved in many diseases for example Parkinson’s disease and Alzheimer’s disease. The fact, that proteases regulate the coagulation, and are involved in interleukin and cytokine release leads to the conclusion that they are involved in inflammation processes.
The studies of N-Octyl-N-Arginine-Chitosan coated liposome as an oral delivery system of Cyclosporine A
Authors: Deng Jin , Zhang Zhenhai , Liu Chunyan , Yin Lifang , Zhou Jianping , Lv Huixia
Published: June 2015

Objectives

An amphiphilic polymer N-Octyl-N-Arginine-Chitosan (OACS) was synthesized to coat the Cyclosporine A (CsA) liposomes (CL) to decrease the destruction of liposomes in gastrointestinal tract (GI) tract and improve its oral absorption.

Methods

CL and OACS-CsA liposomes (OACS-CL) were prepared by rotary-film evaporation method, and characterized by dynamic light scattering, transmission electron microscopy, atomic force microscope and releasing properties. In-situ single pass perfusion experiment and in-vivo studies in rats were carried out to verify its absorption enhancement.

Key findings

The characterization results showed that its particle size, zeta potential and morphology changed before and after polymer coating. Release experiment indicated that OACS could slow down drug release and protect its degradation in the stomach. In-situ single pass perfusion proved that the absorption of OACS-CL at the jejunum was enhanced about 3 and 22 times compared with commercial preparation of microemulsions (Tianke) and CsA suspensions, respectively. In vivo, AUC0→∞ of three different OACS-CL groups (93.48 ± 2.54, 100.98 ± 13.08 and 99.01 ± 19.02 h·μg/ml, respectively) were higher than those of Tianke (69.34 ± 7.93 h·μg/ml), CL group (54.31 ± 6.70 h·μg/ml) and suspensions (31.14 ± 1.30 h·μg/ml).

Conclusions

Therefore, OACS coated liposomes can be an effective strategy to promote drug's absorption and further reduce the anaphylactic reaction of abundant surfactants in commercial preparations.