bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Vancomycin and Tobramycin Polymethylmethacrylate Impregnated Beads in the Management of Chronic Osteomyelitis
Authors: Scott David M. , Rotschafer John C. , Behrens Fred
Published: December 2017

Over the past several years there has been a growing interest in the use of locally implanted beads containing antibiotics for the treatment of chronic osteomyelitis. This method has been popularized in Europe and, with few exceptions, gentamicin has been the only antibiotic used. There have been only a few reports from the U.S. and there is little information regarding the pharmacokinetics of antibiotics used in this fashion. To our knowledge this is the first report using vancomycin. Three patients with chronic osteomyelitis were treated with vancomycin and/or tobramycin polymethylmethacrylate beads. These beads were extemporaneously compounded and implanted for up to six weeks. From the site of bead implantation local fluid aliquots were collected for the measurement of antibiotic concentrations. In two patients, initial tobramycin concentrations exceeded 400 mg/L. In one patient receiving vancomycin, initial localized concentrations were approximately 100 mg/L. In all three patients therapeutic concentrations of localized antibiotic were maintained with immeasurable systemic concentrations throughout the period of bead placement. Localized antibiotic therapy for the management of chronic osteomyelitis represents a potential therapeutic alternative to long-term parenteral therapy. Data presented here suggest that other antibiotics, such as vancomycin and tobramycin, can be used successfully in polymethylmethacrylate beads and provide preliminary facts for future investigations of such applications.
Are Estrogens Indicated for the Treatment of Postmenopausal Women?
Authors: Metzger Deborah A. , Hammond Charles B.
Published: December 2017

A woman in the U.S. can now expect to live for 30 years or more past the menopause in a state of estrogen deprivation. Hypoestrogenic-associated conditions can be managed by a variety of medical regimens and lifestyle changes, but estrogen replacement therapy (ERT) is the most specific and universal treatment for all of the above conditions. Although concern for potential risks has limited its acceptance, the benefits of ERT extend beyond the amelioration of estrogen deprivation symptoms. Evidence is accumulating that ERT may offer protection from cardiovascular atherogenic disease. Several of the risks that have been associated with continuous ERT, such as endometrial cancer and breast cancer, are significantly reduced with the use of cyclic progestogens. Moreover, any concern arising from the use of conjugated estrogens and synthetic progestogens are being addressed by the recent introduction of orally active natural estrogen and soon, progesterone. With the demonstrated efficacy and safety of ERT, such therapy should be considered for all postmenopausal women.
Small Hospitals: A Case Report
Authors: Siler William A.
Published: December 2017

The author spent one half of 1987 working as an institutional pharmacist and the other half working as a community pharmacist. After quizzing administrators, educators, laboratory technicians, nurses, pharmacists, physicians, secretaries, and consumers throughout central Illinois, a picture of the small hospital in transition began to emerge. Exciting new roles for institutional pharmacists are developing, but the future for the “tiny” hospital (smaller than 100 beds), the health service providers who staff them, and the communities they serve is in doubt. This article is intended to provide a view of what is happening in small and very small hospitals in some communities in Illinois.
Estrogen Priming in Advanced Breast Cancer
Authors: Maghsoodnia Maziar , Holleran Walter M. , DeGregorio Michael W.
Published: December 2017

The successful treatment of advanced breast cancer has reached a plateau in recent years. Estrogen priming is a new combination therapy involving estrogens, antiestrogens, and chemotherapy that may result in the improvement of treatment responses. This investigational therapy is designed to synchronize cell cycles with estrogens and antiestrogens in order to enhance the activity of cell cycle-specific anticancer drugs. The pharmacological manipulation of cell growth coupled with appropriate antineoplastic agents could result in a new treatment approach for advanced breast cancer. The rationale and current status of estrogen priming are reviewed.
Evaluation of Passively Absorbed Saliva for Determination of Oral Slow-Release Theophylline Bioavailability in Children
Authors: Vaughan Leigh M. , Milavetz Gary , Weinberger Miles M. , Smith Gary D. , Merrick James G.
Published: December 2017

Assessment in young children of the bioavailability of slow-release theophylline formulations is hampered by the requirement for frequent blood sampling. Calculations of bioavailability from serial serum and passively absorbed saliva samples were therefore compared in six 9- to 12-year-old asthmatic children receiving multiple doses of Theo-Dur Sprinkle every 12 hours, using Theo-Dur tablets, a previously characterized formulation, as a reference. Results indicated 85 ± 5 percent and 82 ± 8 percent (mean ± SEM) relative bioavailability based on serum and salivary measurements, respectively. Correlation coefficient for serum and passively absorbed saliva bioavailabilities was 0.90. Passively absorbed saliva provides an acceptably accurate, noninvasive method for theophylline bioavailability assessment and may be a useful alternative for bioavailability studies in young children.
Flow Rate Variability from Selected syringe and Mobile Infusion Pumps
Authors: Farrington Elizabeth A. , Stull Jill C. , Leff Richard D.
Published: December 2017

Alterations in response to pharmacological agents have been attributed to flow rate variation produced by intravenous infusion devices during drug delivery. A wide range of variation has been shown to occur with large-volume infusion devices. The intent of this investigation was to examine flow variation resulting from the use of selected small-volume syringe and mobile infusion devices and determine whether these devices have greater flow continuity than large-volume infusion pumps. Each syringe and mobile infusion device delivered iv fluid at three flow rates (1, 5, and 10 ml/h). The effusate was collected in a tared beaker and serial weights were measured every ten seconds using a computerized, gravimetric technique. Accuracy, continuity, and pattern of flow were determined for each of the syringe and mobile infusion devices. All of the devices produced accurate flow, within ± 10 percent of the desired 5 and 10 ml/h rates. However, the actual iv flow rate ranged from 53 to 93 percent for the 1 ml/h rate. Continuity and pattern of flow resulting from each device were diverse. When compared with large-volume, microrate infusion devices, no significant differences could be observed. Therefore, no clear advantage to delivering drug solutions on a continuous basis can be expected from the use of small-volume devices. Specific infusion devices may be preferable for certain clinical applications; flow continuity data may be valuable when selecting an infusion device.
Lithium Intoxication with Acute Renal Failure and Death
Authors: Rose S. Rutherfoord , Klein-Schwartz Wendy , Oderda Gary M. , Gorman Richard L. , Young Wesley W.H.
Published: December 2017

A 65-year-old female presented with only gastrointestinal symptoms eight to ten hours after an acute ingestion of an unknown amount of lithium carbonate. The serum lithium concentration was 8.5 mEq/L. Forty-eight hours postingestion she developed acute renal failure, deteriorating mental status, and cardiovascular collapse. Despite both hemodialysis and peritoneal dialysis the patient died approximately four and one-half days after ingestion. A direct nephrotoxic effect of lithium is proposed.
Pruritic Rash with Actinic Keratosis and Impending Exfoliation in a Patient with Hypertension Managed with Minoxidil
Authors: Ackerman Bruce H. , Townsend Michael E. , Golden William , Bryan Ann B.
Published: December 2017

Dermatological toxicity has been reported following initiation of therapy with minoxidil, but no cases have been reported following prolonged use. We report the emergence of an erythematous weeping rash with impending exfoliation three years after the initiation of minoxidil therapy. Minoxidil was withdrawn and the patient responded to therapy with topical corticosteroids. Following minor surgery, the patient was inadvertently rechallenged with minoxidil, Within 24 hours of exposure bullous lesions reappeared in the extremities which again resolved with topical corticosteroids. Dermatological lesions observed on this patient were similar to those reported following acute minoxidil exposure and strongly implicate chronic minoxidil therapy.
Phenytoin Dosing in Obese Patients: Two Case Reports
Authors: de Oca Gelcys Montes , Gums John G. , Robinson J. Daniel
Published: December 2017

Phenytoin is used extensively in the treatment of various forms of epilepsy, and remains the drug of choice in partial and generalized tonic-clonic seizures. Because it demonstrates saturable, Michaelis-Menten pharmacokinetics, dosing of phenytoin within the therapeutic range can be very challenging, especially so in obese patients. We present case reports of two obese patients each requiring very large doses of phenytoin sodium (1000 mg/d) to sustain therapeutic serum concentrations and seizure control. There are very few reports in the literature regarding phenytoin pharmacokinetic changes in the obese. We can only theorize possible changes in these parameters. Further investigation in the form of controlled research trials need to be performed before final dosage recommendations can be given.
Estimation of Creatinine Clearance in Patients with Cushing's Syndrome
Authors: Hatton Jimmi , Parr Michael D. , Blouin Robert A.
Published: December 2017

The predictive value of the Cockcroft-Gault equation in patients with Cushing's syndrome was evaluated in 23 patients. Patients were subdivided based on total body weight into two groups, obese and nonobese. Estimated creatinine clearance (EC1cr) values were obtained by the Cockcroft-Gault method using ideal body weight (IBW) and total body weight (TBW). These values were then compared with a 24-hour measured creatinine clearance (MClcr). EClcr values based on TBW consistently overestimated measured values in all patients (p<0.05). In obese patients with Cushing's syndrome IBW predictions were not statistically different. However, linear regresson analysis revealed a poor correlation (r=0.32). Daily creatinine production rates (Ucr) were calculated and contrasted with an appropriate historical control for obese and nonobese subjects. Nonobese patients revealed a marked reduction in total Ucr compared with normal-weight controls (p<0.05). Obese patients also showed a reduction in Ucr when compared with a normal obese control population (p<0.05). Difficulty in predicting creatinine clearance in patients with Cushing's syndrome appears to be related to alterations in Ucr. These data suggest that the pathophysiologic changes that accompany Cushing's syndrome are sufficient to alter Ucr and may limit the usefulness of existing methods to predict creatinine clearance and renal function in these patients.
Estrogen Replacement Therapy: A Pilot Survey of Primary Care Physicians in West Virginia
Authors: Ponte Charles D. , Swinker Marian L. , Madhavan Suresh
Published: December 2017

Controversy surrounds the optimal use of estrogen replacement therapy (ERT) for the management of vasomotor instability and other perimenopausal symptoms. This fact and the obvious lack of published literature regarding physician prescribing behavior led the investigators to explore these issues with primary care physicians in West Virginia. Data were collected using a mailed, self-administered questionnaire. Issues addressed included reasons for using/not using ERT, patient symptoms, type of therapy prescribed, treatment duration, and symptom resolution or rebound. Approximately 2S percent of the 420 physicians contacted responded to the questionnaire. The overwhelming majority prescribes ERT for their patients. Most physicians prescribe an estrogen/progesterone combination for some or all patients, depending on the clinical situation. Conjugated estrogens in physiologic doses and synthetic progestins are most frequently prescribed and administered on a cyclic basis. Most women prescribed ERT experienced symptom resolution. Treatment outcome was not correlated with treatment duration.
Cost Analysis of Two Clindamycin Dosing Regimens
Authors: Chin Alfred , Gill Mark A. , Ito Matthew K. , Yellin Albert E. , Berne Thomas V. , Heseltine Peter N.R. , Appleman Maria D.
Published: December 2017

A clinical trial of clindamycin 900 mg q8h admixed with gentamicin 1.5 mg/kg (eight-hourly group) versus clindamycin 600 mg q6h with gentamicin 1.5 mg/kg given separately (six-hourly group) was analyzed for relative cost containment. Acquisition costs were significantly higher for the six-hourly group for intravenous supplies ($181.5 ± 47.8) when compared with the eight-hourly group ($67.6 ± 21.6) (p<0.05). Nursing administration costs were greater for the six-hourly group ($28.6 ± 7.5) compared with ($10.7 ± 3.4) for the eight-hourly group (p<0.05). Also, significantly higher cost (p<0.05) was noted for pharmacist and technician manufacturing cost for the six-hourly group ($15.4 ± 4.0) compared with the eight-hourly group ($13.3 ± 4.3). Incorporating all appropriate costs, the mean total drug therapy costs were significantly greater (p<0.05) for clindamycin 600 mg q6h ($527.4 ± 143.0) compared with clindamycin 900 mg q8h ($433.3 ± 99.2). The dosing of clindamycin 900 mg q8h admixed with gentamicin 1.5 mg/kg is a more cost-effective method of drug delivery with similar efficacy and safety when compared with clindamycin 600 mg q6h with gentamicin given separately.
Streptokinase-Induced Anaphylaxis
Authors: Tisdale James E. , Stringer Kathleen A. , Antalek Matthew , Matthews George E.
Published: December 2017

Streptokinase is a thrombolytic agent used most commonly for the dissolution of thrombi obstructing coronary arteries during acute myocardial infarction (MI). Anaphylactic reactions induced by streptokinase occur rarely. We report the case of a patient with acute MI who developed anaphylaxis shortly after the initiation of an intravenous infusion of streptokinase. The patient became profoundly hypotensive and developed an erythematous rash that spread rapidly to cover most of his body. He required mechanical ventilation and the administration of epinephrine for blood pressure support, which succeeded after dopamine and norepinephrine had failed. Streptokinase-induced anaphylaxis is thought to be mediated by immunoglobulin E (IgE), and patients who develop this adverse reaction have been shown to have higher serum concentrations of IgE to streptokinase than those who do not. Epinephrine is the agent of choice for the management of hypotension associated with anaphylaxis. Little evidence exists to support the routine pretreatment of patients who are to receive streptokinase with corticosteroids and/or antihistamines. Streptokinase skin testing may be a useful and accurate means of identifying patients at risk for streptokinase-induced anaphylaxis. Further investigation is required to determine the appropriateness of skin testing in streptokinase therapy.
Verapamil-Associated Stevens-Johnson Syndrome
Authors: Lin Anne Y.F. , Baker Brian A.
Published: December 2017

Stevens-Johnson syndrome (SJS) is a complication infrequently associated with the use of calcium-channel blocking agents. A 59-year-old woman developed symptoms typical of SJS approximately ten days following the initiation of sustained-release verapamil for hypertension management. Symptoms consisted of a generalized red macular rash associated with swelling of the face, tongue, lips, and mouth as well as a fever of 40 °C. Resolution of symptoms began approximately four days after verapamil discontinuation. Rechallenge with verapamil was not peformed. Although SJS appears to be a rare adverse effect of this drug, the potential complications warrant the inclusion of SJS in the differential diagnosis of patients presenting with malaise, fever, rash, and a history of verapamil ingestion.
Panic Attacks and Major Depression after Discontinuation of Long-Term Diazepam Abuse
Authors: Schifano Fabrizio , Magni Guido
Published: December 2017

A case is described of a patient with a history of several years of diazepam abuse (in the last 24 months at dosages of 120 mg/d). A tapering schedule was carried out during a 12-day stay in the hospital in which the diazepam dosage was reduced by a fixed quantity every day, corresponding to about ten percent of the initial dosage. Five days after discharge from the hospital the patient experienced panic attacks, for the first time, which continued until 13 days after discharge. By the 40th day, the patient was experiencing a major depressive episode, which improved after administration of clomipramine therapy. We suggest that a relatively quick withdrawal schedule (ten percent per day) is probably inadequate in preventing withdrawal reactions to long-acting benzodiazepines taken in high doses for an extended period of time.
Comparison of Assay Procedures Used to Measure Total and Unbound Concentrations of Quinidine
Authors: Wooding-Scott Ronald A. , Darling Inger M. , Slaughter Richard L.
Published: December 2017

Individualized quinidine dosing through the assessment of serum concentrations is warranted because of the wide variability observed in its pharmacokinetic behavior and its reported narrow therapeutic index. The free fraction of quinidine also varies widely. Thus the development of procedures that could be widely used to determine quinidine free concentrations would be highly desirable. It was the purpose of this study to evaluate several procedures available to determine total serum quinidine concentrations (rate nephelometry [ICS], homogenous enzyme immunoassay [EMIT], and high-performance liquid chromatography [HPLC]). Furthermore, in samples from 46 patients, equilibrium dialysis and ultrafiltration procedures were compared for their ability to estimate quinidine free fraction. Finally, unbound concentrations of quinidine were compared using a modified EMIT procedure and a standard HPLC method to quantitate quinidine in ultrafiltrates from patient samples. For the measurement of total quinidine concentrations, reasonable agreement was seen when EMIT and ICS systems were compared with HPLC (ICS = 1.03 · HPLC +0.96, r=0.93;EMIT= 1.08 · HPLC + 0.38, r=0.93) The mean errors, however, for these procedures were high (ICS +70 percent, range +7 to +233 percent; EMIT + 35 percent, range 0 to 110 percent). Quinidine free fractions (QFF) determined by equilibrium dialysis (E) and ultrafiltration (U) showed good agreement (QFF(U) = 1.11 · QFF(E) + 0.0; r = 0.96). Unbound quinidine concentration determined by EMIT analysis of ultrafiltrate substantially overestimated the values obtained by HPLC analysis (mean error by EMIT 104 ± 59 percent). It is concluded that HPLC is the method of choice for determining both total and unbound serum quinidine concentrations. The EMIT procedure on average produces acceptable error for the measurement of total quinidine concentrations; however, errors greater than 100 percent do occur. Thus, caution should be used when interpreting the results of the EMIT procedure. For determining unbound concentrations the EMIT produces unacceptable error and the HPLC method should be used to obtain reliable estimates of free quinidine concentrations.
Renal Handling of Beta2-Microglobulin in Patients with Cystic Fibrosis
Authors: Kearns Gregory L. , Berry Phillip L. , Bocchini Joseph A. , Hilman Bettina C. , Wilson John T.
Published: December 2017

We evaluated the renal handling of beta2-microglobulin (β2-M) and creatinine in healthy outpatients (n = 6), normal children hospitalized for infections treated with antibiotics (not including an aminoglycoside) (n = 4); outpatients with cystic fibrosis (CF; n = 12), and hospitalized patients with CF (n = 6) who received a 10- to 14-day course of antibiotic treatment that included an aminoglycoside. The serum β2-M concentrations in the normal outpatients (2020.1 ± 276.6 μg/L) were significantly lower (p <0.05) than those observed for outpatients (2833.3 ± 202.6 μg/L) or patients with CF (2861.8 ± 340.5 μg/L. There were no significant differences found for creatinine clearance or fractional excretion of β2-M when subjects without CF were compared with those with the disease. Furthermore, no significant differences were observed in hospitalized patients with CF when creatinine clearance and fractional excretion of β2-M were compared between the initiation and conclusion of aminoglycoside treatment. Glomerular filtration and proximal tubular reabsorption of β2-M were not altered in patients with CF. These findings do not support a global defect in proximal renal tubular reabsorption as the underlying cause for altered aminoglycoside clearance in patients with CF.
Severe Cardiovascular Adverse Effects in Association with Acute, High-Dose Corticosteroid Administration
Authors: Erstad Brian L.
Published: December 2017

Severe cardiovascular adverse reactions including death have been associated with high-dose intravenous corticosteroid therapy. Some of the patients appeared to have acute hypersensitivity reactions to the corticosteroid, with rashes and bronchospasm; other problems included arrhythmias and myocardial infarctions. Most of the patients had underlying renal disease and/or were undergoing renal transplantation. All of the patients having the cardiovascular reactions associated with the corticosteroid received individual doses of at least 250 mg of methylprednisolone or its equivalent. The doses were usually administered over a 30-minute period or less. A cause-effect relationship between high-dose corticosteroid therapy and severe cardiovascular reactions has not been scientifically proved by a controlled trial, but caution is advised when high-dose corticosteroid therapy is administered.
Pharmacotherapy Part II. Administering the Certification Process
Authors: McLeod Donald C.
Published: December 2017

This editorial is the secondin a series that beganin the November 1989issue.
Philosophical Fieldnotes
Authors: Bridges-Rhoads Sarah
Published: December 2017

What are philosophical fieldnotes? What do they do? How might they welcome thinking/being differently? How are they philosophical? What do they have to do with postqualitative and posthuman inquiries, if anything? In exploring these and other questions, this writing foregrounds uncertainty and embraces rhythms of thinking-in-writing over straightforward descriptions and streamlined theorizations. In so doing, philosophical fieldnotes affirm, and perhaps even catalyze, the ongoing movement-in-thought necessary for inquiry. I invite readers to wander through the text, including its examples of fieldnotes and numerous reading lists in endnotes that came about in writing. I hope the text resonates with readers who find themselves experimenting with thinking-in-writing as a means of reimagining and reordering the world and may invite those who may want to start.
Results From a Pilot Video Intervention to Increase Cervical Cancer Screening in Refugee Women
Authors: Ornelas India J. , Ho Khanh , Jackson J. Carey , Moo-Young Jaime , Le Anh , Do H. Hoai , Lor Bouapanh , Magarati Maya , Zhang Ying , Taylor Victoria M.
Published: December 2017

Many refugee women emigrate from countries with high cervical cancer incidence rates and have low rates of cervical cancer screening both before and after resettlement. Refugee women face many barriers to cervical cancer screening, including limited knowledge of cervical cancer and screening recommendations and cultural and linguistic barriers to being screened. Our pilot study aimed to develop and evaluate educational videos to promote cervical cancer screening among Karen-Burmese and Nepali-Bhutanese refugees, two of the largest groups of refugees arriving to the United States in recent years. We developed culturally tailored narrative videos for each ethnic group. Karen-Burmese and Nepali-Bhutanese women ( N = 40) were recruited through community health educators to participate in a pre- and posttest study. We assessed changes in cervical cancer knowledge and intentions to be screened, and satisfaction with the videos. We found that women were significantly more likely to report having heard of a test for cervical cancer and indicated significantly greater intentions to be screened after watching the video. Their knowledge about cervical cancer and screening also improved significantly, and they reported high levels of acceptability with the video. Our results suggest that culturally tailored narrative educational videos were acceptable to the target audiences and may be effective in increasing cervical cancer screening among refugee women. Further research should assess how health care and social service providers could implement video-based interventions to encourage women to be screened for cervical cancer during early resettlement.
Nonclinical Development of ANX005: A Humanized Anti-C1q Antibody for Treatment of Autoimmune and Neurodegenerative Diseases
Authors: Lansita Janice A. , Mease Kirsten M. , Qiu Haiyan , Yednock Ted , Sankaranarayanan Sethu , Kramer Susan
Published: December 2017

ANX005 is a humanized immunoglobulin G4 recombinant antibody against C1q that inhibits its function as the initiating molecule of the classical complement cascade. The safety and tolerability of ANX005 are currently being evaluated in a phase I trial in healthy volunteers ( www.clinicaltrials.gov Identifier: NCT03010046). Inhibition of C1q can be applied therapeutically in a broad spectrum of diseases, including acute antibody-mediated autoimmune disease, such as Guillain-Barré syndrome (GBS), and in chronic diseases of the central nervous system involving complement-mediated neurodegeneration, such as Alzheimer's disease (AD). To support the clinical development of ANX005, several studies were conducted to assess the pharmacology, pharmacokinetics, and potential toxicity of ANX005. ANX-M1, the murine precursor of ANX005, functionally inhibits the classical complement cascade both in vitro and in vivo, to protect against disease pathology in mouse models of GBS and AD. Toxicology studies with ANX005, itself, showed that intravenous administration once weekly for 4 weeks was well tolerated in rats and monkeys, with no treatment-related adverse findings. Serum levels of ANX005 in monkeys correlate with a reduction in free C1q levels both in the serum and in the cerebrospinal fluid. In summary, ANX005 has shown proof of concept in in vitro and in vivo nonclinical pharmacology models, with no toxicity in the 4-week repeat-dose studies in rats and monkeys. The no observed adverse effect level was 200 mg/kg/dose, which is 200-fold higher than the first-in-human starting dose of 1 mg/kg in healthy volunteers.
Multivariable analysis of the association between electrolyte disturbances and mortality in cats
Authors: Goggs Robert , De Rosa Sage , Fletcher Daniel J
Published: December 2017

Objectives

Electrolyte disorders have been individually associated with mortality in small populations of cats with specific conditions, but the associations and interactions between electrolyte disturbances and outcome have not been evaluated in a large, heterogeneous population. It was hypothesized that abnormalities of sodium, chloride, potassium and calcium concentrations would be independently and proportionately associated with death from natural causes and with all-cause mortality in cats.

Methods

An electronic database containing 7064 electrolyte profiles was constructed to assess the association between disorders of sodium, potassium, corrected-chloride and ionized calcium concentrations with non-survival by multivariable modelling. A second database containing 2388 records was used to validate the models constructed from the first database.

Results

All four electrolytes assessed had non-linear U-shaped associations with case fatality rates, wherein concentrations clustered around the reference interval had the lowest case fatality rates, while progressively abnormal concentrations were associated with proportionately increased risk of non-survival (area under the receiver operator characteristic curve [AUROC] 0.689) or death (AUROC 0.750).

Conclusions and relevance

Multivariable modelling suggested that these electrolyte disturbances were associated with non-survival and with death from natural causes independent of each other. The present study suggests that measurement of electrolyte concentrations is an important component of the assessment of cats in emergency rooms or intensive care units. Future studies should focus on confirming these associations in a prospective manner accounting for disease severity.
Kaupapa Kōrero: a Māori cultural approach to narrative inquiry
Authors: Ware Felicity , Breheny Mary , Forster Margaret
Published: December 2017

In Indigenous culture, stories are a common repository of knowledge and facilitate the process of knowing. Māori academics (Indigenous to Aotearoa New Zealand) have developed approaches based on key principles of Māori research, oral traditions and narrative inquiry to express experiences as Māori. To extend this, a Māori approach called Kaupapa Kōrero was developed to gather, present and understand Māori experiences. The application of whakapapa (genealogy) as a relational analytical framework provided a way of identifying personal kōrero (stories) and integrating them within layers of interrelated kōrero about their whānau (family), te ao Māori (Māori culture) and society that influences contemporary experiences of being Māori. Whakapapa also enabled a cross-examination of kōrero and identification of common intersecting factors such as Māori ethnicity, age, parenting status and socioeconomic position. This Māori narrative approach revealed a more complex and nuanced understanding of the interrelatedness and influence of societal expectations, indigeneity, Māori culture and whānau.
Human Polyomaviruses: The Battle of Large and Small Tumor Antigens
Authors: Baez Camila Freze , Brandão Varella Rafael , Villani Sonia , Delbue Serena
Published: December 2017

About 40 years ago, the large and small tumor antigens (LT-Ag and sT-Ag) of the polyomavirus (PyVs) simian vacuolating virus 40 have been identified and characterized. To date, it is well known that all the discovered human PyVs (HPyVs) encode these 2 multifunctional and tumorigenic proteins, expressed at viral replication early stage. The 2 T-Ags are able to transform cells both in vitro and in vivo and seem to play a distinct role in the pathogenesis of some tumors in humans. In addition, they are involved in viral DNA replication, transcription, and virion assembly. This short review focuses on the structural and functional features of the HPyVs’ LT-Ag and sT-Ag, with special attention to their transforming properties.
Toxic Epidermal Necrolysis Spectrum Management at Sunnybrook Health Sciences Centre: Our Multidisciplinary Approach After Review of the Current Evidence
Authors: Mereniuk Alexandra , Jaque Alejandra , Jeschke Marc G. , Shear Neil H.
Published: December 2017

Toxic epidermal necrolysis spectrum (TENS) is a rare yet severe adverse drug reaction associated with a high mortality rate. Beyond supportive care, there is still no established therapy for TENS, although recent meta-analyses and UK guideline recommendations have attempted to offer a review of relevant literature on this difficult topic. As most directed treatments lack clear consensual evidence, care centres often resort to establishing their own strategies. As Canada’s largest adult burn centre and the provincial reference centre for most burn patients in Ontario, our team at the Ross Tilley Burn Centre, in collaboration with the Department of Dermatology at Sunnybrook Health Sciences Centre, Toronto, Canada, has managed over 60 confirmed cases of TENS over the past 2 decades. We would like to share our management, experience, and present our treatment protocol that we recently established by a collaborative multidisciplinary team approach to help guide treatment of these complex patients not only in Canada but worldwide.
New digital realities and old public service broadcasting models – the case of public access and participation in Singapore’s televisual landscape
Authors: Lim Tania , Bali Azad , Moo Marcus
Published: December 2017

Does public service broadcasting (PSB), with its 20th-century state-controlled and state-funded structure, still have a role to play in increasing access, public participation and a strong national media system in today’s globalising East Asia? This article, by taking Singapore as a case study, examines why and how traditional PSB media players have been forced to change their institutional and transactional responses to the ‘shocks’ of digitisation. In particular, it examines how the rise of Web 2.0, with its de-territorialised media services and social media, challenges PSB’s relevance as trends towards universal access, a greater participatory culture and active audiences render PSB content increasingly anachronistic.
Approach to thrombosis at unusual sites: Splanchnic and cerebral vein thrombosis
Authors: Riva Nicoletta , Ageno Walter
Published: December 2017

Splanchnic vein thrombosis (SVT) and cerebral vein thrombosis (CVT) are two manifestations of unusual site venous thromboembolism (VTE). SVT includes thrombosis in the portal, mesenteric or splenic veins, and the Budd–Chiari syndrome. CVT encompasses thrombosis of the dural venous sinuses and thrombosis of the cerebral veins. Unusual site VTE often represents a diagnostic and therapeutic challenge because of the heterogeneity in clinical presentation, the limited evidence available in the literature on the acute and long-term prognosis of these diseases, and the lack of large randomized controlled trials evaluating different treatment options. This narrative review describes the approach to patients with SVT or CVT by examining the diagnostic process, the assessment of potential risk factors and the appropriate anticoagulant treatment.
Differentiating Hate: Threat and Opportunity as Drivers of Organization vs Action
Authors: Cunningham David
Published: December 2017

While research on hate mobilization tends to conflate organization and action, this article extends theoretical insights from opportunity and threat perspectives on social movements to differentiate explanations of hate groups and hate incidents. Drawing illustratively on data collected by the Southern Poverty Law Center, I suggest that threat serves as the predominant driver of hate organizations, while–in contrast–hate incidents are facilitated primarily by opportunistic environments that provide broadened latitude to act. Decoupling organization and action to recognize the variegated nature of ‘hate’ can improve the precision of our theoretical and analytic approaches to hate-based counter-movements and aid policy responses intended to reduce or halt the commission of such acts.
Anxiety-related symptomatology in young children on the autism spectrum
Authors: Keen Deb , Adams Dawn , Simpson Kate , den Houting Jacquiline , Roberts Jacqueline
Published: December 2017

Anxiety symptomatology is frequently reported in autistic children, and the prevalence of anxiety disorder is estimated at around 40%. However, most studies have focused upon children of age 8 years or above, so little is known about early signs of anxiety in younger children with autism. This study sought to describe anxiety-related symptomatology in 95 5- to 6-year-old autistic children using the Anxiety Scale for Children with Autism Spectrum Disorder. Wide variability was found in levels of symptomatology with the most frequently reported items within the ‘uncertainty’ subscale and the least frequently reported items in the ‘anxious arousal’ subscale. Comparisons of those with scores less than or greater than 70 on adaptive behaviour suggests some influence of ability on presentation of anxiety-related symptomatology.
Age discrimination in out-of-hospital cardiac arrest care: a case-control study
Authors: Wiel Eric , Di Pompéo Christophe , Segal Nicolas , Luc Gérald , Marc Jean-Baptiste , Vanderstraeten Carine , El Khoury Carlos , Escutnaire Joséphine , Tazarourte Karim , Gueugniaud Pierre-Yves , Hubert Hervé ,   on behalf of GR-RéAC
Published: December 2017

Background:

Although some studies have questioned whether cardiopulmonary resuscitation (CPR) in older people could be futile, age is not considered an essential out-of-hospital cardiac arrest (OHCA) prognostic factor. However, in the daily clinical practice of mobile medical teams (MMTs), age seems to be an important factor affecting OHCA care.

Aims:

The purpose of this study was to compare OHCA care and outcomes between young patients (<65 years old) and older patients.

Methods:

We performed a case-control study based on data extracted from the French National Cardiac Arrest (CA) registry. All adult patients with CA recorded between July 2011 and May 2014 were included. Each older patient was matched on three criteria: sex, initial cardiac rhythm and no-flow duration.

Results:

We studied 4347 pairs. We found significantly less basic life support initiation, shorter advanced cardiac life support duration, less MMT automated chest compression, less MMT ventilation and less MMT epinephrine injection in the older patients. Significant differences were also observed for return of spontaneous circulation (odds ratio (OR)=0.84, 95% confidence interval (CI) 0.77–0.92, p<0.001), transport to hospital (OR=0.58, 95% CI 0.51–0.61, p<0.001), vital status at hospital admission (OR=0.55, 95% CI 0.50–0.60, p<0.001) and vital status 30 days after CA (OR=0.42, 95% CI 0.35–0.50, p<0.001).

Conclusion:

All OHCA guidelines, ethical statements and clinical procedures do not propose age as a discrimination criterion in OHCA care. However, in our case-control study, we notice a shorter duration and less intensive care among older patients. This finding may partly explain the lower survival rate compared with younger people.
Permanently installed corrosion monitoring using magnetic measurement of current deflection
Authors: Jarvis Rollo , Cawley Peter , Nagy Peter B
Published: December 2017

The detection of corrosion on insulated and/or coated pipes remains a challenge. A non-destructive evaluation method has been proposed where a low-frequency AC current is directly injected into the pipe at distant locations, and perturbations in the magnetic field induced by current deflection around defects are measured. Structural health monitoring is made possible by detecting changes in the magnetic field due to defect growth using a permanently installed array of sensitive and inexpensive magnetic sensors. The performance of current deflection structural health monitoring is evaluated using a flexible and efficient framework. Individual sensor performance was first predicted using receiver operating characteristics obtained by evaluating the stability of the magnetic field signal measured outside of a section of coated undamaged riser pipe in an environmental chamber over repeated temperature cycles. A finite element model was then used to predict the magnetic perturbation due to defect growth which allowed the potential array configurations for structural health monitoring to be explored. Results suggest that 90% probability of detection and 0.1% probability of false alarm for [Formula: see text] (wall thickness) diameter, 30% of T depth defects are possible outside of 25- to 50-mm-thick pipe coatings/insulation using 10–50 sensors per metre of pipe and 5–10 A of injected current. The structural health monitoring procedure was then demonstrated experimentally, an electrochemically grown defect being successfully monitored; this experiment also served to validate the three-dimensional finite element model. A very good agreement between the predicted and measured changes in the magnetic field due to the current deflection around the growing defect was obtained.
An analysis of barriers to entry of cardiac rehabilitation in patients with diabetes: Using data from the National Audit of Cardiac Rehabilitation
Authors: Harrison Alexander S , Doherty Patrick , Phillips Anne
Published: December 2017

Background:

UK cardiac rehabilitation has reached for the first time 50% uptake in 2016; however, this still leaves 50% of the eligible group not starting cardiac rehabilitation. The characteristics of patients missing cardiac rehabilitation are relatively unknown with some studies in America suggesting that patients with diabetes have a reduced likelihood of joining cardiac rehabilitation.

Methods:

This study used routinely collected data from the National Audit of Cardiac Rehabilitation to investigate proportional differences in patients with cardiovascular disease with, and without, diabetes taking up the offer of cardiac rehabilitation.

Results:

The proportion of patients with diabetes entering cardiac rehabilitation dropped by between 7% and 15% depending on the age group (<40 years, 7% reduction; 61–80 years, 15%). The study’s results showed that in all demographic and diagnostic groups, the proportion of patients with diabetes was significantly less than that of the eligible group ( p < 0.001). There was no difference in the proportion of loss, from eligible to starting cardiac rehabilitation, between males and females, which was 13% for both groups.

Conclusion:

This study confirms, in a new UK population with over 121,002 eligible patients, that there is a statistically significant drop in patients with diabetes taking up cardiac rehabilitation. This study is unique in looking at all four key diagnosis and treatment groups and comparing them to those taking up cardiac rehabilitation. To achieve the target of 65% uptake set by NHS England, improvements in identifying and targeting complex patients, such as those with diabetes, need to be adopted.
Increasing the Elective Endovascular to Open Repair Ratio of Popliteal Artery Aneurysm
Authors: Wrede Axel , Wiberg Frans , Acosta Stefan
Published: December 2017

Background:

Open repair (OR) for popliteal artery aneurysm (PAA) has recently been challenged by endovascular repair (ER) as the primary choice of treatment. The aim of the present study was to evaluate time trends in treatment modality and compare outcomes between OR and ER among electively operated patients after start of screening in 2010 for abdominal aortic aneurysm (AAA), a disease highly associated with PAA.

Methods:

Between January 1, 2009, and April 30, 2017, 102 procedures and 36 acute and 66 elective repairs for PAA were identified.

Results:

Over time, a trend ( P = .089) for an increasing elective to acute repair ratio of PAA and an increase in elective ER to OR ratio ( P = .003) was found. Among electively repaired PAAs, the ER group was older ( P = .047) and had a higher ankle–brachial index (ABI; P = .044). The ER group had fewer wound infections ( P = .003), fewer major bleeding complications ( P = .046), and shorter in-hospital stay ( P < .001). After 1 year of follow-up, the ER group had a higher rate of major amputations ( P = .037). Amputation-free survival at the end of follow-up did not differ between groups ( P = .68). Among the 17 patients with PAA eligible for AAA screening, 4 (24%) were diagnosed with PAA through the screening program of AAA.

Conclusion:

The epidemiology of elective repair of PAA has changed toward increased ER, although ER showed a higher rate of major amputations at 1 year. Confounding was considerable and a randomized trial is needed for evaluation of the best therapeutic option.
Ambroise Paré (1510-1590) and His Innovative Work on the Treatment of War Injuries
Authors: Markatos Konstantinos , Tzivra Anna , Tsoutsos Spyridon , Tsourouflis Gerasimos , Karamanou Marianna , Androutsos Georgios
Published: December 2017

The purpose of this study is to summarize the innovations of Ambroise Paré (1510-1590) on the treatment of war wounds and improving amputation technique through ligature in arteries and veins. Ambroise Paré debunked the widely accepted idea that gun powder was poisonous for wounds. He also minimized the use of cautery of wounds by his dressing methods and the application of ligature during amputations. All these innovative rationales revolutionized the practice of war surgery during the Renaissance and paved the way for the introduction of modern surgery. Nevertheless, although his wound dressing innovations became widely accepted, the same did not happen with ligature and amputation; those techniques could become widely applicable if one could somehow control bleeding until the blood vessels had been tied. This became possible much later in the 18th century when Jean Louis Petit invented the first useful and efficient tourniquet.
Hormetic Response by Silver Nanoparticles on In Vitro Multiplication of Sugarcane (Saccharum spp. Cv. Mex 69-290) Using a Temporary Immersion System
Authors: Bello-Bello Jericó J. , Chavez-Santoscoy Rocío A. , Lecona-Guzmán Carlos A. , Bogdanchikova Nina , Salinas-Ruíz Josafhat , Gómez-Merino Fernando Carlos , Pestryakov Alexey
Published: December 2017

Background:

Hormesis is considered a dose–response phenomenon characterized by growth stimulation at low doses and inhibition at high doses. The hormetic response by silver nanoparticles (AgNPs) on in vitro multiplication of sugarcane was evaluated using a temporary immersion system.

Methods:

Sugarcane shoots were used as explants cultured in Murashige and Skoog medium with AgNPs at concentrations of 0, 25, 50, 100, and 200 mg/L. Shoot multiplication rate and length were used to determine hormetic response. Total content of phenolic compounds of sugarcane, mineral nutrition, and reactive oxygen species (ROS) was determined.

Results:

Results were presented as a dose–response curve. Stimulation phase growth was observed at 50 mg/L AgNPs, whereas inhibition phase was detected at 200 mg/L AgNPs. Mineral nutrient analysis showed changes in macronutrient and micronutrient contents due to the effect of AgNPs. Moreover, AgNPs induced ROS production and increased total phenolic content, with a dose-dependent effect.

Conclusion:

Results suggested that the production of ROS and mineral nutrition are key mechanisms of AgNP-induced hormesis and that phenolic accumulation was obtained as a response of the plant to stress produced by high doses of AgNPs. Therefore, small doses of AgNPs in the culture medium could be an efficient strategy for commercial micropropagation.
Diminished bile acids excretion is a risk factor for coronary artery disease: 20-year follow up and long-term outcome
Authors: Charach Gideon , Argov Ori , Geiger Karyn , Charach Lior , Rogowski Ori , Grosskopf Itamar
Published: December 2017

Background:

Patients with coronary artery disease (CAD) had significantly lower bile acid excretion (BAE) compared with non-CAD patients, leading to the hypothesis that the inability to efficiently excrete bile acids leads to coronary atherosclerosis development. We investigated the long-term role of BAE in CAD development and related mortality in 50 patients with proven CAD compared with that of 50 patients with chest pain and no CAD (controls) matched for clinical and laboratory characteristics.

Methods:

All subjects received a 4-day standard diet that included ~500 mg of cholesterol. Fecal bile acids from 24-h stool collections were measured by gas liquid chromatography.

Results:

CAD patients excreted lower amounts of total bile acids than controls ( p < 0.001), less deoxycholic acid ( p < 0.0001) and less lithocholic acid ( p < 0.01). BAE was the best significant independent laboratory factor that predicted CAD ( p < 0.05). Mortality and CAD development rates were significantly lower for the controls at the 20-year follow up.

Conclusions:

These results showed that CAD patients had markedly decreased BAE levels compared with non-CAD controls. BAE <415 mg/day was associated with increased CAD long-term mortality. Impaired ability to excrete cholesterol might be considered an additional independent risk factor for CAD development.