bluuebunny/crossref_metadata_2025 huggingface dataset:
Empowerment through a teacher leadership academy
Authors: Visone Jeremy D.
Published: November 2018

Purpose

The purpose of this paper is to examine the effectiveness of a teacher leadership academy (TLA) organized through a school district/university partnership in a small, US Suburban School District in increasing teachers’ participation in leadership activities.

Design/methodology/approach

TLA participants (n=11) were surveyed using the Teacher Leadership Activities Scale, and their results were compared to a control group of teachers in the district who were not participating in the TLA (n=12). Interviews and open-ended response items provided qualitative data to examine how the TLA contributed to teachers’ growth as leaders.

Findings

Results indicated that teachers in the TLA did increase participation in teacher leadership activities. Qualitative data revealed themes of many espoused benefits from TLA participation, including increased interactions with administrators, improved understanding of the obstacles associated with implementing changes, and expanded leadership capacity.

Research limitations/implications

Conditions that both enhanced and detracted from teacher leaders’ growth were identified and outlined, including formal leaders’ participation in TLA activities, material support for projects, and a supportive atmosphere (enhancers) and administrative roadblocks and the inability to remediate capacity issues for teacher leaders (detractors).

Originality/value

The conditions outlined above will assist those interested in creating TLAs in doing so with purpose and increased chance for buy in and success.
Procedure structuring for programming aircraft maintenance activities
Authors: Junqueira Viviane Souza Vilela , Nagano Marcelo Seido , Miyata Hugo Hissashi
Published: November 2018

Purpose

This paper aims to exemplify the use of project management tools in the scheduling of aircraft maintenance activities. This process is known as maintenance, repair and overhaul and it has gained importance within the aeronautical sector due to its expected growth in the coming years; however, it also faces increasing competitiveness in its market. This fact gives rise to the need of acting in maintenance management and seeking lower costs while maintaining the quality of the service provided. The purpose of this paper is to propose the structuring of a procedure that aims to reduce the total maintenance time (downtime) and guarantee the delivery of the aircraft on time.

Design/methodology/approach

The paper, through a case study at a Brazilian aircraft maintenance center, used critical path method and critical chain project management, the latter being derived from the theory of constraints, with the purpose of analyzing resources systematically and synchronizing the activities in the precedence network.

Findings

As a result, it is shown that downtime can be reduced from 11 to 5 days and improvements are proposed to achieve greater market competitiveness.

Originality/value

This paper demonstrates the competitive advantage that resulted from the application of project management tools in the aircraft maintenance planning and execution.
Simulation of edge quality in fused deposition modeling
Authors: Armillotta Antonio
Published: November 2018

Purpose

The purpose of this paper is to propose a method for simulating the profile of part edges as a result of the FDM process. Deviations from nominal edge shape are predicted as a function of the layer thickness and three characteristic angles depending on part geometry and build orientation.

Design/methodology/approach

Typical patterns of edge profiles were observed on sample FDM parts and interpreted as the effects of possible toolpath generation strategies. An algorithm was developed to generate edge profiles consistent with the patterns expected for any combination of input variables.

Findings

Experimental tests confirmed that the simulation procedure can correctly predict basic geometric properties of edge profiles such as frequency, amplitude and shape of periodic asperities.

Research limitations/implications

The algorithm takes into account only a subset of the error causes recognized in previous studies. Additional causes could be integrated in the simulation to improve the estimation of geometric errors.

Practical implications

Edge simulation may help avoid process choices that result in aesthetic and functional defects on FDM parts.

Originality/value

Compared to the statistical estimation of geometric errors, graphical simulation allows a more detailed characterization of edge quality and a better diagnosis of error causes.
Corporate distress, troubled debt restructurings and equity stripping
Authors: Ghosh Saibal
Published: November 2018

Purpose

The focus on excessive corporate leverage as a key factor influencing bank loan delinquency has come into sharp focus in recent times. However, not much analysis has been undertaken on the factors driving corporate distress in emerging economies. Focusing on India as a case study, the purpose of this paper is to investigate the impact of a particular category of corporate debt restructuring (CDR) proposed by the Indian central bank over the last decade in leading an attempt to address bank loan delinquencies, the authors assess the factors influencing the quantum of restructured debt at the corporate level over the time period 2003–2012.

Design/methodology/approach

Besides univariate analysis, the authors use logit regression techniques to analyze the factors driving CDR outcomes in India.

Findings

The results suggest that firms that successfully exit the debt restructuring process are more profitable and less levered and spend a longer time in such restructuring. Little net equity enters these restructured firms, while there is some evidence of equity stripping, particularly in firms with greater promoter control.

Originality/value

To the best of our knowledge, this is one of the early studies that employ micro-level data to make a comprehensive assessment of the factors driving CDR for a leading emerging economy.
Hepcidin/Ferritin Ratios Differ Among Non‐Dialyzed Chronic Kidney Disease Patients, and Patients on Hemodialysis and Peritoneal Dialysis
Authors: Niikura Takahito , Maruyama Yukio , Nakashima Satomi , Matsuo Nanae , Tanno Yudo , Ohkido Ichiro , Yokoyama Keitaro , Yamamoto Hiroyasu , Yokoo Takashi
Published: November 2018

The serum levels of hepcidin generally increase in patients with chronic kidney disease (CKD) due to inflammation or a decline in the glomerular filtration rate. However, the differences in the ferrokinetics among dialysis modalities are unclear. We investigated the relationship between serum levels of hepcidin and ferritin among non‐dialyzed CKD (ND), hemodialysis (HD), and peritoneal dialysis (PD) patients. We recruited 285 CKD patients (117 ND, 80 HD, and 88 PD patients) and measured the serum levels of hepcidin‐25, ferritin, hemoglobin, iron, transferrin saturation (TSAT), albumin, and high sensitivity C‐reactive protein (hs‐CRP). Hepcidin‐25 levels were elevated in all CKD patients and were significantly higher in PD than in ND and HD patients. The hepcidin/ferritin ratio was significantly higher in PD patients independent of TSAT, hemoglobin, hs‐CRP, and serum albumin. Hepcidin/ferritin ratio, associated with both dialysis modality and inflammation, is expected to be a useful indicator of anemia in CKD.
Masked pemphigus among pediatric patients with Castleman’s disease
Authors: Han Shu‐Ping , Fu Lin‐Shien , Chen Lu‐Jen
Published: November 2018

Aim

Paraneoplastic pemphigus (PNP) is a mucocutaneous autoimmune disorder accompanied with a neoplasm. Castleman's disease (CD), although rare, is the most common cause of PNP in children. It can be life‐threatening when pulmonary involvement occurs. Our study aimed to describe the features of PNP resulting from CD and to find clues for the early diagnosis in pediatric patients.

Method

We report the case of a 13‐year‐old girl who initially presented with oral ulcers and lichen planus, with progression to respiratory failure. A literature review of PNP and CD in children between 1997 and 2016 was performed. The clinical manifestations, pathological findings, treatment, and outcome were analyzed.

Results

Thirty‐two children were included in our study: 16 boys and 16 girls. Intractable mucocutaneous lesions developed early before CD was diagnosed. The clinical manifestations comprised oral ulcers (100%), polymorphous skin rash (86.7%) and genital (62.5%) erosion. Histopathological findings revealed lymphoplasmacytic cells infiltration (92%), vacuolar interface change (72%), acantholysis (68%), and keratinocytes necrosis (36%). Thirty patients underwent tumor resection. These patients mainly had unicentric CD, with the hyaline‐vascular variant dominant. Twenty‐six patients (81.2%) exhibited pulmonary involvement. The mortality rate was 70.0%. Among them, 90.5% exhibited pulmonary involvement, and 81.0% died of respiratory failure.

Conclusion

Intractable mucocutaneous lesions with a concurrent tumor in children strongly indicate PNP resulting from CD. Because stomatitis or skin erosion may be the first presentation, mucocutaneous tissue biopsy and early detection of the underlying tumor are important. Earlier diagnosis is mandatory for the effective treatment of PNP and pulmonary involvement.
Laparoscopic distal gastrectomy in a patient with gastric cancer complicated by eventration of the diaphragm: A case report
Authors: Fujii Takatsugu , Haruta Shusuke , Ohkura Yu , Honda Aya , Kobayashi Nao , Tanaka Tsuyoshi , Ueno Masaki , Udagawa Harushi
Published: November 2018

Diaphragmatic eventration refers to an abnormal elevation of the diaphragm. Here, we report the case of a patient with gastric cancer who underwent successful laparoscopic distal gastrectomy despite the presence of diaphragmatic eventration. The patient was a 72‐year‐old man diagnosed with early gastric cancer in the antrum, as detected by upper gastrointestinal endoscopy. Preoperative imaging revealed an elevation of the left side of the diaphragm, which was diagnosed as diaphragmatic eventration. Laparoscopic surgery is beneficial for obtaining an optimal field of view. However, there are critical points that must be considered when laparoscopic distal gastrectomy is performed in patients with gastric cancer complicated by diaphragmatic eventration. There were difficulties that affected manipulation because the elevated diaphragm drew the intraperitoneal organs into the thoracic cavity, causing displacement of the normal anatomical position. We found it beneficial to secure the lesser curvature of the stomach given the possible effects of gastric deformation.
Laparoscopic rectal tumor surgery after administration of a new sclerosing therapy (aluminum potassium sulfate and tannic acid injection) for internal hemorrhoids: A report of three cases
Authors: Goto Saori , Hida Koya , Hoshino Nobuaki , Hisamori Shigeo , Kawada Kenji , Sakurai Takaki , Sakai Yoshiharu
Published: November 2018

Aluminum potassium sulfate and tannic acid (ALTA) injection is a new sclerosing therapy for internal hemorrhoids that has been gaining widespread use. However, there have been few reports about rectal cancer after ALTA injection. We performed laparoscopic surgery for three patients who had underwent ALTA therapy 6 months or 1 year earlier: (i) a 51‐year‐old man with neuroendocrine tumor; (ii) a 44‐year‐old woman with rectal cancer; and (iii) 77‐year‐old man with rectal cancer. All three patients had sclerosis of the resected rectal wall stump, making transection of the rectum difficult. Histological examination of the specimens also showed an inflammatory reaction and/or fibrosis of the resection stump. Although laparoscopic low anterior resection was planned for all three patients, we had to construct a diverting stoma for two patients and could not perform sphincter‐preserving surgery for the other. We must be well prepared for laparoscopic rectal surgeries after ALTA therapy, and these cases suggest sigmoidoscopy before ALTA therapy should be recommended.
Laparoscopic para‐aortic lymphadenectomy for colorectal cancer with clinically suspected lymph node metastasis
Authors: Yamamoto Seiichiro , Kanai Toshio , Yo Kikuo , Hongo Kumiko , Takano Kiminori , Tsutsui Mai , Nakanishi Ryo , Yoshikawa Yusuke , Nakagawa Motohito
Published: November 2018

Introduction

The optimal surgical management strategy for isolated para‐aortic lymph node (PALN) metastases from colorectal cancer (CRC) remains unclear. However, the complication rates for open approaches remain high. In this study, the outcomes of laparoscopic para‐aortic lymphadenectomy in patients with clinically suspected PALN metastasis were evaluated.

Methods

Between April 2013 and April 2018, we performed laparoscopic primary resection and para‐aortic lymphadenectomy in 11 patients with advanced colorectal cancer and clinically suspected PALN metastasis. This study was a single‐center, retrospective, case series analysis, and the surgical outcomes were reviewed.

Results

There were no cases of perioperative mortality, and conversion to open surgery was necessary in only one patient (9%) because of invasion into a rib. One patient (9%) required a blood transfusion. Postoperative complications occurred in three patients, and the morbidity rate was 27% (3/11). Pathologically, PALN metastasis was confirmed in five patients (45%), all of whom received postoperative chemotherapy. The median survival time for all patients was 25 months, and one patient died of recurrence at 25 months after the initial surgery. Two other patients were alive with recurrence after 47 and 36 months, and two patients were alive without recurrence after 17 and 2 months.

Conclusion

Laparoscopic para‐aortic lymphadenectomy for advanced colorectal cancer with clinically suspected PALN is technically feasible and may be beneficial in selected patients. It is necessary to investigate the feasibility of this procedure in a future case series, and information regarding true oncologic outcome will require long‐term follow‐up.
Case of white‐eyed shunt carotid‐cavernous sinus fistula mimicking optic neuritis
Authors: Hayashi Shintaro , Mashio Kiyoshi , Okamoto Koichi
Published: November 2018

Background

The typical orbito‐ocular manifestations of carotid‐cavernous sinus fistulas are conjunctival hyperemia, chemosis and exophthalmos as a result of increased fistular flow directed anteriorly in the ophthalmic veins. These congestive features are absent if the flow is directed posteriorly, resulting in “white‐eyed shunts.” We describe a rare carotid‐cavernous sinus fistula case presenting with optic neuritis‐like manifestations.

Case presentation

A 71‐year‐old Japanese woman developed periorbital pain, impaired visual acuity with an upper horizontal visual field defect, diminished light reflexes and a relative afferent pupillary defect in her right eye. There were no congestive features in her eyes. Intraocular pressure was normal in both eyes, but fundoscopy revealed a pale optic disc in the right eye. Serum anti‐aquaporin‐4 antibodies were negative. Although optic neuritis was suspected, high‐dose corticosteroid administration did not result in improvement. When referred to Department of Neurology, Gunma University Hospital, she showed a subtle, incomplete oculomotor nerve palsy in the right eye. Magnetic resonance angiography suggested carotid‐cavernous sinus fistula (CCF), and cerebral angiography showed fistulous drainage into the cavernous sinus and inferior petrosal sinus, and a delayed opacification of the superior orbital and angular facial veins on the right side. A diagnosis of white‐eyed shunt CCF was made, and a coil embolization procedure was carried out. However, there was no symptom improvement.

Conclusions

It is difficult to diagnose white‐eyed shunt CCF based only on physical findings, especially when there is an absence of ocular congestive features. We discuss the possible mechanisms underlying the optic neuritis‐like symptoms of CCF.
Anterior maxillary sandwich osteotomy technique with simultaneous implant placement: A novel approach for management of vertical deficiency
Authors: Mansour Hesham Hussein , Badr Ahmed , Osman Ahmed Hesham , Atef Mohammed
Published: November 2018

Background

The introduction of sandwich osteotomy technique with simultaneous implant placement allowed various procedures to be carried out with a level of great precision and accuracy thus saving time for the patient and clinician.

Purpose

The aim of the current study is to evaluate the efficacy of this new technique regarding increasing the anterior maxillary alveolar height with simultaneous implant placement.

Materials and Methods

Nine patients suffering from multiple missing anterior maxillary teeth were selected with vertical dimension not less than 10 mm. anterior maxillary sandwich osteotomy technique was carried out for all patients using xenograft bone particulate with simultaneous implant placement at single stage surgery.

Results

For two patients, four implants showed significant marginal bone loss with maximum marginal bone loss up to 2.8 mm. However, the immediate postoperative follow up went uneventful for all nine patients included in the present study. None of them showed any complication regarding postoperative wound dehiscence, infection, or segment mobility. Four months postoperative upon the prosthetic phase, all the 18 placed implant were clinically osseointegtated.

Conclusion

All 18 implants were successfully integrated in the present study. The prosthetic phase started after 4 months for all cases and there was no need for harvesting of autogenous bone from the patient. But further studies are required to evaluate the viability of such approach in single implant placement cases.
Historical perspectives on contemporary human–environment dynamics in southeast Africa
Authors: Douglass Kristina , Walz Jonathan , Quintana Morales Eréndira , Marcus Richard , Myers Garth , Pollini Jacques
Published: November 2018

The human communities and ecosystems of island and coastal southeast Africa face significant and linked ecological threats. Socioecological conditions of concern to communities, governments, nongovernmental organizations, and researchers include declining agricultural productivity, deforestation, introductions of non‐native flora and fauna, coastal erosion and sedimentation, damage to marine environments, illegal fishing, overfishing, waste pollution, salinization of freshwater supplies, and rising energy demands, among others. Human–environment challenges are connected to longer, often ignored, histories of social and ecological dynamics in the region. We argue that these challenges are more effectively understood and addressed within a longer‐term historical ecology framework. We reviewed cases from Madagascar, coastal Kenya, and the Zanzibar Archipelago of fisheries, deforestation, and management of human waste to encourage increased engagement among historical ecologists, conservation scientists, and policy makers. These case studies demonstrate that by widening the types and time depths of data sets we used to investigate and address current socioecological challenges, our interpretations of their causes and strategies for their mitigation varied significantly.
Changes in social networks are associated with lesbian, bisexual and queer women quitting smoking: An analysis of Australian survey data
Authors: Kolstee Johann , Deacon Rachel M. , Haidar Samar , Gray James , Mooney‐Somers Julie
Published: November 2018

Introduction and Aims

Lesbian, bisexual and queer (LBQ) women in Australia and internationally are smoking at least twice the rate of women in the general population. An understanding of smoking behaviours in this population is essential in order to develop effective interventions. Our analysis aimed to investigate differences in smoking patterns and contexts of smoking between current smokers and recent quitters (<2 years to 1 month).

Design and Methods

Data were collected through an online anonymous survey conducted in mid‐2015. Participants were recruited online from a variety of social networking sites and community‐based mailing groups.

Results

Overall 257 lesbian, bisexual and queer women completed the survey, 73% current smokers and 27% recent quitters; nearly all had smoked daily at some point in their lives. Multivariate analysis showed recent quitters were less likely to have some (adjusted odds ratio [aOR] 0.19, 95% confidence interval [CI] 0.05–0.71) or half/most/all (aOR 0.12, 95% CI 0.03–0.048) close friends who smoked compared to none, and were more likely to have a non‐smoking (aOR 10.2, 95% CI 3.86–27.0) or no regular partner (aOR 4.01, 95% CI 1.47–10.9) than one who smoked. Non‐Anglo‐Australian women were also more likely to be recent quitters (aOR 2.45 [95% CI 1.10–5.42]) than Anglo‐Australian women.

Discussion and Conclusions

Understanding the social significance of partners and friends in lesbian, bisexual and queer women's smoking and cessation efforts will be important for developing meaningful, effective and targeted interventions to address the persistent high rates of smoking in this population.
Diversity: A Byproduct of Inclusion?
Authors: Anderson Eric
Published: November 2018

DMI's “Innovative Thinking on Diversity & Inclusion” conference was much needed and well received by attendees and participants. This designer found himself thinking about the range of experiences and information shared and ponders some questions raised.

A designer of color looks back on his career and reflects on what he saw at DMI's Design Leadership conference.
Inclusion in Practice: Takeaways from the DMI Conference
Authors: Myers Cheryl
Published: November 2018

DMI's recent Design Leadership Conference highlighted the challenges and opportunities of diversity and inclusion while also confirming the unique value that practitioners of design thinking bring to this global conversation. This article presents key takeaways from the conference and shares design thinking insights that may be valuable to anyone seeking to cultivate more diversity and inclusion in their workplace and their way of thinking.

What is a diverse team? What really defines an inclusive process? Simply focusing on representation isn't the answer.
Moving beyond small solute clearance: What evidence is there for more permeable dialyzers and haemodiafiltration?
Authors: Davenport Andrew
Published: November 2018

Dialyzers were initially developed for diffusive clearance of uraemic toxins. Diffusion most effectively clears small uncharged solutes from plasma water, such as urea. Sessional urea clearance targets have been shown to be important for short‐term patient survival, but over the longer term, although low‐flux dialysis can prolong patient survival, accumulation of middle‐sized uraemic toxins, such as β2 microglobulin can lead to disabling arthropathy. Although the introduction of high‐flux dialyzers, designed to increase β2 microglobulin clearance, has reduced the prevalence of arthropathy; this has not been translated into a demonstrable significant improvement in patient survival. However, analysis of individual patients recruited into trials of haemo‐diafiltration reported that greater convective clearance was associated with better survival, although the individual trials reported mixed outcomes. Most haemodiafiltration trials were not designed to study the effect of convective dose, so although reported patient survival was greater for those receiving greater convective volume exchange, these results could potentially be confounded by patient or center effects. An alternative approach to increasing middle‐sized solute clearances would be to use more permeable dialyzers, but as yet there are no trials reporting survival with larger cutoff dialyzers. As such, although there is increasing evidence that increasing middle‐sized molecular uraemic solute clearance is associated with improved patient survival, further prospective trials are required to determine whether as with Kt/Vurea there is a threshold effect of how much convective or middle‐sized solute clearance is required to improve patient survival.
Plagues, climate change, and the end of an empire. A response to Kyle Harper's The Fate of Rome (2): Plagues and a crisis of empire
Authors: Haldon John , Elton Hugh , Huebner Sabine R. , Izdebski Adam , Mordechai Lee , Newfield Timothy P.
Published: November 2018

This is the second of a three‐section review of Kyle Harper's The Fate of Rome in which we examine in detail Harper's treatment of two allegedly widespread and mortal Roman outbreaks of disease. In the case of the second‐century Antonine plague, we demonstrate that Harper overlooked a major controversy and instead portrayed an oversimplified narrative of a catastrophic event. In the case of the third‐century Cyprianic plague, we call attention to several glaring methodological issues in Harper's treatment of the episode, point out the absence of corresponding evidence in the papyri, and cast doubt on the linkage previously drawn between the plague and archaeology.
Fisetin decreases TET1 activity and CCNY/CDK16 promoter 5hmC levels to inhibit the proliferation and invasion of renal cancer stem cell
Authors: Si Yibing , Liu Junfeng , Shen Hongliang , Zhang Chen , Wu Yuanhao , Huang Yongyi , Gong Zhangbin , Xue Jun , Liu Te
Published: November 2018

As a natural flavonol, fisetin has significant inhibitory effects on many cancers. Although fisetin can inhibit kidney cancer, its effects on kidney renal stem cells (HuRCSCs) remain unknown. Our study found that renal cancer tissues and CD44+/CD105+ HuRCSCs both show high TET1 protein expression. Both in vivo and in vitro experiments showed that fisetin can effectively inhibit HuRCSC cell division and proliferation, invasion, in vivo tumourigenesis and angiogenesis. Our findings showed that fisetin can significantly decrease TET1 expression levels in HuRCSCs and overall 5hmC levels in the genomes of these cells. At the same time, ChIP‐PCR results showed that fisetin can effectively inhibit 5hmC modification levels at the CpG islands in cyclin Y (CCNY) and CDK16 and reduce their transcription and activity. Thus, we conclude that fisetin inhibits the epigenetic mechanism in renal cancer stem cells, that is, fisetin inhibits TET1 expression and reduces 5hmC modification in specific loci in the promoters of CCNY/CDK16 in HuRSCs. This in turn inhibits transcription of these genes, causing cell cycle arrest and ultimately inhibiting renal cancer stem cell activity.
Empagliflozin and kidney outcomes in Asian patients with type 2 diabetes and established cardiovascular disease: Results from the EMPA‐REG OUTCOME® trial
Authors: Kadowaki Takashi , Nangaku Masaomi , Hantel Stefan , Okamura Tomoo , von Eynatten Maximilian , Wanner Christoph , Koitka‐Weber Audrey
Published: November 2018

Aims/Introduction

In the EMPA‐REG OUTCOME® trial, empagliflozin added to standard of care improved clinically relevant kidney outcomes by 39%, slowed progression of chronic kidney disease, and reduced albuminuria in patients with type 2 diabetes and established cardiovascular disease. This exploratory analysis investigated the effects of empagliflozin on the kidneys in Asian patients.

Materials and Methods

Participants in the EMPA‐REG OUTCOME® trial were randomized (1:1:1) to empagliflozin 10 mg, 25 mg or a placebo. In patients of Asian race, we analyzed incident or worsening nephropathy (progression to macroalbuminuria, doubling of serum creatinine, initiation of renal‐replacement therapy or renal death) and its components, estimated glomerular filtration rate (eGFR) and urine albumin‐to‐creatinine ratio changes, and renal safety.

Results

Of 7,020 treated patients, 1,517 (26.1%) were Asian. In this subgroup, consistent with the overall trial population, empagliflozin reduced the risk of incident or worsening nephropathy (hazard ratio 0.64, 95% confidence interval 0.49–0.83), progression to macroalbuminuria (hazard ratio 0.64, 95% confidence interval 0.49–0.85) and the composite of doubling of serum creatinine, initiation of renal‐replacement therapy or renal death (hazard ratio 0.48, 95% confidence interval 0.25–0.92). Furthermore, empagliflozin‐treated participants showed slower eGFR decline versus placebo, and showed rapid urine albumin‐to‐creatinine ratio reduction at week 12, maintained through week 164, with effects most pronounced in those with baseline microalbuminuria or macroalbuminuria. The kidney safety profile of empagliflozin in the Asian subgroup was similar to the overall trial population.

Conclusions

In Asian patients from the EMPA‐REG OUTCOME® trial, empagliflozin improved kidney outcomes, slowed eGFR decline and lowered albuminuria versus placebo, consistent with the overall trial population findings.
Systemic features of retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations: a monogenic small vessel disease
Authors: Pelzer N. , Hoogeveen E. S. , Haan J. , Bunnik R. , Poot C. C. , van Zwet E. W. , Inderson A. , Fogteloo A. J. , Reinders M. E. J. , Middelkoop H. A. M. , Kruit M. C. , van den Maagdenberg A. M. J. M. , Ferrari M. D. , Terwindt G. M.
Published: November 2018

Background

Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL‐S) is a small vessel disease caused by C‐terminal truncating TREX1 mutations. The disease is typically characterized by vascular retinopathy and focal and global brain dysfunction. Systemic manifestations have also been reported but not yet systematically investigated.

Methods

In a cross‐sectional study, we compared the clinical characteristics of 33 TREX1 mutation carriers (MC+) from three Dutch RVCL‐S families with those of 37 family members without TREX1 mutation (MC‐). All participants were investigated using personal interviews, questionnaires, physical, neurological and neuropsychological examinations, blood and urine tests, and brain MRI.

Results

In MC+, vascular retinopathy and Raynaud's phenomenon were the earliest symptoms presenting from age 20 onwards. Kidney disease became manifest from around age 35, followed by liver disease, anaemia, markers of inflammation and, in some MC+, migraine and subclinical hypothyroidism, all from age 40. Cerebral deficits usually started mildly around age 50, associated with white matter and intracerebral mass lesions, and becoming severe around age 60–65.

Conclusions

Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations is a rare, but likely underdiagnosed, systemic small vessel disease typically starting with vascular retinopathy, followed by multiple internal organ disease, progressive brain dysfunction, and ultimately premature death.
The accuracy of baseline viral load for predicting the efficacy of elbasvir/grazoprevir in participants with hepatitis C virus genotype 1a infection: An integrated analysis
Authors: Serfaty Lawrence , Jacobson Ira , Rockstroh Jürgen , Altice Frederick L. , Hwang Peggy , Barr Eliav , Robertson Michael , Haber Barbara
Published: November 2018

European treatment guidelines for hepatitis C virus (HCV) infection recommend that people with genotype (GT) 1a infection and baseline viral load ≤800 000 IU/mL receive elbasvir/grazoprevir (EBR/GZR) for 12 weeks, and those with baseline viral load >800 000 IU/mL receive EBR/GZR plus ribavirin for 16 weeks. This analysis was conducted to clarify whether baseline viral load can serve as an accurate, sensitive or specific stratification factor for defining EBR/GZR regimens. In this post hoc, integrated analysis, participants with GT1a infection who received EBR 50 mg/GZR 100 mg for 12 weeks were stratified according to baseline viral load. Sustained virologic response at 12 weeks post‐treatment was achieved by 95.2% (911/957) of participants and was higher among participants with baseline viral load ≤800 000 IU/mL vs >800 000 IU/mL (98.5% vs 93.9%). The 800 000 IU/mL threshold had a positive predictive value of 98.5%, a negative predictive value of 6.1%, a specificity of 91.3%, a sensitivity of 28.4% and an overall accuracy of 31.5%. A baseline viral load cutpoint of 800 000 IU/mL had high positive predictive value and specificity but poor negative predictive value, sensitivity and accuracy in predicting treatment outcomes in this population. Baseline NS5A resistance‐associated substitutions (RASs) were detected in 25% (1/4) of virologic failures with baseline viral load ≤800 000 IU/mL and 59.5% (25/42) of those with baseline viral load >800 000 IU/mL. Overall, these data suggest that, compared with the use of a baseline viral load cutpoint, baseline testing for NS5A RASs enables more individuals to receive the 12‐week EBR/GZR regimen without compromising the opportunity for SVR.
Liver decompensation in HIV/Hepatitis B coinfection in the combination antiretroviral therapy era does not seem increased compared to hepatitis B mono‐infection
Authors: Lieveld Faydra I. , Smit Colette , Richter Clemens , van Erpecum Karel J. , Spanier Bernhard W. M. , Gisolf Elisabeth H. , Vrolijk Jan M. , Siersema Peter D. , Hoepelman Andy I. M. , Reiss Peter , Arends Joop E.
Published: November 2018

Background & Aims

HIV/hepatitis B virus (HBV) coinfected subjects are thought to have faster progression to end‐stage liver disease (ESLD) than HBV mono‐infected subjects. We assessed whether this remains in the current cART‐era.

Methods

Data from subjects with follow‐up completion post‐2003 were compared between HIV/HBV coinfected subjects in the Dutch HIV Monitoring database and HBV mono‐infected subjects from two centres. The primary outcomes of composite ESLD included portal hypertension, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver‐related mortality. Outcomes were analysed using time‐dependent cause‐specific Cox regression models adjusted for follow‐up time and relevant covariates. Subset‐analyses were done in subjects with follow‐up pre‐2003.

Results

In the 1336 co‐ vs 742 mono‐infected subjects, coinfected subjects had no increased probability for ESLD compared to mono‐infected subjects (cHR 0.7 (95% CI 0.4‐1.1), but had increased probabilities for all‐cause (cHR 7.4 [4.9‐11.1]) and liver‐related mortality (cHR 3.4 [1.6‐7.5]). In the current combined cohort, treatment with tenofovir or entecavir was inversely associated with ESLD, all‐cause and liver‐related mortality (cHR 0.4 [95% CI 0.3‐0.7], cHR 0.003 [0.001‐0.01]), cHR 0.007 [0.001‐0.05]). Other predictors for ESLD were older age, being of Sub‐Sahara African descent, increased alanine aminotransferase levels and hepatitis C virus coinfection. While the probability for all‐cause mortality was increased in coinfected subjects, this rate decreased compared to pre‐2003 (HR 40.2 (95% CI: 8.7‐186.2).

Conclusions

HIV/HBV coinfected patients no longer seem to be at increased risk for progression to ESLD compared to HBV mono‐infected patients, likely due to widespread use of highly effective cART with dual HBV and HIV activity.
Predictors of therapeutic failure among patients with acute brucellosis treated by dual therapy with doxycycline‐rifampin
Authors: Alsayed Hasanain Ahmad Farooq , El‐Masry Muhammad Abbas , Zayed Ali Abdel‐Azeem Hasan , Nafee Amany Mohamed Adawi , Attia Rasha Abdel‐Monem Hassan , Abdel‐Aal Sherif Mohamed
Published: November 2018

Objective

To determine the frequency of therapeutic failure among patients with acute and subacute brucellosis and to explore the predictors of failure.

Methods

The study included 213 consecutive, naïve patients with acute and subacute brucellosis. All participants underwent clinical evaluation, chest radiography, stool microscopic examination and interferon‐gamma release assay. Patients received the WHO‐recommended therapy of doxycycline 200 mg/day and rifampin 900 mg/day, for 6 weeks.

Results

Mean age of the study population was 39.8 ± 12.2 years; 64.8% of them were males. The therapeutic failure rate was 16.4%. Adverse effects were reported by 13.1%. Multivariate analysis of factors associated with therapeutic failure revealed latent tuberculosis infection (LTBI) (OR 3.1, 95% CI, 1.9–24.6, P: 0.009), ascariasis (OR 2.6, 95% CI 1.5–17.9, P: 0.012), and the use of acid suppressive therapy (OR 2.1, 95% CI 1.2–19.5, P: 0.037) as the predictors of therapeutic failure.

Conclusions

The prevalence of therapeutic failure among the Egyptian patients with acute/subacute brucellosis is increasing. Predictors of therapeutic failure are LTBI, ascariasis, and the use of acid suppressive therapy.
Enhanced quantum coherence in exchange coupled spins via singlet-triplet transitions
Authors: Bae Y. , Yang K. , Willke P. , Choi T. , Heinrich A. J. , Lutz C. P.
Published: November 2018

Long-lived spin coherence arises from two coupled atoms on a surface.
Evidence for a quantum spin Hall phase in graphene decorated with Bi
2
Te
3
nanoparticles
Authors: Hatsuda K. , Mine H. , Nakamura T. , Li J. , Wu R. , Katsumoto S. , Haruyama J.
Published: November 2018

Topological insulating graphene is created using decoration of an extremely small quantity of heavy nanoparticles.
Isolated renal mucormycosis in a patient with Idiopathic CD4 lymphocytopenia
Authors: Sethi Jasmine , Ramachandran Raja , Kohli Harbir Singh , Gupta Krishan Lal
Published: November 2018

Idiopathic CD4 lymphocytopenia (ICL) is characterised by a low CD4 +lymphocyte count in the absence of HIV or other underlying aetiologies. We report a case of a 17-year-old girl with ICL with autoimmune hepatitis who developed isolated renal mucormycosis, which, to our knowledge, is the first reported case described in literature. Combination therapy with antifungals and surgical resection was done, and the patient improved. This case report illustrates the importance of timely multidisciplinary approach to recognise this highly fatal disease at an early stage.
Challenging cause of bullous eruption of the hands in the Arctic
Authors: Kristiansen Bo , Penninga Luit , Diernaes Jon Erik Fraes
Published: November 2018

Phytophotodermatitis is caused by deposition of photosensitising compounds on the skin followed by ultraviolet exposure. We present an unusual case of a 29-year-old Australian male visiting Greenland who presented with severe itchy bullous eruption on his hands. The cause was a combination of exposure to lime fruit juice and prolonged sun exposure from the Arctic midnight sun.
Bronchoalveolar carcinoma as an unsuspected cause for worsening shortness of breath in a patient with metastatic breast cancer
Authors: Nagpal Sukhdeep Kaur , Flynn Michael , Ryan Claire , Harper-Wynne Catherine
Published: November 2018

A 70-year-old woman with lung metastases from a breast cancer presented with worsening cough and dyspnoea. She recently had a pleurodesis for a malignant pleural effusion. Chest CT scans demonstrated various radiological changes leading to diagnostic challenges. Differential diagnoses included empyema, pleural disease progression, pulmonary oedema, pneumonitis, lymphangitis and atypical infections. She deteriorated despite a multimodality treatment strategy. Postmortem examination confirmed that lung changes were consistent with a bronchoalveolar carcinoma unrelated to the known metastatic breast cancer. The eventual knowledge of this diagnosis was reassuring to the treating medical team and a comfort to the relatives who witnessed the lack of response to standard treatment.
Use of Integra dermal substitute to prevent implantable device extrusion in an Olympic athlete
Authors: Page Felicity , Patel Krupali , Jaffe Wayne
Published: November 2018

We present a challenging case of imminent metallic implant extrusion in a Paralympic athlete managed with a single-stage procedure using ‘Integra’ dermal substitute. The patient had hereditary spastic paraparesis, for which a baclofen pump delivering intrathecal medication was vital in the management of his condition. The device had been most recently implanted into the thigh after previous complications. Integra provided robust soft-tissue coverage over the implanted baclofen pump in the thigh. Different operative management strategies were considered but the use of Integra was felt to offer the least morbidity and a quick recovery. The patient was able to successfully compete in a Paralympic canoeing qualifying event the week following surgery and achieve medal success. To the authors’ knowledge, this is first case in which Integra has been used in such circumstances.
Successful treatment of total placenta previa by multidisciplinary therapy in a Jehovah’s Witness patient who refused blood transfusions
Authors: Tachi Sayaka , Yoneda Noriko , Yoneda Satoshi , Saito Shigeru
Published: November 2018

A 35-year-old Jehovah’s Witness patient with total placenta previa was referred to our hospital at 30 weeks of gestation. She refused autologous and allogeneic blood transfusions, but agreed to receive acute normovolaemic haemodilution, intraoperative blood salvage and biological products. At 35 weeks, she underwent emergent caesarean delivery because of labour pains. Multidisciplinary therapy, including the insertion of balloon catheters into the bilateral common iliac arteries, acute normovolaemic haemodilution and intraoperative blood salvage, avoided hysterectomy; however, blood loss included amniotic fluid which was estimated to be 1910 mL. These treatments may be effective for total placenta previa in blood-refusal patients.
Association of coronary dominance with the severity of coronary artery disease: a cross-sectional study in Shaanxi Province, China
Authors: Yan Bin , Yang Jian , Fan Yajuan , Zhao Binbin , Ma Qingyan , Yang Lihong , Ma Xiancang
Published: November 2018

Objective

To investigate whether coronary artery dominance is associated with the severity of coronary artery disease (CAD).

Design

Cross-sectional study.

Setting

Single-centre.

Participants

Between July 2015 and February 2017, 1654 patients who underwent coronary angiography (CAG) were recruited into this cross-sectional study.

Measurement and methods

According to coronary dominance, patients were classified into left dominance (LD), right dominance (RD) and codominance (CD) based on the CAG results. Multiple linear regression analysis was performed to test the association between severity of CAD and coronary dominance.

Results

The total Gensini score was significantly higher in the RD group than in the left-CD group (42.3±33.6 vs 36.3±29.8; p=0.033). After adjusting for potential confounding factors, the results of multivariate linear regression showed that RD was associated with the severity of CAD (β=6.699, 95% CI 1.193 to 12.205, p=0.017).

Conclusions

The results suggest that right coronary dominance was associated with the severity of CAD.
Impact and longevity of measles-associated immune suppression: a matched cohort study using data from the THIN general practice database in the UK
Authors: Gadroen Kartini , Dodd Caitlin N , Masclee Gwen M C , de Ridder Maria A J , Weibel Daniel , Mina Michael J , Grenfell Bryan T , Sturkenboom Miriam C J M , van de Vijver David A M C , de Swart Rik L
Published: November 2018

Objective

To test the hypothesis that measles infection increases the incidence of non-measles infectious diseases over a prolonged period of time.

Design

A population-based matched cohort study.

Data sources

This study examined children aged 1–15 years in The Health Improvement Network UK general practice medical records database. Participants included 2228 patients diagnosed with measles between 1990 and 2014, which were matched on age, sex, general practitioner practice and calendar year with 19 930 children without measles. All controls had received at least one measles vaccination. Children with a history of immune-compromising conditions or with immune-suppressive treatment were excluded.

Primary outcome measures

Incidence rate ratio (IRR) of infections, anti-infective prescriptions and all-cause hospitalisations following measles in predetermined periods using multivariate analysis to adjust for confounding variables.

Results

In children with measles, the incidence rate for non-measles infectious disease was significantly increased in each time period assessed up to 5 years postmeasles: 43% in the first month (IRR: 1.43; 95% CI 1.22 to 1.68), 22% from month one to the first year (IRR: 1.22; 95% CI 1.14 to 1.31), 10% from year 1 to 2.5 years (IRR: 1.10; 95% CI 1.02 to 1.19) and 15% (IRR: 1.15; 95% CI 1.06 to 1.25) in years 2.5 to 5 years of follow-up. Children with measles were more than three times as likely to receive an anti-infective prescription in the first month and 15%–24% more likely between the first month and 5 years. The rate of hospitalisation in children with measles was increased only in the month following diagnosis but not thereafter (IRR: 2.83; 95% CI 1.72 to 4.67).

Conclusion

Following measles, children had increased rates of diagnosed infections, requiring increased prescribing of antimicrobial therapies. This population-based matched cohort study supports the hypothesis that measles has a prolonged impact on host resistance to non-measles infectious diseases.
Complaints from patients with functional neurological disorders: a cross-sectional UK survey of why patients complain and the effect on the clinicians who look after them
Authors: Bolton Clare , Goldsmith Paul
Published: November 2018

Objective

To evaluate the nature of complaints from patients with functional neurological disorders and understand the reaction of UK neurology consultants to receiving complaints from this patient group.

Methods

A voluntary online retrospective survey was advertised to UK consultant neurologists. Questions asked about the nature of the complaint, how it was dealt with, how it affected their emotional well-being and attitude to work, and whether it influenced their clinical practice. Responses were anonymised. The frequency of responses and percentage of total responses were analysed. Respondents were also given opportunities to add personal comments.

Results

Responses from 58 clinicians were received. Patient disagreement with the diagnosis was a factor in 90% of complaints received. Only 77% of complaints were resolved within 6 months and 61% of clinicians received no feedback about the outcome. 31% of clinicians reported their most problematic complaint had an adverse effect on their mood. 67% of respondents changed their practice following the complaint with 59% investigating more frequently or due to perceived pressure from patients.

Conclusions

Complaints from patients with functional neurological disorders appear to be primarily due to disagreement with the diagnosis. They are more difficult to resolve than other complaints, and clinicians who deal with them often become the ‘second victim’ in the process leading to potentially adverse effects on patient care. Strategies to tackle these issues are discussed.