bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of intra- and inter-rater reliability and concurrent validity of the Italian version of the Jebsen–Taylor Hand Function Test in adults with rheumatoid arthritis
Authors: Savona Andrea , Ferralis Luca , Saffioti Marco , Tofani Marco , Nobilia Marta , Culicchia Greta , Berardi Anna , Servadio Annamaria , Galeoto Giovanni
Published: April 2019

Introduction

In rheumatoid arthritis, a reduction in hand function can lead to a decrease in health, with a consequent limitation of daily life activities and restriction in social participation. Evaluation plays a decisive role in the functional recovery process and in rehabilitation programs. The Jebsen–Taylor Hand Function Test is one of the most widely used non-diagnosis-specific assessment tools in rehabilitation. The aim of the study was to evaluate the intra-rater and inter-rater reliability and concurrent validity of the Italian version of the Jebsen–Taylor Hand Function Test (JTHFT-IT) in a population with rheumatoid arthritis.

Methods

The test’s reliability and validity were assessed by following international guidelines. Its internal consistency and intra- and inter-rater reliability were examined using Cronbach’s alpha coefficient and the intraclass correlation coefficient, respectively. Its concurrent validity was evaluated using Pearson’s correlation coefficient with a dynamometer instrument.

Results

The test was given to 108 people with rheumatoid arthritis. Cronbach’s alpha reported a value of 0.91 for the dominant hand and 0.87 for the non-dominant hand. Intra- and inter-rater reliability were evaluated with a subgroup of 30 individuals. Intraclass correlation coefficients ranged from 0.46 to 1.00 in the dominant and non-dominant hands. Pearson’s correlation between subtests and the dynamometer ranged from –0.14 to –0.59.

Conclusions

The present study supports the use of the JTHFT-IT as a measure of hand functionality in people with rheumatoid arthritis. It is an important tool for Italian professionals and it can be useful both in clinical practice to evaluate improvement after rehabilitation treatments and for research in hand rehabilitation.
National Variability in Prion Disease–Related Safety Policies for Neurologic Procedures
Authors: Werbaneth Katherine , Tummalapalli Praveen , Gold Carl A.
Published: April 2019

Prion diseases are fatal neurodegenerative disorders that can be transmitted via contact with infective tissue. Variability in hospital safety policies related to prion disease may place health-care workers at risk. We sought to assess variability of safety policies related to prion disease for neurosurgical procedures and lumbar punctures among neurological institutions in the United States. We e-mailed neurologists associated with 2016 US News and World Report “Top 50” Neurology & Neurosurgery Institutions to request hospital policies regarding safety precautions related to prion disease. For institutional surgical policies, the main outcome was concordance with each of the 8 specific precautions described in World Health Organization (WHO) guidelines published in 1999. No similar guidelines are available for lumbar puncture, so themes were identified and quantified among the lumbar puncture policies we collected. Of the 51 institutions contacted, there were 38 responses. Two institutions did not have relevant policies and 3 institutions declined to share their policies, yielding 33 institutional policies for review. Of these, 85% had a surgical policy and 54% had a lumbar puncture policy. Concordance with all 8 specific precautions described in the WHO guidelines was found in 14% of surgical policies. Lumbar puncture policies demonstrated variability in methods of waste disposal and decontamination procedures. There is significant variability in policies regarding safety precautions in patients with suspected prion disease. We advocate for the formation of national or international committees to examine this issue, set new guidelines, and foster implementation at the level of individual institutions.
Adolescent Sexting: Myths, Facts, and Advice
Authors: Van Ouytsel Joris , Madigan Sheri , Ponnet Koen , Walrave Michel , Temple Jeff R.
Published: April 2019

Adolescent sexting remains an important public health issue because of the potential for psychosocial and legal consequences. This article briefly reviews the current state of the science of adolescent sexting research. It serves as an up-to-date and data-driven resource to school nurses and school staff to help augment understanding and facilitate discussion regarding teen sexting. The review is structured along popular myths about sexting.
Beyond the collaterals: Additional value of multiphase CTA in acute ischemic stroke evaluation
Authors: Volders D , Shewchuk JR , Marangoni M , Ni Mhurchu E , Heran MKS
Published: April 2019

Purpose

Multiphase computed tomography angiography (MP-CTA) is an innovative imaging tool that can give those managing acute ischemic stroke temporal information on degree and extent of pial collateral arterial filling in the affected brain. We sought to estimate the incidence of false-positive or -negative evaluation of the carotid bifurcation or intracranial thrombus on single-phase CTA (SP-CTA) compared with MP-CTA.

Material and methods

A single-center, retrospective consecutive review was conducted of imaging and clinical records of 150 patients in two months who presented with neurological symptoms with a National Institutes of Health Stroke Scale score ≥ 2 and who received an MP-CTA as part of their investigative work-up. The cohort consisted of 52.3% male and 47.7% female patients. Median individual age was 68 years (interquartile range 60–79). Extracranial and intracranial vessel images of the initial early arterial phase were evaluated and compared with late arterial and early venous phase images.

Results

In the cohort of 150 patients, in three patients (2%) SP-CTA would have led to an incorrect diagnosis and management without MP-CTA–acquired source imaging. The three scenarios represented differentiating a carotid string sign from internal carotid artery occlusion, determining the appearance and extent of thrombus in carotid T-occlusion, and differentiating slow flow and contrast mixing-related artifacts from intraluminal thrombus.

Conclusions

In addition to improving assessment of collateral circulation in acute stroke patients, MP-CTA is also useful in assessing specific flow-related scenarios for which SP-CTA may give spurious results.
An interdisciplinary approach to the treatment of a complex infraclinoidal internal carotid artery aneurysm
Authors: Ole Nöldeke Jan , Lemcke Johannes , Gräwe Alexander , Gölz Leonie , Gutowski Pawel
Published: April 2019

We present the case of a 49-year-old woman with sudden onset of severe headaches and a ruptured aneurysm located inside the fenestration of the infraclinoid part of the internal carotid artery in the segments C4 and C5 distal to the origin of the ophthalmic artery. An interdisciplinary approach enabled the successful treatment of the aneurysm by wrapping and stent-assisted coiling. We discuss this rare congenital anomaly of a fenestrated internal carotid artery together with the 12 other cases published worldwide.
Relevance research on carotid atherosclerosis and levels of serum cathepsin K and cystatin C on patients with ischemic cerebral vascular disease
Authors: Sun Yaxuan , Ding Yongxia , Li Jiangxia
Published: April 2019

The relationship between carotid atherosclerosis (AS) and levels of serum cathepsin K (CatK) and cystatin C (CysC) on patients with ischemic cerebral vascular disease (ICVD) was explored. In total, 266 patients with ICVD who were admitted in our hospital were enrolled. According to the results of carotid ultrasound, they were randomly divided into plaque group (n = 133) and control group (n = 133). According to atherosclerotic plaque type distribution, the plaque group was divided into stable plaque group and unstable group. The relationship between levels of serum CatK and CysC of two groups and carotid AS indicator (such as intima-media thickness (IMT)) were analyzed with Spearman’s correlation. Spearman’s correlation analysis showed that IMT level was positively correlated with stability of carotid atherosclerotic plaque ( P < 0.05). The level of serum CatK in plaque group was significantly higher than control group, and the level of serum CysC in plaque group was significantly lower than control group ( P < 0.05); the level of serum CatK in unstable plaque group was significantly higher than stable plaque group, and the level of serum CysC in unstable plaque group was significantly lower than stable plaque group ( P < 0.05). Serum CatK and IMT levels were positively correlated, and serum CysC and CatK levels were negatively correlated ( P < 0.05). CatK and CysC levels may be used as serum markers for predicting carotid AS plaque instability, providing a new observational index for prevention and treatment of ICVD caused by carotid AS plaque.
The expression of long-chain non-coding RNA DMTF1v4 in colorectal cancer tissue and its relationship with clinicopathological features
Authors: Cai Yanjuan , Zhuang Shutong , Liu Hongpeng , Qiu Jianfu , Zeng Li
Published: April 2019

Emerging studies have showed that long-chain non-coding RNA DMTF1v4 might participate in the process of multidrug resistance phenotype of gastric cancer. However, its expression and function in colorectal cancer (CRC) is still unknown. In this study, we discovered that DMTF1v4 was generally 5.15 ± 1.67 times upregulated in CRC tissues compared to the adjacent normal tissues. Moreover, the expression level of DMTF1v4 was closely related to the distant metastasis of tumor, but it was not related to age, sex, tumor location, tumor staging, depth of invasion, lymph node metastasis, and differentiation level. Survival analysis showed that the overall survival rate of patients with high expression of DMTF1v4 was 45.0% in cancer tissues, which was significantly lower than 82.5% of DMTF1v4 low expression patients (χ2 = 11.562, P < 0.01). The results of univariate COX regression analysis showed that DMTF1v4, TNM (tumor, node, metastasis) staging, distant metastasis, and tumor differentiation were closely related to the prognosis of patients ( P < 0.05). Multivariate COX regression analysis showed that DMTF1v4 and distant metastasis could be independent prognostic factors for CRC patients. In conclusion, this study revealed that DMTF1v4 might promote the development of CRC, which can be used as an independent factor to judge the prognosis of CRC.
Pulmonary Artery Banding for Congenitally Corrected Transposition of the Great Arteries With Hydrops Fetalis: A Case Report
Authors: Takeda Yuka , Momoi Nobuo , Hayashi Mariko , Endo Kisei , Aoyagi Yoshimichi , Kawashima Ryoko , Wakamatsu Hiroki , Kurosawa Hiroyuki
Published: April 2019

At 32 weeks of gestation, a male fetus with congenitally corrected transposition of the great arteries developed hydrops fetalis caused by a combination of mitral valve regurgitation and tricuspid valve regurgitation (TR). We performed a pulmonary artery banding (PAB) at 108 days old for gradually progressing TR, after confirming that a balloon dilatation test in the main pulmonary artery reduced TR. As the patient grew, the PAB became tighter and systolic blood pressure in the morphological left ventricle increased. At present, the patient is waiting for a double switch operation.
Intramedullary Stabilization of Pubic Ramus Fractures in Elderly Patients With a Photodynamic Bone Stabilization System (IlluminOss)
Authors: Oikonomidis Stavros , Alabsi Ahmad , Ashqar Ghazi , Graf Markus , Sobottke Rolf
Published: April 2019

Introduction:

A photodynamic bone stabilization system (PBSS) is a percutaneous operating method that provides intramedullary stabilization. The purpose of the study was to assess the clinical and radiological outcome after treatment of pubic ramus fractures with the PBSS.

Materials and Methods:

In a retrospective study, patients with osteoporotic pubic ramus fractures were included. The patients were treated with the PBSS in a percutaneous method. In the routine follow-up examination, pain was measured with the visual analog scale (VAS) and the type of mobilization was verified. Computer tomography of the pelvis was carried out in the follow-up examination (mean of 7.5 months after surgery) to investigate bone healing.

Results:

A total of 32 patients (25 females and 7 males) were included in the study. The average hospital stay was 16.5 ± 7.9 days (range: 5-37 days) and the mean operation time was 116.8 ± 47.1 minutes (range: 33-255 minutes). Two cases of wound infections and 1 case of misplacement of the PBSS implant with revision surgery have been documented. The mean VAS score for pelvic/hip pain at the day of inpatient discharge was 4.4 ± 1.4 (range: 2-7). A total of 25 patients could attend the follow-up examination 7.5 ± 1.7 months (range: 6-14) after the procedure, reporting a mean VAS for pelvic/hip pain of 3.0 ± 2.2 (range: 0-8). A total of 11 patients could walk without an orthopedic walking device, 7 patients needed underarm crutches, 6 patients used a walker-rollator, and 1 patient was immobilized. Consolidated pubis ramus fractures were described in 24 (96%) cases.

Discussion:

The results of our study reveal adequate clinical and radiological outcomes after treatment of osteoporotic pubic ramus fractures with the PBSS. This is the first study investigating the outcome after treating pubic ramus fractures with the PBSS.

Conclusion:

Based on our findings, the PBSS is an alternative to known techniques for the stabilization of the pubic ramus.
Application of Lean Tool for Process Improvement of Bank Branches
Authors: Baag Pankaj Kumar , Kavitha P.  , Sarkar Ashutosh
Published: April 2019

The drawbacks in the service operations of the Indian public sector banks include high cost per employee and lower service quality compared to private and foreign banks. This article for the first time confirms the application of lean thinking for process improvement of service operations in an Indian public sector bank through ‘value stream mapping’. The article uses action research methodology and two case studies that describe the process and outcomes of the action research to achieve the objective of studying the applicability of lean thinking and lean tools in process improvement of bank branches. The results of introducing lean thinking in the branches of the public sector bank in India were efficiency improvements through lower wait time for customers and lower stress levels for employees, besides increased customer satisfaction, profit and business—factors which justify and support the use of lean thinking in banks.
Reducing the Device Delay Mismatch Can Improve Sound Localization in Bimodal Cochlear Implant/Hearing-Aid Users
Authors: Zirn Stefan , Angermeier Julian , Arndt Susan , Aschendorff Antje , Wesarg Thomas
Published: April 2019

In users of a cochlear implant (CI) together with a contralateral hearing aid (HA), so-called bimodal listeners, differences in processing latencies between digital HA and CI up to 9 ms constantly superimpose interaural time differences. In the present study, the effect of this device delay mismatch on sound localization accuracy was investigated. For this purpose, localization accuracy in the frontal horizontal plane was measured with the original and minimized device delay mismatch. The reduction was achieved by delaying the CI stimulation according to the delay of the individually worn HA. For this, a portable, programmable, battery-powered delay line based on a ring buffer running on a microcontroller was designed and assembled. After an acclimatization period to the delayed CI stimulation of 1 hr, the nine bimodal study participants showed a highly significant improvement in localization accuracy of 11.6% compared with the everyday situation without the delay line ( p < .01). Concluding, delaying CI stimulation to minimize the device delay mismatch seems to be a promising method to increase sound localization accuracy in bimodal listeners.
Urban redevelopment at the block level: Methodology and its application to all Chinese cities
Authors: Han Zhiyuan , Long Ying , Wang Xuan , Hou Jingxuan
Published: April 2019

Urban redevelopment is the reconstruction or upgrade of current urban built-up areas; it revitalizes old towns and contributes to sustainable development. This paper proposes a methodological framework that integrates open-source street networks and point-of-interest data and aims to identify and evaluate urban redevelopment at the block level from the perspective of urban form and function. It is found that (1) urban blocks can be categorized into eight groups regarding the spatial form of road junctions that have emerged within them over time, and blocks of each group share common features that can be automatically identified; (2) there are more blocks that have been morphologically redeveloped than functionally redeveloped, and the two types of redevelopments also significantly overlap with one another; and (3) the evaluation of urban redevelopment identification results presents a high accuracy rate that verifies the validity of the proposed framework. Based on the identification results, the impact factors of urban redevelopment are explored on both the inter- and intracity levels. The intercity analysis indicates that Chinese cities with a lower administrative level, lower urbanization rate, and higher density of road junctions tend to be associated with a higher proportion of urban redevelopment. Meanwhile, the intracity analysis attempts to determine which kinds of urban blocks are more likely to undergo urban redevelopment, which are found to be the blocks with lower points of interest density, a smaller distance to city centers, higher transit accessibility, a higher land use mixed index, and larger size.
Understanding Women’s Aspirations: A Study in Three Indian States
Authors: Chaturvedi Gitanjali , Sahai Garima
Published: April 2019

This study provides an insight to the aspirations of women and girls in three states in India. This study is a product of primary research, based on focus group discussions and interviews, that highlights the voices of women in remote rural districts as well as tribal areas where women want jobs, security, savings, education and a happy life. Women in peri-urban areas are more confident of realizing their aspirations than those in rural areas. Younger women are more aspirational, and thus they are less willing to do manual labour. They aspire for white-collar jobs with the government and the security that the jobs provide. As girls get more educated, it is important to match their skills with the labour market, ensure safe and reliable transport and public spaces so that they can achieve their aspirations. Big hurdles to achieving their dreams are the mindsets at home—notably that of parents, husbands and in-laws—that continue to determine how far they will be educated and whether they will have jobs and careers.
Sources of Finance, Innovation and Exportability in Asia: Cross-country Evidences
Authors: Singh Prakash , Maiti Dibyendu
Published: April 2019

Sunk costs determine the level of productivity and exportability of a firm according to the modern trade theory. While productivity rise requires finance for innovation and technology adoption from external sources, this article attempts to argue that sources of finance would be detrimental to the innovation ability of firms. Although formal banking finance suffers from asymmetric information, it is less risky to invest on R&D compared to that of non-banking sources and capital market. In other words, the fund received from formal banking source raises innovation, and, thereby, exportability of firms and financing from other sources involve higher cost and limit innovation capacity and exportability. Analysis of firm-level database provided by the World Bank Enterprise Survey confirms that firms depend more on formal banking source for investment in innovation, and this is found to be significant in explaining innovation and exportability.

JEL Codes: F20, F36
Fragmentation Trade and Vertical Specialisation: How Does South Asia Compare with China
Authors: Veeramani C.
Published: April 2019

This article analyses the trends and patterns of export and fragmentation trade by South Asian countries—Bangladesh, India, Pakistan and Sri Lanka. To place the discussion in a comparative perspective, the analysis also covers China. Experience of China and other East Asian countries shows that export-led industrialisation and a high degree of participation in global production networks/value chains, based initially on specialisation in labor-intensive activities, are crucial for sustained employment generation and poverty reduction. However, exports have not become a major engine of growth in South Asian countries. An important reason for this is that South Asia has been locked out of the global production networks/value chains in several industries, except Bangladesh and Sri Lanka in readymade garments and India in automobiles. India’s export basket is biased towards capital- and skill-intensive products, which is an anomaly as the country’s true comparative advantage lies in unskilled labor-intensive activities. We argue that India’s labor laws have had the unintended consequence of discouraging specialisation in labor-intensive stages of the production process in manufacturing industries. Greater integration of domestic industries with global production networks/value chains will accelerate the process of shifting the surplus labor from agriculture to manufacturing.

JEL Codes: F10, F15, F40
The effect of gefapixant, a P2X3 antagonist, on cough reflex sensitivity: a randomised placebo-controlled study
Authors: Morice Alyn H. , Kitt Michael M. , Ford Anthony P. , Tershakovec Andrew M. , Wu Wen-Chi , Brindle Kayleigh , Thompson Rachel , Thackray-Nocera Susannah , Wright Caroline
Published: April 2019

We evaluated the effect of gefapixant on cough reflex sensitivity to evoked tussive challenge.

In this phase 2, double-blind, two-period study, patients with chronic cough (CC) and healthy volunteers (HV) were randomised to single-dose gefapixant 100 mg or placebo in a crossover fashion. Sequential inhalational challenges with ATP, citric acid, capsaicin and distilled water were performed 1, 3 and 5 h after dosing. Mean concentrations evoking ≥2 coughs (C2) and ≥5 coughs (C5) post doseversusbaseline were co-primary endpoints. Objective cough frequency (coughs·h−1) over 24 h and a cough severity visual analogue scale (VAS) were assessed in CC patients. Adverse events were monitored.

24 CC patients and 12 HV were randomised (mean age 61 and 38 years, respectively). The cough challenge threshold increased for ATP by 4.7-fold (C2, p≤0.001) and 3.7-fold (C5, p=0.007) for gefapixantversusplacebo in CC patients; in HV, C2 and C5 increased 2.4-fold (C2, p=0.113; C5, p=0.003). The distilled water C2 and C5 thresholds increased significantly (p<0.001) by a factor of 1.4 and 1.3, respectively, in CC patients. Gefapixant had no effect on capsaicin or citric acid challenge. Median cough frequency was reduced by 42% and the least squares mean cough severity VAS was 18.0 mm lower for gefapixantversusplacebo in CC patients. Dysgeusia was the most frequent adverse event (75% of HV and 67% of CC patients).

ATP-evoked cough was significantly inhibited by gefapixant 100 mg, demonstrating peripheral target engagement. Cough count and severity were reduced in CC patients. Distilled water may also evoke cough through a purinergic pathway.
Needle-based confocal laser endomicroscopy for real-time diagnosing and staging of lung cancer
Authors: Wijmans Lizzy , Yared Joey , de Bruin Daniel M. , Meijer Sybren L. , Baas Paul , Bonta Peter I. , Annema Jouke T.
Published: April 2019

Diagnosing lung cancer in the absence of endobronchial abnormalities is challenging. Needle-based confocal laser endomicroscopy (nCLE) enables real-time microscopic imaging of cells. We assessed the feasibility and safety of using nCLE for real-time identification of lung cancer.

In patients with suspected or proven lung cancer scheduled for endoscopic ultrasound (EUS), lung tumours and mediastinal lymph nodes were imaged with nCLE before fine-needle aspiration (FNA) was performed. nCLE lung cancer characteristics were identified by comparison with pathology. Multiple blinded raters validated CLE videos of lung tumours and mediastinal nodes twice.

EUS-nCLE-FNA was performed in 22 patients with suspected or proven lung cancer in whom 27 lesions (six tumours, 21 mediastinal nodes) were evaluated without complications. Three nCLE lung cancer criteria (dark enlarged pleomorphic cells, dark clumps and directional streaming) were identified. The accuracy of nCLE imaging for detecting malignancy was 90% in tumours and 89% in metastatic lymph nodes. Both inter-observer agreement (mean κ=0.68, 95% CI 0.66–0.70) and intra-observer agreement (mean±sdκ=0.70±0.15) were substantial.

Real-time lung cancer detection by endosonography-guided nCLE was feasible and safe. Lung cancer characteristics were accurately recognised.
French experience of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension
Authors: Brenot Philippe , Jaïs Xavier , Taniguchi Yu , Garcia Alonso Carlos , Gerardin Benoit , Mussot Sacha , Mercier Olaf , Fabre Dominique , Parent Florence , Jevnikar Mitja , Montani David , Savale Laurent , Sitbon Olivier , Fadel Elie , Humbert Marc , Simonneau Gérald
Published: April 2019

Aims

To evaluate safety and efficacy of balloon pulmonary angioplasty (BPA) in a large cohort of patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

From 2014 to 2017, 184 inoperable CTEPH patients underwent 1006 BPA sessions. Safety and efficacy during the first 21 months (initial period) were compared with those of the last 21 months (recent period). A total of 154 patients had a full evaluation after a median duration of 6.1 months.

Results

Overall, there was a significant improvement in New York Heart Association functional class, 6-min walk distance (mean change +45 m), and a significant decrease in mean pulmonary artery pressure (PAP) and in pulmonary vascular resistance (PVR) by 26% and 43%, respectively. The percentage decreases of mean PAP and PVR were 22% and 37% in the initial periodversus30% and 49% in the recent period, respectively (p<0.05). The main complications included lung injury, which occurred in 9.1% of 1006 sessions (13.3% in the initial periodversus5.9% in the recent period; p<0.001). Per-patient multivariate analysis revealed that baseline mean PAP and the period during which BPA procedure was performed (recentversusinitial period) were the strongest factors related to the occurrence of lung injury. 3-year survival was 95.1%.

Conclusion

This study confirms that a refined BPA strategy improves short-term symptoms, exercise capacity and haemodynamics in inoperable CTEPH patients with an acceptable risk–benefit ratio. Safety and efficacy improve over time, underscoring the unavoidable learning curve for this procedure.
CCSP counterbalances airway epithelial-driven neutrophilic chemotaxis
Authors: Knabe Lucie , Petit Aurélie , Vernisse Charlotte , Charriot Jérémy , Pugnière Martine , Henriquet Corinne , Sasorith Souphatta , Molinari Nicolas , Chanez Pascal , Berthet Jean-Philippe , Suehs Carey , Vachier Isabelle , Ahmed Engi , Bourdin Arnaud
Published: April 2019

Club cell secretory protein (CCSP) knockout mice exhibit increased airway neutrophilia, as found in chronic obstructive pulmonary disease (COPD). We therefore investigated whether treating COPD airway epithelia with recombinant human CCSP (rhCCSP) could dampen exaggerated airway neutrophilia.

Control, smoker and COPD air–liquid interface (ALI) cultures exposed to cigarette smoke extract (CSE) were treated with and without rhCCSP. The chemotactic properties of the supernatants were assessed using Dunn chambers. Neutrophil chemotaxis along recombinant human interleukin 8 (rhIL8) gradients (with and without rhCCSP) was also determined. rhCCSP–rhIL8 interactions were tested through co-immunoprecipitation, Biacore surface plasmon resonance (SPR) andin silicomodelling. The relationship between CCSP/IL8 concentration ratios in the supernatant of induced sputum from COPD patientsversusneutrophilic airway infiltration assessed in lung biopsies was assessed.

Increased neutrophilic chemotactic activity of CSE-treated ALI cultures followed IL8 concentrations and returned to normal when supplemented with rhCCSP. rhIL8-induced chemotaxis of neutrophils was reduced by rhCCSP. rhCCSP and rhIL8 co-immunoprecipitated. SPR confirmed thisin vitrointeraction (equilibrium dissociation constant=8 µM).In silicomodelling indicated that this interaction was highly likely. CCSP/IL8 ratios in induced sputum correlated well with the level of small airway neutrophilic infiltration (r2=0.746, p<0.001).

CCSP is a biologically relevant counter-balancer of neutrophil chemotactic activity. These different approaches used in this study suggest that, among the possible mechanisms involved, CCSP may directly neutralise IL8.
Hypocoagulation induced by broad-spectrum antibiotics in extensive burn patients
Authors: Liu Jian , Liu Yiqing , Liu Shengjun , Zhang Qin , Zheng Jiexin , Niu Yiwen , Wang Xuefeng
Published: April 2019

Background

Patients with extensive burns usually develop pro-coagulation soon after the injury if there is no sepsis occurred. We describe the case of an extensive burn adult suffering from hypocoagulation not related to sepsis, but secondary to antibiotic treatment.

Case presentation

Here, we report a case of an adult male patient suffering from flame burns of 45% total body surface area (40% full thickness) combined with inhalation injury. Hypocoagulopathy with soaring prolonged activated partial thromboplastin time value occurred on third week post-burn while systemic infection had been under control by application of broad-spectrum antibiotics. Investigations showed that not the infection but vitamin K-related coagulation factor deficiency were responsible for unexpected bleeding. However, supplemental vitamin K was not the key as we expected, which prompted us trying to decode the underlying cause of coagulation disturbance in this patient and pick out the most effective treatment for live-saving. After the withdrawal of highly suspected broad-spectrum antibiotic, Meropenem®, disturbed vitamin K related coagulation factors gradually restored to their optimal levels so as to maintain normal coagulation status. Therefore, surgical procedures without further risk of bleeding could be carried out in time for wound recovery. The patient was discharged on post-burn day 67 and transferred to a secondary hospital for his rehabilitation.

Conclusion

Hypocoagulopathy may be devoted to different reasons other than sepsis in extensive burns. Early recognition of the cause for coagulation disturbance is critical to make appropriate treatment and save patients’ lives. This case illustrated the importance of unveiling the mist cause for coagulation disturbance occurred in extensive burn patient, which paved the way for optimal life-saving treatments. And we also recommend burn surgeons to be alerted to antibiotic-induced vitamin K deficiency-related coagulopathy among critical burn patients.
Role of Treatment Deintensification in the Management of p16+ Oropharyngeal Cancer: ASCO Provisional Clinical Opinion
Authors: Adelstein David J. , Ismaila Nofisat , Ku Jamie A. , Burtness Barbara , Swiecicki Paul L. , Mell Loren , Beitler Jonathan J. , Gross Neil , Jones Christopher U. , Kaufman Marnie , Le Quynh-Thu , Semrad Thomas J. , Siu Lillian L. , Ridge John A.
Published: April 2019

PURPOSE

An ASCO provisional clinical opinion offers timely clinical direction to ASCO’s membership after publication or presentation of potentially practice-changing data from major studies. This provisional clinical opinion addresses the role of treatment deintensification in the management of p16+ oropharyngeal cancer (OPC).

CLINICAL CONTEXT

For patients with p16+ OPC, current treatment approaches are well established. In the good-prognosis subset of nonsmoking p16+ patients with early-stage disease, these treatments have been highly successful, albeit with significant associated acute and late toxicity. Deintensification of surgical, radiation, and medical treatment in an effort to reduce toxicity while preserving high survival rates is an appropriate therapeutic objective currently being explored in patients who are experiencing the best treatment results. However, careful delineation of this good-risk subset is essential. While the current eighth edition of the American Joint Committee on Cancer staging system is prognostically robust, it should not be interpreted as reason to alter therapeutic decisions or justify treatment deintensification. The development of transoral surgical techniques and the adoption of intensity-modulated radiation therapy planning have been transformative in disease management and suggest potentially beneficial approaches. Recent advances in systemic treatments have been notable. The optimal integration and modification of these modalities to ameliorate toxicity has not been defined and remains an important focus of current investigation.

PROVISIONAL CLINICAL OPINION

The hypothesis that de-escalation of treatment intensity for patients with p16+ OPC can reduce long-term toxicity without compromising survival is compelling and necessitates careful study and the analysis of well-designed clinical trials before changing current treatment standards. Treatment deintensification for these patients should only be undertaken in a clinical trial. Additional information is available at www.asco.org/head-neck-cancer-guidelines .
Understanding Inherited Risk in Unselected Newly Diagnosed Patients With Endometrial Cancer
Authors: Cadoo Karen A. , Mandelker Diana L. , Mukherjee Semanti , Stewart Carolyn , DeLair Deborah , Ravichandran Vignesh , Srinivasan Preethi , Hurley Daire , Kemel Yelena , Arnold Angela G. , Sheehan Margaret , Pradhan Nisha , Joseph Vijai , Chi Dennis S. , Gardner Ginger J. , Jewell Elizabeth L. , Leitao Mario M. , Long Roche Kara , Mueller Jennifer J. , Sonoda Yukio , Zivanovic Oliver , Walsh Michael , Carlo Maria I. , Berger Michael F. , Hyman David M. , Zhang Liying , Robson Mark E. , Offit Kenneth , Aghajanian Carol , Abu-Rustum Nadeem R. , Stadler Zsofia
Published: April 2019

PURPOSE

Mutations in DNA mismatch repair genes and PTEN, diagnostic of Lynch and Cowden syndromes, respectively, represent the only established inherited predisposition genes in endometrial cancer to date. The prevalence of other cancer predisposition genes remains unclear. We determined the prevalence of pathogenic germline variants in unselected patients with endometrial cancer scheduled for surgical consultation.

PATIENTS AND METHODS

Patients prospectively consented (April 2016 to May 2017) to an institutional review board–approved protocol of tumor-normal sequencing via a custom next-generation sequencing panel—the Memorial Sloan Kettering–Integrated Mutation Profiling of Actionable Cancer Targets—that yielded germline results for more than 75 cancer predisposition genes. Tumors were assessed for microsatellite instability. Per institutional standards, all tumors underwent Lynch syndrome screening via immunohistochemistry (IHC) for mismatch repair proteins.

RESULTS

Of 156 patients who consented to germline genetic testing, 118 (76%) had stage I disease. In 104 patients (67%), tumors were endometrioid, and 60 (58%) of those tumors were grade 1. Twenty-four pathogenic germline variants were identified in 22 patients (14%): seven (4.5%) had highly penetrant cancer syndromes and 15 (9.6%) had variants in low-penetrance, moderate-penetrance, or recessive genes. Of these, five (21%) were in Lynch syndrome genes (two MSH6, two PMS2, and one MLH1). All five tumors had concordant IHC staining; two (40%) were definitively microsatellite instability–high by next-generation sequencing. One patient had a known BRCA1 mutation, and one had an SMARCA4 deletion. The remaining 17 variants (71%) were incremental findings in low- and moderate-penetrance variants or genes associated with recessive disease.

CONCLUSION

In unselected patients with predominantly low-risk, early-stage endometrial cancer, germline multigene panel testing identified cancer predisposition gene variants in 14%. This finding may have implications for future cancer screening and risk-reduction recommendations. Universal IHC screening for Lynch syndrome successfully identifies the majority (71%) of high-penetrance germline mutations.
Effect of a Ketogenic Diet on Submaximal Exercise Capacity and Efficiency in Runners
Authors: SHAW DAVID M. , MERIEN FABRICE , BRAAKHUIS ANDREA , MAUNDER ED , DULSON DEBORAH K.
Published: April 2019

Purpose

We investigated the effect of a 31-d ketogenic diet (KD) on submaximal exercise capacity and efficiency.

Methods

A randomized, repeated-measures, crossover study was conducted in eight trained male endurance athletes (V˙O2max, 59.4 ± 5.2 mL⋅kg−1⋅min−1). Participants ingested their habitual diet (HD) (13.1 MJ, 43% [4.6 g⋅kg−1⋅d−1] carbohydrate and 38% [1.8 g⋅kg−1⋅d−1] fat) or an isoenergetic KD (13.7 MJ, 4% [0.5 g·kg−1⋅d−1] carbohydrate and 78% [4 g⋅kg−1⋅d−1] fat) from days 0 to 31 (P < 0.001). Participants performed a fasted metabolic test on days −2 and 29 (~25 min) and a run-to-exhaustion trial at 70% V˙O2max on days 0 and 31 following the ingestion of a high-carbohydrate meal (2 g⋅kg−1) or an isoenergetic low-carbohydrate, high-fat meal (<10 g CHO), with carbohydrate (~55 g⋅h−1) or isoenergetic fat (0 g CHO⋅h−1) supplementation during exercise.

Results

Training loads were similar between trials and V˙O2max was unchanged (all, P > 0.05). The KD impaired exercise efficiency, particularly at >70% V˙O2max, as evidenced by increased energy expenditure and oxygen uptake that could not be explained by shifts in respiratory exchange ratio (RER) (all, P < 0.05). However, exercise efficiency was maintained on a KD when exercising at <60% V˙O2max (all, P > 0.05). Time-to-exhaustion (TTE) was similar for each dietary adaptation (pre-HD, 237 ± 44 vs post-HD, 231 ± 35 min; P = 0.44 and pre-KD, 239 ± 27 vs post-KD, 219 ± 53 min; P = 0.36). Following keto-adaptation, RER >1.0 vs <1.0 at V˙O2max coincided with the preservation and reduction in TTE, respectively.

Conclusion

A 31-d KD preserved mean submaximal exercise capacity in trained endurance athletes without necessitating acute carbohydrate fuelling strategies. However, there was a greater risk of an endurance decrement at an individual level.
Effectiveness of a mobile health intervention on infant and young child feeding among children ≤ 24 months of age in rural Islamabad over six months duration
Authors: Akber Subhana , Mahmood Hana , Fatima Razia , Wali Ahmed , Alam Ashraful , Sheraz Syed Yahya , Yaqoob Aashifa , Najmi Hina , Abbasi Saleem , Mahmood Humaira , Dibley Michael J. , Hazir Tabish
Published: April 2019

Background: Childhood development is highly influenced by feeding practices at the infancy and young age of children. Unfortunately, according to the National Nutrition Survey (2011), the prevalence of exclusive breastfeeding in Pakistan was 21% at four months, and 13% at six months of age with 51.3% of mothers initiating semisolid foods to their children at the recommended 6-8 months of age. The latest Pakistan Demographic & Health Survey (PDHS 2018) however; indicates that only 48% of infants are exclusively breastfed which has been improved from 38% as reported in the past five years but still more improvement is anticipated.

Methods: A quasi-experimental study design was employed for this post-intervention survey assessing effectiveness of mobile health (mhealth) regarding infant & young child feeding (IYCF) among pregnant and lactating mothers in Tarlai, Islamabad from May to June 2018. A total of 135 mothers who were earlier included in the intervention phase were recruited after obtaining verbal & written consent. The data was entered in EpiData (3.1) and analyzed in SPSS version 21.

Results: The mean age of these pregnant and lactating mothers was 30.5 years ± 4.5 SD with the majority of mothers in the age group of 25 to 29 years. After the intervention, the overall knowledge of mothers regarding IYCF nutrition was raised to 69.6% among 94 mothers as compared to 74 (54.8%). Overall attitude regarding IYCF was found to be positive among 86 (63.7%) of the mothers, whereas 88 (65.2%) of the mothers had good IYCF related practices.

Conclusion: Our post-intervention survey signifies the effectiveness of mhealth in raising knowledge, attitude, and practices of mothers regarding IYCF in rural Islamabad. However, implementation of mhealth in masses requires future research specifically to address the cost-effectiveness of such interventions in maternal & child health programmes.
Institutional Economics
Authors: Назарова Ирина , Nazarova Irina , Тумин Валерий , Tumin Valyeriy , Тумин Валерий , Tumin Valeriy
Published: April 2019

The textbook deals with the basic concepts of institutional Economics (institutions, transaction costs, forms of ownership, contracts, etc.). The interrelation of economic institutions at the micro and macroeconomic level of analysis (typology of the state, its functions, models of transformation of economic systems) is shown. Theoretical sections are supported by teaching materials containing control questions and tests, sample solutions to typical problems.
For students enrolled in the enlarged group of directions and specialties of training 38.00.00 "Economics and management", as well as for students of technological specialties in terms of their training in the disciplines of economic-organizational and management cycles.
Screenwriting for new film mediums: Conceptualizing visual models for interactive storytelling
Authors: Ogle Gwendolyn
Published: April 2019

This article considers challenges specific to screenwriting for interactive storytelling in new film mediums, and proposes fifteen visual, conceptual models for interactive storytelling. The models are placed on a continuum with increasing degrees of interactivity. Three arguments are posed for the necessity of visual, conceptual models and a review of literature is presented that lends credence to these arguments. Though technology’s ability to provide interaction is an important factor, technology is not the focus of this article. Instead, the focus is on the need for authors to have a voice and a process in this new, interdisciplinary domain of interactive storytelling in new film mediums. The models proposed in this article help establish a common vernacular from which authors, programmers and others can communicate and direct interactive storytelling efforts towards the design of interactive storytelling systems.
Anorexia e bulimia: uma reflexão psicanalítica
Authors: Lima Gerusa Marcondes Pimentel de Abreu
Published: April 2019

Objetivou-se neste artigo refletir sobre a teoria psicanalítica dos transtornos alimentares e os seus efeitos no campo psíquico e subjetivo dos indivíduos doentes, evidenciando a anorexia e bulimia. Freud observou que as cobranças da realidade levam as crianças a entrarem em contato com a falta e com a perda, partindo desta perspectiva, o que se sobressai é a falta desse objeto. Nesse caso, a falta está relacionada Ã  castração da mãe que levará a criança a prosseguir para o desenvolvimento de sua subjetividade e consequentemente, ao seu psiquismo. A angústia de perda é destruidora, pois se perde algo de que ela depende integralmente. Estes são um dos mecanismos apresentados as pacientes com transtornos alimentares.
Do enclausuramento à autonomia: o Acompanhamento Terapêutico na Reforma Psiquiátrica
Authors: Baptista Juliana Aguiar dos Santos , Cavalcante Rebeca Juliane da Silva , Barbosa Maicon
Published: April 2019

Esse artigo objetiva compreender a relação entre o Acompanhamento Terapêutico e a Reforma Psiquiátrica brasileira, a partir de uma revisão bibliográfica de artigos publicados em revistas acadêmicas da área de Psicologia. Foram analisados 26 artigos, publicados entre 2005 e 2016, encontrados no Scielo, Pepsic e Google acadêmico. A partir do material levantado, foram construídos quatro eixos de análise: autonomia e garantia de direitos; a Reforma Psiquiátrica e o Acompanhamento Terapêutico; o acompanhante terapêutico e sua relação com o acompanhado; e o espaço urbano na clínica do AT. Conclui-se que o AT teve papel importante no processo de desinstitucionalização da loucura, contrapondo-se ao cotidiano enclausurado das instituições manicomiais e construindo outras relações entre a Saúde Mental e a cidade.
Álcool como sintoma: histórias de vida de dependentes
Authors: Kobayashi Márcio , Silva Marjorie C. R. , Fiamenghi-Jr Geraldo A.
Published: April 2019

Esta pesquisa objetivou investigar a relação entre dependência do álcool e história de vida num grupo de sete homens, com idades entre 42 a 70 anos, frequentadores, há mais de dois anos, do AA, numa cidade do interior de São Paulo. Apresentou-se aos participantes uma Narrativa Interativa inacabada, elaborada pelos pesquisadores, sobre o tema do alcoolismo, que os participantes completavam por escrito, além de entrevistas gravadas. Foram definidos sete campos de sentido a partir da interpretação das narrativas e das entrevistas, articulados teoricamente com a literatura psicanalítica. Observou-se que cada sujeito possui histórias singulares quanto ao início e permanência no uso do álcool; a importância da fala do sujeito e seu poder curativo; a necessidade de reparação pelos danos causados à própria vida e/ou no ambiente familiar e a identificação dos sujeitos dependentes com o grupo AA, no qual buscam ajuda para recuperação.
Por uma (re)dimensão artefatual da "Psique Humana" - Teoria Ator-Rede e Psicologia
Authors: Collodel-Benetti Idonézia , Roberti Junior João Paulo
Published: April 2019

A Psicologia tem a característica singular de rever com elevada frequência as suas próprias categorias analíticas e os seus preceitos teórico-metodológicos. Um desses momentos de questionamento vem das reflexões levantadas pela perspectiva dos Estudos Sociotécnicos ou Teoria Ator-Rede de Bruno Latour. Este ensaio, com delineamento qualitativo e de problematização teórica, tem como objetivo colocar em discussão uma série de estudos e debates que se têm realizado sobre a Teoria Ator-Rede e suas contribuições para a Psicologia. O foco será o modo como são tratadas as associações entre humanos e não humanos e as apreciações como o social, a rede, o sujeito/objeto. Assim, foram sistematizados alguns conceitos e princípios da perspectiva sociotécnica e de simetria generalizada. Incluiu-se um rastreamento dos trabalhos produzidos na Psicologia, a partir da perspectiva sociotécnica da Teoria Ator-Rede. Os resultados apontam para novas concepções da relação entre Psicologia e Teoria-Ator Rede.
Perfil do homem com disfunção sexual que procura profissional clínico especializado em medicina ou psicologia
Authors: Simão Juliana Bonetti , Simão Omar Pacheco
Published: April 2019

Este relato de experiência visou elucidar as queixas e problemas de homens que procuram a ajuda de um urologista ou psicólogo especialista em sexualidade. As metodologias utilizadas foram observação direta e análise clínica de pacientes que frequentaram, nos últimos cinco anos, os consultórios de um urologista e de um psicólogo especializado em sexualidade. Os resultados sugerem que a amostra masculina tem disfunção sexual, em sua maioria, por temor de desempenho. Tem também o fanatismo religioso e a homossexualidade latente como possíveis causas. Assim é possível compreender aspectos emocionais semelhantes capazes de agrupá-los em perfis psicológicos para melhor conduzir os casos.