bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Endovascular Repair for Abdominal Aortic Aneurysms
Authors: Hoshina Katsuyuki , Ishimaru Shin , Sasabuchi Yusuke , Yasunaga Hideo , Komori Kimihiro
Published: September 2017

Objective:

To analyze data on patients treated with a bifurcated stent graft for abdominal aortic aneurysm (AAA).

Background:

The Japan Committee for Stentgraft Management (JACSM) was established in 2007 to manage the safety of endovascular aortic aneurysm repair (EVAR) in Japan. The JACSM registry includes detailed anatomical and clinical data of all patients who undergo stent graft insertion in Japan.

Methods:

Among 51,380 patients treated with bifurcated stent graft for AAA, we identified 38,008 eligible patients (excluding those with rupture or insufficient data). The analyzed factors included age, sex, comorbidities, AAA pathology and etiology, aneurysm and neck diameters, 7 anti-instructions for use (IFU) factors, and endoleaks at hospital discharge. The endpoints were death, adverse events, sac dilatation (≥5 mm), and reintervention.

Results:

The rates of intraoperative and in-hospital mortality were 0.08% and 1.07%, respectively. Infectious aneurysm and pseudo-aneurysm were associated with overall survival and reintervention. Older age, large aneurysm diameter, and all types of persistent endoleaks were strong predictors of adverse events, sac dilatation, and reintervention. Comorbid cerebrovascular disease, renal dysfunction, and respiratory disorders were also risk factors. In total, 47.6% of patients violated the IFU; among the anti-IFU factors assessed, poor access and severe neck calcification were strong risk factors for mortality, reintervention, and adverse events. The sac dilatation rate at 5 years was 23.3%.

Conclusions:

Although the analysis included EVAR with poor anatomy, the perioperative mortality rate was acceptable compared with that in previous large population studies.
Formality and informality in an Indian urban waste economy
Authors: Harriss-White Barbara
Published: September 2017

Purpose

The purpose of this paper is to contribute original evidence about the conditions for formal and informal contracts for commodities and labour in the waste economy of a South Indian town.

Design/methodology/approach

Field research was exploratory, based on snowball sampling and urban traversing. The analysis follows capital and labour in the sub-circuits of capital generating waste in production, distribution, consumption, the production of labour and the reproduction of society.

Findings

Regardless of legal regulation, which is selectively enforced, formal contracts are limited to active inspection regimes; direct transactions with or within the state; and long-distance transactions. Formal labour contracts are least incomplete for state employment, and for relatively scarce skilled labour in the private sector.

Research limitations/implications

The research design does not permit quantified generalisations.

Practical implications

Waste management technology evaluations neglect the social costs of displacing a large informal labour force.

Social implications

While slowly dissolving occupational barriers of untouchability, the waste economy is a low-status labour absorber of last resort, exit from which is extremely difficult.

Originality/value

The first systematic exploration of formal and informal contracts in an Indian small-town waste economy.
Altered oesophageal mechanosensitivity of secondary peristalsis as a pathophysiological marker in patients with globus sensation
Authors: Lei W‐Y. , Hung J‐S. , Liu T‐T. , Yi C‐H. , Chen C‐L.
Published: September 2017

Objective

Secondary peristalsis is important for clearance of retained food bolus and refluxate from the oesophagus. We aimed to investigate whether patients with globus sensation have altered physiological characteristics of secondary peristalsis.

Design

Prospective case‐controlled study

Setting

Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.

Participants

Seventeen globus patients and 18 healthy controls.

Main outcome measures

After a baseline recording of primary peristalsis, secondary peristalsis was stimulated with slow and rapid mid‐oesophageal injections of air. Distension thresholds and peristaltic activities of secondary peristalsis were analysed and compared between the patients and healthy controls.

Results

The threshold volume for generating secondary peristalsis during slow air distension did not differ between the patient and control groups (P = .55). The threshold volume for generating secondary peristalsis during rapid air distension was significantly greater in patients with globus than healthy controls (7.0 ± 0.9 vs 5.0 ± 0.3 mL, P = .04). Secondary peristalsis was triggered less frequently in globus patients as compared with healthy control after rapid air distension (40% [30%‐65%] vs 60% [60%‐83%], P = .001). There was no difference in any of peristaltic parameters for primary and secondary peristalsis between the groups.

Conclusions

Our work identifies functional defects of oesophageal secondary peristalsis in patients with globus sensation and such defects are characterised with defective triggering of secondary peristalsis during rapid air distension. Whether current findings have therapeutic implication in the management of patients with globus sensation warrants further investigation.
Why Do Earnings Fall with Job Displacement?
Authors: Carrington William J. , Fallick Bruce
Published: September 2017

Displaced workers experience reduced earnings for many years. While this empirical phenomenon is well established, the theory of displacement‐induced earnings loss is scattered. Policy discussion often interprets displacement‐induced losses through the lens of specific human capital theory but there are other credible theories with different causal mechanisms and different interpretations. This paper reviews theories of costly job displacement and discusses their consistency with the available empirical evidence for the United States. We find that specific human capital theory and matching theory have considerable but far from conclusive empirical support. We suggest avenues for better discriminating among theories.
A holistic dynamic concept on dry eye disease identifies several different interacting self‐enforcing vicious circles of disease progression
Authors: Knop E. , Knop N.
Published: September 2017

Purpose

Dry Eye Disease (DED) is a complex alteration of the ocular surface. Typical are self‐enforcing mechanisms that drive the condition are termed ′Vicious Circles′ (VC). It is generally believed that ′a vicious circle′ occurs in DED that is driven by inflammation .

Methods

A NLM PubMed based review of the literature review was performed and pathogenetic mechanisms were analyzed according to patho‐physiology.

Results

This approach in DED indicates that Basic primary causative factors are (A) deficiency of tear SECRETION by the ocular secretory glands (aqueous lacrimal gland, oily Meibomian glands, single conjunctival goblet cell mucin glands) and (B) deficiency in FORMATION of a stable tear FILM by the eye lids & blinking. The two main pathologies are (1) tear film deficiency and (2) tissue damage. Several VC in DED were identified: One important VC is destruction of the surface epithelium by insufficient wetting due to a deficient tear film which, in turn, further reduces the tissue wettability and thus tear film stability. Surface destruction leads to induction of inflammatory pathways that drive VS for progression of disease. Since the destruction of the tissue also impairs the ocular glands, large VC of gland destruction (Pathological Carousels) occur wherein tissue destruction increasingly impairs gland secretion which, in turn, drives further surface destruction. Other VC are hidden in the gland pathology of Meibomian Gland Dysfunction (MGD) and Lacrimal Gland Dysfunction (LGD).

Conclusions

A holistic dynamic analysis of DED can identify, In contrast to present over‐simplified models, that Vicious Circles do not necessarily depend on inflammation and that there are in fact several, different, interacting vicious circles instead of just one. The relevant VC must be identified in the individual patient to allow an effective therapy.
Optical control of corneal nerve activity using chemical photoswitches
Authors: Gallar J. , Ares‐Suarez D. , Quirce S. , Acosta M.C. , Belmonte C. , Meseguer V.
Published: September 2017

Purpose

Photo‐isomerizable small molecules (photoswitches) allow modulation of neural activity acting on native ion channels without requiring exogenous gene expression. DENAQ, a synthetic photoswitch, confers light‐sensitivity to retinal ganglion cells in a mouse model of retinitis pigmentosa. However, there are no direct evidences on whether photoswitches can modulate electrical activity of neural structures located far away from the neuron cell body, such as corneal sensory nerve terminals. Our objective was to photo‐modulate the activity of corneal cold sensory nerve terminals (CSNTs) in excised guinea‐pig corneas pre‐incubated with DENAQ.

Methods

Corneas were incubated with 2 mM DENAQ (40 min at 34°C). Then, electrical activity of CSNTs was recorded extracellularly from corneas superfused at 34°C. A LED was used to deliver pulses of blue light (460 nm, 125 mW/cm2) to the perfused corneas. Light stimulation protocol consisted of 5 cycles of alternating 15s light/dark intervals.

Results

Blue light had no effect on the ongoing activity (OA) of CSNTs recorded from naïve corneas, not pre‐incubated with DENAQ (7.4±0.4 vs 7.4±0.4 imp·s‐1, dark vs blue light, n=8, p=0.79, paired t‐test). In corneas pre‐incubated with DENAQ, OA of CSNTs was significantly higher in the dark than under blue light (4.5±0.8 vs 2.3± 0.4 imp·s‐1, p=0.001, n=8). OA of CSNTs under blue light was significantly lower in DENAQ pre‐incubated corneas than in naïve corneas (p=0.013, t‐test).

Conclusions

DENAQ produces a robust decrease of the spontaneous electrical activity of guinea pig corneal cold sensory nerve endings in the presence of blue light. Small molecules acting as chemical photoswitches may be potentially useful as drugs for patients with ectopic corneal nerve activity, such as in dry eye and ocular neuropathic pain. (SAF2014‐54518‐C3‐1‐R and ‐2‐R, MINECO, Spain, and ERDF, EC)
Correlation between electrophysiological test and visual dysfunction in multiple sclerosis patients
Authors: Vildades Palomar E. , Orduna Hospital E. , Ciprés M. , Obis J. , Rodrigo SanJuan M.J. , Satué Palacian M. , Garcia‐Martin E.
Published: September 2017

Purpose

Evaluate best corrected visual acuity (BCVA), contrast sensitivity (SC), pattern electroretinogram (pERG), multifocal electroretinogram (mfERG), and multifocal visual evoked potentials (mfVEP) in multiple sclerosis (MS) and compare with healthy controls.

Methods

Fifty‐eight eyes were included: 14 of healthy controls and 44 of subjects with MS (of whom 17 presented a previous episode of optic neuritis). The BCVA ETDRS was recorded at 100% contrast, 2.5% and 1.25%, CS with CSV1000 test (at 3, 6, 9 and 12 cycles per degree) and Pelli Robson. The pERG, mfERG and mfVEP electrophysiology tests were performed with the Roland Consult's Reti‐port / scan device.

Results

Patients with MS showed a significant reduction of VA at 100% contrast (p = 0.013), 2.5% (p <0.001) and 1.25% (p = 0.008), CSV‐1000 was also affected at 3 (p = 0.017), 9 (p = 0.017), and 12 cycles per degree (p = 0.048), and also Pelli Robson (p <0.001). The mfERG showed in MS patients a significant affectation for amplitude and latency at the inferonasal and superonasal quadrants (p = 0.045 and 0.042 respectively), and the overall values of the mfPEV sown abnormalities at N1 and P1 amplitudes (p = 0.019 and p = 0.039, respectively).

Conclusions

Patients with MS have a clear impairment of visual function in both psychophysical and electrophysiological tests.
Reflecting on clinical practice: hectoring talk or reality?
Authors: CARR ELOISE C. J.
Published: September 2017

Reflection can be seen as a useful tool to enable the practitioner to explore the everyday world of clinical practice. This paper reviews the background to reflection and its relevance to nursing in reducing the theory ‐ practice gap and its role in generating theory from practice.

Exemplars from clinical practice are reflected upon and Carper's (1978) ‘Patterns of Knowing’ are used as a framework to identify nursing knowledge embedded in practice.

The process of reflection is critically discussed in the light of the author's experience.
Protein 4.1R is Involved in the Transport of 5‐Aminolevulinic Acid by Interaction with GATs in MEF Cells
Authors: Ning Shuwei , Kang Qiaozhen , Fan Dandan , Liu Jingjing , Xue Chaoyue , Zhang Xiaolin , Ding Cong , Zhang Jianying , Peng Qian , Ji Zhenyu
Published: September 2017

5‐aminolevulinic acid (5‐ALA)‐based photodynamic therapy (PDT) has been successfully used in the treatment of cancers. However, the mechanism of 5‐ALA transportation into cancer cells is still not fully elucidated. Previous studies have confirmed that the efficiency of 5‐ALA‐PDT could be affected by the membrane skeleton protein 4.1R. In this study, we investigated the role of 4.1R in the transport of 5‐ALA into cells. Wild‐type (4.1R+/+) and 4.1R gene knockout (4.1R−/−) mouse embryonic fibroblast (MEF) cells were incubated with 1 mm 5‐ALA and different concentrations of specific inhibitors of GABA transporters GAT (1‐3). Our results showed that the inhibition of GAT1 and GAT2 in particular markedly attenuated the intracellular PpIX production, reactive oxygen species (ROS) level and 5‐ALA‐induced photodamage. However, the inhibition of GAT3 did not show such effects. Further research showed that 4.1R−/− MEF cells had a lower expression of GAT1 and GAT2 than 4.1R+/+ MEF cells. Additionally, 4.1R directly bound to GAT1 and GAT2. Taken together, GAT1 and GAT2 transporters are involved in the uptake of 5‐ALA in MEF cells. 4.1R plays an important role in transporting 5‐ALA into cells via at least partly interaction with GAT1 and GAT2 transporters in 5‐ALA‐PDT.
Preference Functions for Spatial Risk Analysis
Authors: Keller L. Robin , Simon Jay
Published: September 2017

When outcomes are defined over a geographic region, measures of spatial risk regarding these outcomes can be more complex than traditional measures of risk. One of the main challenges is the need for a cardinal preference function that incorporates the spatial nature of the outcomes. We explore preference conditions that will yield the existence of spatial measurable value and utility functions, and discuss their application to spatial risk analysis. We also present a simple example on household freshwater usage across regions to demonstrate how such functions can be assessed and applied.
Translation and field testing of the family functioning, family health and social support questionnaire in Danish outpatients with heart failure
Authors: Østergaard Birte , Pedersen Karen Steenvinkel , Lauridsen Jørgen , Nørgaard Birgitte , Jeune Bernard
Published: September 2017

Background

Valid and reliable instruments to assess family functioning, health and social support in families with heart failure constitute a cornerstone in the detection of the families’ needs, in improving their functioning and in evaluating the effects of nursing interventions.

Aim

To translate the three scales of the Family Functioning, Family Health and Social Support (FAFHES) questionnaire from Finnish into Danish, to test validity and reliability of the Danish version among outpatients with heart failure and to add to previous studies by reconstructing scales using confirmatory factor analysis.

Methods

A cross‐sectional design was used to study a sample of 330 patients with heart failure who completed the FAFHES. The validity (dimensionality) and reliability (internal consistency and test–retest) were assessed for each of the three scales. The scales were constructed using confirmatory factor analysis.

Results

Patients were primarily men (76%) with a mean age of 66.5 (SD 12.5), categorised as New York Heart Association (NYHA) classification II (80%) and NYHA III (20%) for clinical severity of symptoms. In all three modified scales, construct validity was supported by the analysis. There were strong correlations within the factors, with Cronbach's alpha ranging from 0.73 to 0.95 across the three scales, and significant, though weak, correlations between most of the factors. None of the revised scales showed good model fit according to the goodness‐of‐fit indices used. The test–retest showed interclass correlation coefficients ranging between 0.69 and 0.86, indicating acceptable test–retest reliability.

Conclusion

The Danish version of the FAFHES is an instrument that can be used to measure family functioning, family health and social support from the perspective of the patient with heart failure. Further testing is recommended.
Determining the inventory impact of extended‐shelf‐life platelets with a network simulation model
Authors: Blake John T.
Published: September 2017

BACKGROUND

The regulatory shelf life for platelets (PLTs) in many jurisdictions is 5 days. PLT shelf life can be extended to 7 days with an enhanced bacterial detection algorithm. Enhanced testing, however, comes at a cost, which may be offset by reductions in wastage due to longer shelf life. This article describes a method for estimating systemwide reductions in PLT outdates after PLT shelf life is extended.

STUDY DESIGN AND METHODS

A simulation was used to evaluate the impact of an extended PLT shelf life within a national blood network. A network model of the Canadian Blood Services PLT supply chain was built and validated. PLT shelf life was extended from 5 days to 6, 7, and 8 days and runs were completed to determine the impact on outdates.

RESULTS

Results suggest that, in general, a 16.3% reduction in PLT wastage can be expected with each additional day that PLT shelf life is extended. Both suppliers and hospitals will experience fewer outdating units, but wastage will decrease at a faster rate at hospitals. No effect was seen by blood group, but there was some evidence that supplier site characteristics influences both the number of units wasted and the site's ability to benefit from extended‐shelf‐life PLTs.

CONCLUSION

Extended‐shelf‐life PLTs will reduce wastage within a blood supply chain. At 7 days, an improvement of 38% reduction in wastage can be expected with outdates being equally distributed between suppliers and hospital customers.
An exploratory investigation of echocardiographic parameters and the effects of posture on cardiac structure and function in the Livingstone's fruit bat (Pteropus livingstonii)
Authors: Drane Aimee L. , Shave Robert , Routh Andrew , Barbon Alberto
Published: September 2017

There is growing evidence that dilated cardiomyopathy may be a major cause of death in captive Livingstone's fruit bats (Pteropus livingstonii). Therefore, the primary aim of this prospective, exploratory study was to examine whether a systematic cardiac ultrasound protocol is feasible in this critically endangered species and to report basic measures of cardiac structure and function from a cohort of apparently healthy bats. A secondary aim was to test the effect posture (dorsal recumbency vs. roosting) has upon cardiac function in this species. Transthoracic echocardiograms, including 2D, Doppler, and tissue Doppler measures of cardiac structure and function were completed as part of routine health examinations for bats at a single center (n = 19). Bats were then grouped by age and disease status and the mean and range data reported for each group. In healthy adult bats, with the exception of a reduction in heart rate (P ≤ 0.05), right atrial systolic area (P ≤ 0.05), and right ventricular velocity during atrial contraction, there were no significant changes in cardiac structure or function in response to the roosting position. However, in the bats presenting with dilated cardiomyopathy the current data suggest that left ventricular ejection fraction is improved while roosting. Further work is required to confirm our initial findings, generate diagnostic reference intervals, and explore the causes of dilated cardiomyopathy in this species.
NIH's massive health study is off to a slowstart
Authors: Kaiser Jocelyn
Published: September 2017

All of Us hopes to begin recruiting 1 million volunteers by early 2018.
Trapped in orbit
Authors: Cho Adrian
Published: September 2017

Atomic physicists will soon make ultracold states of matter on the space station.
The road to Crohn's disease
Authors: Kaser Arthur , Blumberg Richard S.
Published: September 2017

A stress pathway directs the antimicrobial response to an enteric pathogen
A tale of two amyloids
Authors: Morris Jill K.
Published: September 2017

Plasma β-amyloid drives peripheral insulin resistance, which precedes an increase in cerebral neuropathology in a novel mouse model that combines Alzheimer’s and diabetes pathologies.
How Germinal Centers Evolve Broadly Neutralizing Antibodies: the Breadth of the Follicular Helper T Cell Response
Authors: De Boer Rob J. , Perelson Alan S.
Published: September 2017

Many HIV-1-infected patients evolve broadly neutralizing antibodies (bnAbs). This evolutionary process typically takes several years and is poorly understood as selection taking place in germinal centers occurs on the basis of antibody affinity. B cells with the highest-affinity receptors tend to acquire the most antigen from the follicular dendritic cell (FDC) network and present the highest density of cognate peptides to follicular helper T (Tfh) cells, which provide survival signals to the B cell. bnAbs are therefore expected to evolve only when the B cell lineage evolving breadth is consistently capturing and presenting more peptides to Tfh cells than other lineages of more specific B cells. Here we develop mathematical models of Tfh cells in germinal centers to explicitly define the mechanisms of selection in this complex evolutionary process. Our results suggest that broadly reactive B cells presenting a high density of peptides bound to major histocompatibility complex class II molecules (pMHC) are readily outcompeted by B cells responding to lineages of HIV-1 that transiently dominate the within host viral population. Conversely, if broadly reactive B cells acquire a large variety of several HIV-1 proteins from the FDC network and present a high diversity of several pMHC, they can be rescued by a large fraction of the Tfh cell repertoire in the germinal center. Under such circumstances the evolution of bnAbs is much more consistent. Increasing either the magnitude of the Tfh cell response or the breadth of the Tfh cell repertoire markedly facilitates the evolution of bnAbs. Because both the magnitude and breadth can be increased by vaccination with several HIV-1 proteins, this calls for experimental testing.

IMPORTANCEMany HIV-infected patients slowly evolve antibodies that can neutralize a large variety of viruses. Such broadly neutralizing antibodies (bnAbs) could in the future become therapeutic agents. bnAbs appear very late, and patients are typically not protected by them. At the moment, we fail to understand why this takes so long and how the immune system selects for broadly neutralizing capacity. Typically, antibodies are selected based on affinity and not on breadth. We developed mathematical models to study two different mechanisms by which the immune system can select for broadly neutralizing capacity. One of these is based upon the repertoire of different follicular helper T (Tfh) cells in germinal centers. We suggest that broadly reactive B cells may interact with a larger fraction of this repertoire and demonstrate that this would select for bnAbs. Intriguingly, this suggests that broadening the Tfh cell repertoire by vaccination may speed up the evolution of bnAbs.
Environmental and Genetic Determinants of Biofilm Formation in Paracoccus denitrificans
Authors: Kumar Santosh , Spiro Stephen
Published: September 2017

The bacterium
Paracoccus denitrificans
is a model for the process of denitrification, by which nitrate is reduced to dinitrogen during anaerobic growth. Denitrification is important for soil fertility and greenhouse gas emission and in waste and water treatment processes. The ability of bacteria to grow as a biofilm attached to a solid surface is important in many different contexts. In this paper, we report that attached growth of
P. denitrificans
is stimulated by nitric oxide, an intermediate in the denitrification pathway. We also show that calcium ions stimulate attached growth, and we identify a large calcium binding protein that is required for growth on a polystyrene surface. We identify components of a signaling pathway through which nitric oxide may regulate biofilm formation. Our results point to an intimate link between metabolic processes and the ability of
P. denitrificans
to grow attached to a surface.
A case of De Garengeot hernia and literature review
Authors: Bidarmaghz Bardia , Tee Chin Li
Published: September 2017

Femoral hernia accounts for only 3% of all the hernias and in only 0.5%–5% of the events, the appendix can travel through the femoral hernia which is called De Garengeot hernia, and the incidence of appendicitis in this type of hernia is as low as 0.08%–0.13%. We present a case of a 69-year-old healthy woman who was referred to the emergency department by her general practitioner for CT-proven appendicitis in the femoral canal. On initial assessment, she was found to have a hard, tender lump in her right groin below the inguinal ligament, and open appendectomy and herniorrhaphy were performed. Surgery is the mainstay of treatment of this type of hernia but due to the rarity of this condition, there is no specific guideline as for the surgical procedure. This article demonstrated a case of De Garengeot hernia which was diagnosed preoperatively and managed surgically.
Ganglioneuroma of the retropharyngeal space in a patient with glottic cancer
Authors: Dias Raquel Baptista , Rosa Duarte , Rito Miguel , Borges Alexandra
Published: September 2017

We describe the case of a 71-year-old man with a ganglioneuroma of the retropharyngeal space. The patient presented with a submucosal bulge of the left oropharyngeal wall during follow-up examination of a treated vocal cord carcinoma. CT and MRI revealed a non-specific, well-defined retropharyngeal soft tissue lesion. Positron emission tomography-CT did not show relevant metabolic activity, excluding the hypothesis of metastatic nodal disease. Surgical biopsy of the lesion was compatible with ganglioneuroma. Ganglioneuromas are well-differentiated tumours composed of mature sympathetic ganglion cells that account for approximately 1% of spinal and paraspinal tumours. Peripherally, ganglioneuromas are predominantly found in the posterior mediastinum and retroperitoneal space. Only nine ganglioneuromas of the retropharyngeal space have been reported in the English literature since the early 1980s.
APpropriAteness of percutaneous Coronary interventions in patients with ischaemic HEart disease in Italy: the APACHE pilot study
Authors: Leonardi Sergio , Marino Marcello , Crimi Gabriele , Maiorana Florinda , Rizzotti Diego , Lettieri Corrado , Bettari Luca , Zuccari Marco , Sganzerla Paolo , Tresoldi Simone , Adamo Marianna , Ghiringhelli Sergio , Sponzilli Carlo , Pasquetto Giampaolo , Pavei Andrea , Pedon Luigi , Bassan Luciano , Bollati Mario , Camisasca Paola , Trabattoni Daniela , Brancati Marta , Poli Arnaldo , Panciroli Claudio , Lettino Maddalena , Tarelli Giuseppe , Tarantini Giuseppe , De Luca Leonardo , Varbella Ferdinando , Musumeci Giuseppe , De Servi Stefano
Published: September 2017

Objectives

To first explore in Italy appropriateness of indication, adherence to guideline recommendations and mode of selection for coronary revascularisation.

Design

Retrospective, pilot study.

Setting

22 percutaneous coronary intervention (PCI)-performing hospitals (20 patients per site), 13 (59%) with on-site cardiac surgery.

Participants

440 patients who received PCI for stable coronary artery disease (CAD) or non-ST elevation acute coronary syndrome were independently selected in a 4:1 ratio with half diabetics.

Primary and secondary outcome measures

Proportion of patients who received appropriate PCI using validated appropriate use scores (ie, AUS≥7). Also, in patients with stable CAD, we examined adherence to the following European Society of Cardiology recommendations: (A) per cent of patients with complex coronary anatomy treated after heart team discussion; (B) per cent of fractional flow reserve-guided PCI for borderline stenoses in patients without documented ischaemia; (C) per cent of patients receiving guideline-directed medical therapy at the time of PCI as well as use of provocative test of ischaemia according to pretest probability (PTP) of CAD.

Results

Of the 401 mappable PCIs (91%), 38.7% (95% CI 33.9 to 43.6) were classified as appropriate, 47.6% (95% CI 42.7 to 52.6) as uncertain and 13.7% (95% CI 10.5% to 17.5%) as inappropriate. Median PTP in patients with stable CAD without known coronary anatomy was 69% (78% intermediate PTP, 22% high PTP). Ischaemia testing use was similar (p=0.71) in patients with intermediate (n=140, 63%) and with high PTP (n=40, 66%). In patients with stable CAD (n=352) guideline adherence to the three recommendations explored was: (A) 11%; (B) 25%; (C) 23%. AUS was higher in patients evaluated by the heart team as compared with patients who were not (7 (6.8) vs 5 (4.7); p=0.001).

Conclusions

Use of heart team approaches and adherence to guideline recommendations on coronary revascularisation in a real-world setting is limited. This pilot study documents the feasibility of measuring appropriateness and guideline adherence in clinical practice and identifies substantial opportunities for quality improvement.

Trial registration number

NCT02748603.
Feasibility randomised multicentre, double-blind, double-dummy controlled trial of anakinra, an interleukin-1 receptor antagonist versus intramuscular methylprednisolone for acute gout attacks in patients with chronic kidney disease (ASGARD): protocol study
Authors: Balasubramaniam Gowrie , Parker Trisha , Turner David , Parker Mike , Scales Jonathan , Harnett Patrick , Harrison Michael , Ahmed Khalid , Bhagat Sweta , Marianayagam Thiraupathy , Pitzalis Costantino , Mallen Christian , Roddy Edward , Almond Mike , Dasgupta Bhaskar
Published: September 2017

Introduction

Acute gout occurs in people with chronic kidney disease, who are commonly older people with comorbidities such as hypertension, heart disease and diabetes. Potentially harmful treatments are administered to these vulnerable patients due to a lack of clear evidence. Newly available treatment that targets a key inflammatory pathway in acute gout attacks provides an opportunity to undertake the first-ever trial specifically looking treating people with kidney disease. This paper describes the protocol for a feasibility randomised controlled trial (RCT) comparing anakinra, a novel interleukin-1 antagonist versus steroids in people with chronic kidney disease (ASGARD).

Methods and analysis

ASGARD is a two-parallel group double-blind, double-dummy multicentre RCT comparing anakinra 100 mg, an interleukin-1 antagonist, subcutaneous for 5 days against intramuscular methylprednisolone 120 mg. The primary objective is to assess the feasibility of the trial design and procedures for a definitive RCT. The specific aims are: (1) test recruitment and retention rates and willingness to be randomised; (2) test eligibility criteria; (3) collect and analyse outcome data to inform sample and power calculations for a trial of efficacy; (4) collect economic data to inform a future economic evaluation estimating costs of treatment and (5) assess capacity of the project to scale up to a national multicentre trial. We will also gather qualitative insights from participants. It aims to recruit 32 patients with a 1:1 randomisation. Information from this feasibility study will help design a definitive trial and provide general information in designing acute gout studies.

Ethics and dissemination

The London-Central Ethics Committee approved the protocol. The results will be disseminated in peer-reviewed journals and at scientific conferences.

Trial registration number

EudraCT No. 2015-001787-19, NCT/Clinicalstrials.gov No.NCT02578394, pre-results, WHO Universal Trials Reference No. U1111-1175-1977. NIHR Grant PB-PG-0614–34090.
Psychological distress following a motor vehicle crash: evidence from a statewide retrospective study examining settlement times and costs of compensation claims
Authors: Guest Rebecca , Tran Yvonne , Gopinath Bamini , Cameron Ian D , Craig Ashley
Published: September 2017

Objective

To determine whether psychological distress associated with musculoskeletal injuries sustained in a motor vehicle crash (MVC), regardless of time of onset, impacts compensation outcomes such as claim settlement times and costs. Second, to identify factors routinely collected by insurance companies that contribute to psychological distress during the compensation process.

Design

Statewide retrospective study.

Data source

Analysis of the New South Wales statewide (Australia) injury register for MVC survivors who lodged a compensation claim from 2011 to 2013.

Participants

6341 adults who sustained a musculoskeletal injury and who settled a claim for injury after an MVC. Participants included those diagnosed with psychological distress (n=607) versus those not (n=5734).

Main outcome measures

Time to settlement and total costs of claims, as well as socio-demographic and injury characteristics that may contribute to elevated psychological distress, such as socio-economic disadvantage, and injury severity.

Results

Psychological distress in those with a musculoskeletal injury was associated with significantly longer settlement times (an additional 17 weeks) and considerably higher costs (an additional $A41 575.00 or 4.3 times more expensive). Multivariate logistic regression analysis identified risk factors for psychological distress including being female, social disadvantage, unemployment prior to the claim, not being at fault in the MVC, requiring ambulance transportation and rehabilitation as part of recovery.

Conclusions

Results provide compelling evidence that psychological distress has an adverse impact on people with musculoskeletal injury as they progress through compensation. Findings suggest that additional resources should be directed toward claimants who are at risk (eg, the socially disadvantaged or those unemployed prior to the claim), the major aim being to reduce risk of psychological distress, such as post-traumatic stress disorder, and associated risk of increased settlement times and claim costs. Prospective studies are now required that investigate treatment strategies for those at risk of psychological distress associated with an MVC.
Effectiveness and cost-effectiveness of a cardiovascular risk prediction algorithm for people with severe mental illness (PRIMROSE)
Authors: Zomer Ella , Osborn David , Nazareth Irwin , Blackburn Ruth , Burton Alexandra , Hardoon Sarah , Holt Richard Ian Gregory , King Michael , Marston Louise , Morris Stephen , Omar Rumana , Petersen Irene , Walters Kate , Hunter Rachael Maree
Published: September 2017

Objectives

To determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI.

Setting

Primary care setting in the UK. The analysis was from the National Health Service perspective.

Participants

1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years and without existing CVD, populated the model.

Interventions

Four cardiovascular risk algorithms were assessed: (1) general population lipid, (2) general population body mass index (BMI), (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those considered high risk (>10%) were assumed to be prescribed statin therapy while others received usual care.

Primary and secondary outcome measures

Quality-adjusted life years (QALYs) and costs were accrued for each algorithm including no algorithm, and cost-effectiveness was calculated using the net monetary benefit (NMB) approach. Deterministic and probabilistic sensitivity analyses were performed to test assumptions made and uncertainty around parameter estimates.

Results

The SMI-specific BMI algorithm had the highest NMB resulting in 15 additional QALYs and a cost saving of approximately £53 000 per 1000 patients with SMI over 10 years, followed by the general population lipid algorithm (13 additional QALYs and a cost saving of £46 000).

Conclusions

The general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of an SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.
N-mix for fish: estimating riverine salmonid habitat selection via N-mixture models
Authors: Som Nicholas A. , Perry Russell W. , Jones Edward C. , De Juilio Kyle , Petros Paul , Pinnix William D. , Rupert Derek L.
Published: September 2017

Models that formulate mathematical linkages between fish use and habitat characteristics are applied for many purposes. For riverine fish, these linkages are often cast as resource selection functions with variables including depth and velocity of water and distance to nearest cover. Ecologists are now recognizing the role that detection plays in observing organisms, and failure to account for imperfect detection can lead to spurious inference. Herein, we present a flexible N-mixture model to associate habitat characteristics with the abundance of riverine salmonids that simultaneously estimates detection probability. Our formulation has the added benefits of accounting for demographics variation and can generate probabilistic statements regarding intensity of habitat use. In addition to the conceptual benefits, model application to data from the Trinity River, California, yields interesting results. Detection was estimated to vary among surveyors, but there was little spatial or temporal variation. Additionally, a weaker effect of water depth on resource selection is estimated than that reported by previous studies not accounting for detection probability. N-mixture models show great promise for applications to riverine resource selection.
Protective effect of (−)-α-bisabolol on rotenone-induced toxicity in Drosophila melanogaster
Authors: Leite Gerlânia de Oliveira , Ecker Assis , Seeger Rodrigo Lopes , Krum Bárbara Nunes , Lugokenski Thiago Henrique , Fachinetto Roselei , Sudati Jéssie Haigert , Barbosa Nilda Vargas , Wagner Caroline
Published: September 2017

(−)-α-Bisabolol (BISA) is a sesquiterpene alcohol, which has several recognized biological activities, including anti-inflammatory, anti-irritant, and antibacterial properties. In the present study, we investigated the influence of BISA (5, 25, and 250 μmol/L) on rotenone (500 μmol/L)-induced toxicity in Drosophila melanogaster for 7 days. BISA supplementation significantly decreased rotenone-induced mortality and locomotor deficits. The loss of motor function induced by rotenone correlated with a significant change in stress response factors; it decreased thiol levels, inhibited mitochondria complex I, and increased the mRNA expression of antioxidant marker proteins such as superoxide dismutase (SOD), catalase (CAT), and the keap1 gene product. Taken together, our findings indicate that the toxicity of rotenone is likely due to the direct inhibition of complex I activity, resulting in a high level of oxidative stress. Dietary supplementation with BISA affected the expression of SOD mRNA only at a concentration of 250 μmol/L, and did not affect any other parameter measured. Our results showed a protective effect of BISA on rotenone-induced mortality and locomotor deficits in Drosophila; this effect did not correlate with mitochondrial complex I activity, but may be related to the antioxidant protection afforded by eliminating superoxide generated as a result of rotenone-induced mitochondrial dysfunction.
On the non-perturbative realization of QCD gauge-invariance
Authors: Fried H. M. , Grandou T. , Hofmann R.
Published: September 2017

A few years ago the use of standard functional manipulations was demonstrated to imply an unexpected property satisfied by the fermionic Green’s functions of QCD: effective locality. This feature of QCD is non-perturbative as it results from a full integration of the gluonic degrees of freedom. In this paper, previous derivations of effective locality are reviewed, corrected, and enhanced. Focusing on the way non-Abelian gauge-invariance is realized in the non-perturbative regime of QCD, the deeper meaning of effective locality is discussed.
CORP: Ultrasound assessment of vascular function with the passive leg movement technique
Authors: Gifford Jayson R. , Richardson Russell S.
Published: September 2017

As dysfunction of the vascular system is an early, modifiable step in the progression of many cardiovascular diseases, there is demand for methods to monitor the health of the vascular system noninvasively in clinical and research settings. Validated by very good agreement with more technical assessments of vascular function, like intra-arterial drug infusions and flow-mediated dilation, the passive leg movement (PLM) technique has emerged as a powerful, yet relatively simple, test of peripheral vascular function. In the PLM technique, the change in leg blood flow elicited by the passive movement of the leg through a 90° range of motion is quantified with Doppler ultrasound. This relatively easy-to-learn test has proven to be ≤80% dependent on nitric oxide bioavailability and is especially adept at determining peripheral vascular function across the spectrum of cardiovascular health. Indeed, multiple reports have documented that individuals with decreased cardiovascular health such as the elderly and those with heart failure tend to exhibit a substantially blunted PLM-induced hyperemic response (~50 and ~85% reduction, respectively) compared with populations with good cardiovascular health such as young individuals. As specific guidelines have not yet been put forth, the purpose of this Cores of Reproducibility in Physiology (CORP) article is to provide a comprehensive reference for the assessment and interpretation of vascular function with PLM with the aim to increase reproducibility and consistency among studies and facilitate the use of PLM as a research tool with clinical relevance.
Numerical Solution of Time-Fractional Diffusion-Wave Equations via Chebyshev Wavelets Collocation Method
Authors: Zhou Fengying , Xu Xiaoyong
Published: September 2017

The second-kind Chebyshev wavelets collocation method is applied for solving a class of time-fractional diffusion-wave equation. Fractional integral formula of a single Chebyshev wavelet in the Riemann-Liouville sense is derived by means of shifted Chebyshev polynomials of the second kind. Moreover, convergence and accuracy estimation of the second-kind Chebyshev wavelets expansion of two dimensions are given. During the process of establishing the expression of the solution, all the initial and boundary conditions are taken into account automatically, which is very convenient for solving the problem under consideration. Based on the collocation technique, the second-kind Chebyshev wavelets are used to reduce the problem to the solution of a system of linear algebraic equations. Several examples are provided to confirm the reliability and effectiveness of the proposed method.
H. capsulatum: A Not-So-Benign Cause of Pericarditis
Authors: Soriano Paolo K. , Iqbal Muhammad , Kandaswamy Shakthishri , Akram Sami , Kulkarni Abhishek , Hudali Tamer
Published: September 2017

The common causes of pericarditis and its course are benign in the majority of cases. Thus, further testing is usually not pursued and treatment for a presumptive viral etiology with nonsteroidal agents and steroids has been an accepted strategy. We present a patient with pericarditis who was unresponsive to first-line therapy and was subsequently found to have necrotizing granulomas of the pericardium with extensive adhesions and fungal elements seen on tissue biopsy. Serologic testing confirms activeH. capsulatuminfection, and he responded well to Itraconazole treatment. In patients with pericarditis who fail standard therapy with NSAIDs and steroids, it is suggested that they undergo thorough evaluation and that histoplasmosis be considered as an etiology, especially in endemic regions.
Physicochemical Characterization and Polyphenolic Content of Beninese Honeys
Authors: Lokossou Sênan Christa , Tchobo Fidèle Paul , Yédomonhan Hounnankpon , Soumanou Mohamed Mansourou
Published: September 2017

The physicochemical and phytochemical analyses of honeys (n=50) from Sudanese, Sudano-Guinean, and Guinean areas of Benin were investigated. Results showed that dark amber is the dominant color. Moisture content ranged from 15.50% to 23.50%, and 72% of honeys respected the Codex Alimentarius recommendation. pH varied between 2.87 and 6.15, and free acidity ranged from 9.00 to 39.00 meq/kg. Electrical conductivity varied from 0.37 to 1.43 mS/cm. The content in fructose varied from 21.67% to 94.21%, and proline content ranged between 306.31 and 1187.93 mg/kg. All physicochemical characteristics varied with the areas. A negative correlation was found between pH and moisture content (r=-0.55; p<0.01). A positive correlation was established between pH and conductivity (r=0.79; p<0.01) and between proline and color (r=0.44; p<0.01). Total phenolic content varied between 55.97 and 224.99 mg GAE/100 g, and flavonoid content ranged between 1.43 and 29.81 mg CAE/100 g. Flavonoid was positively correlated with color (r=0.78; p<0.01) and proline (r=0.47; p<0.01). Tukey’s test revealed differences between total phenolic and flavonoid contents of honeys from five areas (p<0.01). In general, Sudanese and Sudano-Guinean honeys showed potential toward therapeutic applications because of their high phenolic contents.
EUS Morphology Is Reliable in Selecting Patients with Mucinous Pancreatic Cyst(s) Most Likely to Benefit from Surgical Resection
Authors: Javia Siddharth , Munigala Satish , Guha Sushovan , Agarwal Banke
Published: September 2017

Background and Study Aims. Endoscopic ultrasound (EUS) surveillance of patients with mucinous pancreatic cysts relies on the assessment of morphologic features suggestive of malignant transformation. These criteria were derived from the evaluation of surgical pathology in patients with pancreatic cysts who underwent surgery. Reliability of these criteria when evaluated by EUS in identifying lesions which require surgery has still not been established. Patients and Methods. This retrospective cohort study included seventy-eight patients who underwent surgical resection of pancreatic cysts based on EUS-FNA (fine-needle aspiration) findings suggestive of mucinous pancreatic cysts with concern for malignancy. Results. Final surgical pathology diagnoses of patients were the following: adenocarcinoma (19), intraductal papillary mucinous neoplasm (IPMN) (39), mucinous cystic neoplasm (MCN) (13), serous cystadenoma (2), pseudocyst (3), mucinous solid-cystic lesion of indeterminate type (1), and mesenteric cyst (1). Cysts with focal wall thickening ≥ 3 mm (p=0.0008), dilation of pancreatic duct (PD) (p=0.0067), and cyst size ≥ 3 cm (p=0.016) had significantly higher risk of adenocarcinoma. None of the patients without any of these morphologic features had cancer. Conclusions. In patients with mucinous pancreatic cyst(s), focal wall thickening, cyst size ≥ 3 cm, and PD dilation as assessed by EUS can help identify advanced mucinous cysts which require surgery and should routinely be evaluated during EUS surveillance.