bluuebunny/crossref_metadata_2025 huggingface dataset:
Postpartum venous thromboembolism prophylaxis may cause more harm than benefit: a critical analysis of international guidelines through an evidence‐based lens
Authors: Kotaska A
Published: March 2018

Based on prediction models and expert opinion, most obstetric venous thromboembolism guidelines recommend low‐molecular‐weight heparin for many postpartum women, including most delivering by caesarean. Scrutiny reveals major oversights: prediction models are based on studies that report asymptomatic deep vein thrombosis; risk estimates are not adjusted for time exposure; and harm caused by heparin has been overlooked. The benefits of heparin are exaggerated and its harms are under‐appreciated. Estimates of the numbers‐needed‐to‐treat and harm are universally lacking. This paper critically reviews the evidence and quantifies the benefit and harm from low‐molecular‐weight heparin in postpartum women with common risk factors.

Funding

This work was unsponsored and unfunded.

Tweetable abstract

Randomised trials should demonstrate more benefit than harm before widespread postpartum low‐molecular‐weight heparin is recommended.
Relative importance of long‐term changes in climate and land‐use on the phenology and abundance of legume crop specialist and generalist aphids
Authors: Luquet Martin , Hullé Maurice , Simon Jean‐Christophe , Parisey Nicolas , Buchard Christelle , Jaloux Bruno
Published: March 2018

Insect populations are prone to respond to global changes through shifts in phenology, distribution and abundance. However, global changes cover several factors such as climate and land‐use, the relative importance of these being largely unknown. Here, we aim at disentangling the effects of climate, land‐use, and geographical drivers on aphid abundance and phenology in France, at a regional scale and over the last 40 years. We used aerial data obtained from suction traps between 1978 and 2015 on five aphid species varying in their degree of specialization to legumes, along with climate, legume crop area and geographical data. Effects of environmental and geographical variables on aphid annual abundance and spring migration dates were analyzed using generalized linear mixed models. We found that within the last four decades, aphids have advanced their spring migration by a month, mostly due to the increase in temperature early in the year, and their abundance decreased by half on average, presumably in response to a combination of factors. The influence of legume crop area decreased with the degree of specialization of the aphid species to such crops. The effect of geographical variation was high even when controlling for environmental variables, suggesting that many other spatially structured processes act on aphid population characteristics. Multifactorial analyses helped to partition the effects of different global change drivers. Climate and land‐use changes have strong effects on aphid populations, with important implications for future agriculture. Additionally, trait‐based response variation could have major consequences at the community scale.
The structured demography of open populations in fluctuating environments
Authors: Schreiber Sebastian J. , Moore Jacob L.
Published: March 2018

At the spatial scale relevant to many field studies and management policies, populations may experience more external recruitment than internal recruitment. These sources of recruitment, as well as local demography, are often subject to stochastic fluctuations in environmental conditions. Here, we introduce a class of stochastic models accounting for these complexities, provide analytic methods for understanding their long‐term behaviour and illustrate the application of methods to two marine populations.

The population state n(x) of these stochastic models is a function or vector keeping track of densities of individuals with continuous (e.g. size) or discrete (e.g. age) traits x taking values in a compact metric space. This state variable is updated by a stochastic affine equation nt+1 = At+1nt + bt+1 where is At+1 is a time varying operator (e.g. an integral operator or a matrix) that updates the local demography and bt+1 is a time varying function or vector representing external recruitment.

When the realized per‐capita growth rate of the local demography is negative, we show that all initial conditions converge to the same time‐varying trajectory. Furthermore, when A1,A2,… and b1,b2,… are stationary sequences, this limiting behaviour is determined by a unique stationary distribution.

When the stationary sequences are periodic, uncorrelated or a mixture of these two types of stationarity, we derive explicit formulas for the mean, within‐year covariance and autocovariance of the stationary distribution. Sensitivity formulas for these statistical features are also given.

The analytic methods are illustrated with applications to discrete size‐structured models of space‐limited coral populations and continuously size‐structured models of giant clam populations.
Randomized controlled trial of intra‐articular ketorolac on pain and inflammation after minor arthroscopic knee surgery
Authors: Solheim N. , Gregersen I. , Halvorsen B. , Bjerkeli V. , Stubhaug A. , Gordh T. , Rosseland L. A.
Published: March 2018

Background

Ketorolac is an effective non‐steroidal anti‐inflammatory drug, commonly used with local anaesthetics as part of local infiltration analgesia protocols following orthopaedic surgery. However, systemic uptake and drug action may be the major mechanism after local infiltration. The aims of this project were to study the effects of a small, systemically ineffective dose of ketorolac given intra‐articularly for post‐operative pain and also to study synovial inflammatory biomarkers. We investigated whether ketorolac affects pro‐inflammatory biomarkers in an in vitro model, as well.

Methods

In this placebo‐controlled, blind, randomized study, we analysed intra‐articular ketorolac (5 mg) in ambulatory minor knee surgery patients with moderate or severe pain (n = 44). We assessed post‐operative pain intensity (n = 44) and analysed microdialysis samples taken from knee synovial tissue every 20 min (n = 34). We also tested cyclooxygenase‐independent effects of ketorolac in synovial cells stimulated by prostaglandin E2 and chondroitin sulphate in vitro.

Results

Intra‐articular ketorolac (5 mg) administration did not reduce pain or synovial pro‐inflammatory cytokines CXCL1, IL‐8, and MCP‐1, 0–120 min after knee arthroscopy. Female gender was a risk factor for moderate or severe pain (relative risk 1.45, 95% confidence interval 1.04–2.01). Paradoxically, ketorolac increased the release of CXCL1 and IL‐8 in prostaglandin E2 and chondroitin sulphate‐stimulated synovial cells in vitro.

Conclusion

Ketorolac prescribed at a low dose intra‐articularly does not produce any detectable analgesic effect after minor knee surgery.
Fluid accumulation during acute kidney injury in the intensive care unit
Authors: Berthelsen R. E. , Perner A. , Jensen A. K. , Jensen J.‐U. , Bestle M. H.
Published: March 2018

Introduction

Fluid therapy is a ubiquitous intervention in patients admitted to the intensive care unit, but positive fluid balance may be associated with poor outcomes and particular in patients with acute kidney injury. Studies describing this have defined fluid overload either at specific time points or considered patients with a positive mean daily fluid balance as fluid overloaded. We wished to detail this further and performed joint model analyses of the association between daily fluid balance and outcome represented by mortality and renal recovery in patients admitted with acute kidney injury.

Method

We did a retrospective cohort study of patients admitted to the intensive care unit with acute kidney injury during a 2‐year observation period. We used serum creatinine measurements to identify patients with acute kidney injury and collected sequential daily fluid balance during the first 5 days of admission to the intensive care unit. We used joint modelling techniques to correlate the development of fluid overload with survival and renal recovery adjusted for age, gender and disease severity.

Results

The cohort contained 863 patients with acute kidney injury of whom 460 (53%) and 254 (29%) developed 5% and 10% fluid overload, respectively. We found that both 5% and 10% fluid overload was correlated with reduced survival and renal recovery.

Conclusion

Joint model analyses of fluid accumulation in patients admitted to the intensive care unit with acute kidney injury confirm that even a modest degree of fluid overload (5%) may be negatively associated with both survival and renal recovery.
A Multisite Intervention for Pediatric Community‐acquired Pneumonia in Community Settings
Authors: McDaniel Corrie E. , Haaland Wren , Parlaman Joshua , Zhou Chuan , Desai Arti D.
Published: March 2018

Objectives

The majority of children with community‐acquired pneumonia (CAP) are primarily evaluated in community hospital emergency departments (EDs); however, studies on the management of pediatric CAP have largely targeted care provided in freestanding children's hospital EDs or inpatient settings. The objectives of this study were to examine whether implementation of a CAP pathway within three community hospital EDs and inpatient units improved process measures related to appropriate laboratory testing and antibiotic prescribing and to compare performance on these measures between the community hospitals and a freestanding children's hospital.

Methods

Through a multidisciplinary approach (including general emergency medicine [EM] providers, pediatric fellowship‐trained EM providers, and pediatric hospitalists), a CAP pathway was designed and implemented at three community hospitals in January and February 2016. Diagnostic and therapeutic process measures were collected using administrative data and medical record abstraction 1 year pre‐ and postintervention. Chi‐square statistics and statistical process control P‐charts were used to examine adherence to these process measures.

Results

Across the community hospitals, 544 patients preintervention and 321 patients postintervention met inclusion criteria, with 290 children's hospital patients meeting criteria in the postintervention period. Adherence to process measures increased postintervention for appropriate laboratory testing, narrow‐spectrum antibiotic stewardship and macrolide stewardship by 10.8% (95% confidence interval [CI] = 4.7% to 16.9%), 8.3% (95% CI = 21.5% to 15.2%), and 3.1% (95% CI = –4.3% to 10.4%), respectively. Statistical process control P‐charts demonstrated special cause variation immediately after implementation of the intervention in regards to appropriate laboratory testing.

Conclusion

Implementation of a CAP pathway through a multisite community hospital intervention improved adherence to evidence‐based recommendations for laboratory testing and antibiotic stewardship. Similar interventions may improve the quality of care for children with CAP on a population level, as community hospitals are where these patients are seen most frequently.
What makes a meaningful life? Examining the effects of interpersonal harmony, dialectical coping, and nonattachment
Authors: Wang Shu‐Yi , Wong Y. Joel , Yeh Kuang‐Hui , Wang Lei
Published: March 2018

Past cross‐cultural research on well‐being has tended to base Eastern construction of well‐being on the interdependent self‐construal, mainly as an offshoot of Confucius relationalism. However, other influential philosophical traditions in East Asian societies (i.e., Taoism and Buddhism) that portray a different picture of well‐being have received scant scholarly attention. We aim to foreground the distinctiveness of three well‐being constructs salient to Chinese culture, namely, interpersonal harmony, dialectical coping, and nonattachment, by providing experimental evidence on their differential effects on perceived meaning in life. Participants were 173 Taiwanese college students. Using priming procedures, participants primed with interpersonal harmony and dialectical coping reported higher levels of meaning in life as compared to those in the nonattachment and neutral control conditions. In addition, comparisons among the three well‐being constructs revealed that although the effects of interpersonal harmony and dialectical coping on meaning in life were similar in strength, they were both significantly stronger than that of nonattachment. The findings attest to the importance of recognizing within‐culture differences when conducting research on well‐being. Results were considered in terms of their methodological and theoretical implications.
Short course of grass allergen peptides immunotherapy over 3 weeks reduces seasonal symptoms in allergic rhinoconjunctivitis with/without asthma: A randomized, multicenter, double‐blind, placebo‐controlled trial
Authors: Mösges R. , Bachert C. , Panzner P. , Calderon M. A. , Haazen L. , Pirotton S. , Wathelet N. , Durham S. R. , Bonny M.‐A. , Legon T. , von Frenckell R. , Pfaar O. , Shamji M. H.
Published: March 2018

Background

Immunotherapy with peptide hydrolysates from Lolium perenne (LPP) is an alternative treatment for seasonal allergic rhinitis with or without asthma. The aim of this study was to assess the clinical efficacy and safety of a cumulative dose of 170 μg LPP administered subcutaneously over 3 weeks.

Methods

In a randomized, double‐blind, placebo‐controlled trial, 554 adults with grass pollen rhinoconjunctivitis were randomized (1:2 ratio) to receive 8 subcutaneous injections of placebo or 170 μg LPP administered in increasing doses in 4 visits over 3 weeks. The primary outcome was the combined symptom and medication score (CSMS) measured over the peak pollen season. Reactivity to conjunctival provocation test (CPT) and quality of life (QOL) was assessed as secondary endpoints.

Results

The mean reduction in CSMS in the LPP vs placebo group was −15.5% (P = .041) during the peak period and −17.9% (P = .029) over the entire pollen season. LPP‐treated group had a reduced reactivity to CPT (P < .001) and, during the pollen season, a lower rhinoconjunctivitis QOL global score (P = .005) compared with placebo group. Mostly mild and WAO grade 1 early systemic reaction (ESR) were observed ≤30 minutes in 10.5% of LPP‐treated patients, whereas 3 patients with a medical history of asthma (<1%) experienced a serious ESR that resolved with rescue medication.

Conclusion

Lolium perenne pollen peptides administered over 3 weeks before the grass pollen season significantly reduced seasonal symptoms and was generally safe and well‐tolerated.
Laparoscopic repair of large hiatal hernias: clinical outcomes of 10 years
Authors: Chen Zhen , Zhao Hongzhi , Sun Xiangyu , Wang Zhenyu
Published: March 2018

Background

Whilst laparoscopic repair is the most common surgical procedure for the treatment of large hiatal hernias, knowledge of long‐term outcomes (>10 years) is scarce. The aim of this study was to evaluate the long‐term results following this approach, in particular the hernia recurrence rate and the impact of repair on quality of life (QoL).

Methods

Patients were identified from a prospective database. A standardized questionnaire was used to assess symptoms and a barium swallow radiograph was performed to determine anatomy. A validated QoL measure, Gastrointestinal Quality of Life Index (GIQLI) was also applied to all patients.

Results

Of the 69 eligible patients, clinical follow‐up was available for 54 patients (78.3%). Follow‐up ranged from 72 to 185 (median: 114) months. Post‐operative heartburn and dysphagia were significantly improved, with 45 patients (83%) reporting a good or excellent result. Contrast radiology in 35 patients (65%) revealed recurrence in 12 patients (34%). Fifty‐four patients answered the GIQLI questionnaire. The mean GIQLI score was 117 (61–136). Patients with objectively documented anatomic recurrence had a QoL index of 92 (61–121) compared to an index of 122 (77–136, P < 0.01) in the non‐recurrent hernia group.

Conclusions

At mean 114 months follow‐up, laparoscopic repair of large hiatal hernias achieves effective and durable relief of symptoms, and most patients are satisfied with the outcome.
Post‐operative outcomes in older patients: a single‐centre observational study
Authors: Tang Benjamin , Green Cameron , Yeoh Aun Chian , Husain Faisal , Subramaniam Ashwin
Published: March 2018

Background

Improved life‐expectancies have seen increased rates of older patients undergoing surgery worldwide. These patients are at increased risk of post‐operative complications. Australian evidence is limited regarding the association between age and post‐operative outcomes, especially rapid response calls (RRCs) as indicators of adverse outcomes. The aim was to compare the post‐operative outcomes of older patients (≥80 years) to younger patients. Specifically, 30‐day in‐hospital mortality; unplanned intensive care unit (ICU) admission; and RRC activation within 72 h post‐operatively.

Methods

Single‐centre retrospective observational study conducted over 12 months in a metropolitan Australian hospital. All adult patients (≥16 years) undergoing surgical procedures were included, excluding cardiac and obstetric/gynaecological surgeries. Patient co‐morbidities were quantified using Charlson co‐morbidity index (CCI) and American Society of Anesthesiologists physical status classification.

Results

Seven thousand four hundred and seventy‐nine patients met inclusion criteria, 14.5% (n = 1086) aged ≥80 years. Most procedures (65%) were elective; and general surgical procedures were most common (24.2%). Compared to younger patients, older patients had significantly higher 30‐day mortality (2.3% versus 0.2%; P < 0.001), increased post‐operative RRC rates (7.3% versus 1.2%; P < 0.001), and unplanned ICU admissions (3.2% versus 1.6%; P < 0.001). Increasing age was associated with increased risk of post‐operative RRC, unplanned ICU admission, and in‐hospital mortality (all P < 0.01), with associations remaining significant after controlling for surgery type and CCI.

Conclusion

Older patients are at increased risk of adverse post‐operative outcomes, including post‐operative RRC, unplanned ICU admission, and mortality, especially if they underwent emergency procedures. This has implications for preoperative risk stratification and post‐operative management. Incidence of post‐operative RRCs may be an important indicator of post‐operative care.
Can oxytocin augmentation modify the risk of epidural analgesia by maternal age in cesarean sections?
Authors: Rossen Janne , Klungsøyr Kari , Albrechtsen Susanne , Løkkegård Ellen , Rasmussen Steen , Bergholt Thomas , Skjeldestad Finn E.
Published: March 2018

Introduction

Maternal age is an established risk factor for cesarean section; epidural analgesia and oxytocin augmentation may modify this association. We investigated the effects and interactions of oxytocin augmentation, epidural analgesia and maternal age on the risk of cesarean section.

Material and methods

In all, 416 386 nulliparous women with spontaneous onset of labor, ≥37 weeks of gestation and singleton infants with a cephalic presentation during 2000–2011 from Norway and Denmark were included [Ten‐group classification system (Robson) group 1]. In this case‐control study the main exposure was maternal age; epidural analgesia, oxytocin augmentation, birthweight and time period were explanatory variables. Chi‐square test and logistic regression were used to estimate associations and interactions.

Results

The cesarean section rate increased consistently with advancing maternal age, both overall and in strata of epidural analgesia and oxytocin augmentation. We observed strong interactions between maternal age, oxytocin augmentation and epidural analgesia for the risk of cesarean section. Women with epidural analgesia generally had a reduced adjusted odds ratio when oxytocin was used compared with when it was not used. In Norway, this applied to all maternal age groups but in Denmark only for women ≥30 years. Among women without epidural, oxytocin augmentation was associated with an increased odds ratio for cesarean section in Denmark, whereas no difference was observed in Norway.

Conclusions

Oxytocin augmentation in nulliparous women with epidural analgesia is associated with a reduced risk of cesarean section in labor with spontaneous onset.
Attitudes toward surrogacy among doctors working in reproductive medicine and obstetric care in Sweden
Authors: Stenfelt Camilla , Armuand Gabriela , Wånggren Kjell , Skoog Svanberg Agneta , Sydsjö Gunilla
Published: March 2018

Introduction

The aim of this study was to investigate attitudes and opinions towards surrogacy among physicians working within obstetrics and reproductive medicine in Sweden.

Material and methods

Physicians working within medically assisted reproduction (MAR), antenatal care and obstetrics were invited to participate in a cross‐sectional nationwide survey study. The study‐specific questionnaire measured attitudes and experiences in three domains: attitudes towards surrogacy, assessment of prospective surrogate mothers, and antenatal and obstetric care for surrogate mothers.

Results

Of the 103 physicians who participated (response rate 74%), 63% were positive or neutral towards altruistic surrogacy being introduced in Sweden. However, only 28% thought that it should be publicly financed. Physicians working at fertility clinics were more positive towards legalization as well as public financing of surrogacy compared than were those working within antenatal and delivery care. The majority of the physicians agreed that surrogacy involves the risk of exploitation of women's bodies (60%) and that there is a risk that the commissioning couple might pay the surrogate mother “under the table” (82%). They also expressed concerns about potential surrogate mothers not being able to understand fully the risks of entering pregnancy on behalf of someone else.

Conclusion

There is a relatively strong support among physicians working within obstetrics and reproductive medicine for the introduction of surrogacy in Sweden. However, the physicians expressed concerns about the surrogate mothers’ health as well as the risk of coercion. Further discussions about legalization of surrogacy should include views from individuals within a wide field of different medical professions and laymen.
Letter: predicting azathioprine‐associated pancreatitis in IBD—phenotype or genotype?
Authors: Teich N. , Bruns T. , Stallmach A.
Published: March 2018

Linked Content

This article is linked to Wilson et al papers. To view these articles visit https://doi.org/10.1111/apt.14483 and https://doi.org/10.1111/apt.14562.
Bariatric surgery is associated with increased risk of new‐onset inflammatory bowel disease: case series and national database study
Authors: Ungaro R. , Fausel R. , Chang H. L. , Chang S. , Chen L. A. , Nakad A. , El Nawar A. , Prytz Berset I. , Axelrad J. , Lawlor G. , Atreja A. , Roque Ramos L. , Torres J. , Colombel J.‐F.
Published: March 2018

Background

Case series suggest a possible association between bariatric surgery and incident IBD.

Aim

The aim of this study was to evaluate the association between bariatric surgery and new‐onset IBD.

Methods

We first conducted a multi‐institutional case series of patients with a history of IBD and bariatric surgery. We next conducted a matched case‐control study using medical and pharmacy claims from 2008 to 2012 in a US national database from Source Healthcare Analytics LLC. Bariatric surgery was defined by ICD‐9 or CPT code. Bariatric surgery was evaluated as recent (code in database timeframe), past (past history V code) or no history. Conditional logistic regression was used to estimate odds ratios (OR) and 95% CI for new‐onset IBD, CD and UC.

Results

A total of 15 cases of IBD (10 CD, 4 UC, 1 IBD, type unclassified) with a prior history of bariatric surgery were identified. Most cases were women, had Roux‐en‐Y surgery years prior to diagnosis and few IBD‐related complications. A total of 8980 cases and 43 059 controls were included in our database analysis. Adjusting for confounders, a past history of bariatric surgery was associated with an increased risk of new‐onset IBD (OR 1.93, 95% CI 1.34‐2.79). However, patients who had recent bariatric surgery did not appear to be at shorter term risk of IBD (OR 0.94, 95% CI 0.58‐1.52).

Conclusion

New‐onset IBD was significantly associated with a past history of bariatric surgery. This potential association needs to be confirmed in future prospective studies.
Letter: the addition of an immunosuppressant in patients with unsatisfactory response to vedolizumab—Authors' reply
Authors: Strik A. S. , D'Haens G. R.
Published: March 2018

Linked Content

This article is linked to Strik et al and Macaluso et al papers. To view these articles visit https://doi.org/10.1111/apt.13994 and https://doi.org/10.1111/apt.14541.
Patterns and profiles of methylphenidate use both in children and adults
Authors: Pauly Vanessa , Frauger Elisabeth , Lepelley Magalie , Mallaret Michel , Boucherie Quentin , Micallef Joëlle
Published: March 2018

Aim

The aim of the present study was to characterize patterns of use of methylphenidate (MPH), a prescription stimulant medication recommended in the treatment of attention deficit hyperactivity disorder (ADHD) and of narcolepsy, in France, both in children and adults, over a 3‐year period.

Methods

Using the French General Health Insurance database, limited to two areas covering approximately 4 million individuals, we made up a cohort of incident MPH users between July 2010 and June 2013. Splitting them into distinct age groups (18–24, 25–49 and ≥50 years of age for adults and <6, 6–11 and 12–17 years of age for children), we established the characteristics of these populations at MPH initiation and during follow‐up according to the duration of treatment, quantities dispensed and coprescription with central nervous system (CNS) drugs.

Results

We included a cohort of 3534 incident users, involving 30 238 dispensings of MPH, leading to an annual rate of 29 incident users per 100 000 in 2013. Children (66% of new users) were characterized by long‐term use of MPH with few comedications. The group of 25–49‐year‐old patients were dispensed MPH more frequently than other groups, had the highest mean dose and were more often coprescribed other CNS drugs. The ≥50 year‐old group was more often coprescribed antidepressants and antiparkinsonian drugs.

Conclusions

Our pharmacoepidemiological study involving incident MPH users with a large number of characteristics showed different patterns of MPH use among children and adults. The results from the 25–49‐year‐old group suggested that MPH might be being used for medical conditions other than ADHD or narcolepsy in adults, and that it might be subject to misuse and/or abuse.
Circadian modulation of neuroplasticity by melatonin: a target in the treatment of depression
Authors: Valdés‐Tovar Marcela , Estrada‐Reyes Rosa , Solís‐Chagoyán Héctor , Argueta Jesús , Dorantes‐Barrón Ana María , Quero‐Chávez Daniel , Cruz‐Garduño Ricardo , Cercós Montserrat G , Trueta Citlali , Oikawa‐Sala Julián , Dubocovich Margarita L , Benítez‐King Gloria
Published: March 2018

Mood disorders are a spectrum of neuropsychiatric disorders characterized by changes in the emotional state. In particular, major depressive disorder is expected to have a worldwide prevalence of 20% in 2020, representing a huge socio‐economic burden. Currently used antidepressant drugs have poor efficacy with only 30% of the patients in remission after the first line of treatment. Importantly, mood disorder patients present uncoupling of circadian rhythms. In this regard, melatonin (5‐methoxy‐N‐acetyltryptamine), an indolamine synthesized by the pineal gland during the night, contributes to synchronization of body rhythms with the environmental light/dark cycle. In this review, we describe evidence supporting antidepressant‐like actions of melatonin related to the circadian modulation of neuroplastic changes in the hippocampus. We also present evidence for the role of melatonin receptors and their signalling pathways underlying modulatory effects in neuroplasticity. Finally, we briefly discuss the detrimental consequences of circadian disruption on neuroplasticity and mood disorders, due to the modern human lifestyle. Together, data suggest that melatonin's stimulation of neurogenesis and neuronal differentiation is beneficial to patients with mood disorders.

Linked Articles

This article is part of a themed section on Recent Developments in Research of Melatonin and its Potential Therapeutic Applications. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v175.16/issuetoc
The familial aggregation of atopic diseases and depression or anxiety in children
Authors: Brew B. K. , Lundholm C. , Gong T. , Larsson H. , Almqvist C.
Published: March 2018

Background

Children with asthma and atopic diseases have an increased risk of depression or anxiety. Each of these diseases has strong genetic and environmental components; therefore, it seems likely that there is a shared liability rather than causative risk.

Objective

To investigate the existence and nature of familial aggregation for the comorbidity of atopic diseases and depression or anxiety.

Methods

Participants came from the Childhood and Adolescent Twin Study in Sweden (CATSS), n = 14 197. Current and ever asthma, eczema, hay fever and food allergy were reported by parents. Internalizing disorders were identified using validated questionnaires. Familial co‐aggregation analysis compared monozygotic (MZ) twins and same‐sex dizygotic (DZ) twins for atopic disease in 1 twin with internalizing disorder in the other to test for genetic liability. Several familial liability candidates were also tested including parental education, recent maternal psychological stress, childhood family trauma and parental country of birth.

Results

Familial co‐aggregation analysis found that if 1 twin had at least 1 current atopic disease the partner twin was at risk of having an internalizing disorder regardless of their own atopic status (adjusted OR 1.22 (95% CI 1.08, 1.37). Similar results were found for each atopic disease ever and current. MZ associations were not higher than DZ associations, suggesting that the liability is not genetic in nature. Including other familial candidates to the models made little difference to effect estimates.

Conclusions and Clinical Relevance

Atopic diseases and depression or anxiety tend to occur together in families; therefore, when treating for 1 disease, the physician should consider comorbidity in both the individual and the individual's siblings. We did not find evidence to support a genetic explanation for comorbidity, and further exploration is needed to disentangle the environmental and epigenetic reasons for familial aggregation.
Novel innate and adaptive lymphocytes: The new players in the pathogenesis of inflammatory upper airway diseases
Authors: Liu Y. , Yao Y. , Wang Z.‐C. , Ning Q. , Liu Z.
Published: March 2018

Host immunity (innate and adaptive immunity) plays essential roles in the pathogenesis of inflammatory upper airway diseases, including allergic rhinitis and chronic rhinosinusitis. Recently, the discovery of novel innate immune cells, particularly innate lymphoid cells, has renewed our view on the role of innate immunity in inflammatory upper airway diseases. Meanwhile, the identification of new subsets of T helper (Th) cells, including Th22, Th9 and follicular Th cells, and regulatory B cells in the adaptive immunity, has broadened our knowledge on the complex immune networks in inflammatory upper airway diseases. In this review, we focus on these newly identified innate and adaptive lymphocytes with their contributions to the immunological disturbance in allergic rhinitis and chronic rhinosinusitis. We further discuss the perspective for future research and potential clinical utility of regulating these novel lymphocytes for the treatment of allergic rhinitis and chronic rhinosinusitis.
Liquid biopsy to monitor melanoma patients
Authors: Gaiser Maria Rita , von Bubnoff Nikolas , Gebhardt Christoffer , Utikal Jochen Sven
Published: March 2018

During the last six years, several innovative, systemic therapies for the treatment of metastatic malignant melanoma (MM) have emerged. Conventional chemotherapy has been superseded by novel first‐line therapies, including systemic immunotherapies (anti‐CTLA4 and anti‐PD1; authorization of anti‐PDL1 is anticipated) and therapies targeting specific mutations (BRAF, NRAS, and c‐KIT). Thus, treating physicians are confronted with new challenges, such as stratifying patients for appropriate treatments and monitoring long‐term responders for progression. Consequently, reliable methods for monitoring disease progression or treatment resistance are necessary.

Localized and advanced cancers may generate circulating tumor cells and circulating tumor DNA (ctDNA) that can be detected and quantified from peripheral blood samples (liquid biopsy). For melanoma patients, liquid biopsy results may be useful as novel predictive biomarkers to guide therapeutic decisions, particularly in the context of mutation‐based targeted therapies. The challenges of using liquid biopsy include strict criteria for the phenotypic nature of circulating MM cells or their fragments and the instability of ctDNA in blood. The limitations of liquid biopsy in routine diagnostic testing are discussed in this review.
The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta‐analysis
Authors: Booth Adam T C , Buizer Annemieke I , Meyns Pieter , Oude Lansink Irene L B , Steenbrink Frans , van der Krogt Marjolein M
Published: March 2018

Aim

The aim of this systematic review was to investigate the effects of functional gait training on walking ability in children and young adults with cerebral palsy (CP).

Method

The review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Web of Science) for relevant literature published between January 1980 and January 2017. Included studies involved training with a focus on actively practising the task of walking as an intervention while reporting outcome measures relating to walking ability.

Results

Forty‐one studies were identified, with 11 randomized controlled trials included. There is strong evidence that functional gait training results in clinically important benefits for children and young adults with CP, with a therapeutic goal of improved walking speed. Functional gait training was found to have a moderate positive effect on walking speed over standard physical therapy (effect size 0.79, p=0.04). Further, there is weaker yet relatively consistent evidence that functional gait training can also benefit walking endurance and gait‐related gross motor function.

Interpretation

There is promising evidence that functional gait training is a safe, feasible, and effective intervention to target improved walking ability in children and young adults with CP. The addition of virtual reality and biofeedback can increase patient engagement and magnify effects.

What this paper adds

Functional gait training is a safe, feasible, and effective intervention to improve walking ability.

Functional gait training shows larger positive effects on walking speed than standard physical therapy.

Walking endurance and gait‐related gross motor function can also benefit from functional gait training.

Addition of virtual reality and biofeedback shows promise to increase engagement and improve outcomes.
Diagnostic performance of body mass index to identify excess body fat in children with cerebral palsy
Authors: Duran Ibrahim , Schulze Josefa , Martakis Kyriakos , Stark Christina , Schoenau Eckhard
Published: March 2018

Aim

To assess the diagnostic performance of body mass index (BMI) cut‐off values according to recommendations of the World Health Organization (WHO), the World Obesity Federation (WOF), and the German Society for Adiposity (DAG) to identify excess body fat in children with cerebral palsy (CP).

Method

The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation programme. Excess body fat was defined as a body fat percentage above the 85th centile assessed by dual‐energy X‐ray absorptiometry.

Results

In total, 329 children (181 males, 148 females) with CP were eligible for analysis. The mean age was 12 years 4 months (standard deviation 2y 9mo). The BMI cut‐off values for ‘overweight’ according to the WHO, WOF, and DAG showed the following sensitivities and specificities for the prediction of excess body fat in our population: WHO: sensitivity 0.768 (95% confidence interval [CI] 0.636–0.870), specificity 0.894 (95% CI 0.851–0.928); WOF: sensitivity 0.696 (95% CI 0.559–0.812), specificity 0.934 (95% CI 0.898–0.960); DAG: sensitivity 0.411 (95% CI 0.281–0.550), specificity 0.993 (95% CI 0.974–0.999).

Interpretation

Body mass index showed high specificity, but low sensitivity in children with CP. Thus, ‘normal‐weight obese’ children with CP were overlooked, when assessing excess body fat only using BMI.

What this paper adds

Excess body fat in children with cerebral palsy (CP) is less common than previously reported.

Body mass index (BMI) had high specificity but low sensitivity in detecting excess body fat in children with CP.

BMI evaluation criteria of the German Society for Adiposity could be improved in children with CP.
Age distribution and metabolic disorders in people with Type 1 diabetes in Beijing and Shantou, China: a cross‐sectional study
Authors: Huo L. , Ji L. , Deng W. , Shaw J. E. , Zhang P. , Zhao F. , McGuire H. C. , Kissimova‐Skarbek K. , Whiting D.
Published: March 2018

Aims

To examine whether the age profile of people with Type 1 diabetes differs from that of the general population and in what manner, and to study the clinical characteristics related to metabolic disorders among people with Type 1 diabetes in China.

Methods

We sequentially enrolled 849 people with Type 1 diabetes from hospital records review, inpatient wards and outpatient clinics. Data were collected via face‐to‐face interviews, medical records and venous blood samples. Beijing census data for 2011 were used to provide the general population statistics. Descriptive analysis of the results and tests for differences were performed.

Results

The median (interquartile range) age at diagnosis of diabetes was 16 (9–28) years and the duration of diabetes was 4 (1–8) years. The mean ± sd HbA1c concentration was 76±28 mmol/mol (9.1±2.5%). Compared with the general population, the population with Type 1 diabetes comprised more young individuals and fewer elderly individuals. The overall prevalence of metabolic syndrome among those with Type 1 diabetes was 10.1% (95% CI 7.9–12.2). People with metabolic syndrome were older and were diagnosed with diabetes at an older age. Hypertension and dyslipidaemia were more common in obese individuals with Type 1 diabetes than in their non‐obese counterparts.

Conclusions

Compared with the general population, people with Type 1 diabetes comprised more young and fewer elderly individuals. The prevalence of metabolic syndrome in the Type 1 diabetes population was 10.1%. Hypertension and dyslipidaemia were more prevalent in obese than non‐obese individuals.
Why Empathy and Customer Closeness is Crucial for Design Thinking
Authors: Dalton Jonathan , Kahute Trent
Published: March 2018

An understanding of people and culture is crucial for the success of design‐thinking initiatives. Here are some approaches that will help establish and maintain customer closeness and empathy throughout the process.

Design thinking as a way of getting close to your customers and the stakeholders in your business.
Neural substrates for allocentric‐to‐egocentric conversion of remembered reach targets in humans
Authors: Chen Ying , Monaco Simona , Crawford J. Douglas
Published: March 2018

Targets for goal‐directed action can be encoded in allocentric coordinates (relative to another visual landmark), but it is not known how these are converted into egocentric commands for action. Here, we investigated this using a slow event‐related fMRI paradigm, based on our previous behavioural finding that the allocentric‐to‐egocentric (Allo–Ego) conversion for reach is performed at the first possible opportunity. Participants were asked to remember (and eventually reach towards) the location of a briefly presented target relative to another visual landmark. After a first memory delay, participants were forewarned by a verbal instruction if the landmark would reappear at the same location (potentially allowing them to plan a reach following the auditory cue before the second delay), or at a different location where they had to wait for the final landmark to be presented before response, and then reach towards the remembered target location. As predicted, participants showed landmark‐centred directional selectivity in occipital–temporal cortex during the first memory delay, and only developed egocentric directional selectivity in occipital–parietal cortex during the second delay for the ‘Same cue’ task, and during response for the ‘Different cue’ task. We then compared cortical activation between these two tasks at the times when the Allo–Ego conversion occurred, and found common activation in right precuneus, right presupplementary area and bilateral dorsal premotor cortex. These results confirm that the brain converts allocentric codes to egocentric plans at the first possible opportunity, and identify the four most likely candidate sites specific to the Allo–Ego transformation for reaches.
Influences of photic stress on postsubicular head‐directional processing
Authors: Passecker Johannes , Islam Md. Nurul , Hok Vincent , O'Mara Shane M.
Published: March 2018

The stress response serves vital adaptive functions. However, acute stress episodes often negatively impact cognitive processing. Here, we aimed to elucidate whether stress detrimentally affects the head‐direction cells of the postsubiculum, which may in turn impair downstream spatial information processing. We recorded neurons in the rats’ postsubiculum during a pellet‐chasing task during baseline non‐stress conditions and after a 30‐min acute photic stress exposure. Based on their baseline firing rate, we identified a subpopulation of head‐direction cells that drastically decreased its firing rate as a response to stress while preserving their head directionality. The remaining population of head‐direction cells as well as other neurons recorded in the postsubiculum were unaffected. The observed altered activity in the subpopulation might be the basis for spatial processing deficits observed following acute stress episodes.
Association between impaired renal function and stroke outcome in patients with versus without atrial fibrillation
Authors: Pan Y. , Jing J. , Chen W. , Wang Y. , He Y.
Published: March 2018

Background and purpose

Chronic kidney disease and atrial fibrillation (AF) are two commonly coexisting risk factors of stroke. The aim of this study was to compare the association between impaired renal function and poor prognosis in ischaemic stroke patients with versus without AF.

Methods

Patients with ischaemic stroke in the China National Stroke Registry were included. Low estimated glomerular filtration rate (eGFR) on admission was defined as <60 ml/min/1.73 m2. Outcomes included stroke recurrence, death, poor outcome defined as 3−6 on the modified Rankin Scale (mRS) and ordinal mRS at 12 months.

Results

Of 9154 patients included, 1143 (12.5%) patients had a low eGFR. Patients with a low eGFR had more presence of AF compared with those with an eGFR of ≥90 ml/min/1.73 m2 [21.5% vs. 6.9%; odds ratio (OR) 1.77, 95% confidence interval (CI) 1.43–2.20]. An interaction of eGFR category by AF was observed for poor outcome and ordinal mRS (P for interaction = 0.04 and 0.002). In patients with AF, the OR with 95% CI of low eGFR was 1.86 (1.19–2.92) for stroke recurrence, 2.87 (1.82–4.52) for death, 1.83 (1.09–3.05) for poor outcome and 2.20 (1.52–3.18) for ordinal mRS. In patients without AF, low eGFR was only associated with death and ordinal mRS (OR 1.61, 95% CI 1.28–2.02; common OR 1.20, 95% CI 1.04–1.38; respectively).

Conclusions

Stroke patients with lower eGFR had more presence of AF. The associations of low eGFR with risk of poor prognosis in stroke patients with AF were stronger than those without AF.
Fatigue life prediction of additively manufactured material: Effects of surface roughness, defect size, and shape
Authors: Yadollahi A. , Mahtabi M.J. , Khalili A. , Doude H.R. , Newman J.C.
Published: March 2018

In this paper, the effects of process‐induced voids and surface roughness on the fatigue life of an additively manufactured material are investigated using a crack closure‐based fatigue crack growth model. Among different sources of damage under cyclic loadings, fatigue because of cracks originated from voids and surface discontinuities is the most life‐limiting failure mechanism in the parts fabricated via powder‐based metal additive manufacturing (AM). Hence, having the ability to predict the fatigue behaviour of AM materials based on the void features and surface texture would be the first step towards improving the reliability of AM parts. Test results from the literature on Inconel 718 fabricated via a laser powder bed fusion (L‐PBF) method are analysed herein to model the fatigue behaviour based on the crack growth from semicircular/elliptical surface flaws. The fatigue life variations in the specimens with machined and as‐built surface finishes are captured using the characteristics of voids and surface profile, respectively. The results indicate that knowing the statistical range of defect size and shape along with a proper fatigue analysis approach provides the opportunity of predicting the scatter in the fatigue life of AM materials. In addition, maximum valley depth of the surface profile can be used as an appropriate parameter for the fatigue life prediction of AM materials in their as‐built surface condition.
Particle swarm optimization procedure in determining parameters in Chaboche kinematic hardening model to assess ratcheting under uniaxial and biaxial loading cycles
Authors: Li Jiawen , Li Qiang , Jiang Jinpeng , Dai Jian
Published: March 2018

As parameters in Chaboche model are difficult to be determined from experimental data, a single objective particle swarm optimization procedure was employed to obtain them. Hysteresis loop and uniaxial and biaxial ratcheting simulations were conducted to validate the determined models. Chaboche models determined by particle swarm optimization give more accurate simulation of ratcheting compared with the model determined by trial and error method. Chaboche models containing different backstress components were studied. Models determined considering uniaxial ratcheting can only predict uniaxial ratcheting precisely, while giving very bad simulation of biaxial ratcheting. The linear hardening rule in the N3L1 model clearly decreases the rate of the accumulation of ratcheting strain, and the N3L1 model gives the best simulations. For biaxial ratcheting, the fourth backstress component can decrease the rate of the accumulation apparently, while it has a little influence on prediction of uniaxial ratcheting.