bluuebunny/crossref_metadata_2025 huggingface dataset:
Activation of the c‐Jun N‐terminal kinase pathway aggravates proteotoxicity of hepatic mutant Z alpha1‐antitrypsin
Authors: Pastore Nunzia , Attanasio Sergio , Granese Barbara , Castello Raffaele , Teckman Jeffrey , Wilson Andrew A. , Ballabio Andrea , Brunetti‐Pierri Nicola
Published: January 2017

Alpha1‐antitrypsin deficiency is a genetic disease that can affect both the lung and the liver. The vast majority of patients harbor a mutation in the serine protease inhibitor 1A (SERPINA1) gene leading to a single amino acid substitution that results in an unfolded protein that is prone to polymerization. Alpha1‐antitrypsin defciency‐related liver disease is therefore caused by a gain‐of‐function mechanism due to accumulation of the mutant Z alpha1‐antitrypsin (ATZ) and is a key example of an disease mechanism induced by protein toxicity. Intracellular retention of ATZ triggers a complex injury cascade including apoptosis and other mechanisms, although several aspects of the disease pathogenesis are still unclear. We show that ATZ induces activation of c‐Jun N‐terminal kinase (JNK) and c‐Jun and that genetic ablation of JNK1 or JNK2 decreased ATZ levels in vivo by reducing c‐Jun–mediated SERPINA1 gene expression. JNK activation was confirmed in livers of patients homozygous for the Z allele, with severe liver disease requiring hepatic transplantation. Treatment of patient‐derived induced pluripotent stem cell‐hepatic cells with a JNK inhibitor reduced accumulation of ATZ. Conclusion: These data reveal that JNK is a key pathway in the disease pathogenesis and add new therapeutic entry points for liver disease caused by ATZ. (Hepatology 2017;65:1865‐1874).
Value‐based care in hepatology
Authors: Strazzabosco Mario , Allen John I. , Teisberg Elizabeth O.
Published: January 2017

The migration from legacy fee‐for‐service reimbursement to payments linked to high‐value health care is accelerating in the United States because of new legislation and redesign of payments from the Centers for Medicare and Medicaid Services. Because patients with chronic diseases account for substantial use of health care resources, payers and health systems are focusing on maximizing the value of care for these patients. Because chronic liver diseases impose a major health burden worldwide affecting the health and lives of many individuals and families as well as substantial costs for individuals and payers, hepatologists must understand how they can improve their practices. Hepatologists practice a high‐intensity cognitive subspecialty, using complex and costly procedures and medications. High‐value patient care requires multidisciplinary coordination, labor‐intensive support for critically ill patients, and effective chronic disease management. Under current fee‐for‐service reimbursement, patient values, medical success, and financial success can all be misaligned. Many current attempts to link health outcomes to reimbursement are based on compliance with process measures, with less emphasis on outcomes that matter most to patients, thus slowing transformation to higher‐value team‐based care. Outcome measures that reflect the entire cycle of care are needed to assist both clinicians and administrators in improving the quality and value of care. A comprehensive set of outcome measures for liver diseases is not currently available. Numerous researchers now are attempting to fill this gap by devising and testing outcome indicators and patient‐reported outcomes for the major liver conditions. These indicators will provide tools to implement a value‐based approach for patients with chronic liver diseases to compare results and value of care between referral centers, to perform health technology assessment, and to guide decision‐making processes for health authorities. This review sets the groundwork for implementing a value‐based, patient‐centered approach to chronic liver diseases within a health system. (Hepatology 2017;65:1749‐1755).
Assimilation of historical head data to estimate spatial distributions of stream bed and aquifer hydraulic conductivity fields
Authors: Alzraiee Ayman H. , Bailey Ryan , Bau Domenico
Published: January 2017

Management of water resources in alluvial aquifers relies mainly on understanding interactions between hydraulically connected streams and aquifers. Numerical models that simulate this interaction often are used as decision support tools for water resource management. However, the accuracy of numerical predictions relies heavily on unknown system parameters (e.g., streambed conductivity and aquifer hydraulic conductivity), which are spatially heterogeneous and difficult to measure directly. This paper employs an ensemble smoother to invert groundwater level measurements to jointly estimate spatially varying streambed and alluvial aquifer hydraulic conductivity along a 35.6‐km segment of the South Platte River in Northeastern Colorado. The accuracy of the inversion procedure is evaluated using a synthetic experiment and historical groundwater level measurements, with the latter constituting the novelty of this study in the inversion and validation of high‐resolution fields of streambed and aquifer conductivities. Results show that the estimated streambed conductivity field and aquifer conductivity field produce an acceptable agreement between observed and simulated groundwater levels and stream flow rates. The estimated parameter fields are also used to simulate the spatially varying flow exchange between the alluvial aquifer and the stream, which exhibits high spatial variability along the river reach with a maximum average monthly aquifer gain of about 2.3 m3/day and a maximum average monthly aquifer loss of 2.8 m3/day, per unit area of streambed (m2). These results demonstrate that data assimilation inversion provides a reliable and computationally affordable tool to estimate the spatial variability of streambed and aquifer conductivities at high resolution in real‐world systems.
Pregnancy and Leprosy
Authors: Jafari Kianoosh , Stepto Robert C. , Petrys Richard
Published: January 2017

Jafari, K., Stepto, R. C. and Petrys, R. (Dept. of Obstetrics and Gynecology, Cook County Hospital, Chicago, Ill., USA). Pregnancy and leprosy.

Int J Gynaecol Obstet 13: 222–224, 1975.

A case of lepromatous leprosy in a patient with pregnancy is reported. Literature was reviewed. Fetal and maternal outcome and the modality of the treatment is discussed.
Midtrimester Abortion
Authors: Ragab M. Ismail , Edelman David A.
Published: January 2017

Ragab, M. I. and Edelman, D. A. (Ain Shams University, Cairo, Egypt and International Fertility Research Program, Research Triangle Park, North Carolina, USA). Midtrimester abortion. A comparison of intraamniotic prostaglandin F2α and hypertonic saline.

Int J Gynaecol Obstet 14: 393–396, 1976.

The safety and effectiveness of two intraamniotic prostaglandin F2α (PGF2α) dose schedules (a single 50 mg dose and a repeated 25 mg dose) and intraamniotic hypertonic saline were evaluated in a study where each abortion procedure was randomly assigned to 50 patients. All patients were at 16 to 20 weeks’ gestation. Rates of gastrointestinal and other side effects were generally higher for the 50 mg PGF2α dose schedule than for the other two procedures. Complications were infrequent with all three study procedures. The repeated 25 mg PGF2α dose schedule resulted in higher 24‐hour (68.0%) and 48‐hour (98.0%) cumulative abortion rates than the 50 mg PGF2α dose schedule (54.0%, 92.0%) or saline (34.7%, 91.8%). Rates of spontaneous placental expulsion were highest for the repeated 25 mg PGF2α dose (74.0%) and lowest for the 50 mg PGF2α dose schedule (40.0%).
Uterine Perforation in Connection with Vacuum Aspiration for Legal Abortion
Authors: Moberg Peter J.
Published: January 2017

The incidence of uterine perforation complicating vacuum aspiration for legal termination of first trimester pregnancy varies widely. Nineteen cases of perforation (0.64%) occurred 1967–1974 at the Department of Obstetrics and Gynecology, Karolinska Sjukhuset, Sweden. These cases were analysed and compared with 71 other reported uterine perforations. The dilator, suction curette and uterine sound were about equally the instrument responsible for perforation. The dilatation of the cervix is a critical point of the operation. In 22% the lesion was observed in the cervix‐isthmus. If this procedure could be replaced by administration of prostaglandins the number of perforations might be reduced. Correct judgement of uterine position and size immediately prior to operation appears to be of utmost importance.
The Effect of Recent FDA Legislation on Contraceptive Development and Safety
Authors: Dickey Richard P.
Published: January 2017

By law, medical devices with a potential hazard to health or safety are now subject to the same premarket approval and scientific review processes as drugs. Manufacturers of intrauterine contraceptive devices and new instruments or devices for surgical sterilization will be required to present evidence of their products' effectiveness and safety to a United States Food and Drug Administration advisory panel made up of physicians and scientists from outside the agency. Hazards previously experienced with contraceptive devices and requirements for testing new devices are described.
Experience with Medroxyprogesterone Acetate (Depo‐Provera®) as an Injectable Contraceptive
Authors: Ellinas Symeon P.
Published: January 2017

The efficacy and side effects of medroxyprogesterone acetate (Depo‐Provera®) are presented along with the potential benefits of an injectable contraceptive. Numerous graphs and charts present data pertaining to the use of this drug.
Contraceptive Practice After Women Have Undergone “Spontaneous” Abortion in Indonesia and Sudan
Authors: Rushwan H. , Doodoh A. , Chi I‐cheng , Bernard Roger P.
Published: January 2017

Studies of hospitalized “spontaneous” abortion patients in two Muslim countries (Indonesia and Sudan) revealed the need for contraception in this group of married women and indicated the potential role of maternity hospitals in providing them with contraceptive counseling. It could not be determined which of the abortions were induced outside the hospital and which were truly spontaneous. Of the 893 women treated at the Djakarta Hospital, 15.3% used contraceptives during the month of conception of the index abortion, compared to 10.0% of the 2 759 patients in Khartoum. After hospitalization for completion of the abortion, the rates of contraceptive use increased by more than one third in both cities. The highest rates of increase in contraceptive use after abortion were noted among poorly educated women, women with large families, and women with abortions diagnosed as septic. Among the nonseptic patients at all hospitals, those experiencing complications associated with the abortion reported a slightly higher rate of postabortion contraceptive use. In hospitals where contraceptive counseling was provided, there was a proportional increase in postabortion use of contraceptives by the study population.
Clostridial Sepsis After Abortion with PGF2α and Intracervical Laminaria Tents—A Case Report
Authors: Green Stephen L. , Brenner William E.
Published: January 2017

A case of clostridial endomyometritis and sepsis necessitating total abdominal hysterectomy which occurred 12 hours following abortion induced with intraamniotic administration of prostaglandin F2α and laminaria tent insertion is discussed. Cultures from cervical, blood, and surgical specimens all yielded Clostridium perfringens. Intrauterine contamination with this microorganism most likely followed the insertion of laminaria tents through the cervical os, which was colonized with C. perfringens. Since C. perfringens may be present in the microflora of the lower female genital tract, great care must be taken to cleanse this area prior to intracervical laminaria tent insertion.
Plasma Concentrations of Methylergometrine After Intravenous and Intramuscular Administration
Authors: Kanto J. , Allonen H. , Erkkola R. , Kleimola T. , Mantyla R.
Published: January 2017

The concentrations of methylergometrine (M) in the plasma were determined by a new radioimmunoassay after a single intravenous and intramuscular administration of two brands, Methergin (Sandoz Pharmaceuticals, Inc, East Hanover, NJ, USA) and Myomergin (Leiras Pharmaceuticals, Turku, Finland). No significant differences between the two brands were found. After the intravenous injection, M distributed quickly from the plasma to the tissues, and according to the elimination phase half‐life M has no cumulative properties. After the intramuscular injection, M was absorbed quickly with peak plasma concentrations at one‐half hour.
Sex Differences in Fetal Sheep Adrenal Steroidogenesis
Authors: Ayromlooi Jahangir , Essman Walter B.
Published: January 2017

The formation of several steroids was determined in vitro in adrenals removed from 18 female and six male fetuses of 113–115 days' gestation and in two female and two male fetuses at near term (137–143 days). Samples were incubated with 14C‐acetate and the formation of labeled steroids was determined by two‐dimensional paper chromatography. Protein and corticosterone concentrations were determined by chromophore absorption and acid hydrolysis fluorescence methods, respectively. Tissue corticosterone concentrations were significantly higher in female (0.145 ± 0.010 μg/mg protein) than in male (0.083 ± 0.010 μg/mg protein) adrenal tissue at both stages, whereas corticosterone formation was similar in both sexes. Cholesterol formation was significantly higher in female (0.103 ± 0.079 μM/mg protein) than in male (0.044 ± 0.011 μM/mg protein) adrenals at both stages. Both testosterone and estradiol were synthesized at higher rates in female than in male adrenals (52% and 33%, respectively), whereas pregnanediol formation was 21% higher in the male. These results indicate that significant sex differences exist in the formation of various adrenocortical hormones by fetal tissues. The relevance of these findings to better survival of female premature newborns from respiratory distress syndrome in contrast with male, is discussed.
Müllerian Aplasia with Hypoplastic Thumbs: Two Case Reports
Authors: Michels Virginia V. , Caskey C. Thomas
Published: January 2017

Two cases of Müllerian aplasia associated with unilateral hypoplasia of the thumbs and skeletal spine deformities in two unrelated females are reported, and the pertinent literature is reviewed. Müllerian aplasia is frequently associated with skeletal spine deformities, but has not been reported to be associated with hypoplasia of the thumbs. Several heritable syndromes, including the hand‐foot‐uterus syndrome, are characterized by uterovaginal and distal extremity malformations but are not associated with skeletal spine anomalies. The two cases reported here represent a previously unreported constellation of anomalies.
The International Confederation of Midwives: An Overview
Authors: Hardy F. Margaret
Published: January 2017

This paper presents an overview of the role and the activities of the International Confederation of Midwives and discusses its links with other organizations.
Umbilical Blood Gas Analysis: I. Effect of Storage of Samples on Outcome
Authors: Nhan Vu Quy , de Bruyn H. W. A. , Huisjes H.J.
Published: January 2017

The pH and blood gas values of umbilical blood samples must be determined as soon as possible after birth to avoid changes in pH, oxygen pressure (PO2) and carbon dioxide pressure (PCO2). Since a continuous around‐the‐clock laboratory service is not available in every hospital, a method of reducing these changes is desirable. Determination of pH and blood gas values at different time intervals while the samples were stored on ice showed that pH decreased by a mean of 0.003 unit/hr, whereas PCO2 and PO2 increased. A method of reducing glycolysis in blood cells must be found to make postponement of analysis acceptable.
A Double‐Blind Controlled Trial of PGE2 Gel in Cervical Ripening
Authors: Hutchon D. J. R. , Geirsson R. , Patel N. B.
Published: January 2017

A double‐blind controlled trial of intracervical prostaglandin E2 gel was carried out in patients with an unripe cervix. Half of the treated group, compared to 8.6% of the controls became established in labor before planned amniotomy. There was no significant improvement in the state of the cervix in the remaining patients and the outcome of labor was not improved in the treated group in terms of fetal distress or cesarean section.
Coagulation Studies in Asian Women Using Injectable Progestogen for Contraception
Authors: Tsakok F. H. M. , Koh S. , Yuen R. , Ratnam S. S.
Published: January 2017

Coagulation, fibrinolytic activity and platelet function were studied in 104 Asian women volunteers who received 150 mg of depot medroxyprogesterone acetate intramuscularly every three months for two years or more. The results were compared with those in matched controls. There was a paucity of change in coagulation factors. The fibrinogen levels were increased and prothrombin time was shortened. The fibrinolytic activity, as shown by the euglobulin clot lysis time, was significantly increased. This latter change contrasts with the many reports concerning Caucasian women and may reflect an increase in fibrinolytic potential in Asian women.
Evaluation of Threatened Abortion by Human Chorionic Gonadotropin Levels and Ultrasonography
Authors: Sande H. A. , Reiertsen O. , Fønstelien E. , Torjesen P.
Published: January 2017

To determine the prognostic value of human chorionic gonadotropin (HCG) concentrations in maternal plasma and urine, we studied 104 women with threatened abortion (cases) and 108 women with normal pregnancies and normal serum levels of HCG (controls). Of the 104 cases, 48 were also examined ultrasonically. We concluded that measurements of serum levels of HCG are of more accurate prognostic value than those of urine levels. Low serum levels of HCG indicate a poor prognosis for the pregnancy, as do steady decreases, in repeated measurements, of initially high HCG levels. The combination of normal serum levels of HCG and signs of fetal life during ultrasonic examination indicates a very good prognosis for the pregnancy.
Prevention of Maternal Death in a Nigerian Village
Authors: Hartfield V. J. , Woodland M.
Published: January 2017

In a Nigerian village, the expected maternal mortality would be between 6 and 12 per 1000 live births, the most common causes of maternal death being obstructed labor, hemorrhage and eclampsia. Yet, over an 8½‐year period, when 2324 births occurred, the rate was 1.72 per 1000, of which 0.43 were due to obstetric complications. The four deaths were associated, respectively, with typhoid fever, tuberculosis and typhoid fever, infectious hepatitis and postpartum hemorrhage with dysentery. Using the experience gained in the village, recommendations are made for reducing maternal mortality in rural areas.
Clinical Observations of Malignant Trophoblastic Disease
Authors: Adeleye J. A. , Osinusi B. O. , Adewunmi O. A. , Aimakhu V. E.
Published: January 2017

We studied the clinical records of 64 women with malignant trophoblastic disease. Fifty‐five patients (68%) were aged 25‐50 years. The current pregnancy was preceded by abortion in 24 cases, by molar pregnancy in 23 cases and by normal pregnancy in 17 cases. The most common presenting symptoms were vaginal bleeding, abdominal mass and abdominal pain. Pulmonary lesions were mostly silent, but hemoptysis occurred in seven patients. Metastases were found in 39 patients. Treatment was mainly chemotherapy. Remission for over 12 months occurred in 40 patients, and 21 patients died.
Cul‐de‐sac Insufflation to Induce Pneumoperitoneum: An Analysis of Rare Problems
Authors: van Schie Kees J. , van Lith Dirk A. F. , Beekhuizen Willem , du Plessis‐Alblas Marijke
Published: January 2017

Since 1977, cul‐de‐sac insufflation has been used to achieve pneumoperitoneum for laparoscopic sterilization of 570 women. The authors have previously published findings on 350 of these women (Int J Gynaecol Obstet 17(4):375, 1980), reporting technical failure rates of 3.6% and 1.9% for a series of 195 and 155 women, respectively. The failure rate for the latest series of 220 women declined to 1.4%. Reasons for this lower rate and recurring causes of the failures are given, and recommendations for the use of cul‐de‐sac insufflation for inducing pneumoperitoneum are suggested.
Oral Contraceptives and Family Health in Rural Bangladesh
Authors: Huber Sallie Craig , Huber Douglas H. , Khan Atiqur Rahman , Chakraborty J. , Chowdhury Abu Yusef , Rahman Makhlisur , Chowdhury A. I.
Published: January 2017

A case‐control survey of mothers was undertaken in rural Bangladesh to assess the health problems of oral contraceptive users compared with two groups of nonusers. The complaint most often reported was weakness—more than 80% of all women surveyed. Significantly more pill users than nonusers reported experiencing dizziness and eye problems. However, only one fifth of dizziness complaints among pill users could be attributed to the pill. Although more pill users reported a decrease in lactation, a greater problem among the control group was total cessation of lactation related to a subsequent pregnancy. Therefore, in this context the pill may postpone weaning more often than it reduces lactation. That few women choose to use oral contraceptives in the early postpartum period, when a reduction in breast milk would be most hazardous to the child, contributes to this favorable balance. The attitude toward early termination of pregnancy was positive for 61% of pill users and 34% of nonusers. It is likely that abortion services would be favorably received in this traditional society.
A Study of Out‐of‐Wedlock Pregnancies: Outcome and Utilization of Maternal/Child Health Services
Authors: Srinivasa D. K. , Pankajam R.
Published: January 2017

The characteristics of unwed pregnant women, their utilization of maternal and child health services and the infant mortality among these out‐of‐wedlock births were investigated. During the study period, 5% of all pregnancies (48 of 855) were of this nature. Utilization of antenatal services was poor among unwed pregnant women, compared to those who were married. However, they used the child care services satisfactorily, as observed by the well‐baby‐clinic visits and acceptance of immunization. The infant mortality was 125 per 1000 live births, more than double the rate among infants born to married women. Either immediately after child birth or within one year after delivery, 50% of the unwed mothers started living with the putative fathers.
An Immunologic Study of Vaginal Candidiasis
Authors: Tomšíková Alena , Tomaierová Věra , Kotál Luboš , Nováčková Dana
Published: January 2017

The immunologic reaction to Candida antigens was studied in 188 women aged 18‐61 years. The four groups included 50 women suffering from various vaginal disorders, 50 pregnant women, 38 sterile women and 50 healthy women without candidiasis. The serum antibodies were determined by agglutination, fixation of the complement, counterimmunoelectrophoresis and immunodiffusion; allergy was determined by skin tests. A significantly higher antibody level and a stronger allergic reaction were found in women with candidiasis. The authors discuss determining immunologic reaction for diagnostic purposes and recommend isolating precipitating antibodies and performing skin tests with the mannan‐protein antigens in addition to microscopy and culture.
Etiology and Management of Transverse Lie
Authors: Jabbar Abdul , Meshari Al
Published: January 2017

Sixty‐two cases of transverse lie were studied, with an average incidence of 1:250. The different etiologic factors predisposing to transverse lie are discussed, and the medical literature is reviewed. Antenatal management and management at term are also discussed.
Generation of Immortalized Equine Chondrocytes With Inducible Sox9 Expression Allows Control of Hypertrophic Differentiation
Authors: Gurusinghe Saliya , Hilbert Bryan , Trope Gareth , Wang Lexin , Bandara Nadeeka , Strappe Padraig
Published: January 2017

Immortalization of chondrocytes enables long term in vitro culture; however, the chondrogenic capacity of transformed cells varies, thus highlighting the need to develop a proliferative and tuneable chondrocyte cell line where hypertrophic differentiation can be controlled. In this study the SV40 large T antigen and human telomerase reverse transcriptase were employed to immortalize pooled equine chondrocytes through lentiviral vector mediated transduction either singly or on combination. Transformed chondrocytes proliferated stably over multiple passages, but resulted in significantly lower expression of chondrocyte specific collagen II mRNA (P < 0.0001) and up regulation of the hypertrophic marker collagen X (P < 0.0001) in three dimensional cultures. A Col2a1 promoter driven GFP reporter was constructed for real time monitoring of chondrogenic differentiation and a significant increase in promoter activation was observed in cultures treated with the growth factor TGFβ‐3 (P < 0.05). To recapitulate the native articular chondrocyte phenotype we further transduced large T antigen immortalized chondrocytes with lentiviral vectors allowing either constitutive or doxycycline inducible expression of Sox9. In 3D cultures, the Sox9 over‐expressing chondrocytes secreted significantly higher levels of extracellular matrix polysaccharide glycosaminoglycan (P < 0.05), while up‐regulating collagen II and Aggrecan mRNA (P < 0.05) in both expression systems with a similar patterns observed with imunohistochemical staining. High levels of collagen X mRNA and protein were maintained with constitutive sox9 reflecting hypetrophic differentiation but significantly lower expression could be achieved with inducible Sox9. In conclusion, immortalization of equine chondrocytes results in stable proliferation but a reduction of chondrogenic potential whilst modulation of sox9 expression enabled control of hypertrophic characteristics. J. Cell. Biochem. 118: 1201–1215, 2017. © 2016 Wiley Periodicals, Inc.
Enhancement of Muramyl Dipeptide‐Dependent NOD2 Activity by a Self‐Derived Peptide
Authors: Mann Jasdeep K. , Shen Jiaochen , Park Sheldon
Published: January 2017

Nucleotide‐binding and oligomerization domain like receptors (NLR) are pattern recognition receptors used to provide rapid immune response by detecting intracellular pathogen‐associated molecules. Loss of NLR activity is implicated in genetic disorders, disruption of adaptive immunity, and chronic inflammation. One NLR protein, NOD2, is frequently mutated in Crohn's disease (CD), which is an inflammatory disease of the gastrointestinal tract. Three commonly occurring CD‐associated NOD2 mutations, R702W, G908R, and L1007fs, are clustered near the regulatory domain, leucine rich region (LRR), and lowers the activity of NOD2 in response to muramyl dipeptide (MDP). As LRR is also the ligand binding domain, this suggests that the mutations either affect the binding of MDP or how the molecule responds to ligand binding. To model the role of R702 in ligand‐dependent activation of NOD2, we used homology modeling to map the residue R702 to the interface between the oligomerization domain and LRR. We show that a peptide derived from NOD2(697‐718) binds LRR in vitro, and upon co‐expressing or importing the peptide into HEK293 expressing NOD2, there is an increase in the MDP‐dependent NOD2 activity. The study thus suggests that the R702W mutation interferes with the conformational changes needed for MDP binding and activation. J. Cell. Biochem. 118: 1227–1238, 2017. © 2016 Wiley Periodicals, Inc.
Role of the clinical pharmacist in improving the appropriateness of venous thromboembolism prophylaxis in hospitalised patients in Jordan
Authors: Gharaibeh Lubna , Younes Nidal , Albsoul‐Younes Abla
Published: January 2017

Background

Venous thromboembolism (VTE) is one of the most important preventable causes of death in hospitalised patients. The role of the clinical pharmacist in Jordan is still at its beginnings in this field; this study explored the contribution of the clinical pharmacist to improving the frequency of appropriate VTE prophylaxis.

Aim

To evaluate the role of the clinical pharmacist in improving appropriate VTE prophylaxis in a tertiary hospital.

Methods

This study with a single‐group pretest‐post test design. Recommendations of the clinical pharmacist concerning VTE prophylaxis for a group of hospitalised patients with odd ID numbers were provided to physicians. The main outcome measure was the appropriateness of VTE prophylaxis; therapy was defined as appropriate when it was fully concordant with the American College of Chest Physicians (ACCP) guidelines. Appropriateness of VTE prophylaxis was measured before and after the provision of recommendations.

Results

The extent of concordance with the ACCP guidelines increased from 78.9% to 87.8%, with a statistically significant increase of 8.9% (p < 0.001).

Conclusion

Employment of a clinical pharmacist coincided with an improvement in the rate of appropriate VTE prophylaxis.
Postreperfusion microcirculatory derangements after liver transplantation: Relationship to hemodynamics, serum mediators, and outcome
Authors: Pulitano Carlo , Joseph David , Sandroussi Charbel , Verran Deborah , Ho Phong , Debiasio Ashe , Luongo Adriano , McCaughan Geoffrey W. , Shackel Nicholas A. , Crawford Michael
Published: January 2017

Despite the growing data supporting the role of microcirculation in regulating liver function, little of this knowledge has been translated into clinical practice. The aim of this study is to quantify hepatic microcirculation in vivo using sidestream dark field (SDF) imaging and correlate these findings with hepatic blood flow, hemodynamic parameters, and soluble mediators. Postreperfusion hepatic microcirculation was assessed using SDF imaging. Hepatic microcirculation measurements included functional sinusoidal density (cm/cm2), sinusoidal diameter (μm), red blood cell velocity (μm/second), volumetric blood flow (pl/second), and flow heterogeneity (FH) index. The serum concentrations of endothelin 1 (ET‐1) and other inflammatory markers were analyzed with Luminex technology. Portal venous and hepatic artery flows were measured using a flowmeter. Twenty‐eight patients undergoing cadaveric liver transplantations have been included in this study. Early allograft dysfunction (EAD) occurred in 7 (25%) patients and was associated with microcirculatory dysfunction. Low arterial and portal flow, high dose of inotropes, cold ischemia time, steatosis, and high ET‐1 levels were all associated with impaired microcirculation. The time interval between portal venous and hepatic arterial reperfusion significantly correlated with the changes of the liver grafts’ microcirculation. EAD patients tended to have higher serum levels of ET‐1 on postoperative days 1, 2, 5, and 7 (all P < 0.01). Serum levels of ET‐1 correlated significantly with microcirculation parameters. In conclusion, postreperfusion hepatic microcirculation is a determinant of organ dysfunction after liver reperfusion and could be used to identify very early patients at risk of EAD. Liver Transplantation 23 527–536 2017 AASLD.
Systematic review of severity scales and screening instruments for tics: Critique and recommendations
Authors: Martino Davide , Pringsheim Tamara M. , Cavanna Andrea E. , Colosimo Carlo , Hartmann Andreas , Leckman James F. , Luo Sheng , Munchau Alexander , Goetz Christopher G. , Stebbins Glenn T. , Martinez‐Martin Pablo ,   the Members of the MDS Committee on Rating Scales Development
Published: January 2017

Background: Several clinician, informant, and self‐report instruments for tics and associated phenomena have been developed that differ in construct, comprehensiveness, and ease of administration.

Objective: A Movement Disorders Society subcommittee aimed to rate psychometric quality of severity and screening instruments for tics and related sensory phenomena.

Methods: Following the methodology adopted by previous Movement Disorders Society subcommittee papers, a review of severity and screening instruments for tics was completed, applying a classification as “recommended,” “suggested,” or “listed” to each instrument.

Results: A total of 5 severity scales (Yale Global Tic Severity Scale, Tourette Syndrome Clinical Global Impression, Tourette's Disorder Scale, Shapiro Tourette syndrome Severity Scale, Premonitory Urges for Tics Scale) were “recommended,” and 6 (Rush Video‐Based Tic Rating Scale, Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey, Tourette Syndrome Global Scale, Global Tic Rating Scale, Parent Tic Questionnaire, Tourette Syndrome Symptom List) were “suggested.” A total of 2 screening instruments (Motor tic, Obsession and compulsions, Vocal tic Evaluation Survey and Autism‐Tics, Attention Deficit/Hyperactivity Disorder and Other Comorbidities Inventory) were “recommended,” whereas 2 others (Apter 4‐questions screening and Proxy Report Questionnaire for Parents and Teachers) were “suggested.”

Conclusions: Our review does not support the need for developing new tic severity or screening instruments. Potential objectives of future research include developing a rating instrument targeting the full spectrum of tic‐related abnormal behaviors, assessing/screening malignant forms of tic disorders, and developing patient‐reported outcome measures. © 2017 International Parkinson and Movement Disorder Society.
Heart rate variability in leucine‐rich repeat kinase 2‐associated Parkinson's disease
Authors: Visanji Naomi P. , Bhudhikanok Grace S. , Mestre Tiago A. , Ghate Taneera , Udupa Kaviraj , AlDakheel Amaal , Connolly Barbara S. , Gasca‐Salas Carmen , Kern Drew S. , Jain Jennifer , Slow Elizabeth J. , Faust‐Socher Achinoam , Kim Sam , Azhu Valappil Ruksana , Kausar Farah , Rogaeva Ekaterina , William Langston J. , Tanner Caroline M. , Schüle Birgitt , Lang Anthony E. , Goldman Samuel M. , Marras Connie
Published: January 2017

Background

Heart rate variability is reduced in idiopathic PD, indicating cardiac autonomic dysfunction likely resulting from peripheral autonomic synucleinopathy. Little is known about heart rate variability in leucine‐rich repeat kinase 2‐associated PD.

Objectives

This study investigated heart rate variability in LRRK2‐associated PD.

Methods

Resting electrocardiograms were obtained from 20 individuals with LRRK2‐associated PD, 37 nonmanifesting carriers, 48 related noncarriers, 26 idiopathic PD patients, and 32 controls. Linear regression modelling compared time and frequency domain values, adjusting for age, sex, heart rate, and disease duration.

Results

Low‐frequency power and the ratio of low–high frequency power were reduced in idiopathic PD versus controls (P < .008, P < .029 respectively). In contrast, individuals with LRRK2‐associated PD were not statistically different from controls in any parameter measured. Furthermore, all parameters trended toward being higher in LRRK2‐associated PD when compared with idiopathic PD.

Conclusions

Heart rate variability may remain intact in LRRK2‐associated PD, adding to a growing literature supporting clinical‐pathologic differences between LRRK2‐associated and idiopathic PD. © 2017 International Parkinson and Movement Disorder Society
Identification and implication of an allergenic PR‐10 protein from walnut in birch pollen associated walnut allergy
Authors: Wangorsch Andrea , Jamin Annette , Lidholm Jonas , Gräni Nora , Lang Claudia , Ballmer‐Weber Barbara , Vieths Stefan , Scheurer Stephan
Published: January 2017

Scope

English walnut (Juglans regia) belongs to the most important allergenic tree nuts. Co‐sensitization with birch (Betula verrucosa) pollen has been reported. We aimed to identify a walnut allergen homologous to the major birch pollen allergen Bet v 1.

Methods and results

A cDNA encoding a Bet v 1‐homologous allergen (Jug r 5) in walnut kernels was cloned by RT‐PCR. Jug r 5 was expressed in Escherichia coli, purified by column chromatography and characterized by circular dichroism spectroscopy. Specific IgE levels to walnut, Bet v 1, and Jug r 5 in birch pollen allergics (n = 16) with concomitant walnut allergy were measured by ImmunoCAP: 44% of the patients were tested positive to walnut while 94% were reactive to Jug r 5, and 100% to Bet v 1. Jug r 5 and Bet v 1 allergens showed bidirectional IgE cross‐reactivity by competitive ELISA and were capable of inducing histamine release from effector cells. Immunoblot competition experiments demonstrated the presence of IgE‐reactive Jug r 5 in walnut extract, but at low levels.

Conclusion

A Bet v 1‐like allergen was identified in walnut. Diagnostic use of Jug r 5 will compensate for the low sensitivity of walnut extract for patients with birch pollen associated walnut allergy.
Differential effects of myostatin deficiency on motor and sensory axons
Authors: Jones Maria R. , Villalón Eric , Northcutt Adam J. , Calcutt Nigel A. , Garcia Michael L.
Published: January 2017

Introduction

Deletion of myostatin in mice (MSTN−/−) alters structural properties of peripheral axons. However, properties like axon diameter and myelin thickness were analyzed in mixed nerves, so it is unclear whether loss of myostatin affects motor, sensory, or both types of axons.

Methods

Using the MSTN−/− mouse model, we analyzed the effects of increasing the number of muscle fibers on axon diameter, myelin thickness, and internode length in motor and sensory axons.

Results

Axon diameter and myelin thickness were increased in motor axons of MSTN−/− mice without affecting internode length or axon number. The number of sensory axons was increased without affecting their structural properties.

Discussion

These results suggest that motor and sensory axons establish structural properties by independent mechanisms. Moreover, in motor axons, instructive cues from the neuromuscular junction may play a role in co‐regulating axon diameter and myelin thickness, whereas internode length is established independently. Muscle Nerve 56: E100–E107, 2017
Solving large‐scale problems by Taylor Meshless method
Authors: Yang Jie , Hu Heng , Potier‐Ferry Michel
Published: January 2017

A true integration‐free meshless method based on Taylor series named Taylor meshless method (TMM) has been proposed to solve two‐dimensional partial differential equations (PDEs). In this framework, the shape functions are approximated solutions of the PDE, and the discretization concerns only the boundary. In this paper, the applicability of TMM to solve large‐scale problems is discussed under two aspects. First, as in some other meshless methods, ill‐conditioned matrices and round‐off error propagation could lead to a loss of accuracy when the number of unknowns increases. This point will be investigated in the case of large‐scale problems. Second, the computation time and its distribution are analyzed from numerical experiments for PDEs in a 3D domain. It is established that the TMM method is efficient and robust, even in the case of large‐scale problems, while the finite element numerical model involves more than 3 million degrees of freedom. Copyright © 2017 John Wiley & Sons, Ltd.
Nitrogen enhanced thermal stability of nickel monosilicide
Authors: Zuruzi A. S. , Chi D. Z. , Mangelinck D.
Published: January 2017

The effect of annealing ambient during rapid thermal processing on thermal stability of NiSi has been investigated. Nickel films deposited onto Si(100) were annealed in vacuum, Ar and N2 at pressures up to 40 Torr. Rapid thermal annealing in vacuum or in Ar at 750 °C resulted in the formation of NiSi2 with concomitant increase in sheet resistance and surface roughness. However, annealing in N2 increases the NiSi2 nucleation temperature and thus the thermal stability of NiSi. Higher the N2 pressure, higher was the annealing temperature required to initiate NiSi2 nucleation. Experimental results were analyzed using a simple thermodynamic model. It suggests dissolved nitrogen impurities lower the chemical potential and increase thermal stability of NiSi phase. Phase stability observed experimentally was in agreement with that predicted by the model.

Threshold nitrogen pressure exists for stabilization of nickel monosilicide during rapid thermal annealing.
Barotropic decelerations of the southern stratospheric polar vortex
Authors: Marques C. A. F. , Castanheira J. M.
Published: January 2017

The northern and southern polar vortices are subject to quite different dynamical forcings, with the variability of the northern polar vortex much more dominated by baroclinic wave processes. Some recent works describe a barotropic structure in vortex‐splitting sudden stratospheric warming events (SSWs). Performing an analysis of the anomalies of the energy cycle, we show that strong decelerations of the southern polar vortex are, in fact, dominated by the transfer of kinetic energy between barotropic components. A major role is played by the barotropic zonal wave number n = 3 in the energy transfer of kinetic energy. This result, conjugated with the fact that stationary tropospheric waves in the southern midlatitudes have an amplitude peak at zonal wave number n = 3, suggests that the barotropic mechanism of ‘nonlinear resonance tuning’ may be the cause of strong decelerations of the southern stratospheric polar vortex.
An approach for sample size determination of average bioequivalence based on interval estimation
Authors: Chiang Chieh , Hsiao Chin‐Fu
Published: January 2017

In 1992, the US Food and Drug Administration declared that two drugs demonstrate average bioequivalence (ABE) if the log‐transformed mean difference of pharmacokinetic responses lies in (−0.223, 0.223). The most widely used approach for assessing ABE is the two one‐sided tests procedure. More specifically, ABE is concluded when a 100(1 − 2α) % confidence interval for mean difference falls within (−0.223, 0.223). As known, bioequivalent studies are usually conducted by crossover design. However, in the case that the half‐life of a drug is long, a parallel design for the bioequivalent study may be preferred. In this study, a two‐sided interval estimation — such as Satterthwaite's, Cochran–Cox's, or Howe's approximations — is used for assessing parallel ABE. We show that the asymptotic joint distribution of the lower and upper confidence limits is bivariate normal, and thus the sample size can be calculated based on the asymptotic power so that the confidence interval falls within (−0.223, 0.223). Simulation studies also show that the proposed method achieves sufficient empirical power. A real example is provided to illustrate the proposed method. Copyright © 2017 John Wiley & Sons, Ltd.
Classicality Lost: K3 and LP after the Fall
Authors: Jenny Matthias ,   Philosophy Documentation Center
Published: January 2017

It is commonly held that the ascription of truth to a sentence is intersubstitutable with that very sentence. However, the simplest subclassical logics available to proponents of this view, namely K3 and LP, are hopelessly weak for many purposes. In this article, I argue that this is much more of a problem for proponents of LP than for proponents of K3. The strategies for recapturing classicality offered by proponents of LP are far less promising than those available to proponents of K3. This undermines the ability of proponents LP to engage in public reasoning in classical domains.
Homunculi Are People Too!
Authors: Gilmore Cody ,   Philosophy Documentation Center
Published: January 2017

David Lewis (1976a: 22) defends the following "non-circular definition of personhood": "something is a continuant person if and only if it is a maximal R-interrelated aggregate of person-stages. That is: if and only if it is an aggregate of person-stages, each of which is R-related to all the rest (and to itself), and it is a proper part of no other such aggregate." I give a counterexample, involving a person who is a part of another, much larger person, with a separate mental life. I then offer an easy repair, which preserves the virtues of Lewis’s definition without introducing any new vices.
Risk of Cesarean scar defect following single‐ vs double‐layer uterine closure: systematic review and meta‐analysis of randomized controlled trials
Authors: Di Spiezio Sardo A. , Saccone G. , McCurdy R. , Bujold E. , Bifulco G. , Berghella V.
Published: January 2017

Objective

There is a growing body of evidence that suggests that the surgical technique for uterine closure following Cesarean delivery influences the healing of the Cesarean scar, but there is still no consensus on the optimal technique. The aim of this systematic review and meta‐analysis was to compare the effect of single‐ vs double‐layer uterine closure on the risk of uterine scar defect.

Methods

MEDLINE, Scopus,
ClinicalTrials.gov, PROSPERO, EMBASE and the Cochrane Central Register of Controlled Trials were searched from inception of each database until May 2016. All randomized controlled trials (RCTs) evaluating the effect of single‐ vs double‐layer uterine closure following low transverse Cesarean section on the risk of uterine scar defect were included. The primary outcome was the incidence of uterine scar defects detected on ultrasound. Secondary outcomes were residual myometrial thickness evaluated by ultrasound and the incidence of uterine dehiscence and/or rupture in subsequent pregnancy. Summary measures were reported as relative risk (RR) or mean difference (MD), with 95% CIs. Quality of the evidence was assessed using the GRADE approach.

Results

Nine RCTs (3969 participants) were included in the meta‐analysis. The overall risk of bias of the included trials was low. Statistical heterogeneity within the studies was low, with no inconsistency in the primary and secondary outcomes. Women who received single‐layer uterine closure had a similar incidence of uterine scar defects as did women who received double‐layer closure (25% vs 43%; RR, 0.77 (95% CI, 0.36–1.64); five trials; 350 participants; low quality of evidence). Compared with double‐layer uterine closure, women who received single‐layer closure had a significantly thinner residual myometrium on ultrasound (MD, –2.19 mm (95% CI, –2.80 to –1.57 mm); four trials; 374 participants; low quality of evidence). No difference was found in the incidence of uterine dehiscence (0.4% vs 0.2%; RR, 1.34 (95% CI, 0.24–4.82); three trials; 3421 participants; low quality of evidence) or uterine rupture (0.1% vs 0.1%; RR, 0.52 (95% CI, 0.05–5.53); one trial; 3234 participants; low quality of evidence) in a subsequent pregnancy.

Conclusions

Single‐ and double‐layer closure of the uterine incision following Cesarean delivery are associated with a similar incidence of Cesarean scar defects, as well as uterine dehiscence and rupture in a subsequent pregnancy. However, the quality level of summary estimates, as assessed by GRADE, was low, indicating that the true effect may be, or is even likely to be, substantially different from the estimate of the effect. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.