bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Smoking on Outcomes of Antivascular Endothelial Growth Factor Therapy in Patients with Neovascular Age-Related Macular Degeneration Smoking and Anti-VEGF Therapy in nAMD
Authors: Kamao Hiroyuki , Goto Katsutoshi , Mito Yumi , Miki Atsushi , Kiryu Junichi
Published: November 2018

Purpose. To evaluate the effect of smoking on the outcome of antivascular endothelial growth factor (VEGF) therapy in patients with neovascular age-related macular degeneration (nAMD).Methods. This retrospective case-control study included 64 eyes in 59 patients with treatment-naïve nAMD. Smoking habits were obtained from hospital records and patient recall. The patients were divided into ever-smokers and never-smokers. The patients were treated with ranibizumab or aflibercept for at least 1 year. Outcome measures were best-corrected visual acuity (BCVA), central retinal thickness (CRT) at the fovea, subfoveal choroidal thickness (SCT), and number of injections received.Results. There were no statistically significant differences in BCVA, CRT, or SCT changes between ever-smokers and never-smokers. The number of injections received was significantly higher in ever-smokers with a history of heavy smokers (never-smokers vs. heavy smokers: 5.3 ± 2.6/year vs. 7.3 ± 2.5/year;P=0.048and mild smokers vs. heavy smokers: 5.2 ± 2.5/year vs. 7.3 ± 2.5/year;P=0.043). There was no significant difference in the baseline CRT or presence of atrophic retinal pigment epithelium in the fellow eyes of patients with nAMD according to smoking status; however, the baseline CRT in eyes with nAMD was significantly thinner in ever-smokers than in never-smokers (P=0.02).Conclusion. The anti-VEGF therapy was frequently required in nAMD patients with a history of heavy smoking. Heavy smoking could cause poor therapeutic response in nAMD patients.
Hydrogen Sulfide Ameliorates Developmental Impairments of Rat Offspring with Prenatal Hyperhomocysteinemia
Authors: Yakovleva O. V. , Ziganshina A. R. , Dmitrieva S. A. , Arslanova A. N. , Yakovlev A. V. , Minibayeva F. V. , Khaertdinov N. N. , Ziyatdinova G. K. , Giniatullin R. A. , Sitdikova G. F.
Published: November 2018

Maternal high levels of the redox active amino acid homocysteine—called hyperhomocysteinemia (hHCY)—can affect the health state of the progeny. The effects of hydrogen sulfide (H2S) treatment on rats with maternal hHCY remain unknown. In the present study, we characterized the physical development, reflex ontogeny, locomotion and exploratory activity, muscle strength, motor coordination, and brain redox state of pups with maternal hHCY and tested potential beneficial action of the H2S donor—sodium hydrosulfide (NaHS)—on these parameters. Our results indicate a significant decrease in litter size and body weight of pups from dams fed with methionine‐rich diet. In hHCY pups, a delay in the formation of sensory‐motor reflexes was observed. Locomotor activity tested in the open field by head rearings, crossed squares, and rearings of hHCY pups at all studied ages (P8, P16, and P26) was diminished. Exploratory activity was decreased, and emotionality was higher in rats with hHCY. Prenatal hHCY resulted in reduced muscle strength and motor coordination assessed by the paw grip endurance test and rotarod test. Remarkably, administration of NaHS to pregnant rats with hHCY prevented the observed deleterious effects of high homocysteine on fetus development. In rats with prenatal hHCY, the endogenous generation of H2S brain tissues was lower compared to control and NaHS administration restored the H2S level to control values. Moreover, using redox signaling assays, we found an increased level of malondialdehyde (MDA), the end product of lipid peroxidation, and decreased activity of antioxidant enzymes such as superoxide dismutase (SOD) and glutathione peroxidase (GPx) in the brain tissues of rats of the hHCY group. Notably, NaHS treatment restored the level of MDA and the activity of SOD and GPx. Our data suggest that H2S has neuroprotective/antioxidant effects against homocysteine‐induced neurotoxicity providing a potential strategy for the prevention of developmental impairments in newborns.
A Reliable Leakage Reduction Technique for Approximate Full Adder with Reduced Ground Bounce Noise
Authors: Goyal Candy , Ubhi Jagpal Singh , Raj Balwinder
Published: November 2018

In this paper, an effective and reliable sleep circuit is proposed, which not only reduces leakage power but also shows significant reduction in ground bounce noise (GBN) in approximate full adder (FA) circuits. Four 1-bit approximate FA circuits are modified using proposed sleep circuit which uses one NMOS and one PMOS transistor. The design metrics such as average power, delay, power delay product (PDP), leakage power, and GBN are compared with nine other 1-bit FA circuits reported till date. All the comparisons are done using post-layout netlist at 45nm technology. The modified designs achieve reduction in leakage power and GBN up to 60% and 80%, respectively, as compared to the best reported approximate FA circuits. The modified approximate FA also achieves 83% reduction in leakage power as compared to conventional FA. Finally, application level metrics such as peak signal to noise ratio (PSNR) are considered to measure the performance of all the proposed approximate FAs.
Analytical Solution of the Stability Problem for the Truncated Hemispherical Shell under Tensile Loading
Authors: Kalamkarov Alexander L. , Andrianov Igor I.
Published: November 2018

Analytical solution of the problem of buckling of truncated hemispherical shell of revolution, subjected to tension loading, is obtained. Assumption of membrane prebuckling state is applied, and the range of applicability of this assumption is estimated. The developed algorithm is based on the asymptotic simplification procedure of bifurcation equations. The formula for the bifurcation tension load is derived and compared with the earlier published empirical and numerical results. It is shown that it is sufficiently accurate and can be used in engineering practice.
The Roles of Car Following and Lane Changing Drivers’ Anticipations during Vehicle Inserting Process: A Structural Equation Model Approach
Authors: Li Li , Zhang Dong , Xu Zhi-gang , Wang Ping , Wang Gui-ping
Published: November 2018

Anticipating ability is a skill that drivers count on to handle risky tasks in the traffic. This paper explores how the drivers of lane changing vehicle and its immediately car follower anticipate surrounding vehicles’ movements and adjust their manoeuvers during vehicle inserting process. The drivers’ anticipating mechanisms are modelled in the framework of structural equation model and estimated from field data. Results show that the change of lane changing type or traffic signal affects the drivers’ anticipation. Increased vehicle speed impels subject driver to anticipate driving condition in further future, but the stimulus is lower than the one coming from the kinematic comparisons of subject vehicle and other vehicles. The drivers care more about the vehicles’ interactions with which they are personally involved than the one to which they are only onlookers. The drivers’ responses to the counterpart vehicle’s movements depend on the progress of vehicle insertion and their roles in vehicle interactions.
Bearing Characteristics of Composite Pile Group Foundations with Long and Short Piles under Lateral Loading in Loess Areas
Authors: Ma Tianzhong , Zhu Yanpeng , Yang Xiaohui , Ling Yongqiang
Published: November 2018

It is very necessary to research the bearing characteristics of composite pile group foundations with long and short piles under lateral load in loess areas, because these foundations are used widely. But few people researched this problem in loess areas up to now worldwide. In this paper, firstly, an indoor test model of a composite pile foundation with long and short piles is designed and then employed to explore the vertical load bearing characteristics and load transfer mechanisms of a single pile, a four-pile group, and a nine-pile group under different lateral loads. Secondly, ANSYS software is employed to analyze the load-bearing characteristics of the test model, and for comparison with the experimental results. The results demonstrate the following. (1) The lateral force versus pile head displacement curves of the pile foundation exhibit an obvious steep drop in section, which is a typical feature of piercing damage. A horizontal displacement limit of the pile foundation is 10 mm and 6mm for the ones sensitive to horizontal displacement. (2) The axial force along a pile and frictional resistance do not coincide, due to significant variations and discontinuities in the collapsibility of loess; a pile body exhibits multiple neutral points. Therefore, composite pile groups including both long and short piles could potentially maximize the bearing capacity and reduce pile settlement. (3) The distribution of stress and strain along the pile length is mainly concentrated from the pile head to a depth of about 1/3 of the pile length. If the lateral load is too large, short piles undergo rotation about their longitudinal axis and long piles undergo flexural deformation. Therefore, the lateral bearing capacity mainly relies on the strength of the soil at the interface with the pile or the horizontal displacement of the pile head.
FDA Approval Summary: Axicabtagene Ciloleucel for Relapsed or Refractory Large B-cell Lymphoma
Authors: Bouchkouj Najat , Kasamon Yvette L. , de Claro R. Angelo , George Bindu , Lin Xue , Lee Shiowjen , Blumenthal Gideon M. , Bryan Wilson , McKee Amy E. , Pazdur Richard
Published: November 2018

In October 2017, the FDA granted regular approval to axicabtagene ciloleucel, a CD19-directed chimeric antigen receptor (CAR) T-cell therapy, for treatment of adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy. Efficacy was based on complete remission (CR) rate and duration of response (DOR) in 101 adult patients with relapsed or refractory large B-cell lymphoma (median 3 prior systemic regimens) treated on a single-arm trial. Patients received a single infusion of axicabtagene ciloleucel, preceded by lymphodepleting chemotherapy with cyclophosphamide and fludarabine. The objective response rate per independent review committee was 72% [95% confidence interval (CI), 62–81], with a CR rate of 51% (95% CI, 41–62). With a median follow-up of 7.9 months, the median DOR was not reached in patients achieving CR (95% CI, 8.1 months; not estimable, NE), whereas patients with partial remission had an estimated median DOR of 2.1 months (95% CI, 1.3–5.3). Among 108 patients evaluated for safety, serious adverse reactions occurred in 52%. Cytokine release syndrome and neurologic toxicities occurred in 94% and 87% of patients, respectively, leading to implementation of a risk evaluation and mitigation strategy.
Risk Factors for Lymph Node Metastasis among Lymphovascular Space Invasion-Positive Women with Endometrioid Endometrial Cancer Clinically Confined to the Uterus
Authors: Sarı Mustafa Erkan , Meydanlı Mehmet Mutlu , Yalçın Ibrahim , Şahin Hanifi , Çoban Gonca , Çelik Hüsnü , Kuşçu Esra , Gungor Tayfun , Ayhan Ali
Published: November 2018

Introduction: We aimed to assess risk factors for lymph node (LN) metastasis among lymphovascular space invasion(LVSI)-positive women with pure endometrioid endometrial cancer (EC) clinically confined to the uterus. Methods: Medical records of women who underwent primary surgery for EC between 2007 and 2016 at either of 2 gynecological oncology centers were retrospectively reviewed. Patient data were analyzed with respect to LN involvement, and predictive factors for LN metastasis were investigated. Results: 280 patients with surgically staged endometrioid-type EC with LVSI were identified. LN involvement was detected in 88 patients (31.4%) with a systematic LN dissection. In multivariate analysis, elevated baseline serum CA 125 levels, deep myometrial invasion (MMI), adnexal involvement and positive peritoneal cytology were found to be independent risk factors for LN metastasis. In women without deep MMI and elevated baseline serum CA 125 levels, the rate of LN metastasis was 19%. The presence of solely deep MMI increased this probability up to 29.1%. The rate of LN metastasis was found to be 46.8% for women with both deep MMI and elevated baseline serum CA 125 levels. Conclusion: These findings may be useful in the decision-making process for LVSI-positive women who are unstaged.
A Rodent Model of Anxiety: The Effect of Perinatal Immune Challenges on Gastrointestinal Inflammation and Integrity
Authors: Hollins Sharon L. , Brock Luke , Barreto Rafael , Harms Lauren , Dunn Ariel , Garcia-Sobrinho Pedro , Bruce Jessica , Dickson Phillip W. , Walker Marjorie M. , Keely Simon , Hodgson Deborah M.
Published: November 2018

Objectives: Gastrointestinal (GI) inflammation and GI integrity deficits are common comorbidities of neuropsychiatric disorders. Ongoing research suggests that these aberrations may be contributing to heightened immune signals that have the potential to disrupt neuronal homeostasis and exacerbate behavioural deficits. The current study aimed to determine whether the well-characterized animal model of neuropsychopathology, the maternal immune activation (MIA) model, produced GI inflammation and integrity disruptions in association with anxiety-like behaviour. Methods: Pregnant Wistar rats were exposed to the viral mimetic polyriboinosinic:polyribocytidilic acid (polyI:C) on gestational days (GD) 10 and 19. Evidence of ANS activation, GI inflammation, and GI barrier integrity was assessed in both neonatal (postnatal day, P7) and adult (P84) offspring. Anxiety-like behaviour was assessed at P100. Results: Neonatal MIA offspring exhibited an altered intestinal inflammatory profile and evidence of an increase in lymphoid aggregates. MIA neonates also displayed disruptions to GI barrier tight junction protein mRNA. In addition, adult MIA offspring exhibited an increase in anxiety-like behaviours. Conclusion: These results indicate that the MIA rat model, which is well documented to produce behavioural, neurochemical, and neuroanatomical abnormalities, also produces GI inflammation and integrity disruptions. We suggest that this model may be a useful tool to elucidate biological pathways associated with neuropsychiatric disorders.
Efficacy of Carboplatin/Paclitaxel-Based Radiochemotherapy in Locally Advanced Squamous Cell Carcinoma of Head and Neck
Authors: Maring Stephan , Elsayad Khaled , Stenner Markus , Rudack Claudia , Haverkamp Uwe , Rehkämper Jan , Wardelmann Eva , Eich Hans T.
Published: November 2018

Background: Cisplatin-based chemotherapy (CTX) is commonly used concurrently with radiotherapy for head and neck cancer. The value of CTX regimens other than cisplatin for locally advanced squamous cell carcinoma of head and neck (LASCCHN) has not been well established. Here we compare the outcome of patients treated with different platinum-based chemotherapy regimens. Methods: Medical records from 104 patients with LASCCHN treated with radiochemotherapy (RCTX) between February 2013 and August 2016 were analyzed. Results: All patients were treated with intensity-modulated radiation therapy (51 definitive, 53 postoperative). The median total dose was 66.6 Gy and the median fraction dose was 1.8 Gy. 81 (78%) patients were administered cisplatin CTX, 23 (22%) patients received carboplatin and paclitaxel (CarboTaxol). The rate of recurrence was 38% in patients treated with cisplatin and 30% in CarboTaxol-treated patients (p = 0.6). Regarding the CTX regimens, event-free survival (EFS) was 37 versus 30 months (p = 0.6) and overall survival (OS) was 35 versus 28 months (p = 0.5) in cisplatin group versus CarboTaxol group, respectively. Significantly higher grade 3/4 acute toxicity in terms of dysphagia was observed following cisplatin-based RCTX (p = 0.002). In multivariable analysis, females and patients with early primary tumors (T1-2) have longer EFS and OS, regardless the CTX regimen. Conclusions: Primary or adjuvant RCXT with CarboTaxol is a safe and effective treatment alternative for LASCCHN patients with contraindication to cisplatin-based RCTX.
Severe Photo Toxicity Recalled by Docetaxel
Authors: Johansson Emma K. , Krynitz Britta , Holmsten Magnus , Klockhoff Kerstin , Isaksson Friman Erika , Xie Hanjing
Published: November 2018

Photo-recall phenomenon is a rarely recognized adverse event of chemotherapeutic agents. The physiopathology of this entity is unclear. We have reported a 56-year old breast cancer patient with severe photo toxicity recalled 5 months after the initial sunburn by one course of adjuvant docetaxel treatment. However, being given right diagnosis and proper managements the patient could be able to complete her adjuvant chemotherapy according to the planed time schedule, without any delay. Our case may be explained by the theory that long-lived memory T-cells may remember former skin damage and cross-react with cytotoxic drugs. In addition, we have proved that weekly paclitaxel can still be the drug of option after docetaxel recalled severe photo toxicity.
Niacin Inhibits Apoptosis and Rescues Premature Ovarian Failure
Authors: Wang Shufang , Sun Min , Yu Ling , Wang Yixuan , Yao Yuanqing , Wang Deqing
Published: November 2018

Background/Aims: Over 99% of mouse and human ovarian follicles will undergo specialized cell death including atresia and apoptosis. Reduction of apoptosis may help reduce infertility and maintain the reproductive ability in women. Methods: 3-day B6D2F1 mice were used to culture small follicle and ovary tissue with niacin and 18-day mice were intraperitoneal injected with niacin to determine its effect on follicle development. Then establish 8-weeks POF animal model with cytoxan (CTX) or radiation. Treatment group was given 0.1 mL of 100 mM niacin by an intraperitoneal injection twice before ovulation. The ovaries were collected and the follicles were counted and categorized, and ovarian histologic sections were stained for TUNEL. Ovarian function was then evaluated by monitoring ovulation. Microarray analyses, Western blot, immunofluorescence and real-time quantitative PCR were used to assess the mechanism of ovarian injury and repair. Results: We found that niacin promotes follicle growth in the immature oocyte and it increased the levels of a germ-line cell marker DDX4, and a cell proliferation marker PCNA in the ovary. Addition of niacin to the cell culture reduced oocyte apoptosis in vitro. Administration of niacin to treat premature ovarian failure (POF) in mouse models showed inhibition of follicular apoptosis under harmful conditions, such as radiation and chemotherapy damage, by markedly reducing cumulus cell apoptosis. Additionally, the number of developing follicles increased after administration of niacin. Conclusion: Niacin may have an important function in treating POF by reducing apoptosis in clinical applications.
Notes on the Dianous aereus complex with description of a new species (Coleoptera, Staphylinidae)
Authors: TANG LIANG , HU CHENG-ZHI
Published: November 2018

Dianous pseudaerator Tang and Hu, sp. n., a new species of the Dianous aereus complex from China, is described and illustrated. Male of D. brevicornis Puthz, 2000, is discovered for the first time. New distributional records are reported for D. vietnamensis Puthz, 1980, D. rougemontianus Puthz, 2000, and D. aerator Puthz, 2016.
A Multiyear Analysis of Global Precipitation Combining CloudSat and GPM Precipitation Retrievals
Authors: Hayden Lindsey , Liu Chuntao
Published: November 2018

Satellite-based instruments are essential to the observation of precipitation at a global scale, especially over remote regions. Each instrument has its own strengths and limitations in accurately determining the rate of precipitation at the surface. By using the complementary strengths of two instruments, a more complete analysis of global precipitation can be performed. The Global Precipitation Measurement (GPM) Core Observatory’s Dual-Frequency Precipitation Radar (DPR) is capable of measuring precipitation at high and medium precipitation rates by using Ku-band (13.6 GHz) radiation. The CloudSat satellite’s Cloud Profiling Radar (CPR) uses higher-frequency W-band (94 GHz) radiation and is therefore capable of measuring precipitation at low rates not detected by the GPM DPR. CloudSat observations from January 2007 to December 2016 and DPR observations from March 2014 to February 2018 are combined and the results examined. Since these datasets are not completely coincident, this study is conducted as a multiyear analysis. Observed precipitation from CloudSat is used starting at the lowest precipitation rates and increasing rates until the occurrence observed by GPM surpasses that of CloudSat, at which point data from GPM are used. The precipitation rate at which this change occurs contains important information on the amount of precipitation missed by each instrument and implications as to the size of the hydrometeors present. Liquid precipitation retrieval from CloudSat is not performed over land; analysis over land is produced here using the information available. By combining the two datasets, a more complete picture of precipitation occurring globally is obtained.
High-Frequency Ultrasound Imaging for Examination of Early Dental Caries
Authors: Kim J. , Shin T.J. , Kong H.J. , Hwang J.Y. , Hyun H.K.
Published: November 2018

The extent of dental tissue destruction during the treatment of white spot lesions (WSLs) increases with the severity of the lesion. If the depth and shape of WSLs can be predicted with a noninvasive diagnostic method before dental caries treatment, more conservative interventions can be planned. Given the superiority of high-frequency ultrasound (HFUS) imaging in observing the internal structures of the body, the present study aimed to verify the possibility of HFUS imaging to examine the depth and shape of WSLs. We prepared tooth samples and developed a biomicroscopic system with a HFUS transducer to obtain images of normal and WSL regions. HFUS images were compared with conventional ultrasound images and micro–computed tomography images. HFUS distinctly differentiated demineralization within WSL and normal regions. WSL depth calculated in the micro–computed tomography image was similar to that in HFUS. This study revealed that HFUS imaging has the potential to detect early dental caries and offer information on the invasion depth of early dental caries quantitatively.
Intellectual Humility, Spirituality, and Counselling
Authors: Gordon Emma C.
Published: November 2018

Although therapists often work with clients with whom they share a great many beliefs, there remain many cases where the therapist and client have very little in common. Spirituality is, especially in the latter kind of case, one specific area in which clashes and similarities may be important. However, recent evidence suggests spirituality is to a surprising extent ignored in therapy when exploring it would be therapeutically relevant and, even more, that counsellors often struggle when training to more effectively engage with client spirituality. These results are problematic, especially when taken together. In this article, I attempt to address this vexing issue in a way that brings together work on counselling and spirituality with recent discussions of intellectual virtue in contemporary epistemology. In particular, I show why it is important for the therapist to cultivate and maintain the virtue of intellectual humility with respect to spirituality in a counselling context. To this end, I explore, with reference to a particularly promising model of intellectual humility, how the therapist can be attentive to—and own—their limitations in a productive way when dealing with a wide range of spiritual backgrounds.
Teaching public financial management: An integrated approach to a critical subject
Authors: Thom Michael
Published: November 2018

This article presents an integrated approach to teaching a graduate-level public financial management course. It stresses the importance of fundamental budgeting proficiencies (e.g., cost allocation; forecasting; operating within constraints; and using Microsoft Excel) and additional skills that tend to receive less attention in financial management courses (e.g., cost–benefit analysis and analyzing audited financial reports). It also links financial management with broader issues in public administration (e.g., accountability and civic engagement). The course design makes use of both case studies and interactive simulation assignments. Anecdotal and empirical evidence suggest this approach is well-received by students. The article includes several options for modifying the course to fit diverse programmatic needs.
Oncologic Emergencies—The Old, the New, and the Deadly
Authors: Thandra Krishna , Salah Zuhair , Chawla Sanjay
Published: November 2018

Cancer continues to be a leading cause of death despite a broader understanding of its biology and the development of novel therapies. Nonetheless, with an increasing survival of this population, intensivists must be aware of the associated emergencies, both old and new. Oncologic emergencies can be seen as an initial presentation of the disease or precipitated by its treatment. In this review, we present key oncologic emergencies that may be encountered in daily practice, complications associated with innovative therapies, and treatment-related adverse events.
On How to Be Flexible (or Not): Modulation of the Stability-Flexibility Balance
Authors: Dreisbach Gesine , Fröber Kerstin
Published: November 2018

Goal-directed behavior in a constantly changing environment requires a dynamic balance between two antagonistic modes of control: On the one hand, goals need to be maintained and shielded from distraction (stability), and on the other hand, goals need to be relaxed and flexibly updated whenever significant changes occur (flexibility). A dysregulation of this stability-flexibility balance can result in overly rigid or overly distractible behavior, and it is therefore important to understand how this balance is regulated in a context-sensitive, adaptive manner. In the present article, we review recent evidence on how positive affect, reward prospect, and task context modulate the stability-flexibility balance. Two distinct underlying cognitive mechanisms will be discussed: Flexibility may result either from lowering the updating threshold in working memory or from keeping multiple tasks active in working memory. Critically, these two mechanisms allow different (testable) predictions: Whereas lowering the updating threshold should ease the access of new information in working memory and thereby increase flexibility in general, concurrent task activation should only increase flexibility between the respective tasks.
Considerations When Designing a Microbiome Study: Implications for Nursing Science
Authors: Maki Katherine A. , Diallo Ana F. , Lockwood Mark B. , Franks Alexis T. , Green Stefan J. , Joseph Paule V.
Published: November 2018

Nurse scientists play an important role in studying complex relationships among human genetics, environmental factors, and the microbiome, all of which can contribute to human health and disease. Therefore, it is essential that they have the tools necessary to execute a successful microbiome research study. The purpose of this article is to highlight important methodological factors for nurse scientists to consider when designing a microbiome study. In addition to considering factors that influence host-associated microbiomes (i.e., microorganisms associated with organisms such as humans, mice, and rats), this manuscript highlights study designs and methods for microbiome analysis. Exemplars are presented from nurse scientists who have incorporated microbiome methods into their program of research. This review is intended to be a resource to guide nursing-focused microbiome research and highlights how study of the microbiome can be incorporated to answer research questions.
Ocrelizumab reduces progression of upper extremity impairment in patients with primary progressive multiple sclerosis: Findings from the phase III randomized ORATORIO trial
Authors: Fox Edward J , Markowitz Clyde , Applebee Angela , Montalban Xavier , Wolinsky Jerry S , Belachew Shibeshih , Fiore Damian , Pei Jinglan , Musch Bruno , Giovannoni Gavin
Published: November 2018

Background:

Upper extremity (UE) impairment is common with primary progressive multiple sclerosis (PPMS).

Objective:

This exploratory analysis examined the effects of ocrelizumab on confirmed progression (CP) and confirmed improvement (CI) in UE impairment in patients from ORATORIO.

Methods:

Patients with PPMS received ocrelizumab 600 mg or placebo every 24 weeks for ⩾120 weeks. The Nine-Hole Peg Test (9HPT) was administered at baseline (BL) and every 12 weeks thereafter. Prespecified exploratory endpoints included change in 9HPT time and proportion of patients with CP of ⩾20% in 9HPT. Analysis populations included intention-to-treat (ITT) patients and subgroups stratified by BL 9HPT time and Expanded Disability Status Scale. Post hoc analyses included the proportion of patients achieving more severe thresholds of CP and the proportion achieving CI in 9HPT.

Results:

Among ITT patients, ocrelizumab significantly reduced the change in 9HPT time over 120 weeks, the risk of CP of ⩾20% in 9HPT time for both hands and the risk of more severe 9HPT progression versus placebo. Numerical trends also favoured ocrelizumab versus placebo with respect to achieving CI. Consistent directional trends were observed in subgroup analyses.

Conclusion:

Ocrelizumab reduces the risk of UE disability progression and may increase the possibility of improvement versus placebo in PPMS.
Cueing the radical voter: The impact of economic, immigration and integration cues on public fear of the EU
Authors: Brigevich Anna
Published: November 2018

This article analyses the extent to which radical left parties (RLPs) and radical right parties (RRPs) invoke fear of the EU in their voters by cueing on the economic, immigration and integration dimensions. In the West, mainstream theories of party cueing hold, although not in the predicted direction. RLPs cue on the economic dimension, with more protectionist cues resulting in less EU fear. RRPs are cueing on immigration, although respondents who vote for a more xenophobic party are less Eurosceptic. In the East, RLPs cue on immigration, with the anticipated outcome that a more xenophobic cue conditions greater EU fear. At the same time, RRPs cue on integration directly, with respondents who vote for a more Eurosceptic party exhibiting less fear. Overall, the most Eurosceptic respondents in the West are those who vote for a RRP, while the same is true for RLP voters in the East.
Reifying difference: Examining the negotiation of internal diversity on a (post-)lesbian subreddit
Authors: Foeken Elsie , Roberts Steven
Published: November 2018

This article contributes to the study of contemporary lesbian communities by examining the management of internal diversity on a lesbian ‘subreddit’ (i.e. a sub-section of the popular social news media website Reddit) in relation to the parallel conceptual categories of ‘post-gay’ and ‘post-lesbian’. Drawing on data obtained via virtual ethnography of this subreddit, it argues that contemporary lesbian communities have diverged significantly from their history of suppressing internal diversity in order to produce a stable category of collective identification. Rather, members of this community drew upon ideals typical of the post-gay era by celebrating internal differences made real through a ‘minoritising’ logic of multi-‘ethnicity’. The article closes with implications for future research into (post-)lesbian communities.
No assemblage required: On pursuing original consumer culture theory
Authors: Belk Russell , Sobh Rana
Published: November 2018

Our title plays with the promise on certain consumer goods packages of “no assembly required,” but in fact we call upon the reader to assemble new theories rather than rely on existing ones like assemblage theory. We argue that consumer culture theory (CCT), also known as interpretive consumer research, has thus far not fulfilled its potential as a theory-generating discipline. Our reluctance to attempt creative theorizing is institutionalized by calls for theory-enabled research rather than truly emergent theory. This retreat has recently been strengthened by the rise of Big Data and correlational approaches that eschew theory altogether. In order to change this situation, we recommend a three-stage approach: (1) original phenomena-driven inquiry, (2) combining grounded theory and abductive reasoning, and (3) generating and comparatively analyzing alternative theoretical explanations. We briefly conceptualize the first two stages and illustrate the third using an example of consumer brand masking and bluffing in Africa. We demonstrate the use of two criteria for comparative theoretical analysis: (a) fit with the data and (b) potential usefulness in other contexts. We also argue that sometimes multiple theories are needed. CCT researchers are uniquely positioned to pursue original theory, and in this article, we offer some ideas as to how this can be done.
Exploring patient–provider decision-making for use of anticoagulation for stroke prevention in atrial fibrillation: Results of the INFORM-AF study
Authors: Pokorney Sean D , Bloom Diane , Granger Christopher B , Thomas Kevin L , Al-Khatib Sana M , Roettig Mayme L , Anderson John , Heflin Mitchell T , Granger Bradi B
Published: November 2018

Background:

Atrial fibrillation is associated with stroke, yet approximately 50% of patients are not treated with guideline-directed oral anticoagulants (OACs).

Aims:

Given that the etiology of this gap in care is not well understood, we explored decision-making by patients and physicians regarding OAC use for stroke prevention in atrial fibrillation.

Methods and results:

We conducted a descriptive qualitative study among providers ( N=28) and their patients with atrial fibrillation for whom OACs were indicated ( N=25). We used purposive sampling across three outpatient settings in which atrial fibrillation patients are commonly managed: primary care ( n=14), geriatrics ( n=10), and cardiology ( n=4). Eligible patients were stratified by those prescribed OAC ( n=13) and not prescribed OAC ( n=12). Semi-structured, in-depth interviews assessed decision-making regarding risk and OAC use. Classical content analysis was used to code narratives and identify themes. Results among patients consisted of the overarching theme of trust in provider recommendations. Sub-themes included: awareness of increased risk of stroke with atrial fibrillation; willingness to accept medications recommended by their physician; and low demand for explanatory decision aids. Among physicians, the overarching theme was decisional conflict regarding the balance between stroke and bleeding risk, and the optimal medication to prescribe. Subthemes included: absence of decision aids for communication; and misperceptions around the assessment and management of stroke risk with atrial fibrillation.

Conclusions:

Patient involvement in decision-making around OAC use did not occur in this study of patients with atrial fibrillation. Improved access to decision aids may increase patient engagement in the decision-making process of OAC use for stroke prevention.
“Making a Stand” Against Neoliberalism: Connections Between Critical Pedagogy and the “Green Tides” Movement for State Education in Spain
Authors: Martínez-Rodríguez Francisco Miguel
Published: November 2018

The global economic crash of 2007, the “structural reforms” and “austerity” policies, together with neoliberal processes have led, in recent years, to the emergence in Spain of a number of social movements, which are demanding greater democracy. One such movement is the “Green Tides” for the State Education in Spain, which has developed a series of proposals, from critical discourses in education, in the form of practices of resistance against neoliberal logic. In this article, we analyze this initiative, in particular in connection with some of the basic dimensions of critical pedagogy. Based on a critical analysis of discourse approach, we link the Green Tides’ manifesto and beliefs to dimensions of critical pedagogy. In addition, we show how these groups have developed what Flesher Fominaya calls practices of “prefigurative politics,” which aim to find social alternatives to the mantra of cuts in social rights, austerity policies, and other neoliberalization processes.
EEG Resting-State Networks Responsible for Gait Disturbance Features in Idiopathic Normal Pressure Hydrocephalus
Authors: Aoki Yasunori , Kazui Hiroaki , Pascual-Marqui Roberto D. , Ishii Ryouhei , Yoshiyama Kenji , Kanemoto Hideki , Suzuki Yukiko , Sato Shunsuke , Azuma Shingo , Suehiro Takashi , Matsumoto Takuya , Hata Masahiro , Canuet Leonides , Iwase Masao , Ikeda Manabu
Published: November 2018

Idiopathic normal pressure hydrocephalus (iNPH) is a neuropsychiatric disease characterized by gait disturbance, cognitive dysfunction, and urinary incontinence that affects a large population of elderly people. These symptoms, especially gait disturbance, can potentially be improved by cerebrospinal fluid (CSF) drainage, which is more effective if performed at an early stage of the disease. However, the neurophysiological mechanisms of these symptoms and their recovery by CSF drainage are poorly understood. In this study, using exact low-resolution brain electromagnetic tomography-independent component analysis (eLORETA-ICA) with electroencephalography (EEG) data, we assessed activities of five EEG resting-state networks (EEG-RSNs) in 58 iNPH patients before and after drainage of CSF by lumbar puncture (CSF tapping). In addition, we assessed correlations of changes in these five EEG-RSNs activities with CSF tapping–induced changes in iNPH symptoms. The results reveal that compared with 80 healthy controls, iNPH patients had significantly decreased activities in the occipital alpha rhythm, visual perception network, and self-referential network before CSF tapping. Furthermore, CSF tapping–induced changes in occipital alpha activity correlated with changes in postural sway and frontal lobe function. Changes in visual perception network activity correlated with changes in gait speed. In addition, changes in memory perception network activity correlated with changes in Parkinsonian gait features. These results indicate a recruitment of cognitive networks in gait control, and involvement of the occipital alpha activity in cognitive dysfunction in iNPH patients. Based on these findings, eLORETA-ICA with EEG data can be considered a noninvasive, useful tool for detection of EEG-RSN activities and for understanding the neurophysiological mechanisms underlying this disease.
Bilateral Metacarpal Hands: Reconstruction With 6 Toe Transfers
Authors: Jones Neil F. , Graham David , Au Katherine
Published: November 2018

Background: Bilateral metacarpal hand injuries are extremely rare, but probably represent the most difficult reconstructive challenge in hand surgery. Methods: We discuss the various options for metacarpal hand reconstruction, including the Krukenberg procedure, bionic prostheses, multiple toe-to-hand transfers, and possibly hand transplantation, and present the long-term functional outcomes, gait analysis, and psychological evaluation after a 4-stage reconstruction of bilateral metacarpal hands in a child using 6 toe-to-hand transfers—bilateral great toe transfers to reconstruct both thumbs and bilateral combined second-third monobloc transfers to reconstruct 2 fingers in each hand. Results: Reconstruction of bilateral metacarpal hands with 6 toe transfers yielded excellent functional results and patient satisfaction. Conclusions: Bilateral metacarpal hand injuries result in a devastating functional deficit and a major psychological impact. Multiple toe transfers (4, 5, or 6) provide an excellent reconstructive outcome with acceptable donor site morbidity.
Outcomes of Distal Ulna Fractures Associated With Operatively Treated Distal Radius Fractures
Authors: Lutsky Kevin F. , Lucenti Ludovico , Beredjiklian Pedro K.
Published: November 2018

Background: The purpose of this study was to report outcomes in patients with nonstyloid distal ulna fractures treated in conjunction with open reduction internal fixation (ORIF) of distal radius fractures. Methods: A retrospective review of all patients who had undergone ORIF of a distal radius fracture over a 5-year period at a single institution was performed. Radiographic review was performed to identify patients with a concomitant fracture of the distal ulna. Radiographs were examined to determine whether and how the distal ulna fracture was stabilized and to assess healing of the distal ulna. Range of motion (ROM) was determined by review of the patients’ charts. All skeletally mature patients with distal ulna fractures (not including isolated styloid fractures) undergoing surgical fixation of the distal radius fracture were included. Patients were excluded if follow-up was inadequate. There were 172 fractures of the distal ulna meeting the inclusion criteria. Seven patients were excluded. There were 91 patients treated without ulna fixation (ulna-no) and 74 patients treated with ulna fixation (ulna-yes). Results: Seventy-two (97%) of the ulna-yes patients healed. All patients in the ulna-no group healed. The only significant difference in ROM was in pronation, although the magnitude of this difference was relatively small. Conclusions: Fractures of the distal ulna have high rates of healing and result in equivalent motion regardless of whether the distal ulna is treated operatively. Routine surgical fixation of concomitant distal ulna fractures during distal radius ORIF does not appear to be necessary.
Effect of music tempo on operating room preparation time
Authors: Mosaed Sameh , Vahidi Ryka , Lin Ken Y
Published: November 2018

Most operating rooms around the world play music, both during the surgeries and in between cases. We investigated whether music tempo (fast or slow) can affect the operating room preparation time in between surgeries (turnover time) in an ambulatory outpatient surgical centre setting. We compiled two playlists, one with fast upbeat tempo and the other with slow relaxing tempo. Each of the playlists was played throughout the workday in the operating room for one week with the same surgeon and nursing staff. The turnover times for each case were analysed. Inclusion criteria were standard cataract extraction with intraocular lens implant surgery. Exclusion criteria were any external reasons causing delays in the turnover time (such as anaesthesia team break time, computer system down, etc.). The turnover time from 32 cases in the slow group and 26 cases in the fast group were compared with Student’s t test. The turnover time was significantly faster in the fast group versus the slow group (17.0 ± 0.60 vs. 20.1 ± 0.96, p < 0.03). Our study demonstrated that fast music tempo in the operating room can significantly reduce turnover time. This improved efficiency could potentially lead to significant cost savings in the healthcare sector.
Reframing civil disobedience: Constituent power as a language of transnational protest
Authors: Niesen Peter
Published: November 2018

In 1992, the Frankfurt scholar Ingeborg Maus launched a polemical attack against then current narratives of democratic protest, objecting to the languages of ‘resistance’ or ‘civil disobedience’ as defensive, servile and insufficiently transformative. This article explores in how far the language of constituent power can be adopted as an alternative justificatory strategy for civil disobedience in transnational protests. In contrast to current approaches that look at states as agents of international civil disobedience-as-constituent power, I suggest we look at political movements. I focus on the example of the Democracy in Europe Movement 2025 (DiEM25) which understands itself as a pan-European movement of civil disobedience, at the same time working towards an articulation and exercise of constituent power among the people(s) of Europe. In the final section, I sharpen the criteria for the invocation of constituent power in transnational protest in distinguishing between its articulation, activation and exercise.
New oral anti-coagulation drugs and prostate biopsy: a call for guidelines
Authors: Coscarella Mathieu , Motte Serge , Dalati Mohamad-Fadi , Oliveira-e-Silva Tania , Entezari Kim , Roumeguere Thierry
Published: November 2018

Background:

Prostate biopsy is a rather frequent procedure, mostly performed in outpatient settings. Bleeding complications following this procedure require precise and delicate management of pre-, peri- and post-procedure anti-coagulation treatments. New oral anti-coagulation drugs (NOACs) are increasingly used. However, the management of such treatments is feared and not yet well known to urologists. A protocol for prostate biopsy management of NOACs seems mandatory.

Materials and methods:

A review of the literature, using Pubmed and Cochrane databases, together with analysis of several medical associations’ recommendations in urology, anaesthesiology, cardiology, oncology and drug safety agency, was performed.

Results:

There are no recommendations about NOAC management for prostate biopsy available from scientific societies. There is also a lack of specific urological studies. However, several panels of expert recommendations could be helpful in establishing standardized protocols adapted from surgery to prostate biopsy. With the growing use of NOACs, recommendations have shifted to continue anti-coagulant treatment without bridging NOACs for low bleeding risk procedures such as prostate biopsy, in carefully selected groups of patients.

Conclusion:

Extensive indications coupled with the ease of use of NOACs contribute significantly to the widespread replacement of traditional vitamin K antagonist. Knowing that heparin bridging leads to more bleeding, and in the pursuit of more autonomy and safety, urologists should be able to propose dedicated anti-coagulant management using NOACs adapted to carefully selected patients before the prostate biopsy procedure. Further studies and guidelines specific to the concept of non-bridging for anti-coagulant-requiring patients are mandatory for this routine procedure.