bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic accuracy of indocyanine green fluorescence imaging and multidetector row computed tomography for identifying hepatocellular carcinoma with liver explant correlation
Authors: Masuda Koichi , Kaneko Junichi , Kawaguchi Yoshikuni , Togashi Junichi , Arita Junichi , Akamatsu Nobuhisa , Sakamoto Yoshihiro , Hasegawa Kiyoshi , Sumihito Tamura , Kokudo Norihiro
Published: February 2017

Aim

Indocyanine green (ICG)‐fluorescence imaging is useful for detecting hepatocellular carcinoma (HCC) during surgery, but its accuracy has not been compared to that of multidetector row computed tomography (MDCT) with liver explant correlation. The aim of the present study was to clarify the precise diagnostic accuracy of ICG‐fluorescence imaging for detecting HCC in a whole explant liver survey.

Methods

Thirty‐three patients with end‐stage liver disease (mean age, 53 years) were prospectively enrolled in the present study. The mean Model for End‐stage Liver Disease score was 14.6. One month before and 1 week prior to living donor liver transplantation, all patients underwent MDCT and administration of ICG. Following whole liver resection, the explanted liver was sliced. Gross examination and ICG‐fluorescence imaging of both sides of the cut specimen was carried out and all focal liver lesions were recorded.

Results

Pathologic examination diagnosed 18 of 84 focal liver lesions as HCC. Of those, MDCT and ICG‐fluorescence imaging diagnosed 12 and 13 HCCs, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MDCT were 66.7%, 92.4%, 70.6%, 91.0%, and 86.9%, respectively, compared with those of ICG‐fluorescence imaging at 72.2%, 31.8%, 22.4%, 80.8%, and 40.5%, respectively.

Conclusion

The sensitivity of ICG‐fluorescence imaging for detecting HCC with liver explant correlation was similar to that of MDCT. However, ICG‐fluorescence imaging had low specificity in the setting of decompensated cirrhotic explant liver correlation.
Development and clinical validation of a novel photography‐based skin erythema evaluation system: a comparison with the calculated consensus of dermatologists
Authors: Cho M. , Lee D.‐H. , Doh E. J. , Kim Y. , Chung J. H. , Kim H. C. , Kim S.
Published: February 2017

Objective

Erythema is the most common presenting sign in patients with skin diseases, and various methods to treat erythema symptoms have become common. To evaluate changes in erythema, a reliable device that can support objective diagnosis is required. We developed a novel photography‐based system for erythema diagnosis that provides a high‐resolution three‐view photograph taken in a consistent photography environment with a curved surface light source and can be integrated with optimized image processing algorithms.

Methods

A new diagnostic algorithm was applied to photographs from 32 patients to determine areas of erythema automatically. To assess the performance in comparison to dermatologists’ evaluations, five dermatologists independently evaluate the areas of erythema, and we defined an area called the clinical consensus area of erythema (CCAE), which is based on the majority opinion of dermatologists during evaluation. The CCAE values obtained were compared with the erythema areas determined by the system's diagnostic algorithm.

Results

Forty‐one photographs with areas of erythema were evaluated by the proposed system and by dermatologists. The results obtained with the proposed system had a mean accuracy of 93.18% with a standard deviation of 3.52% when compared with the CCAE results. The results also showed that the proposed system could detect erythema areas without any pigmentation. In contrast to assessments by individual dermatologists, use of the CCAE reduced the amount of error that occurred owing to bias or subjectivity.

Conclusion

A new erythema evaluation system was developed and validated through CCAE, suggesting that the system can support dermatologists’ objective diagnoses of erythema.
The effect of tapered toothbrush filaments compared to end‐rounded filaments on dental plaque, gingivitis and gingival abrasion: a systematic review and meta‐analysis
Authors: Hoogteijling FCR , Hennequin‐Hoenderdos NL , Van der Weijden GA , Slot DE
Published: February 2017

Aim

This systematic review was performed to establish the effect of a manual toothbrush with tapered toothbrush filaments (TFTBs) compared to a manual toothbrush with end‐rounded toothbrush filaments (ERTB) on clinical parameters of dental plaque, gingivitis and gingival abrasion.

Materials and methods

MEDLINE‐PubMed and Cochrane‐CENTRAL databases were searched. The inclusion criteria were (randomized) controlled clinical trials, participants ≥18 years and papers evaluating the effect of a TFTB compared to an ERTB. Data were extracted for dental plaque index (PI), bleeding scores (BS), gingival index scores (GI) and gingival abrasion scores (GA). A descriptive analysis and a meta‐analysis were performed when appropriate.

Results

An independent screening of 33 unique papers resulted in seven eligible publications, which included eight comparisons. Meta‐analysis did not show a significant difference between TFTB and ERTB with respect to PI scores. The meta‐analysis of the GI scores showed a significant mean difference in favour of the TFTB (DiffM=−0.12 [95% CI: −0.17; −0.07]). Of the three comparisons evaluating GA, no differences were found.

Conclusion

With respect to plaque removal, evidence that supports the recommendation for usage of a TFTB over an ERTB is lacking. Regarding GI, there is minimal evidence favouring a TFTB over an ERTB and the clinical relevance of this difference is probably negligible. Therefore, based on the collective evidence emerging from this systematic review, the strength and direction of the recommendation, there appears to be no firm evidence for a dental healthcare professional to advise the use of a TFTB over the use of an ERTB.
Harvesting Public Audit Knowledge: Implications for Theory and Practice
Authors: McKevitt David
Published: February 2017

For over three decades international public policy has dictated that not‐for‐profit organisations achieve economy, efficiency and effectiveness or ‘value for money’ (VfM). Across the globe VfM performance audits are deployed in order to promote compliance with this objective. Despite consistent political discourse, the current literature lacks conceptual integration of the factors that affect performance information and use, which frustrates efforts to better understand the factors that inhibit the emergence of VfM. Using the lens of information processing theory (IPT) this paper systematically analyses VfM audit reports produced by the Comptroller and Auditor General, Ireland. The contribution categorises strategic, operational and tactical barriers that affect the motivation, opportunity and ability to process information related to value for money. A key implication is that effectiveness needs to be reframed in terms of service‐dominant (S‐D) logic and is thus defined as value co‐created by politicians, policy makers and public servants.
Complex adaptive systems and their relevance for nursing: An evolutionary concept analysis
Authors: Notarnicola Ippolito , Petrucci Cristina , De Jesus Barbosa Maria Rosimar , Giorgi Fabio , Stievano Alessandro , Rocco Gennaro , Lancia Loreto
Published: February 2017

This study aimed to analyse the concept of “complex adaptive systems.” The construct is still nebulous in the literature, and a further explanation of the idea is needed to have a shared knowledge of it.

A concept analysis was conducted utilizing Rodgers evolutionary method. The inclusive years of bibliographic search started from 2005 to 2015. The search was conducted at PubMed©, CINAHL© (EBSCO host©), Scopus©, Web of Science©, and Academic Search Premier©. Retrieved papers were critically analysed to explore the attributes, antecedents, and consequences of the concept. Moreover, surrogates, related terms, and a pattern recognition scheme were identified. The concept analysis showed that complex systems are adaptive and have the ability to process information. They can adapt to the environment and consequently evolve.

Nursing is a complex adaptive system, and the nursing profession in practice exhibits complex adaptive system characteristics. Complexity science through complex adaptive systems provides new ways of seeing and understanding the mechanisms that underpin the nursing profession.
Expression profile of mammalian target of rapamycin‐related proteins in graft biopsy specimens: Significance for predicting interstitial fibrosis after kidney transplantation
Authors: Ogawa Satoshi , Ishimura Takeshi , Miyake Hideaki , Fujisawa Masato
Published: February 2017

Objective

To investigate the influence of the expression profile of mammalian target of rapamycin‐related proteins on the development of interstitial fibrosis after kidney transplantation.

Methods

Immunohistochemical staining was carried out to evaluate the expression of five mammalian target of rapamycin‐related proteins (phosphorylated‐Akt, Ras homolog enriched in brain, phosphorylated‐mammalian target of rapamycin, phosphorylated‐p70 ribosomal S6 kinase and phosphorylated‐4E binding protein 1) in graft biopsy specimens obtained from 77 patients at 3 months after kidney transplantation. The change of the estimated glomerular filtration rate and the change of the fibrosis index (defined as the change in the percent area of fibrosis on Masson's trichrome‐stained sections of biopsy specimens) from 3 months to 3 years after kidney transplantation were determined.

Results

There was a significant correlation between change of the estimated glomerular filtration and change of the fibrosis index in the 77 patients. Univariate analysis identified expression of phosphorylated‐Akt, phosphorylated‐mammalian target of rapamycin and phosphorylated‐p70 ribosomal S6 kinase, as well as donor type and pre‐transplant dialysis duration, as significant predictors of a change of the fibrosis index >10%. However, only phosphorylated‐mammalian target of rapamycin expression, phosphorylated‐p70 ribosomal S6 kinase expression and donor type were independently associated with a change of the fibrosis index >10% according to multivariate analysis.

Conclusions

These findings suggest that mammalian target of rapamycin‐related proteins are involved in the development of interstitial fibrosis after kidney transplantation.
Long‐term management of type 2 diabetes mellitus in callitrichids with oral anti‐hyperglycaemic medication
Authors: Strike T. B. , Feltrer Y.
Published: February 2017

Type 2 diabetes mellitus (T2DM) (also defined as non‐insulin‐dependent diabetes mellitus) is the most common form of spontaneous diabetes in humans and non‐human primates, and has frequently been reported in callitrichids. Oral anti‐hyperglycaemic drugs are the first line of therapy for T2DM along with dietary changes. There are no reports of the successful use of oral anti‐hyperglycaemic medication in callitrichids. Here, we describe the diagnosis of five cases of T2DM in callitrichids at ZSL London Zoo, UK, based on persistent hyperglycaemia, glucosuria and elevated blood‐serum fructosamine. The stabilization and long‐term management of T2DM using oral anti‐hyperglycaemic medication are reported. Treatment with metformin monotherapy was successful in controlling and maintaining normoglycaemia in three individuals for between 4 and 6 years. The addition of glipizide was required to achieve glycaemic control in a fourth animal. A fifth animal was refractory to treatment. Compliance was good and no side effects were seen. Based on these findings, we suggest that anti‐hyperglycaemic drugs, together with appropriate dietary changes, can be effective in the long‐term treatment of T2DM in callitrichids.
Age‐related parasite load and longevity patterns in the sedge warbler Acrocephalus schoenobaenus
Authors: Bielański Wojciech , Biedrzycka Aleksandra , Zając Tadeusz , Ćmiel Adam , Solarz Wojciech
Published: February 2017

We report the results from a nine‐year study on parasite infection in males of a small migrant passerine, the sedge warbler Acrocephalus schoenobaenus. Every year, for each male caught during territory establishment we estimated infection intensity of two lineages of Haemoproteus belopolskyi (SW1 and SW3), using molecular methods. We found a significant relationship between infection intensity and males’ longevity in both studied lineages. There was severe mortality of second‐year sedge warblers after their first breeding season, with lower parasite load in survivors. The lower infection intensity in older age classes was related to between‐individual change in both lineages, but was also a result of differences in infection intensity during the lifetime of individual males in the SW3. The relation between parasite load and longevity suggests that parasite load may be an age‐dependent factor influencing individual survival.
Characteristics of sleep–wake cycle and sleep duration in Japanese type 2 diabetes patients with visceral fat accumulation
Authors: Fukuda Shiro , Hirata Ayumu , Nishizawa Hitoshi , Nagao Hirofumi , Kimura Takekazu , Fujishima Yuya , Yamaoka Masaya , Kozawa Junji , Imagawa Akihisa , Funahashi Tohru , Maeda Norikazu , Shimomura Iichiro
Published: February 2017

Sleep pattern has been shown to be associated with type 2 diabetes mellitus. Here, we investigated the difference in bedtime, waking time and estimated sleep duration in type 2 diabetes mellitus patients with or without visceral fat accumulation, using a questionnaire on sleep patterns. The study participants were 59 Japanese type 2 diabetes mellitus patients (men/women 34/25, age 64.5 ± 12.1 years). Visceral fat accumulation was defined as estimated visceral fat area ≥100 cm2. The patients with visceral fat accumulation (n = 40) showed significantly later bedtime (23.51 ± 01.27 h in the [+] group vs 22.49 ± 01.23 h in the [−] group) and shorter estimated sleep duration (6.6 ± 1.4 h in the [+] group vs 7.9 ± 1.0 h in the [−] group) on weekdays, compared with those without (n = 19). Later bedtime and shorter estimated sleep duration existed in the type 2 diabetes mellitus patients with visceral fat accumulation, compared with those without.
Metabolic and hemodynamic effects of sodium‐dependent glucose cotransporter 2 inhibitors on cardio‐renal protection in the treatment of patients with type 2 diabetes mellitus
Authors: Kashiwagi Atsunori , Maegawa Hiroshi
Published: February 2017

The specific sodium–glucose cotransporter 2 inhibitors (SGLT2 inhibitors) inhibit glucose reabsorption in proximal renal tubular cells, and both fasting and postprandial glucose significantly decrease because of urinary glucose loss. As a result, pancreatic β‐cell function and peripheral insulin action significantly improve with relief from glucose toxicity. Furthermore, whole‐body energy metabolism changes to relative glucose deficiency and triggers increased lipolysis in fat cells, and fatty acid oxidation and then ketone body production in the liver during treatment with SGLT2 inhibitors. In addition, SGLT2 inhibitors have profound hemodynamic effects including diuresis, dehydration, weight loss and lowering blood pressure. The most recent findings on SGLT2 inhibitors come from results of the Empagliflozin, Cardiovascular Outcomes and Mortality in Type 2 Diabetes trial. SGLT2 inhibitors exert extremely unique and cardio‐renal protection through metabolic and hemodynamic effects, with long‐term durability on the reduction of blood glucose, bodyweight and blood pressure. Although a site of action of SGLT2 inhibitors is highly specific to inhibit renal glucose reabsorption, whole‐body energy metabolism, and hemodynamic and renal functions are profoundly modulated during the treatment of SGLT2 inhibitors. Previous studies suggest multifactorial clinical benefits and safety concerns of SGLT2 inhibitors. Although ambivalent clinical results of this drug are still under active discussion, the present review summarizes promising recent evidence on the cardio‐renal and metabolic benefits of SGLT2 inhibitors in the treatment of type 2 diabetes.
Neuroprotective effect of nebivolol against cisplatin‐associated depressive‐like behavior in rats
Authors: Abdelkader Noha F. , Saad Muhammed A. , Abdelsalam Rania M.
Published: February 2017

One‐third of cancer patients undergoing chemotherapy treatment often display symptoms of depression leading to poor adherence and decreased quality of life. Thus, this study aimed to investigate the possible protective effect of nebivolol against cisplatin‐associated depressive symptoms in adult male rats. Nebivolol is a highly cardioselective β‐adrenergic receptor blocker that possesses endothelium‐dependent vasodilator properties and antioxidant capacities. Animals were allocated into four groups. Group one was given aqueous solution of carboxymethyl cellulose and served as control, group two was given nebivolol (10 mg/kg p.o., daily), group three was given cisplatin (2 mg/kg i.p. once per week) for 10 consecutive weeks and group four was treated with cisplatin concomitantly with nebivolol as per above schedule. Cisplatin‐treated rats showed an increase in both depressive‐like behaviors in open‐field and forced swimming tests. In addition, histopathological examination revealed cortical encephalomalacia along with hippocampal neuronal degeneration and kidney dysfunction. In parallel, cisplatin administration prominently reduced GABA and elevated glutamate levels in the cortical and hippocampal tissues. Furthermore, it resulted in a significant decline in cortical and hippocampal brain‐derived neurotrophic factor and nitric oxide contents concomitantly with a marked decrease in endothelial‐ and an increase in inducible‐nitric oxide synthase genes expression. On the other hand, treatment with nebivolol effectively mitigated the aforementioned cisplatin‐associated behavioral, biochemical, and histopathological alterations without changing its antitumor activity as evidenced by sulforhodamine B cell survival assay. Taken together, our results suggest that nebivolol may offer a promising approach for alleviating depressive symptoms associated with the use of cisplatin.

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Comprehensive Care Model for Sex Trafficking Survivors
Authors: Twigg Naomi M.
Published: February 2017

Purpose

The purpose of this study was to identify aftercare services for domestic minor of sex trafficking (DMST) survivors provided by U.S. residential treatment centers.

Design

A qualitative research study was conducted with aftercare program personnel from five U.S. residential treatment centers for DMST survivors.

Methods

Interviews were conducted with staff from five different residential treatment centers providing services exclusively to domestic minor sex trafficking survivors.

Findings

Participants described the range of services offered to address survivors’ posttrafficking needs. Participants’ responses assisted in expanding an existing care model to include education re‐entry, family reunification, family reconciliation, and emergency substance use services.

Conclusions

This study led to the refinement of an aftercare service delivery model and laid the foundation to develop best practice guidelines for providing aftercare services to DMST survivors.

Clinical Relevance

Sex trafficking is a global health problem affecting our youth today. Nurses have a vital role in combatting sex trafficking by raising awareness about the problem and restoring the lives of sex trafficking victims by implementing innovative care programs.
Melatonin restores hippocampal neural precursor cell proliferation and prevents cognitive deficits induced by jet lag simulation in adult mice
Authors: Iggena Deetje , Winter York , Steiner Barbara
Published: February 2017

Frequent flyers and shift workers undergo circadian dysrhythmia with adverse impact on body and mind. The circadian rhythm disorder “jet lag” disturbs hippocampal neurogenesis and spatial cognition, which represent morphological and functional adult brain plasticity. This raises the question if pro‐neurogenic stimuli might prevent those consequences. However, suitable measures to mitigate jet lag‐induced adverse effects on brain plasticity have been neglected so far. Here, we used adult C57Bl6 mice to investigate the pro‐neurogenic stimuli melatonin (8 mg/kg i.p.) as well as environmental enrichment as potential measures. We applied photoperiod alterations to simulate “jet lag” by shortening the dark period every third day by 6 hours for 3 weeks. We found that “jet lag” simulation reduced hippocampal neural precursor cell proliferation by 24% and impaired spatial memory performance in the water maze indicated by a prolonged swim path to the target (~23%). While melatonin prevented both the cellular (~1%) as well as the cognitive deficits (~5%), environmental enrichment only preserved precursor cell proliferation (~12%). Our results indicate that lifestyle interventions are insufficient to completely compensate jet lag‐induced consequences. Instead, melatonin is required to prevent cognitive impairment caused by the same environmental factors to which frequent flyers and shift workers are typically exposed to.
Recruitment of bone marrow‐derived cells to the periodontal ligament via the stromal cell‐derived factor‐1/C‐X‐C chemokine receptor type 4 axis
Authors: Kaku M. , Kitami M. , Rosales Rocabado J. M. , Ida T. , Akiba Y. , Uoshima K.
Published: February 2017

Background/Objectives

The periodontal ligament (PDL) is a non‐mineralized connective tissue that exists between the alveolar bone and root surface cementum and plays important roles in tooth function. The PDL harbors a remarkable reserve of multipotent stem cells, which maintain various types of cells. However, the sources of these stem cells, other than their developmental origin, are not well understood.

Material and Methods

To elucidate the recruitment of bone marrow (BM)‐derived stem cells in the PDL, green fluorescent protein (GFP)‐expressing BM‐derived cells were transplanted into the femoral BM of immunodeficient rats, and the distribution and expression of stem cell markers in the PDL were analyzed in vivo. To evaluate the functional significance of BM‐derived cells to the PDL, tooth replantation was performed and the expression of stromal cell‐derived factor (SDF)‐1, a critical chemotactic signal for mesenchymal stem cell recruitment, was analyzed. To confirm the SDF‐1‐dependency of BM‐derived cell migration to the PDL, PDL‐conditioned medium (CM) was prepared, and BM‐derived cell migration was analyzed using a transwell culture system.

Results

Four weeks after cell transplantation, GFP‐positive cells were detected in the PDL, and some of them were also positive for stem cell markers (i.e., CD29, SSEA4, and αSMA). Seven days after tooth replantation, the number of GFP‐ and SDF‐1‐positive cells significantly increased in PDL. Concurrently, the concentration of SDF‐1 and the number of colony‐forming units of fibroblasts in peripheral blood were increased. BM‐derived cell migration increased in PDL‐CM and was inhibited by an inhibitor of C‐X‐C chemokine receptor type 4 (CXCR4), an SDF‐1 receptor.

Conclusion

These results indicate that stem cells and their progeny in PDL are not only derived from their developmental origin but are also supplied from the BM via the blood as the need arises. Moreover, this BM‐derived cell recruitment appears to be regulated, at least partially, by the SDF‐1/CXCR4 axis.
Dietary supplementation with low‐dose omega‐3 fatty acids reduces salivary tumor necrosis factor‐α levels in patients with chronic periodontitis: a randomized controlled clinical study
Authors: Keskiner I. , Saygun I. , Bal V. , Serdar M. , Kantarci A.
Published: February 2017

Background and Objective

Recent studies have demonstrated the beneficial effects of omega‐3 polyunsaturated fatty acids (PUFAs) on physiological processes and on a variety of chronic inflammatory diseases, including periodontal diseases. In this study, we evaluated the impact of omega‐3 PUFAs in conjunction with scaling and root planing (SRP) on salivary markers in patients with chronic periodontitis.

Material and Methods

Thirty systemically healthy subjects with chronic periodontitis were enrolled and randomly allocated into two groups. The control group (n = 15) was treated with SRP + placebo whereas the test group was treated with SRP and dietary supplementation of low‐dose omega‐3 PUFAs (6.25 mg eicosapentaenoic acid and 19.19 mg docosahexaenoic acid). Clinical parameters were taken at baseline, 1, 3 and 6 mo following therapy. Saliva samples were obtained at the same time intervals and analyzed for tumor necrosis factor‐α (TNF‐α) and superoxide dismutase (SOD).

Results

Both groups showed significant changes in clinical parameters in response to treatment compared to baseline with no significant difference between groups. Salivary TNF‐α levels showed a statistically significant decrease in the test group at 6 mo compared to the control group. Salivary SOD levels increased significantly at 3 and 6 mo in the test group and at 6 mo in placebo groups compared to baseline with no statistically significant differences between the groups.

Conclusion

The results demonstrated that dietary supplementation with low‐dose omega‐3 PUFAs improves salivary TNF‐α without any significant impact on clinical parameters in patients with chronic periodontitis, suggesting that the systemic benefits of dietary omega‐3 PUFAs may not be translated to periodontal health. (ClinicalTrials.gov ID NCT02719587)
“To Move the Spirits of the Beholder to Admiration”: Lively Passionate Performance on the Early Modern Stage
Authors: Holmes Jonathan H.
Published: February 2017

This article examines the meaning of terms such as “lively” and “to the life” in early modern plays and in commentary on dramatic performance. Scholars have tended to interpret these terms as praise for a naturalistic acting style, one that values actors' realistic portrayals of their characters. Conversely, this article argues that liveliness meantenergeia, an Aristotelian term for the aspect of language that moves an audience. Early modern poets and playwrights frequently expressed a strong desire to move their audiences, and the playwright Thomas Heywood claimed that drama was particularly well suited to achieve that goal. By attending to new research on Renaissance emotion, the article considers how a revised understanding of the passions should affect our understanding of dramatic performance. It goes on to demonstrate that liveliness required excessive passion, and though a performance could go too far and, as Hamlet says, “tear a passion to tatters,” the calibration of passion required of actors encouraged excess nonetheless. Not all acting was excessive because not all acting was lively, and it was possible for a performance to become too passionate. But acting was frequently praised as lively, and lively performance required an excess of passion that was considered unnatural.
Management of hepatic angiomyolipoma: A systematic review
Authors: Klompenhouwer Anne J. , Verver Danielle , Janki Shiromani , Bramer Wichor M. , Doukas Michail , Dwarkasing Roy S. , de Man Robert A. , IJzermans Jan N. M.
Published: February 2017

Hepatic Angiomyolipoma (HAML) is a rare mesenchymal liver tumour assumed to be predominantly benign, although incidental cases with malignant behaviour such as invasive growth, recurrence after resection and metastases have been reported. The aim of this systematic review was to assess the biological behaviour, estimate the risk of HAML related mortality and recommend on a justifiable management strategy. We performed a systematic literature search in Embase, Medline, Web‐of‐Science, Scopus, Pubmed Publisher, Cochrane and Google Scholar. We included all articles published from inception until March 2016 which reported on follow‐up of various treatment strategies. We included 18 articles reporting on 292 patients. Male:female ratio was estimated at 1:3 with gender not reported in 31 cases. Of 292 patients 247 were treated with surgery, including one liver transplant, seven with chemotherapy or Sirolimus, three with embolization, and 35 conservatively. Recurrence after resection was described in 6/247 (2.4%) with pathologically proven HAML resulting in metastases and death in 2/247 (mortality rate 0.8%). Progression was described in 6/35 patients treated conservatively (21.4%). Two of 12 patients with malignant behaviour of HAML had an epithelioid‐type HAML, of the remaining 10 histological subtype was undefined. With a risk estimate of 0.8% in surgically treated patients HAML related mortality is very low. Biopsy is indicated when imaging is inconclusive. In case of certain HAML diagnosis on imaging conservative management with annual imaging is justified. Resection should be considered in case of symptoms, inconclusive biopsy or growth in follow‐up.
Do maternal perceptions of child eating and feeding help to explain the disconnect between reported and observed feeding practices?: A follow‐up study
Authors: Bergmeier Heidi J. , Skouteris Helen , Hetherington Marion M. , Rodgers Rachel F. , Campbell Karen J. , Cox Rachael
Published: February 2017

Research demonstrates a mismatch between reported and observed maternal feeding practices. This mismatch may be explained by maternal cognitions, attitudes, and motivations relating to dyadic parent–child feeding interactions. These complex constructs may not be apparent during observations nor evidenced in self‐report questionnaire. Therefore, the aim of this study was to use a qualitative approach to gain a more nuanced and contextualized understanding of (a) maternal perceptions of children's food intake control; (b) how parent–child mealtime interactions influence maternal feeding practices; and (c) ways in which mothers may promote healthy child eating and weight outcomes. Semistructured telephone interviews were conducted with 23 mothers (M = 38.4 ± 3.7 years of age) of preschool‐aged children (M = 3.8 ± 0.6 years of age, 19 were normal weight, 14 were girls), who had previously completed child feeding questionnaire and participated in two home‐based mealtime observations, 12 months apart. Interviews were recorded, transcribed, and themes extracted to create the database. Four major themes emerged: (a) Maternal confidence in children's ability to regulate food intake is variable; (b) Implementing strategies for nurturing healthy relationships with food beyond the dining table; (c) Fostering positive mealtime interactions is valued above the content of what children eat; and (d) Situation‐specific practices and inconsistencies. Findings indicate that maternal feeding practices are shaped by both parent and child influences, and child feeding is mostly guided by controlling the family food environment, rather than by directly pressuring or restricting their child's eating. Results also highlighted the need for research to consider both parent and child influences on child feeding.
Suspected atypical haemolytic uraemic syndrome in two post‐partum patients with foetal‐death in utero responding to eculizumab
Authors: Chua Justin , Paizis Kathy , He Simon Z. , Mount Peter
Published: February 2017

Background

Atypical haemolytic uraemic syndrome (aHUS) is a rare condition with the triad of microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury. Other conditions that present in a similar manner peri‐partum include thrombotic thrombocytopaenic purpura, and pregnancy associated conditions including HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), severe pre‐eclampsia and less commonly acute fatty liver of pregnancy.

Case Reports

We describe two cases of suspected aHUS, who presented post‐partum with foetal death‐in‐utero at 33 and 37 weeks respectively. Both presented with the triad features of aHUS but had considerably different clinical courses. The first case required a prolonged ICU admission, needed intubation for neurological deterioration and dialysis for acute kidney injury, and developed complications including acute liver failure, septic shock, pancreatitis, and ischaemic colitis. Initial ADAMSTS13 activity was borderline‐low (10.3%) and normal on repeat testing (42.6%), and there was no peri‐partum pre‐eclampsia. The other case remained clinically stable throughout her admission with creatinine peaking at 495, not requiring dialysis, minor liver transaminases derangement and was discharged after a week. Her ADAMSTS13 activity was normal (62%), and her pregnancy was complicated by peri‐partum pre‐eclampsia. Both eventually had a reduction in haemolysis with rapid and sustained reduction in LDH and normalised platelet counts, and complete recovery of renal function whilst receiving eculizumab therapy.

Conclusions

It can be difficult to distinguish aHUS from other causes in peri‐partum patients presenting with features of microangiopathic haemolytic anaemia, thrombocytopenia and acute kidney injury, and often, aHUS can be precipitated by pregnancy. In the setting of the clinical urgency to treat aHUS early with eculizumab, this presents a diagnostic challenge, as confirmatory tests for aHUS are not immediately available.
De novo thrombotic microangiopathy following simultaneous pancreas and kidney transplantation managed with eculizumab
Authors: Shochet Lani , Kanellis John , Simpson Ian , Ta Joseph , Mulley William
Published: February 2017

Thrombotic microangiopathy (TMA) is a well‐recognised complication following transplantation, often due to an underlying genetic predisposition, medications or rejection. The use of eculizumab in these settings has been previously described, but its role still remains to be clarified.

A 45‐year‐old man, with a history of type 1 diabetes mellitus and subsequent end‐stage kidney failure, presented for a simultaneous pancreas‐kidney transplant. Immunologically, he was well matched with the donor, and he received standard induction immunosuppression including tacrolimus. His early transplant course was complicated by Haemophilus parainfluenzae paronychia and a Pseudomonas aeruginosa catheter‐associated urinary tract infection. Within 1 week, he developed thrombotic microangiopathy with significant renal dysfunction and eventual dialysis dependence, without evidence of transplant rejection on biopsy. He was also noted to have antiphospholipid antibodies in moderate titres. The TMA did not resolve despite cessation of tacrolimus, and he was subsequently commenced on eculizumab. The patient achieved a partial remission from TMA, with ongoing biochemical evidence of haemolysis, although now with stable graft function, despite significant damage. His transplanted pancreas remained seemingly unaffected by TMA, and continues to function well.

This case describes an unusual presentation of TMA post‐transplantation and is the only described case of eculizumab use following pancreas‐kidney transplant. It remains unclear in this case what the likely precipitant for TMA was, although it seems to be, at least in part, controlled by ongoing use of eculizumab, presumably by terminal complement inhibition.
Ethnic Fractionalization, Governance and Loan Defaults in Africa
Authors: Andrianova Svetlana , Baltagi Badi H. , Demetriades Panicos , Fielding David
Published: February 2017

We present a theoretical model of an imperfectly competitive loans market that is suitable for emerging economies in Africa. The model allows for variation in both the level of contract enforcement (the quality of governance) and the degree of market segmentation (the level of ethnic fractionalization). The model predicts a specific form of nonlinearity in the effects of these variables on loan default. Empirical analysis using African panel data for 110 individual banks in 28 countries over 2000–08 provides strong evidence for these predictions. Our results have important implications for the conditions under which policy reform will enhance financial development.
Electroencephalographic discontinuity during sevoflurane anesthesia in infants and children
Authors: Cornelissen Laura , Bergin Ann M. , Lobo Kimberly , Donado Carolina , Soul Janet S. , Berde Charles B.
Published: February 2017

Background

Deep anesthesia in adults may be associated with electroencephalographic (EEG) suppression and higher rates of postoperative complications. Little is known about the impact of anesthetic depth on short‐ or long‐term outcomes in pediatrics. Brain activity monitoring may complement clinical signs of anesthetic depth. This prospective observational study aimed to assess the frequency and degree of profound EEG suppression using multichannel EEG in children during sevoflurane general anesthesia.

Methods

Children aged 0–40 months who required general anesthesia for elective surgery were included. Continuous EEG recordings were performed starting from when anesthesia began and until recovery. Discontinuity was defined as EEG amplitude <25 uV, lasting ≥2 s, and observed in all electrodes across the scalp. Frequency, duration, and inter‐event interval of discontinuity events were measured. Relationships between discontinuity events and postnatal age, endtidal sevoflurane concentration (etSEVO), and multiple clinical parameters were analyzed.

Results

Discontinuity events were observed in 35/68 children, with a median duration of 10 s (95%CI: 8–12) and a median of 4 events per patient (95%CI: 2–7). Children who had discontinuity events were younger (5.5 months, 95%CI: 3.6–6.5) compared to children who did not have discontinuity events (10.2 months, 95%CI: 6.1–14); (difference between medians, 4.7 months, 95%CI: 2.3–8, P = 0.0002). Younger infants exhibited a higher number of discontinuity events, and the incidence decreased with postnatal age (r68 = −0.53, P < 0.0001). The majority of discontinuity events were observed during the first 30 min of anesthesia (66.4% total events), where etSEVO was >3%. Few discontinuity events were observed during maintenance and none during emergence. Blood pressure, heart rate, tissue oxygen saturation, and endtidal CO2 partial pressure did not change during these events.

Conclusions

Electroencephalographic monitoring may complement clinical signs in providing information about brain homeostasis during general anesthesia. The impact of discontinuity events on immediate and long‐term outcomes merits further study.
A case‐controlled comparison of postoperative analgesic dosing between girls with Rett syndrome and girls with and without developmental disability undergoing spinal fusion surgery
Authors: Barney Chantel C. , Merbler Alyssa M. , Quest Kelsey , Byiers Breanne J. , Wilcox George L. , Schwantes Scott , Roiko Samuel A. , Feyma Timothy , Beisang Arthur , Symons Frank J.
Published: February 2017

Background

Rett syndrome is associated with severe motor and communicative impairment making optimal postoperative pain management a challenge. There are case reports documenting reduced postoperative analgesic requirement in Rett syndrome.

Aim

The goal of this preliminary investigation was to compare postoperative analgesic management among a sample of girls with Rett syndrome compared to girls with and without developmental disability undergoing spinal fusion surgery.

Method

The medical records of eight girls with Rett syndrome (mean age = 13.2 years, sd = 1.9), eight girls with developmental disability (cerebral palsy; mean age = 13.1 years, sd = 2.0), and eight girls without developmental disability (adolescent idiopathic scoliosis; mean age = 13.4, sd = 1.8) were reviewed. Data related to demographics, medications, and route of drug administration were recorded.

Results

Girls with Rett syndrome received significantly fewer morphine equivalent opioids postoperatively (M = 0.26 mg·kg−1·day−1, sd = 0.10) compared to girls with adolescent idiopathic scoliosis (M = 0.47mg·kg−1·day−1, sd = 0.13; 95% CI −0.34 to −0.08; P = 0.001) and girls with CP (M = 0.40 mg·kg−1 per day, sd = 0.14; 95% CI −0.27 to −0.02; P = 0.01). Girls with Rett syndrome received significantly fewer opioid patient‐controlled analgesic (PCA) bolus doses (given by proxy; M = 42.63, sd = 17.84) compared to girls with adolescent idiopathic scoliosis (M = 98.25, sd = 52.77; 95% CI −96.42 to −14.83; P = 0.01). There was also some evidence indicating girls with Rett syndrome received fewer bolus doses compared to girls with CP (M = 80.88, sd = 38.93; 95% CI −79.05 to 2.55; P = 0.06). On average, girls with Rett syndrome also received smaller total doses of acetaminophen, diazepam, and hydroxyzine.

Conclusion

This study highlights possible discrepancies in postoperative pain management specific to girls with Rett syndrome and suggests further investigation is warranted to determine best practice for postoperative analgesic management for this vulnerable patient population.
The impact of capnography monitoring among children and adolescents in the postanesthesia care unit: a randomized controlled trial
Authors: Langhan Melissa L. , Li Fang‐Yong , Lichtor J. Lance
Published: February 2017

Background

Pulse oximetry does not reliably recognize respiratory depression, particularly in the presence of supplemental oxygen. Capnography frequently detects hypoventilation and apnea among children recovering from anesthesia. Although children are routinely monitored with capnography during anesthesia, reducing the rate of adverse events, it is not routinely used in the postanesthesia care unit (PACU), where patients remain at risk for respiratory depression.

Aim

We hypothesized that children monitored with capnography would have more frequent staff interventions and fewer adverse events than children monitored with pulse oximetry alone.

Methods

Otherwise healthy children of age 1–20 years undergoing general anesthesia for elective surgery were eligible for enrollment upon entering the pediatric PACU. Subjects were randomized as to whether PACU staff could view the capnography monitor (intervention group) or not (control group). All children received standard monitoring with pulse oximetry. Vital signs and patient interventions were recorded every 30 s by a portable monitor or a research associate.

Results

Data from 201 children were analyzed. The rates of hypopneic hypoventilation [5% (95% CI: 2–8%) per minute vs 1% (95% CI: −1% to 3%) per minute, difference 4% (95% CI: 0.2–8%) per minute; P = 0.04] and apnea [11% (95% CI: 8–14%) per minute vs 1.5% (95% CI: −2% to 5%) per minute, difference 9% (5–14%) per minute; P < 0.001] decreased significantly faster in our intervention group as compared to the control group. The rates of bradypnea decreased faster in our control group [5% (95% CI: 2–8%) per minute vs 1% (95% CI: 0–4%) per minute, difference 4% per minute, 95% CI: 0–9%; P = 0.05]. Rates of respiratory events over time between groups were affected by the presence or absence of interventions. There were no differences in rates of hypoxemia between groups over time.

Conclusions

Children monitored with capnography have different rates of adverse respiratory events over time than children monitored solely with pulse oximetry. The addition of capnography improved the efficacy of staff interventions, however did not impact rates of oxygen desaturation.
A novel functional gene associated with cold tolerance at the seedling stage in rice
Authors: Zhao Junliang , Zhang Shaohong , Dong Jingfang , Yang Tifeng , Mao Xingxue , Liu Qing , Wang Xiaofei , Liu Bin
Published: February 2017

Identification and cloning of cold‐tolerant genes that can stably express under different cold environments are crucial for molecular rice breeding for cold tolerance. In the previous study, we identified a cold‐tolerant QTL at the seedling stage, qCTS‐9 which could be detected under different cold environments using a recombinant inbred line (RIL) population derived from a cold‐tolerant variety Lijiangxintuanheigu (LTH) and a cold‐sensitive variety Shanhuangzhan 2 (SHZ‐2). In this study, eight candidate genes within the qCTS‐9 interval were identified through integrated analysis of QTL mapping with genomewide differential expression profiling of LTH. The qRT‐PCR assay showed that only Os09g0410300 exhibited different expression patterns between LTH and SHZ‐2 during cold stress, and significantly positive correlation was found between cold induction of Os09g0410300 and seedling cold tolerance in the RI lines. Five SNPs and one InDel in the promoters of Os09g0410300 were detected between LTH and SHZ‐2, and the InDel marker ID410300 designed based on the insertion–deletion polymorphism in the promoter was significantly associated with seedling cold tolerance in RIL population. Further, Os09g0410300 over‐expression plants exhibited enhanced cold tolerance at the seedling stage compared with the wild‐type plants. Thus, our results suggest that Os09g0410300 is the functional gene underlying qCTS‐9. To our knowledge, it is a novel gene contributed to enhance cold tolerance at the seedling stage in rice. Identification of the functional gene underlying qCTS‐9 and development of the gene‐specific marker will facilitate molecular breeding for cold tolerance at the seedling stage in rice through transgenic approach and marker‐assisted selection (MAS).
Decrease in use of contraindicated drugs with automated alerts in children
Authors: Song Inmyung , Shin Han Na , Shin Ju‐Young
Published: February 2017

Background

This study evaluated changes in the use of contraindicated drugs in the pediatric population, via automated alerts through the nationwide drug utilization review.

Methods

We conducted an interrupted time series analysis using the nationwide health insurance database. Study drugs consisted of a total of 72 drugs in 22 classes that were designated as age contraindicated between January 2007 and December 2011. The subjects consisted of the patients in Korea who had been prescribed with any of the study drugs at least once. Changes in the use of age‐contraindicated drugs after the regulatory action were estimated as relative and absolute reductions with 95% CI. Regression analysis was carried out based on the monthly number of users prior to the announcement of age‐contraindicated drugs on 3 December 2009 to estimate the predicted values, and these were then compared with the observed values after the announcement.

Results

A total of 2 541 888 patients were prescribed age‐contraindicated drugs at least once. The percentage of age‐contraindicated drug users was 2.10% of the total users (n = 3 309 566) during the period prior to the 2009 regulatory action, but it decreased to 0.30% (n = 542 529) after the action. Overall, there was an 85.71% relative reduction (95% CI: 71.53–102.72) in the percentage of age‐contraindicated drug users. The projected monthly number of users of age‐contraindicated drugs showed a gradual downward trend.

Conclusion

Decreases in contraindicated drugs have accelerated after a regulatory action with automated alerts.
Berkeleyan idealism and Christian philosophy
Authors: Spiegel James S.
Published: February 2017

Berkeleyan idealism, or ‘immaterialism,’ has had an enormous impact on the history of philosophy during the last three centuries. In recent years, Christian scholars have been especially active in exploring ways that Berkeley's thesis may be fruitfully applied to a variety of issues in philosophy and theology. This essay provides an overview of some of the ways Christian philosophers have deployed immaterialism to solve problems and generate insights in metaphysics, philosophy of mind, philosophy of science, philosophy of religion, and philosophical theology.