bluuebunny/crossref_metadata_2025 huggingface dataset:
Property matrices of [011]-poled rhombohedral Pb(Zn1/3Nb2/3)O3–(4.5-7)%PbTiO3 single crystals
Authors: Zhang S. , Lim L. C.
Published: November 2018

This paper reports the elastic, piezoelectric and dielectric properties of [011]-poled flux grown Pb(Zn1/3Nb2/3)O3-xPbTiO3 (x = 0.0475, 0.055 and 0.065) single crystals of rhombohedral phase measured using the resonance technique at room temperature. The [011]-poled PZN-PT single crystals exhibit excellent transverse and shear properties with reasonable phase transformation properties (k32 ≥ 0.90, k15 ≈ 0.92, d32 ≈ –(2400-3200) pC/N, d15 ≈ 4800 pC/N, TRO ≈ 90-104 °C for PZN-6.5%PT and k32 ≥ 0.90, k15 ≈ 0.89, d32 ≈ –(1850-2400) pC/N, d15 ≈ 4200 pC/N, TRO ≈ 105-115 °C for PZN-5.5%PT). These unique piezoelectric properties of [011]-poled PZN-PT crystals, together with the property matrices provided in this work, can be used advantageously to design high-performance single crystal transducers of transverse or shear activation/sensing modes to suit various application needs.
Hydrogeochemical processes and trace elements in sediments at the south-eastern Mexican karst aquifer
Authors: Sánchez-Ahuactzin Tonatiuh , Rebolledo Vieyra Mario , Ortega-Camacho Daniela , Escobar-Morales Sergio , Hernández Terrones Laura M.
Published: November 2018

The chemical characteristics and hydrogeochemical processes that govern the groundwater in the sinkholes ring of the Yucatan Peninsula were assessed. The groundwater of the area studied is of the Ca–Mg–HCO3 type. Local geology (abundance of dolomite) determines Mg2+ enrichment relative to Ca2+. The absence of seawater intrusion was established. Sinkhole water chemistry is controlled by carbonate rock dissolution, with dominance of Ca2+, Mg2+ and HCO3–. The dynamic and controlling factors of trace elements were determined in sediments of the southern part of Mexico. The order of mean concentrations of trace elements in sediments is Sr>Pb>Cu>Zn>Cr>> Cd. With regard to the sequential extraction procedure, the potential importance of fractions in sediments is in the order residual>organic matter>carbonates>exchangeable>water soluble, confirming that sinkhole sediments works as a sink of trace elements, and that no anthropogenic pressure exists in the groundwater of the hydrogeological reserve area. Trace element stability in sediments decreased as follow: Cd>Pb>Zn>Cr>Cu>Sr. The study results describe the groundwater and sediment condition of the hydrogeological reserve area, and provide insights for stakeholders and authorities. Growing population and economic activities may be major threats to the groundwater in coming decades.
Non-native white piranhas graze preferentially on caudal fins from large netted fishes
Authors: Andrade F. R. , Silva L. D. , Guedes I. , Santos A. M. , Pompeu P. S.
Published: November 2018

In this study we assessed, for the first time, grazing by Serrasalmus brandtii outside its natural range. We observed higher grazing proportions in samples from sites where S. brandtii is the dominant species in relation to sites where it is recorded as present and sites where it is absent. S. brandtii grazed preferentially on caudal fins in relation to all other fins alone or combined. It also preferred to mutilate fins instead of flesh. Larger fish had a higher probability of being mutilated and had a higher number of mutilated fins than smaller fish, which is expected as large fish represent a larger resource to their consumers. S. brandtii avoided mutilating conspecifics and, as its abundance increased, so did the number of species being preferentially grazed.
MicroRNA profile comparison of testicular tissues derived from successful and unsuccessful microdissection testicular sperm extraction retrieval in non-obstructive azoospermia patients
Authors: Fang Na , Cao Congcong , Wen Yujiao , Wang Xiaoli , Yuan Shuiqiao , Huang Xunbin
Published: November 2018

Non-obstructive azoospermia (NOA) is the most severe clinical diagnosis in cases of male infertility. Although in some cases of NOA spermatozoa can be retrieved by microdissection testicular sperm extraction (micro-TESE) to fertilise eggs through intracytoplasmic sperm injection (ICSI), there remains a lack of potential biomarkers for non-invasive diagnosis before micro-TESE surgery. To determine predictive biomarkers for successful sperm retrieval before micro-TESE, the aim of this study was to explore whether microRNAs (miRNAs) were differentially expressed in testicular tissues in NOA patients in whom sperm retrieval had been successful (SSR) versus those in whom it had been unsuccessful (USR) using next-generation small RNA sequencing (RNA-Seq). In all, 180 miRNAs were identified with significantly altered expression levels between SSR and USR testicular tissues. Of these, the expression of 13 miRNAs was upregulated and that of 167 miRNAs was downregulated in the USR compared with SSR group. Unexpectedly, 86 testicular miRNAs were found to be completely absent in the USR group, but showed high expression in the SSR group, suggesting that these miRNAs may serve as biomarkers for micro-TESE and may also play an essential role in spermatogenesis. Furthermore, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses indicated that the miRNAs that differed significantly between the USR and SSR groups were involved in cell apoptosis, proliferation and differentiation, which are of considerable importance during spermatogenesis. In summary, this study identified a panel of miRNAs highly expressed in testicular tissues of SSR but not USR NOA patients, providing new insights into specific miRNAs that may play important roles in epigenetic regulation during spermatogenesis. The findings provide a basis for further elucidation of the regulatory role of miRNAs in spermatogenesis and clues to identifying useful biomarkers to predict residual spermatogenic loci in NOA patients during treatment with assisted reproductive technologies.
Monomerization of far-red fluorescent proteins
Authors: Wannier Timothy M. , Gillespie Sarah K. , Hutchins Nicholas , McIsaac R. Scott , Wu Sheng-Yi , Shen Yi , Campbell Robert E. , Brown Kevin S. , Mayo Stephen L.
Published: November 2018

Anthozoa
-class red fluorescent proteins (RFPs) are frequently used as biological markers, with far-red (λ
em
∼ 600–700 nm) emitting variants sought for whole-animal imaging because biological tissues are more permeable to light in this range. A barrier to the use of naturally occurring RFP variants as molecular markers is that all are tetrameric, which is not ideal for cell biological applications. Efforts to engineer monomeric RFPs have typically produced dimmer and blue-shifted variants because the chromophore is sensitive to small structural perturbations. In fact, despite much effort, only four native RFPs have been successfully monomerized, leaving the majority of RFP biodiversity untapped in biomarker development. Here we report the generation of monomeric variants of HcRed and mCardinal, both far-red dimers, and describe a comprehensive methodology for the monomerization of red-shifted oligomeric RFPs. Among the resultant variants is mKelly1 (emission maximum, λ
em
= 656 nm), which, along with the recently reported mGarnet2 [Matela G, et al. (2017)
Chem Commun (Camb)
53:979–982], forms a class of bright, monomeric, far-red FPs.
r/Agenda_rejection
Authors: Funk Marcus
Published: November 2018

Reddit communities focused on Christianity demonstrate significant resistance to mainstream news media attribute agendas on Christianity and Christians. This computerized content analysis of five years of news coverage and survey responses from 113 Redditors found digital community members soundly rejected mainstream news attribute agendas. Data point to the strength and independence of digital communities to meld and define their own agendas and rhetoric while affirming both a need for orientation and previous research establishing limited agenda-setting effects regarding religion.
Disruptor-in-chief?
Authors: Wiemer Eric C. , Scacco Joshua M.
Published: November 2018

One prominent competitor to press influence on the public in digital spaces is the President of the United States. This presidential influence is largely unaccounted for, however, in contemporary agenda-setting models. This study examines the network agenda-building and setting capabilities of President Trump around tax reform and North Korea to determine whether and how presidential use of Twitter facilitates agenda building and disrupts the traditional press/public agenda-setting process. Offered in this research are contributions to network agenda setting by placing this theoretical perspective in conversation with research on how the press and public “echo” the language of the president under particular circumstances. Our results illustrate the president can disrupt press-public agenda formation in some circumstances, but popular accounts of the all-disrupting influence President Trump has on political life should be approached cautiously.
Fifty years of agenda-setting research
Authors: Vargo Chris J.
Published: November 2018

50 years have passed since the seminal 1968 election study was conducted in Chapel Hill, North Carolina. A conference was held with
formative theorists Drs. Shaw, Weaver and McCombs. Presentations clustered into 9 clear areas. First, there were areas undergoing
theoretical expansion: (1) agenda building, (2) Network Agenda Setting (NAS), (3) Need For Orientation (NFO), and (4)
agendamelding. Beyond the established areas, (5) new theoretical directions were proposed. Other work tested and validated the
theory in the current digital and political landscape. This included work on (6) the current U.S. political climate, and (7)
agenda setting in unique international conditions. Methodological boundaries were pushed, with presentations focused on (8)
qualitative agenda setting and (9) best practices for big data and on social media. This article summarizes the aforementioned
themes and synthesizes comments raised in discussion at the conference.
Between question and answer
Authors: St John Oliver
Published: November 2018

In Sweden, tutoring in the mother tongue is a form of special educational support to enable pupils with non-Swedish language backgrounds to follow Swedish medium instruction and succeed at school. For pupils who risk failing to meet minimal curricular requirements, it is an educational right. This study investigates tutor-mediated interaction with Somali newly arrived pupils and subject teachers in oral examinations at the ninth year and asks how translanguaging may be relevant to speech performances in this multilingual setting. Both tutors and pupils translanguage advantageously to accomplish pedagogical objectives. Translanguaging proves subject to the personal aspirations of speakers, the organization of interaction as well as wider pedagogical goals. Following Bakhtin, discrepancy between tutor translingual interpretation and the other participants’ interpreted utterances is accounted for as the responsive engagement of a second consciousness that supplements other voices creatively. Central aspects of translanguaging are challenged through a dialogic lens. The implications of treating translanguaging in mother tongue tutoring asdialogic actioninclude positioning translanguaging in an interactionist framework, the importance of a discourse of constraint as well as affordance, a dynamic epistemology and the need for teachers and tutors to be aware of the inherent meaning-making processes in translingual interpretation for pupil assessment.
Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction
Authors: Obokata Masaru , Reddy Yogesh N V , Melenovsky Vojtech , Pislaru Sorin , Borlaug Barry A
Published: November 2018

Aims

Prevalent right ventricular (RV) dysfunction (RVD) is associated with increased mortality in patients with heart failure with preserved ejection fraction (HFpEF), but no study has characterized long-term changes in RV structure and function within the same patient.

Methods and results

Patients with unequivocal HFpEF defined by either invasive haemodynamics or hospitalization for pulmonary oedema (n = 271) underwent serial echocardiographic evaluations >6 months apart. Clinical, structural, functional, and haemodynamic characteristics were examined. Over a median of 4.0 years (interquartile range 2.1–6.1), there was a 10% decline in RV fractional area change and 21% increase in RV diastolic area (both P < 0.0001). These changes greatly exceeded corresponding changes in the left ventricle. The prevalence of tricuspid regurgitation increased by 45%. Of 238 patients with normal RV function at Exam 1, 55 (23%) developed RVD during follow-up. Development of RVD was associated with both prevalent and incident atrial fibrillation (AF), higher body weight, coronary disease, higher pulmonary artery and left ventricular filling pressures, and RV dilation. Patients with HFpEF developing incident RVD had nearly two-fold increased risk of death (adjusted hazard ratio 1.89, 95% confidence interval 1.01–3.44; P = 0.04).

Conclusion

While previous attention has centred on the left ventricle in HFpEF, these data show that right ventricular structure and function deteriorate to greater extent over time when compared with changes in the left ventricle. Further study is required to evaluate whether interventions targeting modifiable risk factors identified for incident RVD, including abnormal haemodynamics, AF, coronary disease, and obesity, can prevent RVD and thus improve outcomes.
NFκB Regulates Muscle Development and Mitochondrial Function
Authors: Valentine Joseph M , Li Mengyao E , Shoelson Steven E , Zhang Ning , Reddick Robert L , Musi Nicolas
Published: November 2018

Nuclear factor (NF)κB is a transcription factor that controls immune and inflammatory signaling pathways. In skeletal muscle, NFκB has been implicated in the regulation of metabolic processes and tissue mass, yet its affects on mitochondrial function in this tissue are unclear. To investigate the role of NFκB on mitochondrial function and its relationship with muscle mass across the life span, we study a mouse model with muscle-specific NFκB suppression (muscle-specific IκBα super-repressor [MISR] mice). In wild-type mice, there was a natural decline in muscle mass with aging that was accompanied by decreased mitochondrial function and mRNA expression of electron transport chain subunits. NFκB inactivation downregulated expression of PPARGC1A, and upregulated TFEB and PPARGC1B. NFκB inactivation also decreased gastrocnemius (but not soleus) muscle mass in early life (1–6 months old). Lower oxygen consumption rates occurred in gastrocnemius and soleus muscles from young MISR mice, whereas soleus (but not gastrocnemius) muscles from old MISR mice displayed increased oxygen consumption compared to age-matched controls. We conclude that the NFκB pathway plays an important role in muscle development and growth. The extent to which NFκB suppression alters mitochondrial function is age dependent and muscle specific. Finally, mitochondrial function and muscle mass are tightly associated in both genotypes and across the life span.
An examination of multivariable Mendelian randomization in the single-sample and two-sample summary data settings
Authors: Sanderson Eleanor , Davey Smith George , Windmeijer Frank , Bowden Jack
Published: November 2018

Background

Mendelian randomization (MR) is a powerful tool in epidemiology that can be used to estimate the causal effect of an exposure on an outcome in the presence of unobserved confounding, by utilizing genetic variants that are instrumental variables (IVs) for the exposure. This has been extended to multivariable MR (MVMR) to estimate the effect of two or more exposures on an outcome.

Methods and results

We use simulations and theory to clarify the interpretation of estimated effects in a MVMR analysis under a range of underlying scenarios, where a secondary exposure acts variously as a confounder, a mediator, a pleiotropic pathway and a collider. We then describe how instrument strength and validity can be assessed for an MVMR analysis in the single-sample setting, and develop tests to assess these assumptions in the popular two-sample summary data setting. We illustrate our methods using data from UK Biobank to estimate the effect of education and cognitive ability on body mass index.

Conclusion

MVMR analysis consistently estimates the direct causal effect of an exposure, or exposures, of interest and provides a powerful tool for determining causal effects in a wide range of scenarios with either individual- or summary-level data.
How Do Undergraduate Students Construct Their View of Cybercrime? Exploring Definitions of Cybercrime, Perceptions of Online Risk and Victimization
Authors: Conway Georgia , Hadlington Lee
Published: November 2018

While cybercrime is recognized as an increasing problem in society, it is unclear how users perceive cybercrime and online risks. This qualitative study explored how undergraduate students in England, a group who are at relatively high risk of victimization, viewed language and concepts associated with cybercrime. Three focus groups were conducted with a total of 16 18- to 21-year-old undergraduate students, and data were analyzed inductively and thematically. The themes explored in this article include: the physical world versus the virtual world; confusion regarding the law (including a perceived lack of police interest in responding to cybercrime); the normalization of risky or harmful online behaviour; and victimization. The themes also point towards a variety of misconceptions about cybercrime alongside an ambivalence towards the potential risk of becoming a victim. The data provide a potential step towards tailoring education packages and awareness programmes to ensure at-risk groups are equipped with actionable mechanisms to protect themselves. Further research is suggested in terms of exploring how such perceptions can be changed through effective training and awareness programmes, potentially reducing the level of risk in this group.
Low Substrate pH–Induced Iron/Manganese Toxicity of New Guinea Impatiens: A Diagnostic Guide
Authors: Owen W. Garrett , Whipker Brian E. , Henry Josh B. , Cockson Paul , Landis Hunter
Published: November 2018

New Guinea impatiens (Impatiens hawkeri) are popular bedding plants, but the knowledge of diagnosing abiotic disorders during greenhouse production is evolving. Symptomology of nutrient deficiencies and excessive fertilization have been extensively documented. Exact symptomology of low substrate pH (<5.5) and toxic iron (Fe) and/or manganese (Mn) leaf tissue levels are not defined or photographed, thereby aiding in diagnosis. Therefore, the objective of the diagnostic guide was to photograph symptomology and document the tissue levels in New Guinea impatiens to provide a definitive guide of low substrate pH–induced Fe and/or Mn toxicity.
Models of Peer Support to Remediate Post-Intensive Care Syndrome: A Report Developed by the Society of Critical Care Medicine Thrive International Peer Support Collaborative*
Authors: McPeake Joanne , Hirshberg Eliotte L. , Christie Leeann M. , Drumright Kelly , Haines Kimberley , Hough Catherine L. , Meyer Joel , Wade Dorothy , Andrews Adair , Bakhru Rita , Bates Samantha , Barwise John A. , Bastarache Julie , Beesley Sarah J. , Boehm Leanne M. , Brown Sheryl , Clay Alison S. , Firshman Penelope , Greenberg Steven , Harris Wendy , Hill Christopher , Hodgson Carol , Holdsworth Clare , Hope Aluko A. , Hopkins Ramona O. , Howell David C. J. , Janssen Anna , Jackson James C. , Johnson Annie , Kross Erin K. , Lamas Daniela , MacLeod-Smith Belinda , Mandel Ruth , Marshall John , Mikkelsen Mark E. , Nackino Megan , Quasim Tara , Sevin Carla M. , Slack Andrew , Spurr Rachel , Still Mary , Thompson Carol , Weinhouse Gerald , Wilcox M. Elizabeth , Iwashyna Theodore J.
Published: November 2018

Objectives:

Patients and caregivers can experience a range of physical, psychologic, and cognitive problems following critical care discharge. The use of peer support has been proposed as an innovative support mechanism.

Design:

We sought to identify technical, safety, and procedural aspects of existing operational models of peer support, among the Society of Critical Care Medicine Thrive Peer Support Collaborative. We also sought to categorize key distinctions between these models and elucidate barriers and facilitators to implementation.

Subjects and Setting:

Seventeen Thrive sites from the United States, United Kingdom, and Australia were represented by a range of healthcare professionals.

Measurements and Main Results:

Via an iterative process of in-person and email/conference calls, members of the Collaborative defined the key areas on which peer support models could be defined and compared, collected detailed self-reports from all sites, reviewed the information, and identified clusters of models. Barriers and challenges to implementation of peer support models were also documented. Within the Thrive Collaborative, six general models of peer support were identified: community based, psychologist-led outpatient, models-based within ICU follow-up clinics, online, groups based within ICU, and peer mentor models. The most common barriers to implementation were recruitment to groups, personnel input and training, sustainability and funding, risk management, and measuring success.

Conclusions:

A number of different models of peer support are currently being developed to help patients and families recover and grow in the postcritical care setting.
Quitting Smoking in Mainland China
Authors: Li Weijia , Kung Kenny , Li Zhe , Hui Christopher , Holroyd Eleanor , Wong William C. W.
Published: November 2018

China has more than 300 million cigarette smokers and 1 million deaths every year attributed to smoking. Despite its huge economic implications, the lack of smoking and associated lifestyle-related data on China's outpatients makes it difficult for health care professionals to provide individualized assessments and targeted interventions. This study aimed to identify factors to inform nurse-led smoking behavioral assessments and cessation interventions. Clinical data from new patients attending the family medicine outpatient department from a large tertiary hospital in a major Southern China city were collected between March and December 2015. Data including basic demographics, medical history, vaccination history, current medication, and information on lifestyle risk factors were collected by frontline nurses during nursing assessment on their initial visit. Chi-square and Student's t tests were used as univariate analysis and post hoc regression analysis to explore which factors contributed toward smoking cessation. Of 7913 eligible visits, smokers and ex-smokers accounted for 13.5% and 2.4% of new patients, respectively, with a majority of them being young and male (gender ratio of 8:1) smokers. Multiple behavioral risks and comorbidities such as hypertension and diabetes mellitus in smokers were common; for example, 17.9% of smokers were also current drinkers, making alcohol users 8.5 to 16.7 times more likely to have smoked. Ex-smokers were more likely to be divorced, to be ex-drinkers, or to have higher diastolic blood pressure and concurrent hypertension. Smoking and associated lifestyle risk assessments run by registered nurses should be incorporated into current outpatient health histories and in targeted smoking cessation intervention programs.
Can telemedicine improve triage and patient satisfaction in urgent care settings?
Authors: Aungst Lesia A.
Published: November 2018

Urgent care centers (UCCs) frequently experience long wait times, overcrowding, and patient dissatisfaction. According to recent studies in the emergency care setting, utilization of telemedicine during patient triage has demonstrated reduction in patient wait time and improvement in patient satisfaction. Implementation of telemedicine in urgent care settings may make triage faster and more efficient and lead to similar improvements in wait time and patient satisfaction. Finally, there is potential for telemedicine to improve working conditions for providers and staff of UCCs.
Hypophosphatasia: A rare disorder
Authors: Hicks Rodney W. , Umnitz Leah , Seibert Diane C.
Published: November 2018

Hypophosphatasia is a rare, progressive metabolic disorder inherited in either an autosomal dominant or an autosomal recessive fashion. Affected individuals may have unusual bone development. Infants may be diagnosed with infantile rickets. Symptoms then abate during adolescence, with bony abnormalities manifesting again as mid-life osteopenia or osteoporosis. Long-term management is focused on minimizing complications, so consultations and periodic visits with a variety of specialists is often warranted. New therapies are on the horizon, but some agents used to treat bone diseases are contraindicated in this population. At-risk relatives should be referred to genetic professionals to determine mode of inheritance and discuss options.
Unique imaging findings in fibromuscular dysplasia of renal arteries
Authors: Kong Weiying , Hu Zhangxue
Published: November 2018

Rationale:

Fibromuscular dysplasia (FMD) is a rare vascular disorder that causes abnormal cell growth in arterial walls. The classic “string of beads” sign has been reported in many cases, whereas the appearance of tubular stenosis and distal tapering of renal arteries with multiple renal infarctions, as well as left kidney atrophy occurring in one patient, has not been precisely described.

Patient concerns:

A 19-year-old woman presented to us with a history of elevated blood pressure without any symptoms for the past 1 month. Routine laboratory tests indicated a moderately impaired renal function, and ultrasound examination demonstrated a small-sized left kidney and seriously decreased blood flow of the left renal artery and its branches.

Diagnosis:

Subsequent contrast-enhanced computed tomographic angiography (CTA) demonstrated multiple ischemic infarctions in the bilateral kidneys, and FMD was suggested at that time. Thereafter, we performed selective reno-angiography, which confirmed that the all left renal arteries had tubular stenosis and that right renal arterial branches presented distal tapering.

Intervention:

Antihypertensive drugs were prescribed conservatively, including nifedipine 60 mg/d and prazosin 4 mg/d, to lower the patient's blood pressure.

Outcomes:

The patient had a well-controlled blood pressure and an improved renal function at her 6-month follow-up.

Lessons:

We should take the diagnosis of FMD into account if young women develop asymptomatic hypertension. To our knowledge, this is the first case that exhibited renal artery FMD manifesting as tubular stenosis and distal tapering, especially followed by bilateral renal infarctions and significant atrophy of the left kidney. In addition, CTA combined with digital subtraction angiography (DSA) may be more sensitive than other tests with respect to the detection of intrarenal infarctions and arterial variants of FMD.
The clinical value of using chloroquine or hydroxychloroquine as autophagy inhibitors in the treatment of cancers
Authors: Xu Ran , Ji Ziyi , Xu Chen , Zhu Jing
Published: November 2018

Background:

Autophagy is a mechanism which relies on lysosomes for clearance and recycling of abnormal proteins or organelles. Many studies have demonstrated that the deregulation of autophagy is associated with the development of various diseases including cancer. The use of autophagy inhibitors is an emerging trend in cancer treatment. However, the value of autophagy inhibitors remains under debate. Thus, a meta-analysis was performed, aiming to evaluate the clinical value of autophagy-inhibitor-based therapy.

Methods:

We searched for clinical studies that evaluated autophagy-inhibitor-based therapy in cancer. We extracted data from these studies to evaluate the relative risk (RR) of overall response rate (ORR), 6-month progression-free survival (PFS) rate, and 1-year overall survival (OS) rate.

Results:

Seven clinical trials were identified (n = 293). Treatments included 2 combinations of hydroxychloroquine and gemcitabine, 1 combination of hydroxychloroquine and doxorubicin, 1 combination of chloroquine and radiation, 2 combinations of chloroquine, temozolomide, and radiation, and 1 hydroxychloroquine monotherapy. Autophagy-inhibitor-based therapy showed higher ORR (RR: 1.33, 95% confidence interval [CI]: 0.95–1.86, P = .009), PFS (RR: 1.72, 95% CI: 1.05–2.82, P = .000), OS (RR: 1.39, 95% CI: 1.11–1.75, P = .000) values than the therapy without inhibiting autophagy.

Conclusion:

This meta-analysis showed that autophagy-inhibitor-based therapy has better treatment response compared to chemotherapy or radiation therapy without inhibiting autophagy, which may provide a new strategy for the treatment of cancers.
A methodology to systematically analyze the hospital discharge of terminally ill patients
Authors: Eggen Annemarie Cécile , Jalving Mathilde , Bosma Ingeborg , Veenhuis Derkje J. , Bosscher Lianne J. , Geerling Jenske I. , Reyners Anna Katrien Leontien
Published: November 2018

To provide an appropriate method to systematically analyze the hospital discharge of terminally ill patients especially the cooperation between hospital and community nurses and the quality of the discharge handovers. To evaluate the hospital discharge process of terminally ill patients in an academic hospital in the Netherlands using the proposed method.

Data were collected from a prospective cohort of all terminally ill patients discharged from the University Medical Center Groningen, the Netherlands, between June and November 2014. The hospital discharges were assessed using 2 questionnaires: an inventory questionnaire, to determine the required care, and an evaluation questionnaire, to evaluate the care actually organized and the discharge handovers. The inventory questionnaire was completed prior to discharge and the evaluation questionnaire between 3 to 7 days after discharge.

Around 130 consecutive patients were included. The discharge took place on the desired date in 86% of cases and the average overall discharge grade on a 10-point scale was 7.4 (range: 3–9.5). In 23% of cases discrepancies between required and provided care were identified and medication queries existed in 29%.

This study provides a methodology to analyze the hospital discharge procedure of terminally ill patients that can be utlized in any hospital. Structured analysis of the discharge process is valuable and identifies where improvements can be made. Within the study cohort the home care could be arranged at short notice and was considered sufficient. However, in a significant proportion of patients a discrepancy between required and arranged care and queries about medication were identified.
Prognostic value role of radiofrequency lesion size by cardiac magnetic resonance imaging on outcomes of ablation in patients with ischemic scar-related ventricular tachycardia
Authors: Guler Tümer Erdem , Yalin Kivanç , Aksu Tolga , Golcuk Ebru , Sanli Sukru , Kaya Bilge Ahmet , Adalet Kamil
Published: November 2018

Inadequate ablation lesion formation may be responsible for post-ablation ventricular tachycardia (VT) recurrences.

We aimed to evaluate whether visualisation of radiofrequency (RF) lesion size by cardiac magnetic resonance imaging (CMR) has any role in predicting adequacy of lesion and in estimating outcome.

Retrospective pilot study

Nine consecutive patients (8 male, age 60 ± 13 years) underwent ablation for sustained VT because of ischemic scar were evaluated for pre- and post-procedure scar tissue by CMR to characterize ablation lesions. Microvascular obstruction (MVO) surrounded by late gadolinium enhancement was defined as irreversible RF lesion. All patients were followed for at least 6 months for recurrences.

Five of the patients had previous inferior myocardial infarction (MI), whereas remaining 4 had anterior MI. Acute procedural success, as defined by termination of the arrhythmia without recurrence in 30 minutes, was attained in all patients. Contrast enhancement and wall motion abnormality in presumed infarction area were confirmed by pre-ablation CMR images. MVO was detected at the reported ablation site in 6/9 patients, all arrhythmia- and symptom-free at median 24 months (range 8–38 months) follow-up. In remaining 3 patients who had VT recurrence (clinical VT in 2, sustain VT with a new morphology in 1), MVO was not detected despite achievement of acute procedural success. There was no correlation with pre-ablation scar size and clinical arrhythmia recurrence.

CMR is a useful imaging modality to guide ablation procedures by detecting scar tissue. Additionally MVO seen by post-procedural imaging may be related to adequacy of RF ablation lesions and may correlate with clinical outcome.
A pilot study of the effect of ezetimibe for postprandial hyperlipidemia
Authors: Xue En-Zhong , Zhang Ming-Hui , Liu Chun-Li
Published: November 2018

This study aimed to explore the feasible effect of ezetimibe for postprandial hyperlipidemia (PPHP).

Sixty participants were included in this study. Of these, 30 subjects in the intervention group received ezetimibe, while the remaining 30 participants in the control group did not undergo ezetimibe. All patients in intervention group were treated for a total of 2 weeks. Primary endpoints consisted of serum levels of total cholesterol (Total-C), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG). Secondary endpoints included apoB-48, remnant lipoprotein cholesterol (RLP-C), blood glucose, insulin, hemoglobin A1c (HbA1c), and monocyte chemotactic protein (MCP). All outcomes were measured before and after 2-week treatment.

After 2-week treatment, participants in the intervention group did not show better outcomes in primary endpoints of Total-C, LDL-C, HDL-C, and TG; and secondary endpoints of apoB-48, RLP-C, blood glucose, insulin, HbA1c, and MCP, compared with subjects in the control group.

The results of this study showed that ezetimibe may be not efficacious for participants with PPHP after 2-week treatment.
A nonrandomized controlled study of sacral giant cell tumors with preoperative treatment of denosumab
Authors: Yang Yongkun , Li Yuan , Liu Weifeng , Xu Hairong , Niu Xiaohui
Published: November 2018

The aim of this nonrandomized controlled study (level 3)was to evaluate whether preoperative denosumab treatment can reduce intraoperative blood loss, facilitate surgical treatment, and improve local control of sacral giant-cell tumor (GCT).

Surgical treatment of sacral GCT is very difficult due to extensive bone destruction and complex anatomical structures. The huge intraoperative blood loss may interrupt surgical management and judgment of tumor range. Denosumab can inhibit the differentiation of osteoclast-like giant cells and bone destruction by blocking RANKL-RANK pathway.

Study group (preoperative denosumab treatment) and control group (no denosumab treatment) were matched for age, gender, tumor site, staging, and tumor size. In study group, enhanced computed tomography (CT) was performed before and after denosumab treatment. The comparison parameters between 2 groups: CT enhancement rate, intraoperative blood loss, and oncologic outcome.

The mean preoperative time of denosumab treatment was 5.2 months in study group. The mean CT enhancement rate of study group was 2.60 before treatment and 1.37 after treatment (P = .012). The posttreatment CT enhancement rate of study group was significantly lower than that of control group (P = .007). The mean intraoperative bleeding of study group and control group was 2166.7 and 5240 mL, respectively (P = .040). The mean operative time of study group and control group was 268.3 and 268.5 minutes, respectively (P = .997). The recurrence rate of study group (66.7%) was significantly higher than that of control group (0%) (P = .046).

Preoperative denosumab treatment has the tendency to reduce blood supply and intraoperative bleeding of sacral GCT. But the sclerosis and bony separation can increase the difficulty of tumor curettage and lead to high recurrence rate after denosumab treatment. It is necessary to study the best surgical opportunity after denosumab treatment and precise method to judge tumor range.
STROBE-anastomotic leakage after pull-through procedure for Hirschsprung disease
Authors: Peng Chun-Hui , Chen Ya-Jun , Pang Wen-Bo , Zhang Ting-Chong , Wang Zeng-Meng , Wu Dong-Yang , Wang Kai
Published: November 2018

This study was undertaken to explore the causes, diagnosis, and treatment of anastomotic leakage after pull-through (PT) procedure for Hirschsprung disease (HD).

A retrospective analysis of patients with anastomotic leakage after a PT procedure in the General Surgery Department of Beijing Children's Hospital from July 2013 to June 2016 was undertaken. The surgical characteristics, diagnosis, and treatment were retrospectively analyzed.

Among the 213 patients who underwent PT procedures, 5 patients had a documented anastomotic leakage. The median age of these 5 patients at the time of the PT procedure was 6.8 years old, and this was higher than those without anastomotic leakage (1.7 years old). In all patients, rectal examination in the lithotomy position revealed an anastomotic dehiscence at the 6 o’clock position. The abdominal ultrasonography demonstrated retrorectal pneumatosis with or without an abscess in 4 patients. All patients were treated with ileostomies and anastomotic resuturing. The median delay to management was 4 days (range: 1–29 days). Four patients (4/5, 80%) were cured, and 1 (delay, 29 days) of these 4 patients developed postoperative ileus. The remaining patient (delay, 9 days) was required to undergo a repeat PT procedure. For the 4 cured patients, the median follow-up time was 20 months (range: 15–37 months), and these patients defecated 3 times daily at most without soiling.

Older children with HD might be prone to anastomotic leakage. The findings of the rectal examination and ultrasonography were distinctive and useful for the diagnosis. Early ileostomy and resuturing of the anastomosis could be used to treat anastomotic leakage.
Efficacy and safety of rituximab in childhood-onset, difficult-to-treat nephrotic syndrome
Authors: Ahn Yo Han , Kim Seong Heon , Han Kyoung Hee , Choi Hyun Jin , Cho Heeyeon , Lee Jung Won , Shin Jae Il , Cho Min Hyun , Lee Joo Hoon , Park Young Seo , Ha Il-Soo , Cheong Hae Il , Kim Su Young , Lee Seung Joo , Kang Hee Gyung
Published: November 2018

Background:

The anti-CD20 monoclonal antibody rituximab (RTX) has been proposed as a rescue therapy for difficult-to-treat nephrotic syndrome (NS). We conducted a clinical trial to evaluate the efficacy and safety of RTX in children with difficult-to-treat NS dependent on or resistant to steroids and calcineurin inhibitors (CNIs).

Methods:

A multicenter open-label trial was performed at 8 major pediatric nephrology centers in Korea. The investigation consisted of a randomized controlled trial for steroid- and CNI-dependent NS (DDNS; randomization into the RTX group and the control group, at a ratio of 2:1) and a single-arm study of steroid and CNI-resistant NS (DRNS). DDNS patients in the RTX group and DRNS patients received a single dose of intravenous RTX (375 mg/m2 of body surface area) for B-cell depletion. A second RTX dose was administered at week 2 if the first dose failed to achieve depletion of CD19(+) cells. The primary endpoint was rate of maintaining remission at 6 months after treatment for DDNS and rate of remission achievement for DRNS.

Results:

Sixty-one children with DDNS were enrolled while in remission and randomized to the control group (21 patients) or the RTX group (40 patients). At 6 months after treatment, the remission rates were 74.3% in the RTX group and 31.3% in the control group (P = .003). The mean duration of remission maintenance was significantly higher in the RTX group than in the control group (9.0 vs 2.9 months, P = .004). Of the 23 patients with DRNS enrolled in the single-arm study and treated with RTX, 9 (39.1%) achieved partial or complete remission within 6 months. Depletion of B cells occurred in all patients with RTX therapy. Thirty patients (50.8% of 59 patients analyzed) experienced mild and transient infusion reaction during RTX administration, and most adverse events were mild.

Conclusions:

RTX administration was safe and effective in patients with difficult-to-treat NS. One or 2 doses of RTX may be sufficient to deplete B cells and achieve better control of pediatric NS.
Dexmedetomidine combined with local anesthetics in thoracic paravertebral block
Authors: Wang Kai , Wang Li-jun , Yang Tong-jiu , Mao Qing-xiang , Wang Zhen , Chen Li-yong
Published: November 2018

Background

Dexmedetomidine (DEX) improves postoperative pain scores and prolongs the duration of blockage when combined with local anesthetics (LAs) for neuraxial and brachial plexus block; however, there is little information about the effectiveness of DEX as an adjuvant to LAs in paravertebral block (PVB). Therefore, a systematic review and meta-analysis were performed to evaluate the safety and efficacy of DEX combined with LAs in PVB.

Method

An electronic database search from inception date to February 2018 was performed. Randomized controlled trials (RCTs) comparing DEX as an adjuvant to LAs with LAs alone for PVB in adult patients were included. Postoperative pain scores, duration of analgesia, cumulative perioperative analgesic consumption, and adverse events were analyzed.

Result

We identified 7 trials enrolling 350 patients and found that DEX reduced pain scores at rest by standardized mean differences (SMD) −0.86 cm (95% confidence interval [CI] [−1.55, −0.17], P = .01) and SMD −0.93 cm (95% CI [−1.41, −0.26], P =.008) at postoperative 12 hours and 24 hours, respectively. DEX reduced pain scores while dynamic by SMD −1.63 cm (95% CI [−2.92, −0.34], P =.01) and SMD −1.78 cm (95% CI [−2.66, −0.90], P =.007) for postoperative 12 hours and 24 hours, respectively. DEX extended the duration of analgesia by weighted mean differences (WMD) 201.53 minutes (95% CI [33.45, 369.61], P =.02); and reduced cumulative postoperative analgesic consumption by WMD −7.71 mg (95% CI [−10.64, −4.78], P <.001) and WMD −45.64 mg (95% CI [−69.76, −21.53], P < .001) for 24 hours morphine and 48 hours tramadol subgroups, respectively. DEX also increased the odds of hypotension by odds ratio (OR) 4.40 (95% CI [1.37, 14.17], P = .01); however, there was no statistically significant difference for intraoperative fentanyl consumption and the incidence of the bradycardia.

Conclusions

DEX combined with LAs in PVB significantly improved postoperative pain scores, prolonged the duration of analgesia, reduced postoperative analgesic consumption, and increased the odds of hypotension. However, we cannot neglect the heterogeneity of the included RCTs. More large-scale prospective studies are needed to further clarify the above conclusions.

Systematic review registration

PROSPERO registration number CRD42018090251.
Rapid-onset hyponatremia and delirium following duloxetine treatment for postherpetic neuralgia
Authors: Wang Dandan , Lai Jianbo , Lu Shaojia , Huang Manli , Hu Shaohua , Xu Yi
Published: November 2018

Rationale:

Hyponatremia following duloxetine treatment has been reported in patients with major depressive disorder, fibromyalgia, diabetic neuropathy, or sciatic pain. The manifestations of duloxetine-induced hyponatremia are varying in different individuals. The overall prognosis for this type of hyponatremia is favorable if properly managed.

Patient concerns and diagnoses:

Herein, we reported rapid-onset hyponatremia and delirium in an older patient after 2 doses of duloxetine, which was used to control his postherpetic neuralgia. Laboratory examinations revealed a rapid decline in serum sodium level and indicated the possibility of syndrome of inappropriate antidiuretic hormone (SIADH).

Interventions:

Discontinuation of duloxetine, restriction of water intake, and intravenous supplement of normal saline were adopted to manage the hyponatremia.

Outcomes:

Serum concentration of sodium gradually normalized following aforementioned strategies.

Lessons:

Special attention to the electrolyte abnormality is recommended in old patients undergoing duloxetine treatment.
A case report on cystic meningioma in cerebellopontine angle and recommendations for management
Authors: Li Jiuhong , Meng Jinli , Wang Qiguang , Wang Yanchao , Liu Wenke , Hui Xuhui
Published: November 2018

Rationale:

Cystic meningioma located at the cerebellopontine angle (CPA) is an extremely rare occurrence. It is frequently misdiagnosed preoperatively. Little is known about the clinical features and outcome of this rare disease.

Patient concerns:

A 70-year-old male presenting with progressive headache and gait disturbance.

Diagnosis:

According to the symptoms, signs, and Gd-enhanced magnetic resonance images (MRI), a preoperative diagnosis of hemangioblastoma located in left CPA was made. Finally, the histological examination revealed a meningioma.

Interventions:

A complete resection, including the part of the solid mass together with cyst, was performed.

Outcomes:

The postoperative course of the patient was uneventful, and no residual or recurrent tumor was found during the 24-month follow-up period.

Lessons:

Cystic meningioma should be included in the differential diagnosis of a CPA mass with atypical radiologic features, such as a large cyst and enhanced mural nodule. By summarizing the related literature, we found that the most common pathological subtype of CPA cystic meningioma is the clear cell subtype, which belongs to WHO grade II. Gross total resection including the enhanced cyst wall is extremely important. A close follow-up is necessary because of the high recurrence rate in this subset of meningioma.
Musculoskeletal ultrasonography for arthropathy assessment in patients with hemophilia
Authors: Zhang Cui-ming , Zhang Jun-feng , Xu Jing , Guo Yu-lin , Wang Gang , Yang Lin-hua
Published: November 2018

Magnetic resonance imaging (MRI) is currently considered the gold standard for assessing hemophilic arthropathy (HA) severity; however, MRI is often costly, time-consuming, and difficult to perform in children. In the present study, we evaluated the joint status of hemophilic patients from Shanxi Province, China, using musculoskeletal ultrasonography (MSKUS) and identified the factors that most strongly correlated with disease severity.

The study included 104 patients with hemophilia, who underwent MSKUS examination. A total of 1248 joints (including the shoulder, elbow, wrist, hip, knee, and ankle joints on both sides) from these patients were evaluated. Effusion, hypertrophy, cartilage modification, and bone erosion were assessed. The chi-square test was used to analyze categorical variables, and multivariate logistic regression was used to analyze the relationship between joint disease and risk factors.

MSKUS allowed clear visualization of synovial lesions, effusion, cartilage modification, and bone surface damage; however, it was unable to identify changes deep within bones. The distribution of damaged joints was as follows: shoulder, 2 (1.0%); elbow, 80 (38.5%); wrist, 4 (1.9%); hip, 4 (1.9%); knee, 126 (60.6%); and ankle, 90 (43.3%). Damage was more common in the knee, elbow, and ankle joints than in the shoulder, wrist, and hip joints (P < .001). Among the 1248 joints, 306 showed lesions, which included effusion in 102 (8.2%) joints, synovium hypertrophy in 176 (14.1%), cartilage modification in 193 (15.5%), and bone damage in 176 (14.1%). Many joints had multiple lesions at the same time. The chi-square test and multivariate logistic analysis showed that age and hemophilia severity were significantly associated with joint disease, while type of hemophilia and treatment categories were not associated with joint disease.

MSKUS is a convenient and cost-effective examination that can play an important role in the diagnosis and long-term monitoring of HA.