bluuebunny/crossref_metadata_2025 huggingface dataset:
The molecular basis of antigenic variation among A(H9N2) avian influenza viruses
Authors: Peacock Thomas P. , Harvey William T. , Sadeyen Jean-Remy , Reeve Richard , Iqbal Munir
Published: May 2018

Avian influenza A(H9N2) viruses are an increasing threat to global poultry production and, through zoonotic infection, to human health where they are considered viruses with pandemic potential. Vaccination of poultry is a key element of disease control in endemic countries, but vaccine effectiveness is persistently challenged by the emergence of antigenic variants. Here we employed a combination of techniques to investigate the genetic basis of H9N2 antigenic variability and evaluate the role of different molecular mechanisms of immune escape. We systematically tested the influence of published H9N2 monoclonal antibody escape mutants on chicken antisera binding, determining that many have no significant effect. Substitutions introducing additional glycosylation sites were a notable exception, though these are relatively rare among circulating viruses. To identify substitutions responsible for antigenic variation in circulating viruses, we performed an integrated meta-analysis of all published H9 haemagglutinin sequences and antigenic data. We validated this statistical analysis experimentally and allocated several new residues to H9N2 antigenic sites providing molecular markers that will help explain vaccine breakdown in the field and inform vaccine selection decisions. We find evidence for the importance of alternative mechanisms of immune escape, beyond simple modulation of epitope structure, with substitutions increasing glycosylation or receptor-binding avidity exhibiting the largest impacts on chicken antisera binding. Of these, meta-analysis indicates avidity regulation to be more relevant to the evolution of circulating viruses, suggesting that a specific focus on avidity regulation is required to fully understand the molecular basis of immune escape by influenza, and potentially other viruses.
Assessing distinct patterns of cognitive aging using tissue-specific brain age prediction based on diffusion tensor imaging and brain morphometry
Authors: Richard Geneviève , Kolskår Knut , Sanders Anne-Marthe , Kaufmann Tobias , Petersen Anders , Doan Nhat Trung , Sánchez Jennifer Monereo , Alnæs Dag , Ulrichsen Kristine M. , Dørum Erlend S. , Andreassen Ole A. , Nordvik Jan Egil , Westlye Lars T.
Published: May 2018

Multimodal imaging enables sensitive measures of the architecture and integrity of the human brain, but the high-dimensional nature of advanced brain imaging features poses inherent challenges for the analyses and interpretations. Multivariate age prediction reduces the dimensionality to one biologically informative summary measure with potential for assessing deviations from normal lifespan trajectories. A number of studies documented remarkably accurate age prediction, but the differential age trajectories and the cognitive sensitivity of distinct brain tissue classes have to a lesser extent been characterized.

Exploring differential brain age models driven by tissue-specific classifiers provides a hitherto unexplored opportunity to disentangle independent sources of heterogeneity in brain biology. We trained machine-learning models to estimate brain age using various combinations of FreeSurfer based morphometry and diffusion tensor imaging based indices of white matter microstructure in 612 healthy controls aged 18–87 years. To compare the tissue- specific brain ages and their cognitive sensitivity we applied each of the 11 models in an independent and cognitively well-characterized sample (n=265, 20–88 years). Correlations between true and estimated age in our test sample were highest for the most comprehensive brain morphometry (r=0.83, CI:0.78–0.86) and white matter microstructure (r=0.79, CI:0.74–0.83) models, confirming sensitivity and generalizability. The deviance from the chronological age were sensitive to performance on several cognitive tests for various models, including spatial Stroop and symbol coding, indicating poorer performance in individuals with an over-estimated age. Tissue-specific brain age models provide sensitive measures of brain integrity, with implications for the study of a range of brain disorders.
Human T cell receptor occurrence patterns encode immune history, genetic background, and receptor specificity
Authors: DeWitt William S , Smith Anajane , Schoch Gary , Hansen John A , Matsen Frederick A , Bradley Philip
Published: May 2018

The T cell receptor (TCR) repertoire encodes immune exposure history through the dynamic formation of immunological memory. Statistical analysis of repertoire sequencing data has the potential to decode disease associations from large cohorts with measured phenotypes. However, the repertoire perturbation induced by a given immunological challenge is conditioned on genetic background via major histocompatibility complex (MHC) polymorphism. We explore associations between MHC alleles, immune exposures, and shared TCRs in a large human cohort. Using a previously published repertoire sequencing dataset augmented with high-resolution MHC genotyping, our analysis reveals rich structure: striking imprints of common pathogens, clusters of co-occurring TCRs that may represent markers of shared immune exposures, and substantial variations in TCR-MHC association strength across MHC loci. Guided by atomic contacts in solved TCR:peptide-MHC structures, we identify sequence covariation between TCR and MHC. These insights and our analysis framework lay the groundwork for further explorations into TCR diversity.
CHASMplus reveals the scope of somatic missense mutations driving human cancers
Authors: Tokheim Collin , Karchin Rachel
Published: May 2018

Large-scale cancer sequencing studies of patient cohorts have statistically implicated many genes driving cancer growth and progression, and their identification has yielded substantial translational impact. However, a remaining challenge is to increase the resolution of driver prediction from the gene level to the mutation level, because mutation-level predictions are more closely aligned with the goal of precision cancer medicine. Here we present CHASMplus, a computational method, that is uniquely capable of identifying driver missense mutations, including those specific to a cancer type, as evidenced by significantly superior performance on diverse benchmarks. Applied to 8,657 tumor samples across 32 cancer types in The Cancer Genome Atlas, CHASMplus identifies over 4,000 unique driver missense mutations in 240 genes, supporting a prominent role for rare driver mutations. We show which TCGA cancer types are likely to yield discovery of new driver missense mutations by additional sequencing, which has important implications for public policy.

Significance

Missense mutations are the most frequent mutation type in cancers and the most difficult to interpret. While many computational methods have been developed to predict whether genes are cancer drivers or whether missense mutations are generally deleterious or pathogenic, there has not previously been a method to score the oncogenic impact of a missense mutation specifically by cancer type, limiting adoption of computational missense mutation predictors in the clinic. Cancer patients are routinely sequenced with targeted panels of cancer driver genes, but such genes contain a mixture of driver and passenger missense mutations which differ by cancer type. A patient’s therapeutic response to drugs and optimal assignment to a clinical trial depends on both the specific mutation in the gene of interest and cancer type. We present a new machine learning method honed for each TCGA cancer type, and a resource for fast lookup of the cancer-specific driver propensity of every possible missense mutation in the human exome.
White Matter Network Architecture Guides Direct Electrical Stimulation Through Optimal State Transitions
Authors: Stiso Jennifer , Khambhati Ankit N. , Menara Tommaso , Kahn Ari E. , Stein Joel M. , Das Sandihitsu R. , Gorniak Richard , Tracy Joseph , Litt Brian , Davis Kathryn A. , Pasqualetti Fabio , Lucas Timothy , Bassett Danielle S.
Published: May 2018

Electrical brain stimulation is currently being investigated as a potential therapy for neurological disease. However, opportunities to optimize and personalize such therapies are challenged by the fact that the beneficial impact (and potential side effects) of focal stimulation on both neighboring and distant regions is not well understood. Here, we use network control theory to build a formal model of brain network function that makes explicit predictions about how stimulation spreads through the brain’s white matter network and influences large-scale dynamics. We test these predictions using combined electrocorticography (ECoG) and diffusion weighted imaging (DWI) data from patients with medically refractory epilepsy undergoing evaluation for resective surgery, and who volunteered to participate in an extensive stimulation regimen. We posit a specific model-based manner in which white matter tracts constrain stimulation, defining its capacity to drive the brain to new states, including states associated with successful memory encoding. In a first validation of our model, we find that the true pattern of white matter tracts can be used to more accurately predict the state transitions induced by direct electrical stimulation than the artificial patterns of a topological or spatial network null model. We then use a targeted optimal control framework to solve for the optimal energy required to drive the brain to a given state. We show that, intuitively, our model predicts larger energy requirements when starting from states that are farther away from a target memory state. We then suggest testable hypotheses about which structural properties will lead to efficient stimulation for improving memory based on energy requirements. We show that the strength and homogeneity of edges between controlled and uncontrolled nodes, as well as the persistent modal controllability of the stimulated region, predict energy requirements. Our work demonstrates that individual white matter architecture plays a vital role in guiding the dynamics of direct electrical stimulation, more generally offering empirical support for the utility of network control theoretic models of brain response to stimulation.
Analysis of 19 Highly Conserved Vibrio cholerae Bacteriophages Isolated from Environmental and Patient Sources Over a Twelve-Year Period
Authors: Angermeyer Angus , Das Moon Moon , Singh Durg Vijai , Seed Kimberley D.
Published: May 2018

The Vibrio cholerae biotype ‘El Tor’ is responsible for all current epidemic and endemic cholera outbreaks worldwide. These outbreaks are clonal and are hypothesized to originate from the coastal areas near the Bay of Bengal where the lytic bacteriophage ICP1 specifically preys upon these pathogenic outbreak strains. ICP1 has also been the dominant bacteriophage found in cholera patient stool since 2001. However, little is known about its genomic differences between ICP1 strains collected over time. Here we elucidate the pan-genome and phylogeny of ICP1 strains by aligning, annotating and analyzing the genomes of 19 distinct isolates collected between 2001 and 2012. Our results reveal that ICP1 isolates are highly conserved and possess a large core-genome as well as a smaller, somewhat flexible accessory-genome. Despite its overall conservation, ICP1 strains have managed to acquire a number of unknown genes as well as a CRISPR-Cas system, which is known to be critical for its ongoing struggle for co-evolutionary dominance over its host. This study describes a foundation on which to construct future molecular and bioinformatic studies of this V. cholerae-associated bacteriophages.
The moderating effects of status and trust on the performance of age-diverse work groups
Authors: Scheuer Cara-Lynn , Loughlin Catherine
Published: May 2018

Purpose

The purpose of this paper is to help organizations capitalize on the potential advantages of age diversity by offering insight into two new moderators in the age diversity, work group performance relationship – status congruity and cognition-based trust.

Design/methodology/approach

The authors surveyed 197 employees and 56 supervisors across 59 work groups to test for the moderating effects of status congruity and cognition-based trust on the age diversity, work group performance relationship.

Findings

The results demonstrated, on the one hand, that under conditions of status congruity (i.e. when there were high levels of perceived status legitimacy and veridicality) and/or when perceptions of cognition-based trust were high within the group, the relationship between age diversity and work group performance was positive. On the other hand, under conditions of status incongruity and/or low levels of cognition-based trust, this relationship was negative.

Research limitations/implications

The findings contribute to the literature by being the first to provide empirical evidence for the theorized effects of status on the performance of age-diverse work groups and also by demonstrating the effects of cognition-based trust in a new context – age-diverse work groups.

Practical implications

Arising from the study’s findings are several strategies, which are expected to help organizations enhance perceptions of status congruity and/or trust and ultimately the performance of their age-diverse work groups.

Originality/value

The paper is the first to empirically demonstrate the moderating effects of status congruity and cognition-based trust on the age diversity, work group performance relationship. The study also establishes important distinctions between the effects of objective status differences vs status perceptions.
Soft skills of construction project management professionals and project success factors
Authors: Zuo Jian , Zhao Xianbo , Nguyen Quan Bui Minh , Ma Tony , Gao Shang
Published: May 2018

Purpose

The purpose of this paper is twofold: first, to identify the soft skills of construction project management; and second, to investigate the influence of these soft skills on project success factors in the Vietnamese construction industry.

Design/methodology/approach

A questionnaire survey was conducted with 108 project management professionals from the Vietnamese construction industry. Partial least square structural equation modelling was employed in data analysis.

Findings

Four-dimensional structure of project success factors was confirmed in this study. Results also showed that soft skills of project managers significantly contributed to project success factors and hence the project success.

Research limitations/implications

There may be geographical limitation on the conclusions drawn from the findings. Similarly, the sample size was still small, despite a relatively high response rate. In addition, the majority of the respondents were contractors and clients as other project players were reluctant to respond to the survey.

Practical implications

This study provides an understanding of the relationship between soft skills and project success factors.

Originality/value

Although there have been studies focused on soft skills of project management and project success factors, few have attempted to analyse the effects of these soft skills on critical success factors. Thus, this study adds significantly to the existing research on both project management skills and project success factors.
Building energy conservation in atrium spaces based on ECOTECT simulation software in hot summer and cold winter zone in Iran
Authors: Amani Nima
Published: May 2018

Purpose

This paper aims to investigate the optimum energy consumption of building atriums in hot, cold and dry climate zones in Iran.

Design/methodology/approach

This paper uses simulation software to analyze atrium design for energy saving in buildings and the effects of the energy saving process on the use of atrium in hot summer and cold winter zones in Iran. The buildings exhibit brick cavity concrete block plaster for wall, double-glazed alum frame for glaze, concrete slab on ground for flour and plaster insulation suspend for ceiling. This process is analyzed by choosing a suitable atrium for building energy efficiency in warmest session for warm weather conditions and the coldest session for cold weather conditions in Iran.

Findings

According to the analysis done using simulation software, with respect to the hot need prevention of direct and indirect solar energy and cold need absorption of direct and indirect solar energy, four-side atrium with total radiation incident of 2,506,027 and 69,613 W, radiation absorption of 902,795 and 29,057 W and radiation transmission of 297,118 and 4,201 W in hot summer and in cold winter are the best optimum selections.

Originality/value

The results of this research are useful for both building energy efficiency and producing a comfortable living environment in the future and will support new observations of how residential building developers can accept sustainable strategies to grow their overtaking in the Iranian construction market.
A novel approach to solve a mining work centralization problem in blockchain technologies
Authors: Kano Yuki , Nakajima Tatsuo
Published: May 2018

Purpose

This paper aims to solve a mining work centralization problem using a gamification-based approach.

Design/methodology/approach

The authors have developed a simple blockchain application that incorporates a gamification concept into the mining work. Then, they asked some participants in an experiment to use the application for a week and gathered some insights from the responses on questionnaires.

Findings

The results show that the gamification-based approach distributed mining work among many participants by increasing their motivation to participate mining work.

Originality/value

The gamification-based approach solves a mining work centralization problem and opens a new direction for future blockchain technologies.
The role of actors in interactions between “innovation ecosystems”: drivers and implications
Authors: Pucci Tommaso , Runfola Andrea , Guercini Simone , Zanni Lorenzo
Published: May 2018

Purpose

The purpose of this paper is to study the role of the actors (especially firms) in interactions between contexts defined as “innovation ecosystems.”

Design/methodology/approach

The paper presents a conceptual framework. A review of the literature to frame the concepts of innovation ecosystems and the Industrial Marketing and Purchasing (IMP) approach is presented. A possible integration of the two concepts is then discussed.

Findings

The paper adds new discursive inputs to the concept of innovation ecosystem that validate its use in the context of the knowledge economy and extends the theories of knowledge, by analyzing the role that various actors who populate an innovative ecosystem play in the creation, learning, use, and dissemination of knowledge.

Originality/value

The paper furnishes an approach to the research on knowledge management and innovation, in the attempt to relate the IMP Group approach with the perspective of the “innovation ecosystems” concept.
Spatial heterogeneity in plant–soil feedbacks alters competitive interactions between two grassland plant species
Authors: Xue Wei , Berendse Frank , Bezemer T. Martijn
Published: May 2018

The effects of plants on soil vary greatly between plant species and in mixed plant communities this can lead to spatial variation in plant‐soil feedback (PSF) effects. Such spatial effects are thought to influence plant species coexistence, but the empirical evidence for this hypothesis is limited.

Here, we investigate how spatial heterogeneity in PSFs influences plant growth and competition. The experiment was carried out with high and low nutrient soils to examine how these effects depend on soil fertility. We collected soil from field plots planted for three years with monocultures of Anthoxanthum odoratum and Centaurea jacea and tested the performance of the two species in a greenhouse experiment in heterogeneous soils consisting of patches of “own” and “foreign” soils and in soils where the “own” and “foreign” soils were mixed homogeneously. In the test phase, plants were grown in monocultures and in 1:1 mixtures in live or sterilized soils.

Overall, A. odoratum in monocultures produced less aboveground biomass in heterogeneous soils than in homogeneous soils. Centaurea jacea produced less belowground biomass in live heterogeneous soils than in live homogeneous soils, but there was no difference between sterile heterogeneous and homogeneous soils. The belowground biomass per patch varied more in pots with live heterogeneous soils than in pots with live homogeneous soils for both plant species, but there was no difference between pots with sterile heterogeneous and homogeneous soils. In pots with plant mixtures, the difference in aboveground biomass between the two competing species tended to be smaller in heterogeneous than in homogeneous soils. In pots with heterogeneous soils, both plant species grown in mixtures produced more aboveground biomass in “foreign” soil patches than in “own” soil patches. The responses of plants to heterogeneous PSFs were not different between low and high nutrient soils.

Our results show that spatially heterogeneous PSFs can influence plant performance and competition via reducing the growth inequality between the two competing species by allowing selective growth in foreign soil patches, independent of initial soil nutrient availability. Such effect may slow down exclusion processes and thus promote the coexistence of competing species at the local scale in mixed plant communities.

A plain language summary is available for this article.
Breast and reproductive cancers in the transgender population: a systematic review
Authors: Joint R , Chen ZE , Cameron S
Published: April 2018

Background

The medical transition undergone by a transgender person may influence their risk of breast or reproductive cancer.

Objectives

To assess breast and reproductive cancer prevalence in the transgender population. To elucidate any associations between gender‐affirming hormones and risk of these cancers.

Search strategy

Following registration of review protocol with PROSPERO, five databases were searched.

Selection criteria

Included studies investigated breast, ovarian, uterine, cervical, vaginal, neovaginal, testicular and prostate cancer in the transgender population. Secondary studies, opinions, editorials and conference abstracts were excluded. No date, language or setting restrictions were applied.

Data collection and analysis

Two reviewers conducted literature searches and applied inclusion and exclusion criteria to the results. Studies were categorised, aggregated and analysed by study population (transmen/transwomen) and type of cancer.

Main results

The literature search produced 228 articles; 43 were included. The overall evidence quality was very low to low. In transgender women, 20 breast cancer cases, two neovaginal cancer cases, one testicular cancer case and eight prostate cancer cases were reported. In transgender men, 18 breast cancer cases, five ovarian cancer cases, four uterine/cervical cancer cases and one vaginal cancer case were reported.

Conclusions

There is insufficient evidence to estimate breast or reproductive cancer prevalence in the transgender population. Gender‐affirming hormones have not been shown to affect cancer risk, but there is a clear need for well‐designed, robust studies to confirm or refute this.

Funding

This study was undertaken as an education dissertation. No funding was received.

Tweetable abstract

Little is known about the impact of gender‐affirming hormones on breast or reproductive cancers in trans people.
An optimal rule for patent damages under sequential innovation
Authors: Chen Yongmin , Sappington David E.M.
Published: May 2018

We analyze the optimal design of damages for patent infringement when a follow‐on innovator may infringe the patent of an initial innovator. We consider damage rules that are linear combinations of the popular “lost profit” (LP) and “unjust enrichment” (UE) rules, coupled with a lump‐sum transfer between innovators. Such linear rules can sometimes induce the socially optimal levels of sequential innovation and the optimal allocation of industry output. The optimal linear rule achieves the highest welfare among all rules that ensure a balanced budget for the industry, and often secures substantially more welfare than either the LP rule or the UE rule.
Design of public procurement auctions: evidence from cleaning contracts
Authors: Hyytinen Ari , Lundberg Sofia , Toivanen Otto
Published: May 2018

We analyze a regime change from beauty contests to first‐price sealed‐bid and scoring auctions, using Swedish data on public procurement of cleaning services. In beauty contests, the lowest bid often lost, leaving substantial money on the table. The procurement costs were similar before and after the regime change: (i) Entry strongly decreases the procurement cost but did not change. Entry would have decreased had the municipalities not adjusted the objects of auctions. (ii) Municipalities favored in‐house suppliers in the old regime, leading to more aggressive bidding by others. With favoritism reduced, these changes balanced each other out.
Drug‐induced dysphoria is enhanced following prolonged cocaine abstinence and dynamically tracked by nucleus accumbens neurons
Authors: Haake Rachel M. , West Elizabeth A. , Wang Xuefei , Carelli Regina M.
Published: May 2018

Negative reinforcement models postulate that addicts use drugs to alleviate negative affective states (e.g. dysphoria) associated with withdrawal. In a pre‐clinical model, rats exhibit negative affect to a normally rewarding tastant when it predicts impending, but delayed cocaine, and nucleus accumbens (NAc) neurons dynamically track this state. Here, we examined the effects of short versus prolonged experimenter‐imposed cocaine abstinence on negative affect, cocaine seeking and self‐administration. Rats were given 14 saccharin‐cocaine sessions; NAc activity and affective responses to the taste (i.e. taste reactivity) were measured during sessions 1 and 14. Next, following 1 or 30 days of abstinence, taste reactivity and cell firing were recorded in a three‐phase test session: (1) intraoral saccharin infusions, (2) extinction and (3) cocaine self‐administration. Results showed that 30 days of abstinence led to a significant enhancement of aversive responses to the cocaine‐paired tastant, accompanied by a dramatic decline in NAc phasic activity during tastant infusion. While extinction behavior did not differ across groups, NAc phasic firing reemerged during drug seeking. Further, when drug was again readily available, greater aversion to the drug‐paired tastant before and after abstinence was associated with increased self‐administration following prolonged (30‐day) abstinence in rats classified as high (not low) aversive. Collectively, these findings show that drug‐induced dysphoria is enhanced following prolonged cocaine abstinence and that NAc neural signaling is dynamic, dampening when negative affect is at its highest (phase 1), but transitioning back ‘online’ during subsequent drug seeking and taking (phases 2 and 3).
Oncologist provision of smoking cessation support: A national survey of Australian medical and radiation oncologists
Authors: Day Fiona L. , Sherwood Emma , Chen Tina Y. , Barbouttis Margaret , Varlow Megan , Martin Jarad , Weber Marianne , Sitas Freddy , Paul Christine
Published: April 2018

Aim

Continued smoking in patients diagnosed with cancer affects treatment outcomes and overall survival. With national surveys of Australian medical oncologists (MO) and radiation oncologists (RO) we sought to determine current clinical practices, preferences and barriers in providing patient smoking cessation support.

Methods

Oncologist members of the Medical Oncology Group of Australia (n = 452) and Trans‐Tasman Radiation Oncology Group (n = 230) were invited to participate in a multiple choice survey exploring smoking cessation practices and beliefs.

Results

The survey response rate was 43%. At first consultations more than 90% of MO and RO regularly asked patients if they smoke or use tobacco products, closely followed by documentation of duration of smoking history and current level of consumption. Less common was asking the patient if they intended to quit (MO 63%, RO 53%) and advising cessation (MO 70%, RO 72%). Less than 50% of oncologists regularly asked about current smoking in follow‐up consultations. Although a range of referral options for smoking cessation care were used by oncologists, only 2% of MO and 3% of RO actively managed the patients’ smoking cessation themselves and this was the least preferred option. The majority believed they require more training in cessation interventions (67% MO, 57% RO) and cited multiple additional barriers to providing cessation care.

Conclusions

Oncologists strongly prefer smoking cessation interventions to be managed by other health workers. A collaborative approach with other health professionals is needed to aid the provision of comprehensive smoking cessation care tailored to patients with cancer.
Plasma markers of oxidative status were associated with increasing continuous cardiometabolic risk scores in healthy students aged 16–20 years without central obesity
Authors: Koborová I , Gurecká R , Csongová M , Šebek J , Šebeková K
Published: April 2018

Aim

We studied the association between increased cardiometabolic risk and markers of oxidative status and glycation in apparently healthy subjects who did not present with central obesity.

Methods

From 2011 to 2012, we recruited 2064 students (53% girls) aged 16–20 years from Western Slovakia. Their continuous metabolic syndrome scores (MSS) were calculated as a mean of the sum of the z‐scores of waist‐to‐height ratio, mean arterial pressure, triacylglycerols, high‐density lipoprotein‐cholesterol and quantitative insulin sensitivity check index. Plasma markers of protein glycation and oxidation, lipid peroxidation and total antioxidant status were analysed.

Results

In both genders, advanced oxidation protein products (AOPPs) increased across the MSS quintiles (p < 0.001). AOPPs and fructosamines were significant predictors of the MSS in both genders. Moreover, high‐sensitivity C‐reactive protein, leukocyte counts and advanced glycation end‐products (AGEs) contributed significantly in girls. Triacylglycerols, fructosamines, AGEs and total antioxidant capacity correlated significantly with AOPPs in both genders.

Conclusion

Advanced oxidation protein products may act as inflammatory mediators that contribute to the development of cardiometabolic afflictions. Determining these may provide information related to cardiometabolic risk and represent potential target to reduce or prevent irreversible oxidative stress‐induced cellular damage.
Outpatients with acute osteoarticular infections had favourable outcomes when they received just oral antibiotics without intravenous antibiotics
Authors: Alcobendas Rosa , Remesal Agustín , Murias Sara , Nuñez Esmeralda , Calvo Cristina
Published: April 2018

Aim

The traditional approach for acute paediatric osteoarticular infections (OAI) has comprised initial intravenous antibiotics followed by prompt oral antibiotics. We assessed how providing just oral antibiotics compared to the traditional two‐step approach.

Methods

This prospective study was performed at the Hospital La Paz, Madrid, Spain, from September 2015 to September 2016. We compared 25 outpatients, with good general health and a mean age of 25 months who received just oral antibiotics, with 228 hospitalised children of a similar age who received intravenous and oral antibiotics from other hospitals in the Spanish Network of Osteoarticular Infections.

Results

The groups were comparable in terms of age, sex, fever, erythrocyte sedimentation rate value, C‐reactive protein and diagnosis. The oral group comprised 15 with osteomyelitis, seven with septic arthritis, two with osteoarthritis and one with spondylodiscitis. This group had a lower percentage of Staphylococcus aureus (8% vs 26%, p = 0.06) and higher proportion of Kingella kingae (24% vs 9%, p = 0.017) than the intravenous group. There were complications (24%) and follow‐up sequelae (6%) in the intravenous group, but none in the oral group.

Conclusion

Outpatients with OAI who were in good general health had favourable outcomes when they received oral antibiotics without intravenous antibiotics.
Clinical usefulness of the faecal calprotectin test in suspected paediatric inflammatory bowel disease
Authors: Akobeng Anthony K.
Published: April 2018

Aim

The faecal calprotectin (FC) test is increasingly being used in clinical practice to help select children with gastrointestinal symptoms who might have inflammatory bowel disease (IBD) and benefit from endoscopies. We provide an overview of the advantages and limitations of the FC test.

Methods

PubMed was searched for meta‐analyses that had investigated the diagnostic accuracy of the FC test and the pooled sensitivity and specificity for distinguishing IBD from non‐IBD patients were used to calculate likelihood ratios (LR). These were applied to practical examples to explain how easily clinicians can use the results to modify pre‐test probabilities of IBD and generate post‐test probabilities for IBD.

Results

The positive LR and negative LR of the FC test were 2.8 and 0.015, respectively. The usefulness of the FC test depended on the pre‐test probability of IBD. When the pre‐test probability of IBD was low, a positive FC test did not necessarily indicate IBD. However, because of the very small negative LR, a negative FC result virtually ruled out IBD in most cases.

Conclusion

The FC test should not be used indiscriminately in children with gastrointestinal symptoms but should be targeted at those who are likely to have IBD.
Monitoring and interventions are needed to reduce the very high Caesarean section rates in Vietnam
Authors: Giang Hoang Thi Nam , Ulrich Sarah , Tran Hoang Thi , Bechtold‐Dalla Pozza Susanne
Published: April 2018

Aim

The aim of this study was to estimate the prevalence of Caesarean sections in the third largest city in Vietnam and identify the associated risk factors.

Methods

This descriptive study was conducted in Da Nang from April 2015 to March 2016 and the hospital‐based sample comprised 20 535 women who delivered during this period. Caesarean section cases were categorised into private and public hospitals and groups of primiparous and multiparous women.

Results

We recruited 10 of the 12 hospitals in the City and they covered 90% of births during the study period. The overall Caesarean section rate was 58.6%: 57.9% in public hospitals and 70.6% in private hospitals. The three main indications for Caesarean sections were previous Caesarean sections, cephalopelvic disproportion and foetal distress. The factors that increased the likelihood of Caesarean sections were the mother being over 30, having an office job, a history of abortions, having a male infant and a higher neonatal birth weight.

Conclusion

Our study demonstrated an extremely high rate of Caesarean section and associated factors in public and private hospitals in one of the biggest cities in Vietnam. The findings highlight the need for monitoring and interventions to reduce the Caesarean section rates.
Resources for nurturing childcare practices in urban and rural settings: Findings from the Colombia 2010 Demographic and Health Survey
Authors: Urke H. B. , Mittelmark M. B. , Amugsi D. A. , Matanda D. J.
Published: May 2018

Background

The health and development potential of young children is dependent on nurturing care (NC) provided by primary caregivers. NC encompasses attention to nutrition; symptom management; early learning, attachment, and socialization; and security and safety. Despite the importance of NC to child health and development, the measurement and study of NC are neglected. This has become a point of major concern in the public health field in low‐ and middle‐income countries (LMICs) such as Colombia where many families are hard pressed for childcare resources. The aims of this study were therefore to (a) create age‐specific NC summary indexes (0–5, 6–11, and 12–23 months) suitable for research in LMICs and (2) examine the relationship of NC to maternal resources.

Methods

2010 Colombia Demographic and Health Survey data were obtained from mothers and their children ages 0–5 months (n = 1,357); 6–11 months (n = 1,623); and 12–23 months (n = 3,006). Age‐specific NC indexes were created including information on child feeding, immunization, hygiene, response to illness symptoms, and psychosocial care. Independent variables included mother's education level and household assets, and enrolment in a government child development programme. Regression analyses with NC as the outcome variable were conducted with urban and rural subsamples in the 3 age groups.

Results

Among rural children, NC was significantly higher with greater household assets, maternal decision latitude, and development programme participation, with variation by child age. Among urban children, higher maternal education and white‐collar occupation also predicted higher NC, with some variation by age.

Conclusion

It is feasible to measure age‐specific NC in survey research, and NC is related to maternal resources. Age and urban–rural differences in how NC is related to social factors are observed. The findings support the importance of subgroup analysis in the study of NC in LMICs such as Colombia.
Preconception management of thyroid dysfunction
Authors: Okosieme Onyebuchi E. , Khan Ishrat , Taylor Peter N.
Published: April 2018

Uncorrected thyroid dysfunction in pregnancy has well‐recognized deleterious effects on foetal and maternal health. The early gestation period is one of the critical foetal vulnerability during which maternal thyroid dysfunction may have lasting repercussions. Accordingly, a pragmatic preconception strategy is key for ensuring optimal thyroid disease outcomes in pregnancy. Preconception planning in women with hypothyroidism should pre‐empt and mirror the adaptive changes in the thyroid gland by careful levothyroxine dose adjustments to ensure adequate foetal thyroid hormone delivery in pregnancy. In hyperthyroidism, the goal of preconception therapy is to control hyperthyroidism while curtailing the unwanted side effects of foetal and maternal exposure to antithyroid drugs. Thus, pregnancy should be deferred until a stable euthyroid state is achieved, and definitive therapy with radioiodine or surgery should be considered in women with Graves’ disease planning future pregnancy. Women with active disease who are imminently trying to conceive should be switched to propylthiouracil either preconception or at conception in order to minimize the risk of birth defects from carbimazole or methimazole exposure. Optimal strategies for women with borderline states of thyroid dysfunction namely subclinical hypothyroidism, isolated hypothyroxinaemia and thyroid autoimmunity remain uncertain due to the dearth of controlled interventional trials. Future trial designs should aspire to recruit and initiate therapy before conception or as early as possible in pregnancy.
Role of local anaesthetic nerve block in endoscopic sinus surgery: A systematic review and meta‐analysis
Authors: Shamil E. , Rouhani M.J. , Basetti S. , Bast F. , Hopkins C. , Surda P.
Published: April 2018

Objective

The aim of the study was to perform a systematic review of existing evidence on the role of local anaesthetic nerve block (LAB) in patients undergoing endoscopic sinus surgery (ESS).

Design

The databases searched were the Cochrane Register of Controlled Trials, MEDLINE and Embase using the Ovid portal (1946‐2017).

Results

Seven randomised controlled trials were included. Due to considerable heterogeneity of data, only two studies were pooled into meta‐analysis which demonstrated a statistically significantly better surgical field quality during ESS in the LAB group compared with the control group (MD −0.86; 95% CI −2.24, 0.51; P = .009). No adverse events related to LAB toxicity were reported.

Conclusions

Sphenopalatine ganglion LAB with adrenaline carries relatively low risk of morbidity, but may improve the quality of the surgical field in terms of bleeding. However, there are limitations of the study due to heterogeneity of methods, quality and size of the studies. Well‐conducted large RCTs are needed using standardised inclusion criteria, balanced baseline characteristics of cohorts, and validated subjective and objective outcome measures.
Risk factors including the presence of inflammation at the resection margins for colorectal anastomotic stenosis following surgery for diverticular disease
Authors: Bressan A. , Marini L. , Michelotto M. , Frigo A. C. , Da Dalt G. , Merigliano S. , Polese L.
Published: April 2018

Aim

The aim of this study was to investigate risk factors for anastomotic stenosis in patients operated on for diverticular disease. Histological inflammation and diverticula at the resection margins were also considered.

Method

Patients’ characteristics, the surgical technique and postoperative complications were collected from the medical records. Anastomotic stenoses were evaluated prospectively by rigid sigmoidoscopy during follow‐up examination. Histological specimens were examined by a single pathologist who investigated inflammation and diverticula at the resection margins. Twenty patients with anastomotic colorectal stenosis from a single tertiary centre were compared with 24 consecutive patients without stenosis. They were all operated on for diverticular disease over a specified time period.

Results

Histological inflammation and diverticula were found in 25% and 30% of the resection margins respectively. Univariate analysis showed that age > 71 years (P = 0.0002), female gender (P = 0.0069) and anastomoses located below 12 cm from the anal verge (P = 0.020) were risk factors for stenosis. No correlation was found between anastomotic stenosis and the presence of histological inflammation or diverticula at the resection margins. By multivariate analysis, only age > 71 years was found to be a statistically significant risk factor for stenosis (P = 0.0003, OR = 60.8, 95% CI: 6.4–575.5).

Conclusion

Anastomotic stenosis is a frequent, long‐term complication following surgery for diverticular disease. An analysis demonstrated that age is a risk factor for colorectal stenosis and that histological inflammation and the presence of diverticula near/at the resection margins have no effect on the incidence of stenosis.
Effect of pathologist's dedication on lymph node detection rate and postoperative survival in colorectal cancer
Authors: Unger L. W. , Muckenhuber M. , Riss S. , Argeny S. , Stift J. , Mesteri I. , Stift A.
Published: April 2018

Aim

As adjuvant chemotherapy in colorectal cancer relies on the identification of lymph node metastases, the pathologist's dedication may have a considerable influence on postoperative survival.

Method

The aim of this retrospective study was to assess the impact of the pathologist's dedication on lymph node detection rate and postoperative survival in patients operated on by a single experienced colorectal surgeon within a 5‐year period. We assessed 229 patients undergoing total mesorectal excision or complete mesocolic excision by the senior author between 1 January 2009 and 31 December 2013. Pathologists were grouped as ‘general pathologist’ or ‘dedicated pathologist’ depending on their dedication/specialization.

Results

Dedicated pathologists found statistically significantly more lymph nodes in colorectal specimens than general pathologists [23 (interquartile range 24) vs 14 (interquartile range 11), respectively; P < 0.001]. The detection rate of ≥ 12 lymph nodes per specimen was significantly higher in the dedicated pathologist group [65/74 (87.8%) vs 105/155 (67.7%); P = 0.016]. However, postoperative survival did not differ in the respective subgroups. In the multivariable analysis by Cox proportional hazard model, International Union against Cancer Stage IV was the only factor associated with decreased disease‐specific survival (hazard ratio 28.257; 95% CI 3.850–207.386; P = 0.001).

Conclusion

In our centre, the pathologist's dedication has an impact on lymph node detection rate but does not influence postoperative disease‐specific survival.
Factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus: decision‐curve analysis
Authors: Kondo M. , Nagao Y. , Mahbub M. H. , Tanabe T. , Tanizawa Y.
Published: April 2018

Aims

To identify factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus, using decision‐curve analysis.

Methods

A retrospective cohort study was performed. The participants were 123 Japanese women with gestational diabetes who underwent 75‐g oral glucose tolerance tests at 8–12 weeks after delivery. They were divided into a glucose intolerance and a normal glucose tolerance group based on postpartum oral glucose tolerance test results. Analysis of the pregnancy oral glucose tolerance test results showed predictive factors for postpartum glucose intolerance. We also evaluated the clinical usefulness of the prediction model based on decision‐curve analysis.

Results

Of 123 women, 78 (63.4%) had normoglycaemia and 45 (36.6%) had glucose intolerance. Multivariable logistic regression analysis showed insulinogenic index/fasting immunoreactive insulin and summation of glucose levels, assessed during pregnancy oral glucose tolerance tests (total glucose), to be independent risk factors for postpartum glucose intolerance. Evaluating the regression models, the best discrimination (area under the curve 0.725) was obtained using the basic model (i.e. age, family history of diabetes, BMI ≥25 kg/m2 and use of insulin during pregnancy) plus insulinogenic index/fasting immunoreactive insulin <1.1. Decision‐curve analysis showed that combining insulinogenic index/fasting immunoreactive insulin <1.1 with basic clinical information resulted in superior net benefits for prediction of postpartum glucose intolerance.

Conclusions

Insulinogenic index/fasting immunoreactive insulin calculated using oral glucose tolerance test results during pregnancy is potentially useful for predicting early postpartum glucose intolerance in Japanese women with gestational diabetes.