bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcomes in hypertensive patients treated with a single‐pill fixed‐dose combination of renin‐angiotensin system inhibitor and thiazide diuretic
Authors: Ho Chien-Te , Tung Ying‐Chang , Chou Shing‐Hsien , Hsiao Fu‐Chih , Lin Yu‐Sheng , Chang Chee‐Jen , Chu Pao‐Hsien
Published: October 2018

Two or more antihypertensive agents are required to achieve blood pressure control for the most hypertensive patients. However, comparison of clinical outcomes between fixed‐dose combinations (FDC) and free‐equivalent combinations of renin‐angiotensin system (RAS) inhibitor and thiazide diuretic is lacking nowadays. Patients who were newly diagnosed with hypertension between July 1st, 2008 and December 31st, 2011 and prescribed with FDC (n = 13 176) or free combinations of RAS inhibitors and thiazide diuretic (n = 4392) were identified from the National Health Insurance Research Database of Taiwan and matched in 3:1 ratio using the propensity score method. The primary end point was major adverse cardiovascular events (MACE). The secondary end points were hospitalization of heart failure, new diagnosis of chronic kidney disease, and the initiation of dialysis. Compared with he FDC group was associated with better medication adherence compared with the free combination group. FDC of RAS inhibitor and thiazide diuretic reduced MACE (hazard ratio [HR]: 0.85; 95% confidence interval [CI]: 0.74‐0.97; P = 0.017), hospitalization for heart failure and initiation of dialysis compared with the free combination regimens. The outcome benefits of FDC was mainly driven by reduced cardiovascular and renal events in the patients with proportion of days covered <80%. In this retrospective claims database analysis, compared with the free combination regimens, the use of FDC of RAS inhibitor and thiazide diuretic was associated with improved medication compliance and clinical outcomes in the management of hypertension, particularly in the patients with poor medication adherence.
Sleep duration and 24‐hour ambulatory blood pressure in adults not on antihypertensive medications
Authors: Shulman Rachel , Cohen Debbie L. , Grandner Michael A. , Gislason Thorarinn , Pack Allan I. , Kuna Samuel T. , Townsend Raymond R. , Cohen Jordana B.
Published: October 2018

Short sleep duration has been widely linked to increased cardiovascular morbidity and mortality. We performed a post hoc analysis of 24‐hour ambulatory blood pressure monitoring (ABPM) in the Lifestyle Modification in Blood Pressure Lowering Study (LIMBS) and Penn Icelandic Sleep Apnea (PISA) Study. The 24‐hour mean systolic blood pressure (BP) was 12.7 mm Hg higher in LIMBS (P < 0.001; n = 66) and 4.7 mm Hg higher in PISA (P = 0.005; n = 153) among participants with shorter sleep duration (less than 7 hours) compared to those with longer sleep duration (at least 7 hours). In multivariable adjusted models, shorter sleep duration was strongly associated with higher systolic BP on 24‐hour ABPM, independent of nocturnal BP and in‐office BP. There was no effect modification by obstructive sleep apnea. Adults with shorter sleep duration may benefit from screening with 24‐hour ABPM to promote earlier detection of hypertension and potentially mitigate their increased risk for future cardiovascular disease.
Association Between Sarcopenic Obesity and Falls in a Multiethnic Cohort of Postmenopausal Women
Authors: Follis Shawna , Cook Alan , Bea Jennifer W. , Going Scott B. , Laddu Deepika , Cauley Jane A. , Shadyab Aladdin H. , Stefanick Marcia L. , Chen Zhao
Published: October 2018

OBJECTIVES

To investigate associations between sarcopenia, obesity, and sarcopenic obesity and incidence of falls in a racially and ethnically diverse cohort of healthy postmenopausal women.

DESIGN

Prospective cohort study.

SETTING

Three Women's Health Initiative (WHI) clinical centers (Tucson‐Phoenix, AZ; Pittsburgh, PA; Birmingham, AL).

PARTICIPANTS

Postmenopausal women aged 50 to 79 enrolled in the WHI who underwent bone and body composition scans using dual‐energy x‐ray absorptiometry at baseline (N = 11,020).

MEASUREMENTS

Sarcopenia was defined as the lowest 20th percentile of appendicular lean mass, correcting for height and body fat. Obesity was defined as a body fat percentage greater than 42%. Sarcopenic obesity was defined as co‐occurrence of sarcopenia and obesity. The fall outcome was defined as falling 2 or more times in any year during 7 years of follow‐up. The risk of falls associated with sarcopenic obesity were analyzed using log binomial regression models stratified according to age and race/ethnicity.

Results

Sarcopenic obesity was associated with greater risk of falls in women aged 50 to 64 (relative risk (RR) = 1.35, 95% confidence interval (CI)=1.17–1.56) and 65 to 79 (RR = 1.21, 95% CI=1.05–1.39). Sarcopenic obesity related fall risk was higher in Hispanic women (RR = 2.40, 95% CI=1.56–3.67) than non‐Hispanic white women (RR = 1.24, 95% CI=1.11–1.39).

Conclusion

In a multiethnic cohort of postmenopausal women, sarcopenic obesity–related fall risk was high in women younger than 65 and those age 65 and older. Sarcopenic obesity posed the highest risk for falls in Hispanic women. The findings support identification of causal factors and health disparities in sarcopenic obesity to customize fall prevention strategies and ameliorate this significant public health burden. J Am Geriatr Soc 66:2314–2320, 2018.
Men and women with Down syndrome exhibit different kinematic (but not spatio‐temporal) gait patterns
Authors: Pau M. , Condoluci C. , Zago M. , Galli M.
Published: October 2018

Background

Gait phenotypes are well documented in people with Down syndrome (pwDS), but sex‐related differences are still unexplored. This study investigated the existence of possible differences in spatio‐temporal and kinematic parameters of gait between men and women with DS using quantitative three‐dimensional gait analysis.

Methods

Gait patterns of 117 pwDS (53 F, 64 M) who underwent a computerised gait analysis from 2002 to 2017 were retrospectively analysed to obtain spatio‐temporal gait parameters and kinematics in the sagittal plane at hip, knee and ankle joints, as well as foot progression.

Results

Overall, when considered as a single group, the gait patterns found for pwDS confirmed the findings of previous studies. However, when analysed by sex, our data revealed that women with DS exhibit a larger hip flexion at late stance (42% to 54% of the gait cycle) and reduced knee flexion at the beginning of the swing phase (61% to 69% of the gait cycle). In contrast, men are characterised by larger foot extra‐rotation angles through most of the stance phase (from 0% to 55% of the gait cycle) and at the end of the swing phase (92% to 99% of the gait cycle). No differences between men and women with DS were found concerning ankle dorsi‐ plantar‐flexion or in all spatio‐temporal parameters normalised by individuals' anthropometry, excluding cadence (higher in women).

Conclusions

The findings of the present study highlight the need to investigate gait dysfunctions in pwDS by taking their sex into consideration. Such an approach may be useful not only in gaining a better understanding of the pathophysiology of gait disturbances associated with DS but also in supporting a better orientation of rehabilitative treatments.
Integrative Literature Review Examining Factors Affecting Patient Safety With Robotic‐Assisted and Laparoscopic Surgeries
Authors: Mathew Reshmi , Markey Kathleen , Murphy Jill , Brien Brid O’
Published: October 2018

Purpose

The purpose of this integrative literature review is to examine the evidence on factors affecting patient safety during robotic‐assisted and laparoscopic surgeries.

Design

Systematic review of papers published between 2011 and 2016 that identified factors affecting safety during robotic‐assisted and laparoscopic surgeries, in the areas of colorectal, general, urological, and gynecological surgeries.

Methods

A systematic literature search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Medline databases were performed. Twelve studies met the inclusion criteria outlining factors affecting safety in robotic‐assisted and laparoscopic surgeries. All 12 studies selected were quality appraised using the Critical Appraisal Skills Programme.

Findings

Using thematic analysis, the outcomes from the 12 studies were categorized into three thematic categories. Intraoperative communication, teamwork, and disruptions are the key factors affecting patient safety during robotic‐assisted and laparoscopic surgeries.

Conclusions

This integrative literature review identifies a dearth of evidence examining factors affecting patient safety during robotic‐assisted and laparoscopic surgeries. It draws attention to the complexities with teamwork, intraoperative communication and disruptions during robotic‐assisted and laparoscopic surgeries. Although robotic‐assisted surgery is generally seen as safe and effective, this review highlights the need for education and training that focuses on non‐technical skills development, disruption prevention and alertness in anticipating and minimising risk.

Clinical Relevance

The evidence from this review identifies the different demands and diverse challenges in maintaining safety during robotic‐assisted and laparoscopic surgery. Although specific technical knowledge and skills are essential, this review highlights the importance of developing new ways of thinking with regard to assessment and management of disruptions, developing different teamwork patterns and communication skills, and overcoming challenges introduced during technology advanced surgeries. Nurses in the perioperative setting have an increased responsibility to continue professional development and remain vigilant to factors affecting patient safety. Early identification and management of factors leading to disruptions is imperative in the provision of safe perioperative care.
Differin® and depilation, a word of warning
Authors: Harris Blair , Bitner Benjamin , Thomas Logan
Published: October 2018

Background: Retinoid products are becoming increasingly popular due to their efficacy and mild side effect profile. A few cases of epidermal stripping with wax depilation have been reported, but all have been associated with oral retinoid use.

Aims: We aim to increase awareness of this adverse effect.

Methods: N/A

Results: N/A

Conclusion: While retinoid products are effective and have a low side effect profile, they may still cause adverse effects including the possibility of epidermal stripping with wax depilation.
The role of long‐wavelength ultraviolet A1 (UVA1) in acral vitiligo
Authors: El‐Zawahry Bakr Mohamed , Elmasry Maha Fathy , Ragab Amira
Published: October 2018

Introduction

Acral vitiligo is a resistant subtype of vitiligo that does not respond easily to any treatment modality. Ultraviolet A1 (UVA1) (340‐400 nm) therapy can penetrate the deep dermis of the skin and is relatively free of adverse effects associated with different phototherapeutic modalities. This study's objective was to evaluate the effect of medium‐dose long‐wavelength UVA1 (40‐70 J) in acral vitiligo treatment and compare it with topical psoralen plus ultraviolet A (topical PUVA).

Methods

Patients in this randomized‐controlled comparative clinical trial were divided into two groups, medium‐dose UVA1 group and topical PUVA group (10 acral vitiligo patients each). Patients received 36 sessions of phototherapy over a period of 12 weeks. Every patient was clinically evaluated monthly as regards the appearance of new lesions or increase in diameter of the current lesion according to point counting and vitiligo area severity index.

Results

No statistically significant clinical difference was found between patients in UVA1 and topical PUVA groups regarding response and pattern of response (P > 0.05).

Conclusion

Ultraviolet A1 seems to be of limited use as a monotherapy in acral vitiligo treatment. However, more studies combining it with other treatment modalities as systemic steroids and/or using higher UVA1 doses may prove beneficial.
Diffusely Abnormal White Matter, T2 Burden of Disease, and Brain Volume in Relapsing‐Remitting Multiple Sclerosis
Authors: Vertinsky Alexandra T. , Li David K.B. , Vavasour Irene M. , Miropolsky Vladislav , Zhao Guojun , Zhao Yinshan , Riddehough Andrew , Moore G.R. Wayne , Traboulsee Anthony , Laule Cornelia
Published: October 2018

BACKGROUND AND PURPOSE

Multiple sclerosis (MS) diffusely abnormal white matter (DAWM) is a mildly hyperintense magnetic resonance imaging abnormality distinct from typical lesions. Our goal was to investigate the prevalence and natural history of DAWM in a large cohort (n = 348) of relapsing–remitting MS (RRMS) patients.

METHODS

The presence of DAWM and relationship to changes in T2 burden of disease (BOD), brain volume (brain fractional ratio, BFR), and disability (Expanded Disability Status Scale, EDSS) were investigated at baseline and year 7–8 (long‐term follow‐up, LTF).

RESULTS

DAWM was present in 25.3% (88 of 348) of patients at baseline. At LTF, DAWM was unchanged in 69.3% (61 of 88), decreased in 28.4% (25 of 88), and increased in 2.3% (2 of 88) of patients. Baseline BOD and change in BOD did not significantly differ between patients with and without DAWM. DAWM was associated with greater reduction in BFR at LTF (P = .038). DAWM and DAWM change did not predict EDSS or EDSS progression.

CONCLUSIONS

DAWM is present in a quarter of RRMS patients, and rarely increases or develops de novo. DAWM predicts brain atrophy but does not predict physical disability. Because of its posterior periventricular location, further investigation is warranted to evaluate its relationship to other measures of disability, including visual spatial processing and cognitive function.
The smelly path to sympatric speciation?
Authors: Brock Chad D. , Wagner Catherine E.
Published: October 2018

In this issue of Molecular Ecology, Poelstra et al. () use genomic data to show that cichlid species in the adaptive radiation in Lake Ejagham, Cameroon, experienced gene flow with a riverine relative, primarily prior to their diversification. Intriguingly, this introgression brought with it olfactory alleles that the authors suggest may play a sensory role in speciation. As a classic example of sympatric speciation due to the highly restricted geography of this small (0.49 km2) crater lake (Schliewen et al., ), this result sheds new light on the history of this fascinating radiation. As genomic data for cichlid radiations accumulate, finding evidence of introgression increasingly appears to be the rule rather than the exception (Kautt et al., ; Meier et al., , ). However, two points are pressing as evidence for introgression mounts: (a) It is crucial to understand the assumptions of analytical approaches used and (b) it is important to think clearly about the divergent contexts in which evidence for introgression has been invoked as an important feature of adaptive radiation.
The Symptoms and Clinical events associated with Automatic Reprogramming (SCARE) at replacement notification study
Authors: Sinha Sunil K. , Carlson Daniel , Chrispin Jonathan , Barth Andreas S. , Rickard John Jack , Spragg David D. , Berger Ronald , Love Charles , Calkins Hugh , Tomaselli Gordon F. , Marine Joseph E.
Published: October 2018

Background

Pacemaker patients experience battery depletion that activates pacemaker's alert for replacement notification. Automatic reprogramming at replacement notification can result in loss of rate response and atrioventricular (AV) synchrony.

Objective

To determine if relevant symptoms or clinical events may be associated with automatic reprogramming at replacement notification.

Methods

Electronic medical record review was undertaken for 298 patients referred for pacemaker generator replacement. Primary endpoints were symptoms or clinical events during replacement notification period.

Results

Following elimination of duplicate pacemaker replacements (n = 12), “near‐replacement notification” or “recalled” (n = 15) and pacemakers at “end of life” (n = 5), 266 subjects were included. Three distinct reprogramming cohorts were identified; those with no change (control) in pacing mode (n = 46), those with loss of rate response (n = 154), and those with loss of AV synchrony ± rate response (n = 66). In total, 83 subjects (31.2%) had symptoms with significant differences seen between groups (control = 4.3%, loss of rate response = 26.0%, loss of AV synchrony ± rate response = 62.1%, P < 0.001). Overall, 28 subjects (10.5%) experienced clinical events with significant differences seen between groups (control = 0.0%, loss of rate response = 6.5%, loss of AV synchrony ± rate response = 27.3%, P < 0.001).

Conclusions

Automatic reprogramming at replacement notification was associated with significant symptoms in 26% of those who lost rate response and in 62% of those who lost AV synchrony ± rate response. Additionally, 27% of the latter cohort required nonelective clinical care.
Hybrid accountabilities and managerial agency in the third sector
Authors: Schwabenland Christina , Hirst Alison
Published: October 2018

This article investigates how the dynamics of conflicting accountabilities are managed within the context of the third sector; specifically in organizations providing services for people with learning difficulties. Multiple accountability relationships create organizational settings that are subject to multiple constraints and risks but also offer resources for agency. We analyse how managers take up agency to enable them to enact, resist or reconcile multiple accountabilities. Our study's contribution lies in our elucidation of the far‐reaching hybridity of the third sector and the complex forms of actorhood it cultivates, in which managers are able to handle resources with great dexterity, in pursuit of settlements which may only be contingent and temporary.
Parental satisfaction of child's perioperative care
Authors: Shafer Jonathan S. , Jenkins Brooke N. , Fortier Michelle A. , Stevenson Robert S. , Hikita Natasha , Zuk Jeannie , Gold Jeffrey I. , Golianu Brenda , Kaplan Sherrie H. , Mayes Linda , Kain Zeev N.
Published: October 2018

Background

Satisfaction in the hospital setting is an important component of both hospital funding and patient experience. When it comes to a child's hospital experience, parent satisfaction of their child's perioperative care is also necessary to understand. However, little research has been conducted on the predictors of this outcome. Therefore, the purpose of this current study was to validate a priori selected predictors for parental satisfaction in their child's perioperative process.

Methods

Eight hundred and ten pediatric patients who underwent tonsillectomy and adenoidectomy surgery and their parents were included in this study. The primary outcome was assessed using a 21‐item parent satisfaction questionnaire resulting in three satisfaction scores: overall care satisfaction, OR/induction satisfaction, and total satisfaction.

Results

Descriptive statistics and correlational analysis found that sedative‐premedication, parental presence at anesthesia induction, child social functioning, parental anxiety, and language were all significant predictors of various components of the satisfaction score. Regression models, however, revealed that only parent anxiety and child social functioning remained significant predictors such that parents who reported lower state anxiety (OR/induction satisfaction: OR = 0.975, 95% CI [0.957, 0.994]; total satisfaction: OR = 0.968, 95% CI [0.943, 0.993]) and who had higher socially functioning children (overall care satisfaction: OR = 1.019, 95% CI [1.005, 1.033]; OR/induction satisfaction: OR = 1.011, 95% CI [1.000, 1.022]) were significantly more satisfied with the perioperative care they received.

Conclusion

Lower parent anxiety and higher child social functioning were predictive of higher parental satisfaction scores.
The power of N‐PASS, aEEG, and BIS in detecting different levels of sedation in neonates: A preliminary study
Authors: Giordano Vito , Deindl Philipp , Goeral Katharina , Czaba Christine , Weninger Manfred , Berger Angelika , Olischar Monika , Werther Tobias
Published: October 2018

Background

Sedatives are essential drugs in every intensive care unit in order to ensure the patient's optimal level of comfort. Avoiding conditions of over‐ and under‐sedation is a challenge in a neonatal intensive care setting. Drug administration could be optimized by the concomitant use of objective methods to assess the level of sedation.

Aims

We aimed to look at the ability of different methods (Neonatal Pain, Agitation and Sedation Scale, amplitude‐integrated Electroencephalogram, and Bispectral Index), and their combination, in detecting different level of sedation.

Methods

Twenty‐seven neonates among whom 17 were receiving sedatives with or without opiate analgesics were monitored using the Neonatal Pain, Agitation and Sedation Scale, the amplitude‐integrated Electroencephalogram, and the Bispectral Index. According to the expert opinion of two trained neonatologists, patients were categorized into three groups: no, light, and deep sedation. Four hours of simultaneous assessment of the Neonatal Pain, Agitation and Sedation Scale scores, Burdjalov scores (to summarize the amplitude‐integrated Electroencephalogram trace), and Bispectral Index values were considered for the comparative analysis across these groups.

Results

All three methods could differentiate patients who were not sedated from those who were deeply sedated: median score 12 and 9, respectively, (95% CI of difference = 1.99‐5.99, P = 0.001) for the amplitude‐integrated Electroencephalogram Burdjalov score; median 1 and −5, respectively, (95% CI of difference = 2.99‐8.00, P = 0.001) for the Neonatal Pain, Agitation and Sedation Scale; and median 48 and 37, respectively, (CI of difference = 1.77‐22.00, P = 0.043) for the Bispectral Index. However none of them, used alone, was able to differentiate light and deep sedation: median score 10 and 9, respectively, for the amplitude‐integrated Electroencephalogram Burdjalov score; median −2 and −5, respectively, for the Neonatal Pain, Agitation and Sedation Scale; and median 48 and 37, respectively, for the Bispectral Index. Only the amplitude‐integrated Electroencephalogram and the Neonatal Pain, Agitation and Sedation Scale were able to differentiate between the conditions of no sedation and light sedation. Also, according to the area under the curves values, the combination of the Neonatal Pain, Agitation and Sedation Scale with the Burdjalov score derived from the amplitude‐integrated Electroencephalogram showed the best accuracy in differentiating light and deep sedation.

Conclusion

While none of the three methods alone was able to precisely differentiate between different levels of sedation, we suggest that using a combination of amplitude‐integrated Electroencephalogram and Neonatal Pain, Agitation and Sedation Scale can be useful to distinguish between light and deep sedation in neonatal patients.
Anesthetic considerations for magnetic resonance imaging‐guided right‐heart catheterization in pediatric patients: A single institution experience
Authors: Deutsch Nina , Swink Jonathan , Matisoff Andrew J. , Olivieri Laura J. , Cross Russell R. , Waberski Andrew T. , Unegbu Chinwe , Cronin Ileen F. , Kanter Joshua P. , Schwartz Jamie M.
Published: October 2018

Cardiac catheterization is an integral part of medical management for pediatric patients with congenital heart disease. Owing to age and lack of cooperation in children who need this procedure, general anesthesia is typically required. These patients have increased anesthesia risk secondary to cardiac pathology. Furthermore, multiple catheterization procedures result in exposure to harmful ionizing radiation. Magnetic resonance imaging‐guided right‐heart catheterization offers decreased radiation exposure and diagnostic imaging benefits over traditional fluoroscopy but potentially increases anesthetic complexity and risk. We describe our early experience with anesthetic techniques and challenges for pediatric magnetic resonance imaging‐guided right‐heart catheterization.
A retrospective comparison of propofol to dexmedetomidine for pediatric magnetic resonance imaging sedation in patients with mucopolysaccharidosis type II
Authors: Kang RyungA , Shin Young Hee , Gil Nam‐Su , Oh Ye Na , Hahm Tae Soo , Jeong Ji Seon
Published: October 2018

Background

Mucopolysaccharidosis type II patients are reported to have an elevated incidence of difficult airway. Propofol is a commonly used sedative for magnetic resonance imaging in pediatric patients, but patients who receive it may exhibit dose‐dependent upper airway obstruction and respiratory depression. Dexmedetomidine also provides adequate procedural sedation with a relatively low risk of airway obstruction. Accordingly, we introduced the use of dexmedetomidine in our practice to reduce the risk of airway obstruction during magnetic resonance imaging procedures.

Aims

The aim of this study was to evaluate the incidence of artificial airway interventions in patients sedated with propofol and compare it to that in patients sedated with dexmedetomidine in patients with mucopolysaccharidosis type II during magnetic resonance imaging procedures.

Methods

All mucopolysaccharidosis type II patients undergoing magnetic resonance imaging at our institution between April 2014 and February 2018 were included in this study. The patients were divided into two groups according to whether they were managed before and after the introduction of dexmedetomidine: those who were sedated with propofol (group P) and those who were sedated with dexmedetomidine (group D).

Results

Forty‐six sedations were performed in 27 patients. Artificial airway interventions were significantly more frequent during propofol‐based than dexmedetomidine‐based sedation: 14 of 32 (43.8%) in group P and 1 of 14 (7.1%) in group D (odds ratio, 10.11; 95% confidence interval, 1.18‐86.85; P = 0.018). Time to awake and time to discharge were similar between groups. Changes in hemodynamic variables also did not significantly differ between groups.

Conclusion

Dexmedetomidine provides an adequate level of sedation and is associated with lower rates of artificial airway interventions compared to propofol. Therefore, dexmedetomidine may offer advantages for preserving the native airway compared to propofol when administered during magnetic resonance imaging scans in patients with mucopolysaccharidosis type II.
Analgesic effectiveness, pharmacokinetics, and safety of a paracetamol/ibuprofen fixed‐dose combination in children undergoing adenotonsillectomy: A randomized, single‐blind, parallel group trial
Authors: Playne Rebecca , Anderson Brian J. , Frampton Chris , Stanescu Ioana , Atkinson Hartley C.
Published: October 2018

Background

Pain following tonsillectomy is often poorly managed in the home setting. Multimodal analgesia with acetaminophen (paracetamol) and nonsteroidal anti‐inflammatory drugs offers superior analgesia over monotherapy but may be difficult for caregivers to manage. A fixed‐dose combination oral suspension product containing paracetamol and ibuprofen has been developed to facilitate pediatric dosing.

Aims

The aims of this study are to determine the analgesic effectiveness, pharmacokinetics, and safety of the fixed‐dose combination at two doses in the pediatric population.

Methods

In this prospective, multicenter, randomized, single‐blind, parallel group trial, 251 children aged 2‐12 years undergoing day‐stay (adeno)tonsillectomy were randomized to two dose groups of the fixed‐dose combination. A doubled loading dose was given preoperatively, followed by treatment for up to 11 days (Higher dose: paracetamol 15 mg/kg + ibuprofen 4.5 mg/kg, Lower dose: paracetamol 12 mg/kg + ibuprofen 3.6 mg/kg). Blood samples were collected for pharmacokinetic analysis for up to 6 hours after the loading dose. The analgesic effectiveness was examined on the first day after surgery using both Parents Postoperative Pain Measurement and modified Wong‐Baker Faces pain scales. Rescue medication consumption was recorded throughout the study.

Results

Differences in maximum plasma concentration (Cmax) and total exposure (AUC0→t) between the treatment groups for both analytes were consistent with a 25% increase in dose; there was no difference in time to peak concentration (Tmax). On the first postoperative day, there was no difference in pain scores or rescue medication use between treatment groups (approximately 30% in both groups). The combination was well tolerated by both groups. The most common adverse events were vomiting and nausea. The incidence of postoperative bleeding was 4.4%.

Conclusion

The shallow dose‐response relationship and good tolerability of the fixed‐dose combination over an extended study period supports the utility of both doses of the fixed‐dose combination in the home setting.
Aggressive cribriform‐morular variant of papillary thyroid carcinoma: Report of an unusual case with pulmonary metastasis displaying poorly differentiated features
Authors: Tsuji Hiromi , Yasuoka Hironao , Nakamura Yasushi , Hirokawa Mitsuyoshi , Hiroshima Takashi , Sakamaki Yasushi , Miyauchi Akira , Tsujimoto Masahiko
Published: October 2018

The cribriform‐morular variant of papillary thyroid carcinoma (CMV‐PTC) is a rare morphologic entity in which metastasis rarely occurs. Until now, only three cases of metastasis by CMV‐PTC have been reported. We present a rare sporadic case of CMV‐PTC with multiple lung metastases in a 28‐year‐old female, 3 years after total thyroidectomy. The lung tumor was not encapsulated but well‐circumscribed and showed a mixture of cribriform, papillary, and solid patterns of growth with necrosis. The tall columnar carcinoma cells did not display the typical nuclear features of PTC. Carcinoma cells were positive for thyroid transcription factor 1, paired‐box gene 8, estrogen receptor, progesterone receptor, and adenomatous polyposis coli, and showed positive nuclear and cytoplasmic staining for β‐catenin. Carcinoma cells were negative for thyroglobulin and CDX‐2, and the Ki‐67 labeling index was 22.1%. This immunoprofile suggests a pathological diagnosis of metastasis by a CMV‐PTC displaying poorly differentiated features. To the best of our knowledge, our case is the first report of CMV‐PTC with pulmonary metastasis that was confirmed by histological and immunohistochemical examinations. The present case suggests that CMV‐PTC with a high Ki‐67 labeling index may cause visceral metastasis.
Comparative studies of photosynthetic capacity in three pigmented red algal parasites: Chlorophyll a concentrations and PAM fluorometry measurements
Authors: Preuss Maren , Zuccarello Giuseppe C.
Published: October 2018

Over 100 species of red algae have been described as parasites on other red algae, but the majority show some degree of pigmentation. This raises the question of their parasitic status, especially their abilities to photosynthesize and their dependence on their host for fixed carbon. Are they considered parasites only based on morphological characters, for example, reduced size and secondary pit connection to the host? Translocation of nutrients from host to parasite have been shown for very few red algal parasites, and these were mostly unpigmented. This study investigated three pigmented red algal parasites (Rhodophyllis parasitica, Vertebrata aterrimophila and Pterocladiophila hemisphaerica) from New Zealand. We quantified their chlorophyll a content and also measured their PSII capacity using PAM fluorometry. All three parasites contained chlorophyll a. The parasites Rhodophyllis parasitica and Vertebrata aterrimophila were not able to photosynthesize and must therefore be fully nutritional dependent on their host. The parasite Pterocladiophila hemisphaerica was able to photosynthesize independently, but based on molecular characteristics we suggest that it relies on the host plastid to do photosynthesis. Our results support the parasitic status of all three species and highlights the necessity of more studies investigating the differences in host dependency in red algal parasites.
The lesser mealworm Alphitobius diaperinus: a noxious pest or a promising nutrient source?
Authors: Rumbos Christos I. , Karapanagiotidis Ioannis T. , Mente Eleni , Athanassiou Christos G.
Published: October 2018

The lesser mealworm, Alphitobius diaperinus (Panzer) (Coleoptera: Tenebrionidae), is one of the most common insect pests in commercial poultry farms, where it reproduces within the litter floor, feeding on poultry manure, spilled feed and other organic material. It can also infest, feed and reproduce on stored grains and related amylaceous commodities. Its significance is related mostly with the fact that it serves as reservoir and vector for many pathogens that cause serious diseases, such as Salmonella, Escherichia and various viruses. Recently, A. diaperinus attracted a lot attention as it was listed in the EU Regulation 2017/893 among the insect species that are allowed to be used for the production of insect meal as aquafeed ingredient, changing our perspective on this insect from a noxious pest to a potential nutrient source. This is the first review on A. diaperinus summarizing the significant recent findings in its biology and control. Moreover, this review aims to provide a helpful tool for aquaculture scientists working with A. diaperinus as aquafeed ingredient. Therefore, we gather and highlight the available data that classify A. diaperinus as a promising insect‐based protein provider and we comment and discuss on the public concerns that arise from its utilization as feed.
Lesbian, Gay, and Bisexual human rights as a global health issue
Authors: Marchia Joseph
Published: October 2018

The purpose of this review article is to connect sociological perspectives on global health to Lesbian, Gay, and Bisexual health disparities. This article uses the ecosocial theory of health to analyze the ratification of LGB human rights as a cross‐national contributor to health outcomes for the LGB population. I outline the findings of previous research on this intersection as well as call for more research on this relationship by addressing the gaps within the literature and available data, which have stalled more robust analysis. Finally, I address potential future directions for research including further data collection and attentiveness to national contexts.
Extensive allele‐level remodeling of histone methylation modification in reciprocal F1 hybrids of rice subspecies
Authors: Lv Zhenling , Zhang Wenjie , Wu Ying , Huang Shuangzhan , Zhou Yunxiao , Zhang Ai , Deng Xin , Xu Chunming , Xu Zhengyi , Gong Lei , Liu Bao
Published: October 2018

Epigenetic mechanisms play a major role in heterosis, partly as a result of the remodeling of epigenetic modifications in F1 hybrids. Based on chromatin immunoprecipitation‐sequencing (ChIP‐Seq) analyses, we show that at the allele level extensive histone methylation remodeling occurred for a subset of genomic loci in reciprocal F1 hybrids of Oryza sativa (rice) cultivars Nipponbare and 93‐11, representing the two subspecies japonica and indica. Globally, the allele modification‐altered loci in leaf or root of the reciprocal F1 hybrids involved ˜12–43% or more of the genomic regions carrying either of two typical histone methylation markers, H3K4me3 (>21 000 genomic regions) and H3K27me3 (>11 000 genomic regions). Nevertheless, at the total modification level, the majority (from ˜43 to >90%) of the modification‐altered alleles lay within the range of parental additivity in the hybrids because of concerted alteration in opposite directions, consistent with an overall attenuation of allelic differences in the modifications. Importantly, of the genomic regions that did show non‐additivity in total modification level by either marker in the two tissues of hybrids, >80% manifested transgressivity, which involved genes enriched in specific functional categories. Extensive allele‐level alteration of H3K4me3 alone was positively correlated with genome‐wide changes in allele‐level gene expression, whereas at the total level, both H3K4me3 and H3K27me3 remodeling, although affecting just a small number of genes, contributes to the overall non‐additive gene expression to variable extents, depending on tissue/marker combinations. Our results emphasize the importance of allele‐level analysis in hybrids to assess the remodeling of epigenetic modifications and their relation to changes in gene expression.
Completeness and accuracy of self‐reported history of blood donation: results from a cohort of older adults in Australia
Authors: Karki Surendra , Davison Tanya E. , Thijsen Amanda , Gemelli Carley N. , Irving David O. , Wright Stephen T.
Published: October 2018

BACKGROUND

The validity of studies relying on self‐report of blood donation may be severely threatened by systematic errors.

STUDY DESIGN AND METHODS

We linked the Sax Institute's 45 and Up Study data, which asked self‐report of blood and plasma donation including the date of most recent donation to the blood donor database at the Australian Red Cross Blood Service. We used the linked data to validate the accuracy of self‐reported blood donation history including the completeness and accuracy of reported date of most recent donation.

RESULTS

Of the total 142,503 participants, 47.8 and 5.1% reported ever donating blood and plasma, respectively. Of those self‐reporting blood donation (n = 23,113) and plasma donation (n = 4,451) within the last 10 years of survey, 6262 (27.1%) and 1444 (33.0%) had no record of donation within that period, respectively. Among those who had a record of blood and plasma donation within 10 years before the survey, 97.6 and 93.0% correctly self‐reported ever donating blood and plasma, respectively. Donors consistently reported a donation date more recent than the actual recorded date, and the median discrepancy and variability increased as the length of time from the survey date to the actual date of donation increased.

CONCLUSIONS

Almost 98% of donors donating blood within a decade of survey completion date can correctly self‐report their history of donation as ever donating blood, whereas 27% of participants self‐reporting donation within a decade may not have actually donated blood. Further, self‐reported date of blood donation is not a reliable measure of actual date of donation.
Antibiotic‐resistant Shiga toxin‐producing Escherichia coli: An overview of prevalence and intervention strategies
Authors: Mir Raies A. , Kudva Indira T.
Published: October 2018

Shiga toxin‐producing Escherichia coli (STEC) are foodborne pathogens that can cause severe diseases, including bloody diarrhoea and kidney failure, in humans, while remaining harmless to its primary reservoir hosts, cattle. Antibiotics such as azithromycin, fosfomycin and meropenem are being used and recommended in the treatment of early‐stage STEC (mainly E. coli O157:H7) infections, as these are reportedly effective in preventing Shiga toxin release and kidney failure while eliminating the pathogen. However, antibiotic resistance among STEC isolates could negatively impact these and other similar treatment options while contributing towards the spread of antibiotic resistance genes especially if encoded on mobile genetic elements like plasmids. Antibiotic resistance among STEC isolates recovered from animals and patients is being reported globally. A comprehensive understanding of the prevalence of antibiotic‐resistant STEC (AR‐STEC) and the mechanisms promoting this resistance among these bacteria could help direct therapies and develop strategies to effectively reduce/eliminate these pathogens. Here, we have reviewed literature from the past three decades to gain insights on this prevalence and its impact on human infections. In addition, we have reviewed various strategies proposed by researchers to control STEC that in turn would be applicable to AR‐STEC as well.
Comparison of Physical Parameters of the Individuals Who Have Received NASM-OPT Model & EMS Training in Combination With Traditional Fitness Training Applications Regularly as Personal Training (PT) for 20 Weeks
Authors: Bıyıklı Türker
Published: October 2018

In the study, it is aimed to determine whether there is any improvement in the physical performance development of the individuals, who have made exercise with OPT MODEL -EMS mix. and traditional PT models within the 20-week exercise program. In the study, pre-test, posttest, experimental screening by pattern methods are used. Study groups consist of 30 individuals, who are healthy and voluntary, continuing the fitness centers in Netherlands (OPT-EMS; n=30) and in Turkey (PT; n=30). After the data obtained is entered in computer environment; the arithmetic means (X), standard deviations (ss) of the research groups are taken and the Paired Samples t-test is applied for the differences between the pre-test and posttest. Significance level is examined at p<0.05 level. When the study findings are examined, statistically significant differences are observed in the push-up, squat, crunch, plank and Max Vo2 performance measurements of the participants in 20-week OPT-EMS group (p<0.05). Also, a statistically significant difference is found in the left hand grip and plant test performance measurements of the participants in 20-week PT group (p<0.05).As a result, the OPT model, which is an innovative approach and has five different training phases, and the continuation of training with EMG for a certain period of time can be said to contribute to the physical performance. In addition, in case PT training content is prepared according to the individual, it is considered that it will contribute to physical performance.
Acaricidal and sublethal effects of tobacco leaf and garlic bulb extract and soft soap on Tetranychus urticae Koch. (Acari: Trombidiformes: Tetranychidae)
Authors: Akyazi Rana , Soysal Mete , Altunc Yunus Emre , Lisle Allan , Hassan Errol , Akyol Duygu
Published: October 2018

The ovicidal, adulticidal and fecundity effects of tobacco (Nicotiana tabacum L.) leaf extract, garlic (Allium sativum L.) bulb extract, soft soap and their binary mixtures were investigated against Tetranychus urticae Koch. (Trombidiformes: Tetranychidae) eggs and adult females under controlled conditions [25°C±1, 65±5% R.H. (mean±SD) and a photoperiod of 16L: 8D (Light: Dark)]. The concentrations used for the ovicidal and adulticidal effect were chosen after preliminary bioassays to obtained mortality rates equally distributed between 0%–100%. However, one concentration giving around 50 % percent adult mortality of each compound was tested for fecundity effect. Each stock solution was diluted separately with distilled water to give the desired different concentrations of each extract. The results showed that the tobacco leaf extract, the soft soap and the garlic extract+soap mixture were the most toxic against adult females. Although the garlic bulb extract had the lowest toxic effect, its mixtures with the soft soap and tobacco extract showed higher toxicity against the adults. Moreover, the tobacco application at the tested dose significantly reduced the T. urticae fecundity. It is also determined that the tobacco leaf and garlic bulb extracts have potential to be used in the control of T. urticae eggs. On the other hand, the ovicidal activity of soft soap can be increased by addition of the garlic extract.  However, further investigation is needed to assess their phytotoxicity under greenhouse and field conditions. The efficacy of these compounds to natural enemies should also be measured.
Single-Dose Pharmacokinetics, Excretion, and Metabolism of Zoliflodacin, a Novel Spiropyrimidinetrione Antibiotic, in Healthy Volunteers
Authors: O’Donnell John , Lawrence Ken , Vishwanathan Karthick , Hosagrahara Vinayak , Mueller John P.
Published: October 2018

Zoliflodacin is a novel spiropyrimidinetrione with activity against bacterial type II topoisomerases that inhibits DNA biosynthesis and results in accumulation of double-strand cleavages in bacteria. We report results from two phase 1 studies that investigated the safety, tolerability, and pharmacokinetics (PK) of zoliflodacin and absorption, distribution, metabolism, and excretion (ADME) after single doses in healthy volunteers.
Rapid Detection of Fosfomycin Resistance in Escherichia coli
Authors: Nordmann Patrice , Poirel Laurent , Mueller Linda
Published: October 2018

The rapid fosfomycin/
Escherichia coli
NP test was developed to detect fosfomycin resistance in
E. coli
isolates. The test is based on glucose metabolization and the detection of bacterial growth in the presence of fosfomycin at 40 µg/ml.
Genome-Wide Association Analyses in the Model Rhizobium
Ensifer meliloti
Authors: Epstein Brendan , Abou-Shanab Reda A. I. , Shamseldin Abdelaal , Taylor Margaret R. , Guhlin Joseph , Burghardt Liana T. , Nelson Matthew , Sadowsky Michael J. , Tiffin Peter
Published: October 2018

Genome-wide association analyses are a powerful approach for identifying gene function. These analyses are becoming commonplace in studies of humans, domesticated animals, and crop plants but have rarely been conducted in bacteria. We applied association analyses to 20 traits measured in
Ensifer meliloti
, an agriculturally and ecologically important bacterium because it fixes nitrogen when in symbiosis with leguminous plants. We identified candidate alleles and gene presence-absence variants underlying variation in symbiosis traits, antibiotic resistance, and use of various carbon sources; some of these candidates are in genes previously known to affect these traits whereas others were in genes that have not been well characterized. Our results point to the potential power of association analyses in bacteria, but also to the need to carefully evaluate the potential for false associations.
Intracellular Signaling by the
comRS
System in
Streptococcus mutans
Genetic Competence
Authors: Underhill Simon A. M. , Shields Robert C. , Kaspar Justin R. , Haider Momin , Burne Robert A. , Hagen Stephen J.
Published: October 2018

The ComRS system can function as a quorum sensing trigger for genetic competence in
S. mutans
. The signal peptide XIP, which is derived from the precursor ComS, enters the cell and interacts with the Rgg-type cytosolic receptor ComR to activate
comX
, which encodes the alternative sigma factor for the late competence genes. Previous studies have demonstrated intercellular signaling via ComRS, although release of the ComS or XIP peptide to the extracellular medium appears to require lysis of the producing cells. Here we tested the complementary hypothesis that ComRS can drive
comX
through a purely intracellular mechanism that does not depend on extracellular accumulation or import of ComS or XIP. By combining single-cell, coculture, and microfluidic approaches, we demonstrated that endogenously produced ComS can enable ComRS to activate
comX
without requiring processing, export, or import. These data provide insight into intracellular mechanisms that generate noise and heterogeneity in
S. mutans
competence.