bluuebunny/crossref_metadata_2025 huggingface dataset:
Matched Case-Control Comparative Study of Laparoscopic Versus Open Pancreaticoduodenectomy for Malignant Lesions
Authors: Khaled Yazan S. , Fatania Kavi , Barrie Jenifer , De Liguori Nicola , Deshpande Rahul , O’Reilly Derek A. , Ammori Basil J.
Published: February 2017

Introduction:

Advances in surgical technologies allowed safe laparoscopic pancreaticoduodenectomy (LPD). The aim of this study is to compare the oncologic outcomes of LPD to open pancreaticoduodenectomy (OPD) in terms of safety and recurrence rate.

Materials and Methods:

A cohort of 30 patients were matched for age, sex, American Society of Anaesthesiologists, tumor size, pancreatic duct diameter, and histopathologic diagnosis on a 1:1 basis (15 LPD, 15 OPD). Comparison between groups was performed on intention-to-treat basis. Survival following resection was compared using the Kaplan-Meier survival analysis.

Results:

The median operating time for LPD group was longer than for OPD group (470 vs. 310 min; P=0.184). However, estimated blood loss (300 vs. 620 mL; P=0.023), high dependency unit stay (2.0 vs. 6.0 d; P=0.013) and postoperative hospital stay (9.0 vs. 17.4 d; P=0.017) were significantly lower in the LPD group. There was no significant difference in postoperative rates of morbidity (40% vs. 67%; P=0.431) and mortality (0% vs. 6.7%; P=0.99). The surgical resection margins R0 status (87% vs. 73%; P=0.79) and the number of lymph nodes (18 vs. 20; P=0.99) in the resected specimens were comparable between the 2 groups. There was no significant difference in overall survival outcomes.

Conclusions:

In selected patients, the laparoscopic approach to pancreaticoduodenectomy in the hands of the experienced offers advantages over open surgery without compromising the oncologic resection.
Robotic Rectal Resection With a Single-docking Technique Thanks to the Rotation of the R3 Arm
Authors: Pesi Benedetta , Annecchiarico Mario , Amore Bonapasta Stefano , Nerini Alessandro , Perna Federico , Bencini Lapo , Di Marino Michele , Coratti Andrea
Published: February 2017

Background:

Robotic surgery for rectal resection presents some advantages compared with the traditional technique; however, it also presents some limitations, especially due to the multiple changes of surgical fields. We describe a new technique to perform low-anterior resection using single docking with the rotation of the third arm and our perioperative results.

Materials and Methods:

A total of 31 patients who underwent low-anterior rectal robotic resection with single-docking technique using robotic daVinci SI (Surgical Intuitive System) were included in the study.

Results:

The mean operative time was 338 minutes. The conversion rate was 3%. The mean time of refeeding was 1.4 days and the mean time of hospital stay was 6 days.

Conclusions:

Our technique allowed to use the robot for all surgical steps with a single docking, thereby reducing the cost of the hybrid technique and facilitating the operative team in the management of the robotic cart.
A broad-scale comparison of aerobic activity levels in vertebrates: endotherms versus ectotherms
Authors: Gillooly James F. , Gomez Juan Pablo , Mavrodiev Evgeny V.
Published: February 2017

Differences in the limits and range of aerobic activity levels between endotherms and ectotherms remain poorly understood, though such differences help explain basic differences in species' lifestyles (e.g. movement patterns, feeding modes, and interaction rates). We compare the limits and range of aerobic activity in endotherms (birds and mammals) and ectotherms (fishes, reptiles, and amphibians) by evaluating the body mass-dependence of VO2max, aerobic scope, and heart mass in a phylogenetic context based on a newly constructed vertebrate supertree. Contrary to previous work, results show no significant differences in the body mass scaling of minimum and maximum oxygen consumption rates with body mass within endotherms or ectotherms. For a given body mass, resting rates and maximum rates were 24-fold and 30-fold lower, respectively, in ectotherms than endotherms. Factorial aerobic scope ranged from five to eight in both groups, with scope in endotherms showing a modest body mass-dependence. Finally, maximum consumption rates and aerobic scope were positively correlated with residual heart mass. Together, these results quantify similarities and differences in the potential for aerobic activity among ectotherms and endotherms from diverse environments. They provide insights into the models and mechanisms that may underlie the body mass-dependence of oxygen consumption.
How numbers of nesting sea turtles can be overestimated by nearly a factor of two
Authors: Esteban Nicole , Mortimer Jeanne A. , Hays Graeme C.
Published: February 2017

Estimating the absolute number of individuals in populations and their fecundity is central to understanding the ecosystem role of species and their population dynamics as well as allowing informed conservation management for endangered species. Estimates of abundance and fecundity are often difficult to obtain for rare or cryptic species. Yet, in addition, here we show for a charismatic group, sea turtles, that are neither cryptic nor rare and whose nesting is easy to observe, that the traditional approach of direct observations of nesting has likely led to a gross overestimation of the number of individuals in populations and underestimation of their fecundity. We use high-resolution GPS satellite tags to track female green turtles throughout their nesting season in the Chagos Archipelago (Indian Ocean) and assess when and where they nested. For individual turtles, nest locations were often spread over several tens of kilometres of coastline. Assessed by satellite observations, a mean of 6.0 clutches (range 2–9, s.d. = 2.2) was laid by individuals, about twice as many as previously assumed, a finding also reported in other species and ocean basins. Taken together, these findings suggest that the actual number of nesting turtles may be almost 50% less than previously assumed.
In vitroinduction andin vivoengraftment of lung bud tip progenitor cells derived from human pluripotent stem cells
Authors: Miller Alyssa J. , Hill David R. , Nagy Melinda S. , Aoki Yoshiro , Dye Briana R. , Chin Alana M. , Huang Sha , Zhu Felix , White Eric S. , Lama Vibha , Spence Jason R.
Published: February 2017

The bud tip epithelium of the branching mouse and human lung contains multipotent progenitors that are able to self-renew and give rise to all mature lung epithelial cell types. The current study aimed to understand the developmental signaling cues that regulate bud tip progenitor cells in the human fetal lung, which are present during branching morphogenesis, and to use this information to induce a bud tip progenitor-like population from human pluripotent stem cells (hPSCs)in vitro. We identified that FGF7, CHIR-99021 and RA maintained isolated human fetal lung epithelial bud tip progenitor cells in an undifferentiated statein vitro, and led to the induction of a 3-dimensional lung-like epithelium from hPSCs. 3-dimensional hPSC-derived lung tissue was initially patterned, with airway-like interior domains and bud tip-like progenitor domains at the periphery. Epithelial bud tip-like domains could be isolated, expanded and maintained as a nearly homogeneous population by serial passaging. Comparisons between human fetal lung epithelial bud tip cells and hPSC-derived bud tip-like cells were carried out using immunostaining,in situhybridization and transcriptome-wide analysis, and revealed thatin vitroderived tissue was highly similar to native lung. hPSC-derived epithelial bud tip-like structures survivedin vitrofor over 16 weeks, could be easily frozen and thawed and maintained multi-lineage potential. Furthermore, hPSC-derived epithelial bud tip progenitors successfully engrafted in the proximal airways of injured immunocompromised NSG mouse lungs, where they persisted for up to 6 weeks and gave rise to several lung epithelial lineages.
Sleep enhances knowledge of routes and regions in spatial environments
Authors: Noack Hannes , Schick Wiebke , Mallot Hanspeter , Born Jan
Published: February 2017

Sleep is thought to preferentially consolidate hippocampus-dependent memory, and as such, spatial navigation. Here, we investigated the effects of sleep on route knowledge and explicit and implicit semantic regions in a virtual environment. Sleep, compared with wakefulness, improved route knowledge and also enhanced awareness of the semantic regionalization within the environment, whereas signs of implicit regionalization remained unchanged. Results support the view that sleep specifically enhances explicit aspects of memory, also in the spatial domain. Enhanced region knowledge after sleep suggests that consolidation during sleep goes along with the formation of more abstract schema-like representations.
β-Adrenoceptor activation enhances L-type calcium channel currents in anterior piriform cortex pyramidal cells of neonatal mice: implication for odor learning
Authors: Ghosh Abhinaba , Mukherjee Bandhan , Chen Xihua , Yuan Qi
Published: February 2017

Early odor preference learning occurs in one-week-old rodents when a novel odor is paired with a tactile stimulation mimicking maternal care. β-Adrenoceptors and L-type calcium channels (LTCCs) in the anterior piriform cortex (aPC) are critically involved in this learning. However, whether β-adrenoceptors interact directly with LTCCs in aPC pyramidal cells is unknown. Here we show that pyramidal cells expressed significant LTCC currents that declined with age. β-Adrenoceptor activation via isoproterenol age-dependently enhanced LTCC currents. Nifedipine-sensitive, isoproterenol enhancement of calcium currents was only observed in post-natal day 7–10 mice. APC β-adrenoceptor activation induced early odor preference learning was blocked by nifedipine coinfusion.
A novel molten-salt electrochemical cell for investigating the reduction of uranium dioxide to uranium metal by lithium using in situ synchrotron radiation
Authors: Brown Leon D. , Abdulaziz Rema , Jervis Rhodri , Bharath Vidal , Mason Thomas J. , Atwood Robert C. , Reinhard Christina , Connor Leigh D. , Inman Douglas , Brett Daniel J. L. , Shearing Paul R.
Published: February 2017

A novel electrochemical cell has been designed and built to allow for in situ energy-dispersive X-ray diffraction measurements to be made during reduction of UO2 to U metal in LiCl–KCl at 500°C. The electrochemical cell contains a recessed well at the bottom of the cell into which the working electrode sits, reducing the beam path for the X-rays through the molten-salt and maximizing the signal-to-noise ratio from the sample. Lithium metal was electrodeposited onto the UO2 working electrode by exposing the working electrode to more negative potentials than the Li deposition potential of the LiCl–KCl eutectic electrolyte. The Li metal acts as a reducing agent for the chemical reduction of UO2 to U, which appears to proceed to completion. All phases were fitted using Le Bail refinement. The cell is expected to be widely applicable to many studies involving molten-salt systems.
A modified equally sloped algorithm based on the total variation algorithm in computed tomography for insufficient data
Authors: Wang Lei , Guan Yong , Liang Zhiting , Guo Liang , Wei Chenxi , Luo Ronghui , Liu Gang , Tian Yangchao
Published: February 2017

Computed tomography (CT) has become an important technique for analyzing the inner structures of material, biological and energy fields. However, there are often challenges in the practical application of CT due to insufficient data. For example, the maximum rotation angle of the sample stage is limited by sample space or image reconstruction from the limited number of views required to reduce the X-ray dose delivered to the sample. Therefore, it is difficult to acquire CT images with complete data. In this work, an iterative reconstruction algorithm based on the minimization of the image total variation (TV) has been utilized to develop equally sloped tomography (EST), and the reconstruction was carried out from limited-angle, few-view and noisy data. A synchrotron CT experiment on hydroxyapatite was also carried out to demonstrate the ability of the TV-EST algorithm. The results indicated that the new TV-EST algorithm was capable of achieving high-quality reconstructions from projections with insufficient data.
Ba2VO4Br
Authors: Haberkorn Robert , Bauer Jessica , Kickelbick Guido
Published: February 2017

Single crystals of dibarium vanadate(V) bromide, Ba2VO4Br, were grown from a melt of Ba3(VO4)2and BaBr2. Ba2VO4Br crystallizes in the space groupPbcmand is isotypic with the structure of chlorspodiosite, Ca2PO4Cl. Although the ionic radii in chlorspodiosite are different from those in dibarium vanadate bromide, the structures are very similar to one another. The V atom is coordinated by four O atoms, forming a slightly distorted tetrahedron. The Ba atoms occupy two different sites and are coordinated by six O atoms and three or four Br atoms, depending on the site occupied.
(E)-1-[2-(3,4-Dimethylphenyl)diazen-2-ium-1-yl]naphthalen-2-olate
Authors: Chetioui Souheyla , Boutebdja Mehdi , Boudraa Mhamed , Touzani Rachid , Merazig Hocine
Published: February 2017

The title zwitterion, C18H16N2O, features an intramolecular N—H...O hydrogen bond. The dimethylbenzene ring is rotationally disordered about the N—C bond over two adjacent orientations in a 0.75:0.25 ratio. The dihedral angle between the major orientation of the benzene ring and the naphthalene ring system is 6.06 (2)°. In the crystal, aromatic π–π stacking occurs [shortest centroid–centroid distance = 3.574 (3) Å] and C—H...O interactions are also observed.
Coping styles of failing Brunei vocational students
Authors: Mundia Lawrence , Salleh Sallimah
Published: February 2017

Purpose

The purpose of this paper is to determine the prevalence of two types of underachieving students (n=246) (active failing (AF) and passive failing (PF)) in Brunei vocational and technical education (VTE) institutions and their patterns of coping.

Design/methodology/approach

The field survey method was used to directly reach many participants, administer the instruments and collect the required data.

Findings

The authors found 20 AFs (14 males) and 16 PFs (five females) across the VTE courses. More-able and average students scored relatively higher on all six productive coping strategies (e.g. confronting the stressor), while the AFs and PFs scored lower on these attributes. The AFs and PFs scored relatively higher on both dysfunctional coping styles (e.g. distancing) than more-able and average students. Furthermore, the AFs also scored lower on seeking social support (possible reason for not performing well). Internet connection and students’ financial support need to be improved in Brunei VTE institutions.

Research limitations/implications

The study would have been strengthened by the inclusion of an interview component to probe supplement/complement findings from the quantitative survey and the open-ended qualitative instrument (both self-reports).

Practical implications

The study had practical significance in that its findings could be used by instructors and policy makers to improve the achievement of VTE students in Brunei and elsewhere.

Originality/value

This is the first time the phenomena of AF and PF were investigated in Brunei VTE students. Further qualitative research was recommended to gain additional insights and solutions.
Detecting signals of chronic shedding to explain pathogen persistence:Leptospira interrogansinCalifornia sea lions
Authors: Buhnerkempe Michael G. , Prager Katherine C. , Strelioff Christopher C. , Greig Denise J. , Laake Jeff L. , Melin Sharon R. , DeLong Robert L. , Gulland Frances M.D. , Lloyd‐Smith James O.
Published: February 2017

Identifying mechanisms driving pathogen persistence is a vital component of wildlife disease ecology and control. Asymptomatic, chronically infected individuals are an oft‐cited potential reservoir of infection, but demonstrations of the importance of chronic shedding to pathogen persistence at the population‐level remain scarce.

Studying chronic shedding using commonly collected disease data is hampered by numerous challenges, including short‐term surveillance that focuses on single epidemics and acutely ill individuals, the subtle dynamical influence of chronic shedding relative to more obvious epidemic drivers, and poor ability to differentiate between the effects of population prevalence of chronic shedding vs. intensity and duration of chronic shedding in individuals.

We use chronic shedding ofLeptospira interrogansserovar Pomona in California sea lions (Zalophus californianus) as a case study to illustrate how these challenges can be addressed. Using leptospirosis‐induced strands as a measure of disease incidence, we fit models with and without chronic shedding, and with different seasonal drivers, to determine the time‐scale over which chronic shedding is detectable and the interactions between chronic shedding and seasonal drivers needed to explain persistence and outbreak patterns.

Chronic shedding can enable persistence ofL. interroganswithin the sea lion population. However, the importance of chronic shedding was only apparent when surveillance data included at least two outbreaks and the intervening inter‐epidemic trough during which fadeout of transmission was most likely. Seasonal transmission, as opposed to seasonal recruitment of susceptibles, was the dominant driver of seasonality in this system, and both seasonal factors had limited impact on long‐term pathogen persistence.

We show that the temporal extent of surveillance data can have a dramatic impact on inferences about population processes, where the failure to identify both short‐ and long‐term ecological drivers can have cascading impacts on understanding higher order ecological phenomena, such as pathogen persistence.
Integrating gut microbiota immaturity and disease‐discriminatory taxa to diagnose the initiation and severity of shrimp disease
Authors: Xiong Jinbo , Zhu Jinyong , Dai Wenfang , Dong Chunming , Qiu Qiongfen , Li Chenghua
Published: February 2017

Increasing evidence has emerged a tight link among the gut microbiota, host age and health status. This osculating interplay impedes the definition of gut microbiome features associated with host health from that in developmental stages. Consequently, gut microbiota‐based prediction of health status is promising yet not well established. Here we firstly tracked shrimp gut microbiota (N = 118) over an entire cycle of culture; shrimp either stayed healthy or progressively transitioned into severe disease. The results showed that the gut microbiota were significantly distinct over shrimp developmental stages and disease progression. Null model and phylogenetic‐based mean nearest taxon distance (MNTD) analyses indicated that deterministic processes that governed gut community became less important as the shrimp aged and disease progressed. The predicted gut microbiota age (using the profiles of age‐discriminatory bacterial species as independent variables) fitted well (r = 0.996; P < 0.001) with the age of healthy subjects, while this defined trend was disrupted by disease. Microbiota‐for‐age Z‐scores (MAZ, here defined as immaturity) were relative stable among healthy shrimp, but sharply decreased when disease emerged. By distinguishing between age‐ and disease‐ discriminatory taxa, we developed a model, bacterial indicators of shrimp health status, to diagnose disease from healthy subjects with 91.5% accuracy. Notably, the relative abundances of the bacterial indicators were indicative for shrimp disease severity. These findings, in aggregate, add our understanding on the gut community assembly patterns over shrimp developmental stages and disease progression. In addition, shrimp disease initiation and severity can be accurately diagnosed using gut microbiota immaturity and bacterial indicators.
Fostering employees' proactive strategic engagement: Individual and contextual antecedents
Authors: Strobel Maria , Tumasjan Andranik , Spörrle Matthias , Welpe Isabell M.
Published: February 2017

Proactive strategic scanning is an important aspect of employee proactivity and contributes to engaging employees in the organisation‐wide strategy process. It also contributes to strategic renewal and innovation by helping to identify potential strategic opportunities and threats. However, little is known about its antecedents and how HRM may support this valuable resource. To address this gap, we develop and test a model of individual and contextual antecedents of proactive strategic scanning. We hypothesise and find a positive effect of future‐focused personality on strategic scanning which is mediated by promotion‐focused self‐regulation at work. Moreover, we investigate how work design functions as a contextual boundary condition of this mediated effect. The effect is strengthened under high social support but is not influenced by the level of decision‐making autonomy. Our findings point to specific variables which can be targeted by HRM to enhance employees' strategic engagement and innovative behaviour.
Measuring Urban Water Conservation Policies: Toward a Comprehensive Index
Authors: Hess David J. , Wold Christopher A. , Worland Scott C. , Hornberger George M.
Published: February 2017

This article (1) discusses existing efforts to measure water conservation policies (WCPs) in the United States (U.S.); (2) suggests general methodological guidelines for creating robust water conservation indices (WCIs); (3) presents a comprehensive template for coding WCPs; (4) introduces a summary index, the Vanderbilt Water Conservation Index (VWCI), which is derived from 79 WCP observations for 197 cities for the year 2015; and (5) compares the VWCI to WCP data extracted from the 2010 American Water Works Association (AWWA) Water and Wastewater Rates survey. Existing approaches to measuring urban WCPs in U.S. cities are limited because they consider only a portion of WCPs or they are restricted geographically. The VWCI consists of a more comprehensive set of 79 observations classified as residential, commercial/industrial, billing structure, drought plan, or general. Our comparison of the VWCI and AWWA survey responses indicate reasonable agreement (ρ = 0.76) between the two WCIs for 98 cities where the data overlap. The correlation suggests the AWWA survey responses can provide fairly robust longitudinal WCP information, but we argue the measurement of WCPs is still in its infancy, and our approach suggests strategies for improving existing methods.
Heterogeneous Costs of Alcohol and Drug Problems Across Cities and Counties in California
Authors: Miller Ted R. , Nygaard Peter , Gaidus Andrew , Grube Joel W. , Ponicki William R. , Lawrence Bruce A. , Gruenewald Paul J.
Published: February 2017

Background

Estimates of economic and social costs related to alcohol and other drug (AOD) use and abuse are usually made at state and national levels. Ecological analyses demonstrate, however, that substantial variations exist in the incidence and prevalence of AOD use and problems including impaired driving, violence, and chronic disease between smaller geopolitical units like counties and cities. This study examines the ranges of these costs across counties and cities in California.

Methods

We used estimates of the incidence and prevalence of AOD use, abuse, and related problems to calculate costs in 2010 dollars for all 58 counties and an ecological sample of 50 cities with populations between 50,000 and 500,000 persons in California. The estimates were built from archival and public‐use survey data collected at state, county, and city levels over the years from 2009 to 2010.

Results

Costs related to alcohol use and related problems exceeded those related to illegal drugs across all counties and most cities in the study. Substantial heterogeneities in costs were observed between cities within counties.

Conclusions

AOD costs are heterogeneously distributed across counties and cities, reflecting the degree to which different populations are engaged in use and abuse across the state. These findings provide a strong argument for the distribution of treatment and prevention resources proportional to need.
Alcohol Use Patterns and DSM‐5 Alcohol Use Disorder on Both Sides of the U.S.‐Mexico Border
Authors: Greenfield Thomas K. , Ye Yu , Lown E. Anne , Cherpitel Cheryl J. , Zemore Sarah , Borges Guilherme
Published: February 2017

Background

Alcohol consumption patterns on the U.S.–Mexico border and their relationships with DSM‐5 alcohol use disorders (AUD) have been understudied. Yet, the effects of drinking by Mexican‐origin individuals may differ between cities on versus off the border both in the United States and in Mexico. We characterize prior 12‐month drinking patterns and examine their relationships with AUD, in border and off‐border cities of Texas and adjacent Mexican states.

Methods

Data come from the U.S.–Mexico Study of Alcohol and Related Conditions involving 2,336 Mexican Americans in Texas and 2,460 Mexicans in bordering states of Nuevo Leon and Tamaulipas in Mexico. Drinking pattern was defined as an interaction between volume and maximum amount, or intensity (never vs. ever 5+/4+ [men/women], 8+, and 12+ drinks in a day). DSM‐5 AUD was assessed using an adaptation of the Alcohol Section of the World Health Organization Composite International Diagnostic Interview core. Separately by gender, 5 logistic regressions models controlling for age were estimated predicting symptoms in 2 or more AUD criteria domains from volume, heavy pattern and, successively, effects of country, and (by country) residing on vs. off the border, or in each of 3 cities/country.

Results

A segmentation analysis for Texas males based on rate of experiencing AUD generated several distinct volume groups, each partitioned by an empirically selected maximum, and helped identify a drinking‐pattern typology. In gender‐stratified models of AUD rates using this typology, adjusting for age, significant volume and intensity effects were seen, more strongly in the United States. Border versus interior differences implied more AUD for given patterns at the border in the United States and the reverse in Mexico, with some city differences also evident.

Conclusions

Drinking‐pattern analyses confirm that border proximity may affect drinking problems but in opposite directions in the United States and Mexico, possibly related to economic and psychological stresses specific to respective communities.
Body condition as a quantitative tool to guide hand‐rearing decisions in an endangered seabird
Authors: Morten J. M. , Parsons N. J. , Schwitzer C. , Holderied M. W. , Sherley R. B.
Published: February 2017

The use of wildlife rehabilitation for conservation is growing, but quantitative criteria are rarely used to guide whether and when to remove animals from the wild. Since 2006, large numbers of African penguin Spheniscus demersus chicks have been abandoned annually when adults enter moult with dependent young still in the nest. As part of conservation initiatives for this endangered species, these chicks were collected and hand reared to fledging age. Post‐release survival has been well documented; in this study we develop models to predict survival of individuals during rehabilitation with the aim of improving hand‐rearing success and guiding the use of scarce resources. For 1455 chicks abandoned between 2008 and 2013, we assessed whether a chick body condition index (BCI) could predict outcome (death or release) and time spent in rearing. In addition, for a subset of 173 chicks in 2012, we assessed whether BCI at admission influenced chick growth rates during rehabilitation and examined whether the use of additional structural measurements and sex provided additional power to predict outcome. Models predicted an 82.9% (95% confidence interval: 73.3–89.5%) release rate for chicks admitted with a BCI >0, the proposed guideline for removal from colonies. This fell below 50% for BCIs < −1.05; 66% of chicks were admitted with BCIs between these thresholds. Adding bill length to BCI improved the relative model fit, but in both cases only ~70% of rehabilitation outcomes were correctly predicted. Chicks that grew more quickly were more likely to be released and, for those that were released, had lower BCI at admission suggesting compensatory growth. Chicks were generally removed at an appropriate time to ensure successful hand‐rearing. However, 32% were admitted in good condition, highlighting the importance of using adaptive management to guide wildlife rehabilitation and the allocation of conservation resources.
An investigation into the effects of real vs. stimulated cases and level of experience on the distribution of visual attention during induction of general anaesthesia
Authors: Grundgeiger T. , Klöffel C. , Mohme S. , Wurmb T. , Happel O.
Published: February 2017

In anaesthesia, patient simulators have been used for training and research. However, insights from simulator‐based research may only translate to real settings if the simulation elicits the same behaviour as the real setting. To this end, we investigated the effects of the case (simulated case vs. real case) and experience level (junior vs. senior) on the distribution of visual attention during the induction of general anaesthesia. We recorded eye‐tracking data from 12 junior and 12 senior anaesthetists inducing general anaesthesia in a simulation room and in an actual operating room (48 recordings). Using a classification system from the literature, we assigned each fixation to one of 24 areas of interest and classified the areas of interest into groups related to monitoring, manual, and other tasks. Anaesthetists gave more visual attention to monitoring related areas of interest in simulated cases than in real cases (p = 0.001). We observed no effect of the factor case for manual tasks. For other tasks, anaesthetists gave more visual attention to areas of interest related to other tasks in real cases than in simulated cases (p < 0.001). Experience level did not have an effect on the distribution of visual attention. The results showed that there were differences in the distribution of visual attention by between real and simulated cases. Therefore, researchers need to be careful when translating simulation‐based research on topics involving visual attention to the clinical environment.
Functional benefits and patient satisfaction with upper blepharoplasty – evaluated by objective and subjective outcome measures
Authors: Jacobsen Agnes Galbo , Brost Brian , Vorum Henrik , Hargitai Janos
Published: February 2017

Purpose

To investigate the functional benefits and patient satisfaction with upper blepharoplasty in patients meeting the Danish visitation guidelines for upper blepharoplasty from the Danish Health and Medicines Authority (Sundhedsstyrelsen).

Methods

Before and 3 months after upper blepharoplasty, the following investigations were made: (i) a standard eye examination, (ii) photographic documentation with a normal camera and the infrared camera of a Spectralis Optical Coherence Tomograph and (iii) measurements of the upper visual fields using the blepharoptosis test of Octopus 900. Along with the pre‐ and postoperative examinations, the patients completed a questionnaire concerning the functional and psychosocial impact of their eyelids.

Results

Ninety eyelids of 45 patients were studied, 34 females and 11 males. The mean age was 56.9 years (SD: 12.8). The mean change in the distance between the upper eyelid skin fold and the visual axis or the marginal reflex distance (MRD), depending on which was lowest, was 1.6 mm (SD: 0.8 mm) for the right eyelids and 1.2 (SD: 0.9 mm) for the left eyelids. The mean improvement in the upper visual field was 31.3% points for the right eyelids (SD: 21.4% points) and 28.3% points for the left eyelids (SD: 24.9% points). A statistically significant correlation between the preoperative distance from skin fold to visual axis/MRD and the pre‐ and postoperative visual field was found. The patients reported an improvement in their symptoms postoperatively. All subjects were satisfied with the postoperative result and would undergo the surgery again if they had to make the choice again.

Conclusion

Patients meeting the Danish visitation guidelines for upper blepharoplasty experience a measurable improvement in function and alleviation of symptoms after blepharoplasty.
Photochemical eradication of methicillin‐resistant Staphylococcus aureus by blue light activation of riboflavin
Authors: Makdoumi Karim , Goodrich Ray , Bäckman Anders
Published: February 2017

Purpose

To compare elimination of methicillin‐resistant Staphylococcus aureus (MRSA) by exposure of blue light alone and with riboflavin.

Methods

A reference strain of MRSA was cultured and diluted in PBS with and without riboflavin (0.01%). Fifteen microlitre was added on a microscope slide, creating a fluid layer with a thickness of around 400 microns. Both of the bacterial suspensions were exposed to blue light, and the effect between exposure with and without riboflavin was compared. Evaluation involved two different wavelengths (412 and 450 nm) of blue light with a lower (5.4 J/cm2) and higher dose (approximately 28.5 J/cm2). The effect of 412 nm light was also evaluated for a thicker fluid layer (1.17 mm). After exposure, colony‐forming units (CFUs) were determined for each solution. All measurements were repeated eight times.

Results

The reductions in bacteria were similar for both wavelengths. With riboflavin, a statistically significant elimination was observed for both 412 and 450 nm (p < 0.001). At both dosages, the mean reduction was more pronounced with the presence of riboflavin than without it. Using the higher dose, CFU reduction was 99% and 98%, respectively, for 412 and 450 nm light. The bactericidal efficacy was high also in the deeper fluid layer (93%, higher dose).

Conclusion

Riboflavin enhanced the antibacterial effect on the exposed MRSA strain of blue light for both 412 and 450 nm blue light. This indicates that blue light could be considered for possible implementation in deep corneal infections.
Risk of major bleeding and stroke associated with the use of vitamin K antagonists, nonvitamin K antagonist oral anticoagulants and aspirin in patients with atrial fibrillation: a cohort study
Authors: Gieling Emilie M. , van den Ham Hendrika A. , van Onzenoort Hein , Bos Jacqueline , Kramers Cornelis , de Boer Anthonius , de Vries Frank , Burden Andrea M.
Published: February 2017

Aims

Nonvitamin K antagonist oral anticoagulants (NOACs) are now available for the prevention of stroke in patients with atrial fibrillation (AF) as an alternative to vitamin K antagonists (VKA) and aspirin. The comparative effectiveness and safety in daily practice of these different drug classes is still unclear. The objective of this study was to evaluate the risk of major bleeding and stroke in AF patients using NOACs, VKAs or aspirin.

Methods

A retrospective cohort study was conducted among AF patients using the UK Clinical Practice Research Datalink (March 2008–October 2014). New users of VKAs, NOACs and low dose aspirin were followed from the date of first prescription of an antithrombotic drug until the occurrence of stroke or major bleeding. Analyses were adjusted for a history of comorbidities and drug use with Cox regression analysis.

Results

A total of 31 497 patients were eligible for the study. The hazard ratio (HR) of major bleeding was 2.07 [95% confidence interval (CI) 1.27–3.38] for NOACs compared with VKAs, which was mainly attributed by the increased risk of gastrointestinal bleeding (HR 2.63, 95% CI 1.50–4.62). This increased bleeding risk was restricted to women (HR 3.14, 95% CI 1.76–5.60). Aspirin showed a similar bleeding risk as VKAs. NOACs showed equal effectiveness as VKA in preventing ischaemic stroke (HR 1.22, 95% CI 0.67–2.19). VKAs were more effective than aspirin (HR 2.18, 95% CI 1.83–2.59).

Conclusions

NOACs were associated with a higher risk on gastrointestinal bleeding, particularly in women. The use of NOACs in patients who are vulnerable for this type of bleeding should be carefully considered. NOACs and VKAs are equally effective in preventing stroke. Aspirin was not effective in the prevention of stroke in AF.
Synthesis, characterization, and relaxation studies of Gd‐DO3A conjugate of chlorambucil as a potential theranostic agent
Authors: Kaur Jasleen , Tsvetkova Yoanna , Arroub Karim , Sahnoun Sabri , Kiessling Fabian , Mathur Sanjay
Published: February 2017

DO3A‐based macrocycles serve as attractive templates from which clinically useful theranostic agents can be obtained after coupling with molecular targeted therapeutic drugs. In this study, we describe the chemical synthesis, relaxation, and cytotoxicity studies of a new DO3A conjugate of chlorambucil (CHL) as a magnetic resonance imaging (MRI) theranostic agent. A convenient route of synthesis is reported, which allowed conjugation of the macrocyclic ligand (DO3A) to the chemotherapeutic drug (CHL) via tyrosine for the preparation of an attractive chelate‐drug ensemble (DO3A‐TR‐CHL). The structures of all intermediates and final compound have been determined by 1H, 13C NMR, and MS. The efficacy of DO3A‐TR‐CHL as a non‐ionic magnetic contrast agent was tested by performing relaxometric studies on its gadolinium complex. The complex exhibited relaxivities (7.11 mm−1/s) higher than that of currently used MR contrast agents and showed enhanced contrast in T1‐weighted images. MTT assays revealed that both DO3A‐TR‐CHL and Gd(III)‐DO3A‐TR‐CHL conjugates exhibited dose‐dependent toxicity and an enhanced antiproliferative activity against tumor (A549 and HeLa) cell lines compared to that of parent drug (CHL), thereby demonstrating their potential to be used as a magnetic resonance imaging theranostic for improved molecular imaging and therapy of human cancers.
Interleukin‐6 receptor rs2229238C/T and rs4845625T/C polymorphisms increase the risk of schizophrenia in an Iranian population: A pilot study
Authors: Galavi Hamid Reza , Saravani Ramin , Esmaeilzaei Elahe , Mohamadi Azad
Published: February 2017

Objective

Interleukin‐6 (IL‐6) is an important cytokine that plays a key role in the immune system. Changes in the immune system, particularly increased IL‐6 concentrations, have been reported in schizophrenia (SCZ) patients. Although this cytokine needs its receptor (IL‐6R) to function properly, few studies have examined IL‐6R polymorphisms and the risk of SCZ. The aim of the present study was to evaluate the possible association between IL‐6R polymorphisms (rs2229238 and rs4845625) and susceptibility to SCZ.

Methods

A case–control study was carried out including 92 SCZ patients and 92 healthy controls. Two single‐nucleotide polymorphisms were genotyped using amplification‐refractory mutation system polymerase chain reaction.

Results

It was found that the TC genotype of rs4845625 and CT and TT of rs2229238 increased the SCZ risk (OR 2.691, 95% CI 1.075–6.736, P = 0.034;OR 4.273, 95% CI 1.937–9.433, P < 0.001; and OR 2.123, 95% CI 1.071–4.219, P = 0.031, respectively). In dominant genetic model analysis, it was found that CT+TT of rs2229238 and TC+CC of rs4845625 were associated with the risk of SCZ (OR 2.762, 95% CI 1.426–5.376, P = 0.003 and OR 2.824, 95% CI 1.545–5.154, P < 0.001, respectively).

Conclusions

The findings showed that the rs2229238 and rs4845625 single‐nucleotide polymorphisms were prominently associated with SCZ. Further studies are required to confirm the findings.
The effect of delta‐like 1 homologue on the proliferation and odontoblastic differentiation in human dental pulp stem cells
Authors: Qi Shengcai , Yan Yanhong , Wen Yue , Li Jialiang , Wang Jing , Chen Fubo , Tang Xiaoshan , Shang Guangwei , Xu Yuanzhi , Wang Raorao
Published: February 2017

Introduction

This study aimed to investigate the functions of delta‐like homologue 1 (DLK1) in the proliferation and differentiation of human dental pulp stem cells (hDPSCs).

Methods

Immunohistochemical analysis was used to determine the expression of alkaline phosphatase (ALP), dentin sialophosphoprotein (DSPP), DLK1, NOTCH1 and p‐ERK1/2 in the mouse first maxillary molar. Recombinant lentivirus was constructed to overexpress DLK1 stably in hDPSCs. The cell viability and proliferation of hDPSCs were examined by CCK8 and EdU incorporation assay respectively. The odontoblastic differentiation of hDPSCs was determined by detection of ALPase activity assay, ALP and alizarin red staining and the expression of mineralization‐related genes including ALP, DSPP and dental matrix protein. The mRNA and protein levels of DLK1 and p‐ERK1/2 protein expression were detected. ERK inhibitor was used to test the differentiation effect of DLK1 on hDPSCs.

Results

Delta‐like homologue 1 was highly expressed on the odontoblasts and dental pulp cells on the first maxillary molar; the expression of p‐ERK1/2 is similar with the DLK1 in the same process. The expression level of DLK1 increased significantly after the odontoblastic induction of hDPSCs. DLK1 overexpression increased the proliferation ability of hDPSCs and inhibited odontoblastic differentiation of hDPSCs. The protein level of p‐ERK1/2 significantly increased in hDPSCs/dlk1‐oe group. ERK signalling pathway inhibitor reversed the odontoblastic differentiation effects of DLK1 on hDPSCs.

Conclusions

The proliferation of hDPSCs was promoted after DLK1 overexpression. DLK1 inhibited the odontoblastic differentiation of hDPSCs, which maybe through ERK signalling pathway.
The Gross Motor Function Classification System: 20 years on
Authors: Mccormick Anna
Published: February 2017

This commentary is on the original article by Alriksson‐Schmidt et al. on pages 641–646 of this issue.
Evaluation of subcutaneous glucose monitoring systems under routine environmental conditions in patients with type 1 diabetes
Authors: Aberer Felix , Hajnsek Martin , Rumpler Markus , Zenz Sabine , Baumann Petra M. , Elsayed Hesham , Puffing Adelheid , Treiber Gerlies , Pieber Thomas R. , Sourij Harald , Mader Julia K.
Published: February 2017

Continuous and flash glucose monitoring (GM) systems have been established in diabetes care. We compared the sensor performance of 3 commercially available GM systems. A total of 12 patients with type 1 diabetes were included in a single‐centre, open‐label study in which the sensor performance of the Abbott FreeStyle libre (Abbott), Dexcom G4 Platinum (Dexcom) and Medtronic MiniMed 640G (Medtronic) systems over 12 hours was compared during mimicked real‐life conditions (meals, exercise, hypo‐ and hyperglycaemia). Sensor performance was determined by fulfilment of ISO 15197:2013 criteria, calculating mean absolute relative difference (MARD), and was also illustrated using Parkes error grid and Bland–Altman plots. Sensor performance during changes in metabolic variables (lactate, betahydroxybutyrate, glucagon, non‐esterified‐fatty‐acids) was determined by Spearman's rank correlation coefficient testing. The systems fulfilled ISO 15197:2013 criteria by 73.2% (Abbott), 56.1% (Dexcom) and 52.0% (Medtronic). The MARDs ± standard deviation in the entire glycaemic range were 13.2% ± 10.9% (Abbott), 16.8% ± 12.3% (Dexcom) and 21.4% ± 17.6% (Medtronic), respectively. All sensors performed less accurately during hypoglycaemia and best during hyperglycaemia. We did not observe an influence of metabolic variables on sensor performance.
Efficacy and safety of autoinjected exenatide once‐weekly suspension versus sitagliptin or placebo with metformin in patients with type 2 diabetes: The DURATION‐NEO‐2 randomized clinical study
Authors: Gadde Kishore M. , Vetter Marion L. , Iqbal Nayyar , Hardy Elise , Öhman Peter ,   on behalf of the DURATION‐NEO‐2 study investigators
Published: February 2017

Aims

Glucagon‐like peptide‐1 receptor agonists and dipeptidyl peptidase‐4 inhibitors treat type 2 diabetes through incretin‐signaling pathways. This study compared the efficacy and safety of the glucagon‐like peptide‐1 receptor agonist exenatide once‐weekly (Miglyol) suspension for autoinjection (QWS‐AI) with the dipeptidyl peptidase‐4 inhibitor sitagliptin or placebo.

Materials and methods

In this open‐label, multicentre study of patients with type 2 diabetes who had suboptimal glycaemic control on metformin monotherapy, 365 patients were randomized to receive exenatide 2.0 mg QWS‐AI, sitagliptin 100 mg once daily or oral placebo (3:2:1 ratio). The primary endpoint was change in glycated hemoglobin (HbA1c) from baseline to 28 weeks.

Results

At 28 weeks, exenatide QWS‐AI significantly reduced HbA1c from baseline compared to sitagliptin (−1.13% vs −0.75% [baseline values, 8.42% and 8.50%, respectively];
P
 = .02) and placebo (−0.40% [baseline value, 8.50%]; P = .001). More exenatide QWS‐AI‐treated patients achieved HbA1c <7.0% than did sitagliptin‐ or placebo‐treated patients (43.1% vs 32.0% and 24.6%; both
P
 < .05). Exenatide QWS‐AI and sitagliptin reduced fasting plasma glucose from baseline to 28 weeks (−21.3 and −11.3 mg/dL) vs placebo (+9.6 mg/dL), with no significant difference between the 2 active treatments. Body weight decreased with both active treatments (−1.12 and −1.19 kg), but not with placebo (+0.15 kg). No improvement in blood pressure was observed in any group. The most common adverse events with exenatide QWS‐AI were gastrointestinal events and injection‐site reactions.

Conclusions

This study demonstrated that exenatide QWS‐AI reduced HbA1c more than sitagliptin or placebo and was well tolerated.
Effects of food supply and stream physical characteristics on habitat use of a stream‐dwelling fish
Authors: Akbaripasand Abbas , Closs Gerard P.
Published: February 2017

Identifying the environmental factors that affect freshwater fish can be crucial for their conservation and management. Despite the widespread investigation of relationships between fish habitat use and environmental variables, there is a paucity of knowledge on how abiotic and biotic factors jointly influence stream fish habitat use. Three New Zealand South Island streams were selected to investigate the habitat preference of a stream‐dwelling galaxiid, banded kokopu (Galaxias fasciatus). Fish abundance in several permanent pools was determined by spotlighting at night once a month from June 2008 to May 2009. Drifting invertebrates and key physical features of each pool were measured at the time of fish sampling. An information‐theoretic approach (AIC) indicated that the most parsimonious candidate model to predict banded kokopu biomass was the one that included pool area, undercut banks, water velocity, overhanging vegetation, invertebrate drift density and an interaction term between invertebrate drift density and water velocity. Banded kokopu biomass was positively related to pool area, undercut banks, overhanging vegetation and invertebrate drift density. Our study suggests that fish resource use patterns need to be understood in the context of multiple interacting ecological factors, including prey abundance.
Global Mental Health: A Call for Increased Awareness and Action for Family Therapists
Authors: Patterson Jo Ellen , Edwards Todd M. , Vakili Susanna
Published: February 2017

Global mental health (GMH) is an emerging field that focuses on the need for culturally sensitive mental health services in low‐ and middle‐income countries (LMICs). While many new initiatives have been established worldwide to understand GMH needs and to provide care in LMICs, family therapists have primarily worked with families in high‐income countries. The few existing family‐based initiatives in GMH focus on psychoeducation and are typically not based on general systems theory. However, emerging trends in family therapy may enable family therapists to impact mental health issues in LMICs. These trends, which are shared interests of both family therapy and GMH, include collaborative care, a growing emphasis on the importance of culture in understanding and treating mental health issues, recognition of the ability of families to support or impede recovery from mental illness, and the use of strength‐based and evidence‐based treatments. This paper describes ways for family therapists to become active in the GMH community.