bluuebunny/crossref_metadata_2025 huggingface dataset:
Metal versus plastic stents for drainage of pancreatic fluid collection: A meta‐analysis
Authors: Yoon Seung Bae , Lee In Seok , Choi Myung-Gyu
Published: March 2018

Background

Although metal stents are increasingly being used for endoscopic transmural drainage of pancreatic fluid collection (PFC), the advantages of metal stents in comparison with plastic stents are not clear.

Objective

The aim of this study is to compare the clinical outcomes and adverse events between patients receiving endoscopic transmural drainage of PFCs through metal or plastic stents.

Methods

We performed a systematic literature search to identify all published manuscripts comparing metal and plastic stents for PFC drainage. The primary outcome was clinical success, and the secondary outcomes were technical success, procedure time, overall cost, adverse events, and recurrence.

Results

Seven studies were considered to be appropriate for this meta‐analysis. Metal stents showed a higher clinical success rate (odds ratio (OR) 3.39, 95% confidence interval (CI) 2.05–5.60) and a lower overall adverse event rate (OR 0.37, 95% CI 0.21–0.66) than plastic stents. In subgroup analyses, metal stents showed higher clinical success rates than plastic stents both for pseudocyst (OR 5.35, 95% CI 1.35–21.19) and walled‐off necrosis (OR 3.37, 95% CI 1.89–5.99).

Conclusions

Metal stents are superior to plastic stents for endoscopic transmural drainage of PFC because they have a higher clinical success rate and lower rate of adverse events.
Liver disease in adults with α1‐antitrypsin deficiency
Authors: Mandorfer Mattias , Bucsics Theresa , Hutya Veronika , Schmid-Scherzer Karin , Schaefer Benedikt , Zoller Heinz , Ferlitsch Arnulf , Peck-Radosavljevic Markus , Trauner Michael , Ferenci Peter , Kneussl Meinhard , Reiberger Thomas
Published: March 2018

Background

The natural history of adult liver disease due to α1‐antitrypsin deficiency (A1AD) remains poorly understood.

Objective

We investigated whether heterozygosity for the Z‐allele predisposes for the development of clinically significant portal hypertension (CSPH). Moreover, we aimed to non‐invasively assess the prevalence of liver fibrosis and hepatic steatosis in adults with A1AD treated by pulmonologists.

Methods

SERPINA1 rs28929474 (Z‐allele) was genotyped in 315 patients with CSPH (hepatic venous pressure gradient ≥10 mmHg; cases) and 248 liver donors (controls). In addition, 31 adults with A1AD (Pi*ZZ/Pi*SZ) and 11 first‐degree relatives (Pi*MZ/Pi*MS) underwent liver stiffness and controlled attenuation parameter (CAP) measurement.

Results

Heterozygosity for the Z‐allele was observed in 6.7% of patients with CSPH and 2.8% of liver donors. Thus, harboring the Z‐allele was associated with increased odds of CSPH (odds ratio: 2.47; 95% confidence interval: 1.03–5.9; P = 0.042). Among Pi*ZZ/Pi*SZ patients, 23%/3% had liver stiffness values indicative of liver fibrosis ( ≥F2/ ≥F3). Interestingly, 65%/52% of Pi*ZZ/Pi*SZ patients had CAP values indicative of hepatic steatosis ( ≥S1/ ≥S2).

Conclusions

Heterozygosity for the Z‐allele predisposes for the development of CSPH, confirming its role as a genetic (co)factor in liver disease. Pi*ZZ/SZ patients rarely develop liver fibrosis ≥F3 during adulthood; however, liver fibrosis ≥F2 is common. Elevated CAP values hint at underlying hepatic steatosis, which might promote liver fibrosis progression.
Democracy and police violence
Authors: Jackson Joshua L. , Hall Shelby L. , Hill Daniel W.
Published: March 2018

Are police agencies less likely to use torture in democracies than in non-democracies? Much empirical research has shown that democracies are less likely to engage in torture in general, but most of this research does not distinguish among victim types or state agencies. Using the Ill-Treatment and Torture (ITT) Data, we focus on police agencies and evaluate whether they are less likely to use torture against (separately) political dissidents, criminals, and marginalized communities. Using logistic regressions with random effects, we find that the well-established and relatively high level of democracies’ respect for the rights of dissidents extends to police agencies as well. However, we find weaker statistical evidence that police agencies in democracies are less likely to use torture against criminals, and no evidence that they are less likely to torture marginalized communities. Our results suggest that one of the most robust empirical facts in the literature must be qualified. The protection from violence offered by democratic institutions does not seem to generalize beyond violence directly related to political competition and dissent.
Athletes do better after FAI arthroscopic treatment in male population
Authors: Przybyl M , Walenczak K , Domzalski ME
Published: March 2018

Background:

Arthroscopic surgery is becoming popular in the management of hip pathologies. There are numerous studies describing the outcomes of the treatment of athletes with this method. These outcomes are generally found to be excellent. Yet there are little data in the literature with respect to the arthroscopic treatment of nonathletes. The objective of our study is to compare the outcomes of the femoroacetabular impingement (FAI) treatment between athletes and nonathletes using arthroscopy, using two popular scales.

Methods:

The study involved a total of 129 male patients operated at our departments between 2009 and 2013. The subjects were divided into two groups: athletes and nonathletes. The results were assessed using the Nonarthritic Hip Score (NAHS) and Modified Harris Hip Score (MHHS). In addition, the length of postoperative hospitalization was evaluated.

Results:

Analyses revealed that athletes performed better in NAHS over each period under analysis (prior to the operation, 12 and 24 months after the operation). As regards MHHS in these periods, the results in both groups were comparable. In addition, it was found that the length of postoperative hospitalization was similar in athletes and nonathletes.

Conclusions:

Arthroscopic treatment of FAI is an effective method producing visible effects in athletes as well as nonathletes but quicker recovery in male athletic population. In the examined population, NAHS was a better measurement tool than MMHS, showing differences between the athlete and nonathlete population.
Surveying Dentists’ Perceptions of Caregiver Refusal of Topical Fluoride
Authors: Chi D.L. , Basson A.A.
Published: March 2018

The objective of this study was to assess dentists’ perceptions of caregiver topical fluoride refusal behaviors. We administered an 8-item survey in 2015 and 2016 ( N = 582) and asked dentists about the extent to which fluoride refusal is a problem, refusal trends, comfort talking to caregivers who refuse, and perceived reasons why caregivers refuse. To examine geographic variation, we ran χ2 tests between dentists’ location (US West vs. non-West) and the first 3 perception measures (α = 0.05). Nearly 80% of dentists believed fluoride refusal was a problem, and 42.3% believed it was a growing problem. A significantly larger proportion of dentists who saw fluoride refusal as a problem also believed refusal was a growing problem compared to those who thought refusal was not a problem (89.6% and 41.2%, respectively; P < 0.0001). Caregiver characteristics perceived to be associated with fluoride refusal included immunization refusal (41.3%), White race (37.6%), and high income (33.7%). Thirty-seven percent of surveyed dentists were uncomfortable talking to caregivers who refused. There were no geographic differences in perceptions of fluoride refusal as a problem ( P = 0.52). A significantly larger proportion of non-West dentists believed fluoride refusal has gotten worse (non-West: 65.5%, West: 41.2%; P < 0.0001), but more dentists from the West were uncomfortable talking to caregivers who refused (West: 86%, non-West: 67.4%; P < 0.0001). Caregiver refusal of topical fluoride may be a growing problem, and many dentists are uncomfortable talking to caregivers who refuse. Additional interdisciplinary research is needed to identify the reasons why caregivers refuse fluoride, which is an important next step in developing chairside interventions that address fluoride refusal behaviors.

Knowledge Transfer Statement: The results of this study can be used by researchers to develop chairside strategies to help dentists identify and manage fluoride refusal behaviors in clinical settings. This could help preserve topical fluoride as an evidence-based preventive therapy and address a growing public health problem.
Feature extraction via similarity search: application to atom finding and denoising in electron and scanning probe microscopy imaging
Authors: Somnath Suhas , Smith Christopher R. , Kalinin Sergei V. , Chi Miaofang , Borisevich Albina , Cross Nicholas , Duscher Gerd , Jesse Stephen
Published: March 2018

We develop an algorithm for feature extraction based on structural similarity and demonstrate its application for atom and pattern finding in high-resolution electron and scanning probe microscopy images. The use of the combined local identifiers formed from an image subset and appended Fourier, or other transform, allows tuning selectivity to specific patterns based on the nature of the recognition task. The proposed algorithm is implemented in Pycroscopy, a community-driven scientific data analysis package, and is accessible through an interactive Jupyter notebook available on GitHub.
The Montgomery ruling, individual values and shared decision-making in psychiatry
Authors: Hughes Julian C. , Crepaz-Keay David , Emmett Charlotte , Fulford K. W. M.
Published: March 2018

This article starts with a brief review of the UK Supreme Court's decision in the Montgomery case. Although much of the focus in discussing the case has been on the disclosure of risk, an important aspect of the model of consent contained in the judgment is that of dialogue. The model of informed consent set out in Montgomery suggests shared decision-making as the norm. Central to shared decision-making, however, is an awareness of values and of how values can vary between people. We introduce values-based practice as an approach that is entirely in keeping with the precepts of the Montgomery judgment. We go on to review how values-based practice and shared decision-making are relevant to psychiatric practice, using as examples recovery practice and compulsory detention under the Mental Health Act 1983.

LEARNING OBJECTIVES

•

Appreciate that a new test of consent has been established as of a result of the UK Supreme Court's Montgomery ruling

•

Learn about the role of values-based practice as a partner to evidence-based practice in implementing Montgomery

•

Understand how values-based practice and Montgomery together support shared decision-making in psychiatry

DECLARATION OF INTEREST

None.
How to carry out a literature search for a systematic review: a practical guide
Authors: Atkinson Lauren Z. , Cipriani Andrea
Published: March 2018

Performing an effective literature search to obtain the best available evidence is the basis of any evidence-based discipline, in particular evidence-based medicine. However, with a vast and growing volume of published research available, searching the literature can be challenging. Even when journals are indexed in electronic databases, it can be difficult to identify all relevant studies without an effective search strategy. It is also important to search unpublished literature to reduce publication bias, which occurs from a tendency for authors and journals to preferentially publish statistically significant studies. This article is intended for clinicians and researchers who are approaching the field of evidence synthesis and would like to perform a literature search. It aims to provide advice on how to develop the search protocol and the strategy to identify the most relevant evidence for a given research or clinical question. It will also focus on how to search not only the published but also the unpublished literature using a number of online resources.

LEARNING OBJECTIVES

•

Understand the purpose of conducting a literature search and its integral part of the literature review process

•

Become aware of the range of sources that are available, including electronic databases of published data and trial registries to identify unpublished data

•

Understand how to develop a search strategy and apply appropriate search terms to interrogate electronic databases or trial registries

DECLARATION OF INTEREST

None.
Against the Stream: Generalised anxiety disorder (GAD) – a redundant diagnosis
Authors: Tyrer Peter
Published: March 2018

The diagnosis of generalised anxiety disorder is a distraction of no value. It is highly unreliable, co-occurring with many other disorders of firmer diagnostic status, and has intrinsic connections to personality dysfunction. It is argued that classification would be heartily relieved to rid itself of this unnecessary appendage and for the symptom of anxiety to remain as a descriptive term only.

Declaration of interest

None.
Distinct Phenotypic Clusters of Glioblastoma Growth and Response Kinetics Predict Survival
Authors: Rayfield Corbin A. , Grady Fillan , De Leon Gustavo , Rockne Russell , Carrasco Eduardo , Jackson Pamela , Vora Mayur , Johnston Sandra K. , Hawkins-Daarud Andrea , Clark-Swanson Kamala R. , Whitmire Scott , Gamez Mauricio E. , Porter Alyx , Hu Leland , Gonzalez-Cuyar Luis , Bendok Bernard , Vora Sujay , Swanson Kristin R.
Published: March 2018

Purpose

Despite the intra- and intertumoral heterogeneity seen in glioblastoma multiforme (GBM), there is little definitive data on the underlying cause of the differences in patient survivals. Serial imaging assessment of tumor growth allows quantification of tumor growth kinetics (TGK) measured in terms of changes in the velocity of radial expansion seen on imaging. Because a systematic study of this entire TGK phenotype—growth before treatment and during each treatment to recurrence —has never been coordinately studied in GBMs, we sought to identify whether patients cluster into discrete groups on the basis of their TGK.

Patients and Methods

From our multi-institutional database, we identified 48 patients who underwent maximally safe resection followed by radiotherapy with imaging follow-up through the time of recurrence. The patients were then clustered into two groups through a k-means algorithm taking as input only the TGK before and during treatment.

Results

There was a significant survival difference between the clusters ( P = .003). Paradoxically, patients among the long-lived cluster had significantly larger tumors at diagnosis ( P = .027) and faster growth before treatment ( P = .003) but demonstrated a better response to adjuvant chemotherapy ( P = .048). A predictive model was built to identify which cluster patients would likely fall into on the basis of information that would be available to clinicians immediately after radiotherapy (accuracy, 90.3%).

Conclusion

Dichotomizing the heterogeneity of GBMs into two populations—one faster growing yet more responsive with increased survival and one slower growing yet less responsive with shorter survival—suggests that many patients who receive standard-of-care treatments may get better benefit from select alternative treatments.
Symptom Burden in the First Year After Cancer Diagnosis: An Analysis of Patient-Reported Outcomes
Authors: Bubis Lev D. , Davis Laura , Mahar Alyson , Barbera Lisa , Li Qing , Moody Lesley , Karanicolas Paul , Sutradhar Rinku , Coburn Natalie G.
Published: March 2018

Purpose

Improvement in the quality of life of patients with cancer requires attention to symptom burden across the continuum of care, with the use of patient-reported outcomes key to achieving optimal care. Yet there have been few studies that have examined symptoms in the early postdiagnosis period during which suboptimal symptom control may be common. A comprehensive analysis of temporal trends and risk factors for symptom burden in newly diagnosed patients with cancer is essential to guide supportive care strategies.

Methods

A retrospective observational study was performed of patients who were diagnosed with cancer between January 2007 and December 2014 and who survived at least 1 year. Patient-reported Edmonton Symptom Assessment System scores, which are prospectively collected at outpatient visits, were linked to provincial administrative health care data. We described the proportion of patients who reported moderate-to-severe symptom scores by month during the first year after diagnosis according to disease site. Multivariable logistic regression models were constructed to identify risk factors for moderate-to-severe symptom scores.

Results

Of 120,745 patients, 729,861 symptom assessments were recorded within 12 months of diagnosis. For most symptoms, odds of elevated scores were highest in the first month, whereas nausea had increased odds of elevated scores up to 6 months after diagnosis. On multivariable analysis, cancer site, younger age, higher comorbidity, female sex, lower income, and urban residence were associated with significantly higher odds of elevated symptom burden.

Conclusion

A high prevalence of moderate-to-severe symptom scores was observed in cancers of all sites. Patients are at risk of experiencing multiple symptoms in the immediate postdiagnosis period, which underscores the need to address supportive care requirements early in the cancer journey. Patient subgroups who are at higher risk of experiencing moderate-to-severe symptoms should be targeted for tailored supportive care interventions.
Type 2 Diabetes and Adiposity Induce Different Lipid Profile Disorders: A Mendelian Randomization Analysis
Authors: Wang Ningjian , Cheng Jing , Ning Zhiyuan , Chen Yi , Han Bing , Li Qin , Chen Chi , Zhao Li , Xia Fangzhen , Lin Dongping , Guo Lixin , Lu Yingli
Published: March 2018

Context

Type 2 diabetes and obesity often coexist, so it is difficult to judge whether diabetes or obesity induce certain types of hyperlipidemia due to mutual confounds and reverse causation. We used Mendelian randomization analyses to explore the causal relationships of diabetes and adiposity with lipid profiles.

Design, Setting, and Main Outcome Measures

From 23 sites in East China, 9798 participants were enrolled during 2014 to 2016. We calculated two weighted genetic risk scores as instrumental variables for type 2 diabetes and body mass index (BMI). These scores were used to measure the causal relationships of diabetes and BMI with lipid profiles that included total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TGs).

Results

The causal regression coefficients (βIV) of genetically determined diabetes for the total cholesterol, LDL-C, and log10TG were 0.130 [95% confidence interval (CI): 0.020, 0.240; P = 0.014], 0.125 (96% CI: 0.041, 0.209; P = 0.001), and 0.019 (95% CI: –0.001, 0.039; P = 0.055), respectively. The βIV for HDL-C was –0.008 (95% CI: –0.032. 0.016), which was not significant (P = 0.699). The causal regression coefficients of a genetically determined 10 kg/m2 increase in BMI for HDL-C and log10TG were –0.409 (96% CI: –0.698, –0.120; P = 0.004) and 0.227 (95% CI: 0.039, 0.415; P = 0.026), respectively. The βIVs for TGs and LDL-C were not significant.

Conclusions

This study has provided evidence for the biologically plausible causal effects of diabetes and adiposity by BMI on different elements of the lipid profile using Mendelian randomization analyses.
Impact of Minimal Extrathyroid Extension in Differentiated Thyroid Cancer: Systematic Review and Meta-Analysis
Authors: Diker-Cohen Talia , Hirsch Dania , Shimon Ilan , Bachar Gideon , Akirov Amit , Duskin-Bitan Hadar , Robenshtok Eyal
Published: March 2018

Background

Minimal extrathyroid extension (mETE) in patients with differentiated thyroid cancer (DTC) was defined as an intermediate risk feature in the 2015 American Thyroid Association guidelines. However, controversy persists as several studies suggested mETE has little effect on disease outcome.

Objective

To assess the impact of mETE on DTC patients' outcome.

Methods

Meta-analysis of controlled trials comparing patients with DTC with and without mETE.

Data Extraction and Synthesis

Thirteen retrospective studies including 23,816 patients were included, with a median follow-up of 86 months. mETE in patients without lymph node involvement (N0 disease) was associated with increased risk of recurrence [seven studies: odds ratio (OR), 1.73; 95% confidence interval (CI), 1.03 to 2.92]. The absolute risk of recurrence was 2.2% in patients without extension and 3.5% in patients with mETE (P = 0.04). In studies including patients with and without lymph node involvement (N1/N0 disease), mETE resulted in a significantly higher risk of recurrence (eight studies: OR, 1.82; 95% CI, 1.14 to 2.91). The absolute risk of recurrence was 6.2% in patients without extension and 7% in patients with mETE (P = 0.01). In patients with micropapillary carcinoma (<1 cm), the impact of mETE was nonsignificant (OR, 2.40; 95% CI, 0.95 to 6.03). mETE had no impact on disease-related mortality (eight studies: OR, 0.5; 95% CI, 0.11 to 2.21).

Conclusion

mETE increases risk of recurrence in patients with DTC; however, the absolute increase in risk is small, and in patients with N0 disease the risk is within the low-risk of recurrence category at 3.5%. mETE has no impact on disease-related mortality and should not change tumor stage.
The heart tube forms and elongates through dynamic cell rearrangement coordinated with foregut extension
Authors: Kidokoro Hinako , Yonei-Tamura Sayuri , Tamura Koji , Schoenwolf Gary C. , Saijoh Yukio
Published: March 2018

In the initiation of cardiogenesis, the heart primordia transform from bilateral flat sheets of mesoderm into an elongated midline tube. Here, we discover that this rapid architectural change is driven by actomyosin-based oriented cell rearrangement and resulting dynamic tissue reshaping (convergent extension, CE). By labeling clusters of cells spanning the entire heart primordia, we show that the heart primordia converge toward the midline to form a narrow tube, while extending perpendicularly to rapidly lengthen it. Our data for the first time visualize the process of early heart tube formation from both the medial (second) and lateral (first) heart fields, revealing that both fields form the early heart tube by essentially the same mechanism. Additionally, the adjacent endoderm coordinately forms the foregut through previously unrecognized movements that parallel those of the heart mesoderm and elongates by CE. In conclusion, our data illustrate how initially two-dimensional flat primordia rapidly change their shapes and construct the three-dimensional morphology of emerging organs in coordination with neighboring morphogenesis.
Regulatory integration of Hox factor activity with Tbox factors in limb development
Authors: Jain Deepak , Nemec Stephen , Luxey Maëva , Gauthier Yves , Bemmo Amandine , Balsalobre Aurelio , Drouin Jacques
Published: March 2018

In tetrapods, Tbx4, Tbx5 and Hox cluster genes are crucial for forelimb and hindlimb development and mutations in these genes are responsible for congenital limb defects. The molecular basis of their integrated mechanisms of action in the context of limb development remains poorly understood. We studied Tbx4 and Hoxc10 due to their overlapping loss of function phenotypes and co-localized expression in hindlimb buds. We report an extensive overlap between Tbx4 and Hoxc10 genome occupancy and their putative target genes. Tbx4 and Hoxc10 interact directly with each other, have the ability to bind to a previously unrecognised Tbox-Hox composite DNA motif and show synergistic activity when acting on reporter genes. Pitx1, the master gene for hindlimb specification, also shows extensive genomic colocalization with Tbx4 and Hoxc10. Genome occupancy by Tbx4 in hindlimb buds is similar to Tbx5 occupancy in forelimbs. In contrast, another Hox factor, Hoxd13, also interacts with Tbx4/Tbx5 but Hoxd13 antagonises Tbx4/Tbx5-dependent transcriptional activity. Collectively, the modulation of Tbx-dependent activity by Hox factors acting on common DNA targets may integrate different developmental processes for balanced formation of proportionate limbs.
The Effectiveness of Standing on a Balance Board for Increasing Energy Expenditure
Authors: NELSON MEGAN C. , CASANOVA MADELINE P. , VELLA CHANTAL A.
Published: March 2018

Purpose

This study aimed to investigate differences in energy expenditure (EE), heart rate (HR), productivity, fatigue, and pain while performing desk work while sitting (SIT), standing (STAND), and standing on a balance board (BOARD).

Methods

Thirty healthy adults (60% female, age = 39.7 ± 11.8 yr, body mass index = 26.7 ± 5.0 kg·m−2) employed in sedentary-based jobs volunteered for this randomized crossover trial. Participants performed typing work in three different positions: SIT, STAND, and BOARD, each condition lasting 30 min. Oxygen consumption (V˙O2) was measured via indirect calorimetry, and EE was calculated using respiratory quotient and corresponding caloric equivalent values. Productivity was quantified by measuring words typed per minute, accuracy, and typing mistakes. Overall feelings of fatigue and pain were self-reported three times during each position using validated 10-cm visual analog scales. Repeated-measures ANOVA was used to assess differences in outcome variables across conditions.

Results

V˙O2 was significantly different among all conditions regardless of current standing desk use (SIT = 3.35 ± 0.53, STAND = 3.77 ± 0.48, BOARD = 3.92 ± 0.54 mL·kg−1·min−1, P < 0.001). EE (kcal·min−1) also differed (P < 0.001) among SIT (1.27 ± 0.22), STAND (1.42 ± 0.26), and BOARD (1.48 ± 0.29). Compared with sitting (67 ± 9 bpm), HR was higher in STAND (76 ± 11 bpm) and BOARD (76 ± 11 bpm, P < 0.001). Measures of productivity were not different across conditions (P > 0.05). Fatigue progressively increased over each 30-min condition, whereas pain in SIT and BOARD increased from minute 10 to minute 20 and then leveled off between minutes 20 and 30. For STAND, pain continued to increase over time.

Conclusion

Compared with sitting, a balance board may be effective for increasing EE without interfering with productivity in an occupational setting.
Dopamine synergizes with caffeine to increase the heart rate of Daphnia
Authors: Kundu Aman , Singh Gyanesh
Published: March 2018

Dopamine is a key neurotransmitter, and is widely used as a central nervous system (CNS) agent.  Dopamine plays an important role in humans, including a major role in reward and motivation behaviour. Several addictive drugs are well known to increase neuronal dopamine activity. We selected Daphnia, an important model organism, to investigate the effect(s) of selected CNS agents on heart rate. Dopamine’s effects on Daphnia’s heart has not been previously reported. Caffeine is a well-known and widely consumed stimulant. Ethanol is well known for its effects on both neurological and physiological processes in mammals. We tested the effect of dopamine on the heart rate of Daphnia, and compared its effect with caffeine and ethanol alone and in combination. Both caffeine and dopamine were found to instantly increase the heart rate of Daphnia in a dose-dependent manner. Interestingly, caffeine synergized with dopamine to increase Daphnia’s heart rate. As ethanol decreased the heart rate of Daphnia and dopamine increased the heart rate of Daphnia, we wanted to test the effect of these molecules in combination. Indeed, Dopamine was able to restore the ethanol-induced decrease in the heart rate of Daphnia.  Effects of these CNS agents on Daphnia can possibly be correlated with similar effects in the case of mammals.
Maternal and fetal cytomegalovirus infection: diagnosis, management, and prevention
Authors: Pass Robert F. , Arav-Boger Ravit
Published: March 2018

Congenital cytomegalovirus infection is a major cause of central nervous system and sensory impairments that affect cognition, motor function, hearing, language development, vestibular function, and vision. Although the importance of congenital cytomegalovirus infection is readily evident, the vast majority of maternal and fetal infections are not identified, even in developed countries. Multiple studies of prenatal cytomegalovirus infections have produced a body of knowledge that can inform the clinical approach to suspected or proven maternal and fetal infection. Reliable diagnosis of cytomegalovirus infection during pregnancy and accurate diagnosis of fetal infection are a reality. Approaches to preventing the transmission of cytomegalovirus from mother to fetus and to the treatment of fetal infection are being studied. There is evidence that public health approaches based on hygiene can dramatically reduce the rate of primary maternal cytomegalovirus infections during pregnancy. This review will consider the epidemiology of congenital cytomegalovirus infection, the diagnosis and management of primary infection during pregnancy, and approaches to preventing maternal infection.
The inflammation paradox: Why are Tsimane protected against Western diseases while Westerners are not?
Authors: Freese Jens , Klement Rainer Johannes , Lötzerich Helmut
Published: March 2018

Recently, observational studies in the Amazon region showed that the indigenous Tsimane in Bolivia appear protected against non-communicable diseases (NCDs) such as obesity, type 2 diabetes, and cardiovascular diseases despite increased inflammatory markers. These findings stand in contrast to Western societies, where an increasing body of evidence demonstrates that low-grade-inflammation is the driver of NCDs. In 2013 and 2014, we carried out two field studies (Eifel studies) with Westerners who returned to a simulated Palaeolithic lifestyle in a National park for 4 days and detected elevated inflammation markers, analogous to the conditions of the Tsimane. We here propose three hypotheses for this inflammatory paradox.
Stages of Formation by Young Schoolchildren of Regulatory Educational Actions in the Conditions of Ungraded Classes
Authors: Кузнецова О. , Kuznecova O.
Published: March 2018

The author examines the problem of the formation of regulatory universal educational activities for primary school students in conditions of ungraded classes. The article emphasizes the effectiveness of this assessment system for developing the self-esteem of a younger schoolchildren, the ability to control their activities and adequately assess it. The stages of the formation of regulatory training activities are described.
Organization of Educational Process in Elementary School Based on Regional Natural History Material
Authors: Иващенко Елена , Ivashchenko Elena , Цыбульник И. , Cybul'nik I.
Published: March 2018

The article considers the issues of comprehensive development and patriotic education of younger schoolchildren on the basis of studying history and culture, labor traditions, crafts, land-use skills of native land. The experience of primary school teachers on the use of local history material in the classroom and in done outside of class hours activities is presented on the example of the school museum of local lore in the village of Striguny, Borisov district of the Belgorod region: “Strigunovsky Onion”.
Community palliative care clinical nurse specialists as independent prescribers: part 2
Authors: Latham Kathy , Nyatanga Brian
Published: March 2018

This study explored the lived experiences of clinical nurse specialists who can prescribe independently in their role of providing support to patients with palliative care needs within the community. Part 1 of this study examined how the study was carried out; this second part explores the findings. The nurses reported that being able to prescribe enabled them to provide seamless, holistic care, which gave patients faster access to medicines, especially at weekends when their GP was unavailable. Prompt availability of medicines led to effective symptom control and consequently a better quality of life for patients. The main barrier to prescribing was difficulty in accessing patient records. Independent prescribing by community nurse specialists is beneficial for patients receiving palliative care and their families while they are being cared for at home, and provides job satisfaction for the nurses.
The influence of matrix metalloproteases and biofilm on chronic wound healing: a discussion
Authors: Parnham Alison , Bousfield Chrissie
Published: March 2018

Chronicity in wound healing is a challenge for health services financially and scientifically, with negative consequences on patients' lives. This paper seeks to explore why chronic wounds fail to heal in relation to the inflammatory cellular dysfunction associated with biofilm development. Findings demonstrate an association between chronic wounds failing to heal, the presence of devitalised tissue and abnormal immune cell activity with a consequential excessive release of harmful matrix metalloproteases (MMPs). This process perpetuates the cycle of wound chronicity and extracellular matrix destruction, which prolongs the inflammatory response, fuelling biofilm formation. Evidence suggests that ‘trapping’ MMPs may increase new tissue growth but, while devitalised tissue is present, phagocytic cells continue to secrete MMPs and chronicity persists. Consequently, by removing the trigger and implementing effective, sustained debridement of devitalised tissue, both MMP and biofilm production will be diminished, with positive healing outcomes.
Type II papillary renal cell carcinoma with heterotrophic ossification: a case report
Authors: Jindal T , Jain N , Agarwal A
Published: March 2018

Heterotrophic ossification in tumours is an uncommon phenomenon. The presence of ossification in renal cell carcinomas is extremely rare. In this report, we present a unique case of type II papillary renal cell carcinoma associated with heterotrophic ossification.
A cost-effective cell- and matrix-based minimally invasive single-stage chondroregenerative technique developed with validated vertical translation methodology
Authors: Shetty AA , Kim SJ , Ahmed S , Trattnig S , Kim SA , Jang HJ
Published: March 2018

Introduction

The morbidity and significant health economic impact associated with the chondral lesion has led to a large number of strategies for therapeutic neochondrogenesis. The challenge has been to develop techniques that are cost effective single-stage procedures with minimal surgical trauma that have undergone rigorous preclinical scrutiny and robust reproducible assessment of effectiveness. A biological repair requires the generation of a cellular and matrix composite with appropriate signalling for chondrogenic differentiation.

Methods and results

A technique was developed that allowed chondrogenic primary (uncultured) cells from bone marrow aspirate concentrate, combined with a composite hydrophilic and fibrillar matrix to be applied arthroscopically to a site of a chondral lesion. The construct was tested in vitro and in animal experiments before clinical trials. Clinical trials involved 60 patients in a prospective study. Symptomatic International Cartilage Repair Society grade 3 and 4a lesions were mapped and treated. Pre- and postoperative clinical assessments showed statistically significant improved outcomes; Lysholm Knee Scoring Scale (mean 52.8 to > 76.4; P < 0.05) International Knee Documentation Committee (mean 39 to > 79 P < 0.05) and Knee injury and Osteoarthritis Outcome Score (64.5 to >89.2 P < 0.05). Postoperative magnetic resonance imaging was evaluated morphologically (magnetic resonance observation of cartilage repair tissue, average MOCART score 72) and qualitatively; the regenerate was comparable to native cartilage.

Conclusions

This technique is effective, affordable, requires no complex tools and delivers a single-stage treatment that is potentially accessible to any centre capable of performing arthroscopic surgery. Good clinical results were found to be sustained at five years of follow-up with a regenerate that appears hyaline like using multiple magnetic resonance measures.
Articulating best interests
Authors: Wheeler Robert
Published: March 2018

Each month we take a close look at a recent legal case with implications for the surgical profession.
How to build a healthtech start-up
Authors: Menys Alex
Published: March 2018

From inventions to investors, we present a rough guide to turning clinical expertise into entrepreneurial gold.
Funcionamento familiar e estratégias de resolução de conflitos na fratria
Authors: Carvalho Joana Lopes de , Relva Inês Carvalho , Fernandes Otília Monteiro
Published: March 2018

Diferentes caraterísticas familiares podem influenciar as táticas usadas pelos irmãos para resolver conflitos. O presente estudo analísa a relação entre o funcionamento familiar (medido pelas Family Adaptability and Cohesion Scales – FACES IV) e as táticas de resolução de conflitos (avaliadas através das Revised Conflict Tactics Scales – Sibling Version; CTS2-SP). A amostra foi constituída por 353 sujeitos (entre os 12 e os 18 anos de idade). Os resultados indicaram que os rapazes são quem mais utiliza a agressão física sem sequelas. Relativamente à relação entre o funcionamento familiar e as táticas de resolução de conflitos, as dimensões equilibradas do funcionamento familiar encontram-se associadas positivamente às táticas de resolução de conflitos adequadas (a negociação), verificando-se o oposto para as dimensões desequilibradas do funcionamento familiar, que apresentam associações positivas a agressão (física e/ou psicológica). Os resultados sugerem um efeito preditor da qualidade do funcionamento familiar nas táticas de resolução de conflitos utilizadas no contexto fraterno. Será então importante que se desenvolvam ações junto da comunidade no sentido de sensibilizar para a magnitude e consequências nefastas da violência na fratria, trabalhando as competências comunicacionais das famílias, para melhorar a coesão e a satisfação familiares para uma gestão mais positiva dos conflitos na fratria.
Desafios atuais na formação do enfermeiro: o olhar dos docentes
Authors: Peres Cássia Regina Fernandes Biffe , Marin Maria José Sanches , Tonhom Silvia Franco da Rocha , Marques Maria De Lourdes da Silva Ferreira
Published: March 2018

Objetivo: compreender a visão de docentes de cursos de enfermagem sobre os desafios enfrentados no processo de reconstrução curricular. Métodos: pesquisa qualitativa com 21 docentes enfermeiros de seis Instituições de Ensino Superior. A análise dos dados fez-se pela técnica da hermêutica e dialética. Resultados: ocorrem dificuldades na reorganização curricular em relação à capacitação docente conforme as novas exigências sociais e à falta de integração das diferentes áreas do conhecimento. Há ainda, agravantes, como as lacunas de conhecimento do ensino médio, o distanciamento entre formação e mundo do trabalho e o desinteresse em ser enfermeiro. Conclusão: na visão dos docentes há movimento positivo para organização curricular, embora destacados desafios para a formação do enfermeiro, como falta de capacitação dos docentes para o enfrentamento de propostas inovadoras, distanciamento entre o mundo do trabalho e o processo de formação, pouca valorização social da profissão e baixa qualidade do ensino fundamental e médio brasileiro.
Associação entre fatores maternos e neonatais e o Apgar em recém-nascidos de risco habitual
Authors: Saraiva Jéssica Pinto , Vogt Sibylle Emilie , Rocha Jéssica Da Silva , Duarte Elysângela Dittz , Simão Delma Aurélia Da Silva
Published: March 2018

Objetivo: verificar associação entre fatores maternos e neonatais e o índice de Apgar <7 aos cinco minutos de vida. Métodos: estudo transversal com 134 recém-nascidos. Para análise dos dados coletados com instrumento elaborado pelos pesquisadores, utilizou-se a descrição das frequências absolutas e relativas e a aplicação dos testes Qui-quadrado ou exato de Fisher. Resultados: do total de recém-nascidos, 63,0% tinham mãe primigesta, 56,0% eram do sexo masculino, 79,0% nasceram de parto normal, 65,0% demandaram oxigênio e 45,0% foram reanimados na sala de parto. Entre as mulheres, 71,0% utilizaram ocitocina. Conclusão: uso de ocitocina, oxigênio e reanimação em sala de parto mostraram associação significativa com Apgar <7 aos cinco minutos de vida. Peso ao nascer, tempo de bolsa rota, eliminação de mecônio, tipo de parto e paridade não se relacionaram ao baixo valor de Apgar.
Efetividade do metronidazol no tratamento de odores em feridas tumorais
Authors: Barreto Arthur Monte , Marques Antonio Dean Barbosa , Cestari Virna Ribeiro Feitosa , Cavalcante Rochelle Da Costa , Moreira Thereza Maria Magalhães
Published: March 2018

Objetivo: analisar as evidências da efetividade do Metronidazol no tratamento de odores em feridas tumorais. Métodos: revisão integrativa realizada nas bases de saúde e no portal PubMed. Os estudos foram avaliados pela Escala de Jadad (ensaios clínicos randomizados), Downs e Black (quase experimentais) e o Strengthening the Reporting of Observational studies in Epidemiology (observacionais). Amostra de dez estudos e considerou-se como ponto de corte artigos que atingiram 50,0% dos critérios. Resultados: o Metronidazol se mostrou efetivo em 95,6% dos casos e a preparação em gel a 0,75% foi a mais utilizada nos estudos. Conclusão:as evidências apontam o metronidazol como seguro e eficaz no controle de odores em feridas tumorais, porém não há consenso sobre as formas de apresentação e vias de administração mais efetivas. A maioria dos estudos associa o surgimento de mau odor com o crescimento de bactérias anaeróbias no tecido tumoral.
Health status in 1040 adults with disorders of sex development (DSD): a European multicenter study
Authors: Falhammar Henrik , Claahsen-van der Grinten Hedi , Reisch Nicole , Slowikowska-Hilczer Jolanta , Nordenström Anna , Roehle Robert , Bouvattier Claire , Kreukels Baudewijntje P C , Köhler Birgit , _ _
Published: March 2018

Objective

The knowledge about health status in adults with disorder of sex development (DSD) is scarce.

Design and methods

A cross-sectional observational study in 14 European tertiary centers recruited 1040 participants (717 females, 311 males, 12 others) with DSD. Mean age was 32.4 ± 13.6 year (range 16–75). The cohort was divided into: Turner (n = 301), Klinefelter (n = 224), XY-DSD (n = 222), XX-DSD (excluding congenital adrenal hyperplasia (CAH) and 46,XX males) (n = 21), 46,XX-CAH (n = 226) and 45,X/46,XY (n = 45). Perceived and objective health statuses were measured and compared to European control data.

Results

In DSD, fair to very good general health was reported by 91.4% and only 8.6% reported (very) bad general health (controls 94.0% and 6.0%, P < 0.0001). Longstanding health issues other than DSD and feeling limited in daily life were reported in 51.0% and 38.6%, respectively (controls 24.5% and 13.8%, P < 0.0001 both). Any disorder except DSD was present in 84.3% (controls 24.6%, P < 0.0001). Males reported worse health than females. In the subgroup analysis, Klinefelter and 46,XX-DSD patients reported bad general health in 15.7% and 16.7%, respectively (Turner 3.2% and CAH 7.4%). Comorbidities were prevalent in all DSD subgroups but Klinefelter and Turner were most affected. Early diagnosis of DSD and a healthy lifestyle were associated with less comorbidities.

Conclusions

Overall, general health appeared to be good but a number of medical problems were reported, especially in Klinefelter and Turner. Early diagnosis of DSD and a healthy lifestyle seemed to be important. Lifelong follow-up at specialized centers is necessary.
An ecofeminist perspective on new food technologies
Authors: Lee Angela
Published: March 2018

New food technologies are touted by some to be an indispensable part of the toolkit when it comes to feeding a growing population, especially when factoring in the growing appetite for animal products. To this end, technologies like genetically engineered (GE) animals and in vitro meat are currently in various stages of research and development, with proponents claiming a myriad of justificatory benefits. However, it is important to consider not only the technical attributes and promissory possibilities of these technologies, but also the worldviews that are being imported in turn, as well as the unanticipated social and environmental consequences that could result. In addition to critiquing dominant paradigms, the inclusive, intersectional ecofeminist perspective presented here offers a different way of thinking about new food technologies, with the aim of exposing inherent biases, rejecting a view of institutions like science and law as being objective, and advancing methods and rationales for a more explicitly ethical form of decision-making. Alternative and marginalized perspectives are especially valuable in this context, because careful reflection on the range of concerns implicated by new food technologies is necessary in order to better evaluate whether or not they can contribute to the building of a more sustainable and just food system for all.
Rights for whom? Linking baby’s right to eat with economic, social, and cultural rights for women
Authors: Doonan Christina
Published: March 2018

Breastfeeding women are primary food producers par excellence, delivering a custom-made product to fit the exact needs of a favoured clientele. The importance of breastmilk as a first food has been acknowledged in recent years by many states, which have taken measures to protect and encourage breastfeeding in acknowledgment of the World Health Organization’s 2002 Global Strategy for Infant and Young Child Feeding. Within both state and grassroots efforts to promote it, breastfeeding is often framed in terms of “rights,” though it is not always clear what these entail. This perspective article considers the role of breastmilk as a critical food for children that ensures their “right to the highest attainable standard of health” as articulated in Article 24 of the Convention on the Rights of the Child, and interrogates mothers’ (and others’) role in providing it. While food studies, and even more so, food security scholarship and activism should incorporate breastfeeding scholarship, it should avoid the mistake of framing breastfeeding as a “choice” made by individual women. This article advocates incorporating breastfeeding into the right to food/food security agenda by explicitly supporting measures that increase women’s access to broader economic, social, and cultural (ESC) rights. This, in turn, would put breastfeeding within reach, as an option, for more women. Thus breastfeeding becomes more likely and pressure is diverted from individual mothers and the often false ‘choice’ to breastfeed.
Faux-meat and masculinity: The gendering of food on three vegan blogs
Authors: Hart Dana
Published: March 2018

This study explores the relationship between gender and veganism through a critical analysis of food-based discourse on three vegan blogs. As many researchers note, there is a strong association between meat and masculinity in North American society (Nath, 2011; Rothgerber, 2013; Rozin, Hormes, Faith & Wansink, 2012; Ruby & Heine, 2011; Sumpter, 2015). While some researchers argue that the practice of veganism inherently challenges traditional gender norms (Adams, 2015; Potts and Parry, 2010), in these blog posts there is little room for alternative gender performativity. Drawing upon critical feminist and vegan studies literature, and previous discourse analysis of food blogs, this research examines the intersections of gender and food through the practice of veganism. Furthermore, it analyses how the association between meat and masculinity is applied in the gendering of vegan food. I argue that the gendered discourse of vegan food on these blogs reinforces, rather than challenges, traditional gender norms through the use of tropes describing “carnivorous men” and “manly meals” with hopes of satiating male appetites.