bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective randomised non‐inferiority trial of pelvic drain placement vs no pelvic drain placement after robot‐assisted radical prostatectomy
Authors: Chenam Avinash , Yuh Bertram , Zhumkhawala Ali , Ruel Nora , Chu William , Lau Clayton , Chan Kevin , Wilson Timothy , Yamzon Jonathan
Published: September 2017

Objective

To determine if eliminating the prophylactic placement of a pelvic drain (PD) after robot‐assisted radical prostatectomy (RARP) affects the incidence of early (90‐day) postoperative adverse events.

Patients and Methods

In this parallel‐group, blinded, non‐inferiority trial, we randomised patients planning to undergo RARP to one of two arms: no drain placement (ND) or PD placement. Patients with demonstrable intraoperative leakage upon bladder irrigation were excluded. Randomisation sequence was determined a priori using a computer algorithm, and included a stratified design with respect to low vs intermediate/high D'Amico risk classifications. Surgeons remained blinded to the randomisation arm until final eligibility was verified at the end of the RARP. The primary endpoint was overall incidence of 90‐day complications which, based on our standard treatment using PD retrospectively, was estimated at 13%. The non‐inferiority margin was set at 10%, and the planned sample size was 312. An interim analysis was planned and conducted when one‐third of the planned accrual and follow‐up was completed, to rule out futility if the delta margin was in excess of 0.1389.

Results

From 2012 to 2016, 189 patients were accrued to the study, with 92 patients allocated to the ND group and 97 to the PD group. Due to lower than expected accrual rates, accrual to the study was halted by regulatory entities, and we did not reach the intended accrual goal. The ND and PD groups were comparable for median PSA level (6.2 vs 5.8 ng/mL, P = 0.5), clinical stage (P = 0.8), D'Amico risk classification (P = 0.4), median lymph nodes dissected (17 vs 18, P = 0.2), and proportion of patients receiving an extended pelvic lymph node dissection (70.7% vs 79.4%, P = 0.3). Incidence of 90‐day overall and major (Clavien–Dindo grade >III) complications in the ND group (17.4% and 5.4%, respectively) was not inferior to the PD group (26.8% and 5.2%, respectively; P < 0.001 and P = 0.007 for difference of proportions <10%, respectively). Symptomatic lymphocoele rates (2.2% in the ND group, 4.1% in the PD group) were comparable between the two arms (P = 0.7).

Conclusions

Incidence of adverse events in the ND group was not inferior to the group who received a PD. In properly selected patients, PD placement after RARP can be safely withheld without significant additional morbidity.
Effects of video‐feedback intervention on harmonious parent–child interaction and sensitive discipline of parents with intellectual disabilities: A randomized controlled trial
Authors: Hodes M. W. , Meppelder M. , de Moor M. , Kef S. , Schuengel C.
Published: September 2017

Background

This study tested whether video‐feedback intervention based on attachment and coercion theory increased harmonious parent–child interaction and sensitive discipline of parents with mild intellectual disabilities or borderline intellectual functioning.

Methods

Observer ratings of video‐recorded structured interaction tasks at home formed pretest, post‐test, and 3‐month follow‐up outcome data in a randomized controlled trial with 85 families. Repeated measures analyses of variance and covariance were conducted to test for the intervention effect and possible moderation by IQ and adaptive functioning.

Results

The intervention effect on harmonious parent–child interaction was conditional on parental social adaptive behaviour at pretest, with lower adaptive functioning associated with stronger intervention benefit at post‐test and follow‐up compared to care as usual. Intervention effects were not conditional on parental IQ. Intervention effects for sensitive discipline were not found.

Conclusion

Although the video‐feedback intervention did not affect observed parenting for the average parent, it may benefit interaction between children and parents with lower parental adaptive functioning.
Paradoxical prognostic impact of TERT promoter mutations in gliomas depends on different histological and genetic backgrounds
Authors: You Hao , Wu Yao , Chang Kai , Shi Xiao , Chen Xin‐Da , Yan Wei , Li Rui
Published: September 2017

Aims

The purpose of this study was to explore the clinical significance of telomerase reverse transcriptase (TERT) promoter mutations in gliomas.

Methods and results

We used DNA sequencing data to analyze 887 gliomas for TERT promoter mutations based on histological and genetic backgrounds. TERT promoter mutations were detected in 39.6% of low‐grade gliomas, 40.3% of anaplastic gliomas, 44.7% of primary glioblastomas, 29.4% of secondary glioblastomas, and in 29.7% of Proneural, 38.6% of Neural, 41.8% of Classical, and 41.6% of Mesenchymal subtypes. Frequency of C250T mutation in recurrent gliomas was approximately half that in newly diagnosed gliomas. TERT exhibited improved prognosis when co‐occurred with isocitrate dehydrogenase 1 (IDH1) and 1p19q alteration, but experienced inverse survival in the Mesenchymal subtype or tumor protein p53 (TP53) and epidermal growth factor receptor (EGFR) alteration. Furthermore, the five subtypes were classified based on the prognostic impact of the TERT mutation with different genetic backgrounds of glioma.

Conclusion

We describe the TERT promoter mutation spectrum according to the histological, genetic, and molecular subtypes of glioma, which may aid in glioma subtype classification and have clinical implications.
A systematic review of Clostridium difficile infection following reversal of ileostomy
Authors: Harries R. L. , Ansell J. , Codd R. J. , Williams G. L.
Published: September 2017

Aim

The incidence of Clostridium difficile infection (CDI) has been reported to be as high as 4% following ileostomy reversal. CDI can be associated with significant morbidity. A systematic review on this subject has not been previously reported; our aim was to review the literature to establish incidence and to evaluate the factors that may contribute to an increased risk of CDI following ileostomy reversal.

Method

A systematic review of Ovid, Embase and Medline was undertaken. Search terms included C. difficile, reversal of ileostomy and ileostomy closure. Articles were included where at least one case of C. difficile‐associated diarrhoea following reversal of defunctioning ileostomy was reported. Data extraction for articles was performed by two authors, using predefined data fields. The primary outcome measure was incidence of CDI amongst patients undergoing ileostomy reversal. Secondary outcomes were defunctioning time, antibiotic regime, acid suppression, time to onset of symptoms and study conclusions including colectomy and mortality rate.

Results

Eleven articles were included (five case reports and six cohort studies). The overall incidence of CDI was 1.8% (242/13 728). The mean defunctioning time was 8.7 months (range 6–12). A variety of antibiotic regimes were described. Mean time to onset of symptoms was 6 days (range 3–14). Use of acid suppression, colectomy or mortality rate were frequently not reported.

Conclusion

CDI should be recognized as a potentially life‐threatening complication of ileostomy closure. Careful consideration should be given to peri‐operative antibiotic regime, acid suppression, timing of reversal and appropriate preoperative counselling of patients.
Controlled oxygenated rewarming up to normothermia for pretransplant reconditioning of liver grafts
Authors: von Horn Charlotte , Baba Hideo A. , Hannaert Patrik , Hauet Thierry , Leuvenink Henri , Paul Andreas , Minor Thomas ,   COPE consortium partners
Published: September 2017

Controlled oxygenated rewarming (COR) up to 20°C during ex vivo machine perfusion limits reperfusion‐induced tissue injury upon graft implantation. Rewarming up to normothermia might add further benefits and provide better prediction of post‐transplantation organ function. The effect of 90 minutes of oxygenated machine perfusion with Aqix RS‐I after cold storage combined with gentle rewarming up to 20°C (COR20) or 35°C (COR35) was studied in rat livers and compared with cold storage alone (CS, n = 6, resp). Postpreservation recovery was evaluated upon warm reperfusion using an established in vitro system. COR generally resulted in significantly improved energetic recovery, increased bile flow, less activities alanine aminotransferase (ALT) release, and improved histopathology upon reperfusion as compared to only cold‐stored livers, without significant differences between COR20 and COR35. Parameters obtained during COR, especially during COR35, also allowed for prediction of hepatic recovery upon reperfusion. For instance, ulterior bile production upon reperfusion was found closely correlated to bile flow observed already during COR35 (R2 = 0.91). COR significantly improved liver quality after static cold storage. Elevation of machine perfusion temperature up to 35°C may prove promising to refine ex vivo evaluation of the graft prior to transplantation.
The impact of the non‐invasive follicular thyroid neoplasm with papillary‐like nuclear feature terminology in the routine diagnosis of thyroid tumours
Authors: Jaconi M. , Manzoni M. , Pincelli A. I. , Giardini V. , Scardilli M. , Smith A. , Fellegara G. , Pagni F.
Published: September 2017

Background

Due to the recent proposal of the non‐invasive follicular thyroid neoplasm with papillary‐like nuclear feature (NIFTP) category, the authors analyse the state of the art in the challenging diagnosis of follicular thyroid neoplasms in routine practice.

Methods and results

A consecutive series of 200 histological diagnoses, with complete cytological correlation, was analysed following the introduction of the NIFTP definition. The study was conducted in a general hospital with a high prevalence of thyroid benign nodules that accounted for approximately 60% of surgically‐treated nodules. The significant incidence of the new NIFTP category was 7%. Concurrently, a gradual decrease of the follicular variant of papillary thyroid carcinoma (fvPTC) was observed (3.5%). When evaluating the FNA biopsies within the NIFTP group, despite the systematic evaluation of nuclear crowding, enlargement, irregularities and clearing, the final cytological class was often indeterminate for malignancy (Thy3/III‐IV, 71%). At histology, the application of the semiquantitative NIFTP score for the evaluation of the PTC‐like nuclear features was able to discriminate benign lesions (score 0/1) from fvPTC (score 2/3). A certain degree of overlapping still persisted between NIFTP and fvPTC (score 2) or between NIFTP and benign lesions (score 1).

Conclusions

In the routine evaluation of FNA biopsies, the presence of subtle and questionable PTC‐like nuclear features still remains a controversial aspect of the diagnostic workflow. Given that the NIFTP category was introduced to stratify the low‐risk group of thyroid tumours more precisely, pathologists should force themselves to apply the nuclear score rigorously and to classify cases assigned a score of 1 as benign proliferations.
Symplastic epididymal leiomyoma with bizarre cytology
Authors: Raghavendran M. , Venugopal A. , Kumar K. G.
Published: September 2017

Epididymal symplastic (bizarre) leiomyoma is an extremely rare tumour with only one case reported to date. We report a second such case with special emphasis on the cytodiagnostic aspects which have not been described before.
Constructive Theology, the Cross of Christ, and the Praxis of Liberation
Authors: Gockel Matthias
Published: September 2017

The article relates Paul Hinlicky's project of critical dogmatics to the constructive work of two Reformed theologians, Jürgen Moltmann's The Crucified God (1972) and Mark Lewis Taylor's The Executed God (2001/2015). After highlighting central tenets of Hinlicky's paradigm I discuss and compare the monographs by Moltmann and Taylor, weighing their similarities and differences. I conclude by pointing out the shared interest of critical dogmatics and constructive theology.
Emerging Tapestry: An Evangelical Lutheran Social Ethic
Authors: Willer Roger A.
Published: September 2017

This article argues that an identifiable social ethic is emerging in the social teaching documents of the Evangelical Lutheran Church in America. Reading across the body of teaching and policy it becomes evident how conscientious attention to Lutheran themes and commitments at the interface with contemporary social analysis and questions has produced a coherent ethic. That is, it is relatively comprehensive, responsibly consistent, and remarkably cogent with an identifiable moral imperative and mode of reasoning. The paper delineates the character of this responsibility ethic across the five dimensions of ethics.
Perceptions of dental treatment need in Australian‐born and migrant populations
Authors: Lim Mathew A. W. T. , Crocombe Leonard A. , Do Loc G.
Published: September 2017

The objective of this study was to investigate differences in self‐perceived and dentist‐determined treatment need in Australian‐born and migrant residents of Australia. Participants in the National Survey of Adult Oral Health 2004–06 were categorized into six groups according to country of birth. Interview and examination data were used to analyze differences between self‐perceived and the ‘gold standard’ examiner‐determined treatment need, and to compare the accuracy of self‐reporting according to country of birth. Self‐reported treatment needs, defined as the need for a restoration and/or extraction, were cross‐tabulated with clinically observed conditions and compared using a multivariable logistic regression model. Concordance between self‐reported and clinically‐determined treatment need differed significantly for migrants from Europe and the UK and Australian‐born individuals. In the logistic regression model, stratification according to examiner‐determined treatment need revealed significantly greater reporting of treatment need by Asian‐born migrants than by the Australian‐born reference group. The results of this study demonstrate that self‐perceived treatment need was less than the examiner‐determined findings in European and UK migrant groups and Australian‐born individuals. Additionally, Asian migrants were more likely than Australian‐born individuals to over‐report treatment need for a filling and/or extraction.
Biogeographic responses of the copepod Calanus glacialis to a changing Arctic marine environment
Authors: Feng Zhixuan , Ji Rubao , Ashjian Carin , Campbell Robert , Zhang Jinlun
Published: September 2017

Dramatic changes have occurred in the Arctic Ocean over the past few decades, especially in terms of sea ice loss and ocean warming. Those environmental changes may modify the planktonic ecosystem with changes from lower to upper trophic levels. This study aimed to understand how the biogeographic distribution of a crucial endemic copepod species, Calanus glacialis, may respond to both abiotic (ocean temperature) and biotic (phytoplankton prey) drivers. A copepod individual‐based model coupled to an ice‐ocean‐biogeochemical model was utilized to simulate temperature‐ and food‐dependent life cycle development of C. glacialis annually from 1980 to 2014. Over the 35‐year study period, the northern boundaries of modeled diapausing C. glacialis expanded poleward and the annual success rates of C. glacialis individuals attaining diapause in a circumpolar transition zone increased substantially. Those patterns could be explained by a lengthening growth season (during which time food is ample) and shortening critical development time (the period from the first feeding stage N3 to the diapausing stage C4). The biogeographic changes were further linked to large‐scale oceanic processes, particularly diminishing sea ice cover, upper ocean warming, and increasing and prolonging food availability, which could have potential consequences to the entire Arctic shelf/slope marine ecosystems.
Mapping the future: policy applications of climate vulnerability mapping in West Africa
Authors: Sherbinin Alex De , Apotsos Alex , Chevrier Jeremy
Published: September 2017

We describe the development of climate vulnerability maps for three Sahelian countries – Mali, Burkina Faso, and Niger – and for coastal West Africa, with a focus on the way the maps were designed to meet decision‐making needs and their ultimate influence and use in policy contexts. The paper provides a review of the literature on indicators and maps in the science–policy interface. We then assess the credibility, salience, and legitimacy of the maps as tools for decision‐making. Results suggest that vulnerability maps are a useful boundary object for generating discussions among stakeholders with different objectives and technical backgrounds, and that they can provide useful input for targeting development assistance. We conclude with a discussion of the power of maps to capture policy‐maker attention, and how this increases the onus on map developers to communicate clearly uncertainties and limitations. The assessment of policy uptake in this paper is admittedly subjective; the article includes a discussion of ways to conduct more objective and rigorous assessments of policy impact so as to better evaluate the value and use of vulnerability mapping in decision‐making processes.
Validity of maximum isometric tongue pressure as a screening test for physical frailty: Cross‐sectional study of Japanese community‐dwelling older adults
Authors: Yamanashi Hirotomo , Shimizu Yuji , Higashi Miho , Koyamatsu Jun , Sato Shimpei , Nagayoshi Mako , Kadota Koichiro , Kawashiri Shinya , Tamai Mami , Takamura Noboru , Maeda Takahiro
Published: September 2017

Aim

Maximum isometric tongue pressure (MIP) seems to have a diagnostic value for oral phase dysphagia. The present study aimed to examine the association between MIP and frailty, and to assess the screening validity of MIP for physical frailty.

Methods

We carried out a cross‐sectional study, and enrolled participants aged ≥60 years from Japanese national medical check‐ups in 2015 and 2016. The Fried frailty phenotype model was used. We analyzed odds ratios (OR) and 95% confidence intervals (CI) of physical frailty using one standard deviation increments of tongue pressure. Receiver operating characteristic curves were obtained to predict physical frailty using MIP values.

Results

Out of 1603 participants, 968 were categorized as non‐frail, 605 as pre‐frail and 30 as frail. In logistic regression analysis, one standard deviation increment of MIP significantly differentiated frail and pre‐frail: the OR for frail with one standard deviation increment in MIP was 0.37 (95% CI 0.26–0.54, P < 0.001), and the OR for pre‐frail was 0.63 (95% CI 0.57–0.70, P < 0.001). The area under the receiver operating characteristic curve for predicting frailty with MIP score was as high as 0.776 (95% CI 0.689–0.862). A point of MIP 35 kPa had a sensitivity of 90.0%, specificity of 40.4%, a positive likelihood ratio of 1.5 and a negative likelihood ratio of 0.2 for predicting frailty.

Conclusions

MIP performance is independently associated with frailty. MIP also can be used as a simple screening tool for frailty. Geriatr Gerontol Int 2018; 18: 240–249.
Calculating Groundwater Response Times for Flow in Heterogeneous Porous Media
Authors: Simpson Matthew J.
Published: September 2017

Predicting the amount of time required for a transient groundwater response to take place is a practical question that is of interest in many situations. This time scale is often called the response time. In the groundwater hydrology literature, there are two main methods used to calculate the response time: (1) both the transient and steady‐state groundwater flow equations are solved, and the response time is taken to be amount of time required for the transient solution to approach the steady solution within some tolerance; and (2) simple scaling arguments are adopted. Certain limitations restrict both of these approaches. In this study, we outline a third method, based on the theory of mean action time. We derive the governing boundary value problem for both the mean and variance of action time for confined flow in two‐dimensional heterogeneous porous media. Importantly, we show that these boundary value problems can be solved using widely available software. Applying these methods to a test case reveals the advantages of the theory of mean action time relative to standard methods.
Being a Neighbor: Ideas and Ideals of Neighborliness in the Medieval West
Authors: McDonough Susan
Published: September 2017

This essay takes stock of current scholarship on neighbors in the Middle Ages to think through medieval understandings of the notion of neighborliness. When historians invoke the ideas of neighbors and neighborliness, they mean something beyond the people who lived in adjoining buildings or on adjacent plots of land. When medieval people called someone a “neighbor,” the label conveyed a set of obligations, behaviors, and expectations, rooted in the idea that neighbors were among the group of people who were privy to the intimacies of each others' lives, at times both monumental and mundane. Medieval neighborliness was not uncomplicated or understood as unequivocally positive of course. Neighbors were not always a source of unconditional support or love. Despite a Christian rhetoric that emphasized a love of one's neighbor as a vehicle for loving God, medieval studies have suggested that the figure of the neighbor was, in fact, a source of danger and disquiet. This notion of neighborliness as a source of unease explains, perhaps, why scholars of medieval religion and religious interaction showcase some of the most fruitful uses of the concept. This article considers how scholars have accessed medieval notions of neighbors and neighborliness in their exploration of medieval community.
Role of immune microenvironment in gastrointestinal stromal tumours
Authors: Blakely Andrew M , Matoso Andres , Patil Pallavi A , Taliano Ross , Machan Jason T , Miner Thomas J , Lombardo Kara A , Resnick Murray B , Wang Li‐Juan
Published: September 2017

Aims

The immune microenvironment is a prognostic factor for various malignancies. The significance of key players of this immune microenvironment, including tumour‐infiltrating lymphocytes (TILs) and expression of programmed death‐ligand 1 (PD‐L1), indoleamine 2,3‐dioxygenase (IDO) and tryptophanyl‐tRNA synthetase (WARS) in gastrointestinal stromal tumours (GISTs) is largely unknown.

Methods and results

Tissue microarrays were constructed from pathology files, 1996–2016. Immunohistochemistry for PD‐L1, IDO and WARS was correlated with tumour size, mitoses and outcomes. TILs expressing CD3, CD4, CD8, FoxP3 and GBP5 were counted. A total of 129 GISTs were analysed. Mean patient age was 62.5 years; 52.0% were male. Tumour location included 89 stomach (69.0%), 33 small bowel (25.6%) and seven other (5.4%). Mean tumour size was 5.6 cm; mean mitoses were 7.2 per 50 high‐power field. Nineteen patients (15.0%) developed disease progression, to abdominal wall (n = 8), liver (n = 6) and elsewhere (n = 5). Median progression‐free survival was 56.6 months; five patients died of disease. PD‐L1 was positive in 88 of 127 tumour samples (69.0%), 114 of 127 tumours were IDO‐positive (89.8%) and 60 of 127 were positive for WARS (47.2%). PD‐L1 was associated with increased size (P = 0.01), necrosis (P = 0.018) and mitoses (P = 0.006). Disease progression was not associated with PD‐L1 (P = 0.44), IDO (P = 0.14) or WARS (P = 0.36) expression. PD‐L1‐positive GISTs with CD8+ or CD3+ TILs were significantly smaller than tumours with CD8+ or CD3+ TILs.

Conclusions

PD‐L1 expression was associated with increased size and mitoses. High CD8+ or CD3+ TIL counts were associated with decreased PD‐L1/IDO+ GIST size. PD‐L1 and IDO could be significant in GIST tumour biology, which invites consideration of immunotherapy as a potential treatment option.
5. GROSSRAUM AND GEOPOLITICS: RESITUATING SCHMITT IN AN ATLANTIC CONTEXT
Authors: SPECTER MATTHEW
Published: September 2017

Contemporary theorists of international relations and historians of empire have found utility in the spatial theory of “Grossraum,” or “great space,” that Carl Schmitt developed in the 1930s and 40s. This article asks whether Schmitt's concept of Grossraum can be fully disentangled from its German history—from the Nazi pursuit of Lebensraum in which it eventually culminated, but with which it is not identical either. I argue that Schmitt's Grossraum theory is neither merely a symptomatic reflection of the Third Reich's objectives, nor a free‐floating theory with strong potential for critiquing imperialism, but is best approached as an important moment in the transatlantic conversation among empires that unfolded between 1890 and 1945 about the sources, methods, and prerogatives of global power. It compares Schmitt with other figures in German geopolitics such as Friedrich Ratzel and Karl Haushofer in order to establish a genealogy of the distinction between land and sea powers, arguing that Schmitt's writings on Grossraum modernize and transmit to the twentieth century the most influential theories of political geography and geopolitics developed in the Atlantic world between 1890 and 1930.
Historical Evolution and Global Changes in Women's Imprisonment in Peru
Authors: CONSTANT CHLOÉ
Published: September 2017

This article analyses the evolution of female confinement and imprisonment in Peru from the colonial period until the 21st Century, demonstrating how political, historical and social changes in Peruvian society influenced the changing processes of female imprisonment during three phases of its development. The first important developments were introduced by the transfer of criminal female control from religious institutions to national prison institutions. Second, the context of the internal armed conflict shaped penal policies at the end of the 20th Century and marked the beginning of mass female incarceration. Finally, this phenomenon coincides with important structural changes on a local and regional scale, and can be considered as an echo of global trends in penal policies.
Vulnerability Discourses and Drug Mule Work: Legal Approaches in Sentencing and Non‐Prosecution/Non‐Punishment Norms
Authors: URQUIZA‐HAAS NAYELI
Published: September 2017

This article analyses the meaning of vulnerability in discourses about drug mules and couriers at a national and international level, particularly the cases of Costa Rica and England and Wales. Drawing on policies, legislative reforms and court cases, it examines how vulnerability mobilised claims for more proportionality in sentencing practices for drug offences. Vulnerability discourses also underpin claims that drug mules are trafficked persons whose culpability should be extinguished, or at least, diminished. Yet, this article suggests vulnerability discourses can also reinforce neoliberal governance mechanisms rather than expose and critique the ways in which gender and racial histories of oppression intersect with the international drug control system, contributing to the precarity of drug mule work.
Families, Lovers, and Friends: Women, Social Networks, and Transnational Cocaine Smuggling from Curaçao and Peru
Authors: VAN SAN MARION , SIKKENS ELGA
Published: September 2017

Research on the role of women in organised crime used to be relatively scarce, but since the end of the 1990s more and more research has been conducted on this particular topic. Through this research it has become apparent that a growing number of women plays an increasingly important role in organised drug‐smuggling operations. To understand more about the involvement of women in the drug trade, it is important to study their social networks. We studied the social ties of women who participated in two transnational drug‐trafficking networks: one between Curaçao and the Netherlands and the second between Peru and the Netherlands. What makes the comparison between the two groups interesting is that one group is connected to Curaçao (historically connected to the Netherlands) while the other group is connected to Peru (with no historical connections). Women who smuggle drugs between the Netherlands and Curaçao have transnational familial networks through which criminal capital is transmitted and drug trafficking is facilitated. Women who smuggle between Peru and the Netherlands lack these networks but are often connected to intermediaries through lovers and acquaintances.
Monitoring of hemostatic abnormalities in major orthopedic surgery patients treated with edoxaban by APTT waveform
Authors: Hasegawa M. , Wada H. , Tone S. , Yamaguchi T. , Wakabayashi H. , Ikejiri M. , Watanabe M. , Fujimoto N. , Matsumoto T. , Ohishi K. , Yamashita Y. , Katayama N. , Sudo A.
Published: September 2017

Introduction

An analysis of the activated partial thromboplastin time (APTT) in major orthopedic surgery patients receiving edoxaban for the prevention of venous thromboembolism (VTE) was carried out.

Methods

The APTT waveform was analyzed in the above patients to monitor edoxaban administration.

Results

Of these 99 patients, 12 exhibited deep vein thrombosis, and 25 had massive bleeding. An increased biphasic pattern of the APTT waveform was observed after the administration of edoxaban, but there were no significant differences between the patients with and without complications. The peak times of acceleration, velocity, and 1/2 fibrin formation were significantly prolonged after the administration of edoxaban, especially in patients with massive bleeding, and were moderately correlated with the anti‐Xa activity. While the heights of velocity and acceleration peak 2 were lower in patients receiving warfarin treatment than in those receiving edoxaban, the widths of these parameters were significantly longer. The height of 1/2 fibrin formation and the width of acceleration peaks 1 and 2 and the velocity were significantly increased after the administration of edoxaban.

Conclusion

The peak time of the APTT waveform was significantly prolonged after the administration of edoxaban. The analysis of the APTT waveform may therefore be useful for the prediction of the risk of massive bleeding.
The distribution of total vitamin B12, holotranscobalamin, and the active vitamin B12 fraction in the first 5 weeks postpartum
Authors: van der Woude D. A. A. , Pijnenborg J. M. A. , de Vries J. , van Wijk E. M.
Published: September 2017

Introduction

Total vitamin B12 levels decrease significantly during pregnancy and recover to normal values within 8‐week postpartum. Holotranscobalamin (holoTC) reflects the active part of vitamin B12 and has been shown to remain constant during pregnancy and postpartum. A mechanism of redistribution of vitamin B12 is suggested, with a shift toward holoTC if there is insufficient total vitamin B12 available. Our objective was to examine vitamin B12 deficiency and the active vitamin B12 fraction in postpartum women.

Methods

Total vitamin B12 and holoTC were measured in 171 women within 48 hours (T0) and at 5 weeks (T5) postpartum. Vitamin B12 deficiency was defined as total vitamin B12 < 180 pmol/L or holoTC <32 pmol/L. The active vitamin B12 fraction was defined as holoTC/total vitamin B12.

Results

Without intervention, vitamin B12 deficiency based on both serum total vitamin B12 and holoTC changed from 75% and 60%, to respectively 10% and 6% at T5. The fraction of active vitamin B12 was significant higher in vitamin B12 deficient women at both time points and across time (P < .0001 and P = .002). A high fraction of active vitamin B12 was only present in women with total vitamin B12 deficiency at T0. At T5, no high vitamin B12 fraction was found.

Conclusion

The changes in total vitamin B12 levels seem to be based on a physiological changes rather than vitamin B12 deficiency. The results of this study confirm the hypothesis that a shift toward the metabolic active vitamin B12 (holoTC) occurs in women with insufficient available total vitamin B12.
Insomnia in nursing students and related factors: A cross‐sectional study
Authors: Güneş Zeynep , Arslantaş Hülya
Published: September 2017

Aim

The aim of this study is to determine the factors affecting insomnia in nursing students.

Methods

This study was conducted with 379 nursing students, studying at a university in western Anatolia/Turkey between 2014 and 2015 as a descriptive and cross‐sectional analytic study. Data of the survey were collected using the Personal Inquiry Form, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Trait Anxiety Inventory and the Beck Depression Inventory, and a self‐administered questionnaire.

Results

The Insomnia Severity Index score for the students is 11.51 ± 5.04 on average. It was found that as anxiety and depression increased, the Insomnia Severity Index score for the students also increased and there was a weak positive correlation. Also, a moderate positive correlation between sleep quality and insomnia severity was found. Significant correlations were found between some of the socio‐demographic characteristics (lower socio‐economic situation, irregular bedtime, and smoking) and insomnia, sleep quality, anxiety, and depression.

Conclusion

Anxiety, depression, irregular bedtime, and lower socio‐economic situation are factors that make falling asleep difficult.
Evaluation of a multidisciplinary allied health prostate cancer clinic
Authors: Crowe Helen , Pillay Brindha , Howard Nicholas , Crowe Jane , Rutherford Max , Wootten Addie , Corcoran Niall , Costello Anthony
Published: September 2017

Prostate cancer is the most common male cancer, with increasingly longer survival, and many treatment options for advanced disease. Men with prostate cancer report a high level of unmet supportive care needs. To evaluate unmet needs of a small cohort of Australian men with advanced prostate cancer, and their partners, and to assess the impact of attendance at a multidisciplinary allied health clinic on meeting these needs. Fifty patients were referred to the clinic by their treating specialists. Prior to their clinic consultations patients and partners completed study questionnaires to determine their unmet needs, prostate cancer and treatment related quality of life, levels of anxiety and depression, exercise patterns and prostate cancer‐related functional status. Questionnaires were completed again 1 month post‐clinic attendance, and pre‐and post‐clinic scores were compared. Patients reported unmet needs in several domains including psychological and sexuality needs. These showed a small reduction when assessed post‐clinic. Partners also reported needs in the psychological and emotional, and information domains. Thirty‐two percent of patients reported clinical levels of distress when assessed pre‐clinic attendance, reduced to 8% reporting the same level of distress 1 month post‐clinic. The identified high levels of unmet needs and levels of distress of this group of patients and partners highlights the necessity for additional resources to assist these men. A multidisciplinary allied health care prostate clinic as described here may further assist in the comprehensive care of these men and their partners.
Acute oxygen therapy: an audit of prescribing and delivery practices in a tertiary hospital in Perth, Western Australia
Authors: Kamran Anam , Chia Elisa , Tobin Claire
Published: September 2017

Background

Oxygen is a widely used drug in the hospital setting. However, international audits suggest that oxygen administration practices are often not compliant with prescribed standards. This can place patients at risk and cause serious adverse events.

Aim

To analyse data related to recent practices of oxygen prescription and administration at Royal Perth Hospital (RPH), Western Australia. The results of this audit aim to guide further research on possible interventional studies implementing key solutions.

Methods

All patients who received care in the Acute Medical Unit at RPH between 1 September and 14 September 2015 were included in this audit. Patients who were given supplemental oxygen during their admission were selected for further review of records. Appropriate medically indicated target oxygen saturations for each patient were judged under consultation with a respiratory specialist.

Results

A total of 65 patients received oxygen supplementation within the study period; 36 of these patients (55.4%) had target oxygen saturations prescribed by doctors, and 25% of the prescribed targets were judged to be inappropriate. In total, 49 patients (75.4%) were exposed to a potential risk from oxygen therapy due to prescription error and/or delivery error. A real risk was identified in 19 patients (29.2%) as they received oxygen at levels outside their appropriate medically indicated target range.

Conclusion

The current practices of oxygen prescription and administration within RPH are suboptimal. Patients are placed at risk of oxygen toxicity due to deviation from oxygen prescription guidelines.
Size driven thermodynamic crossovers in phase stability in zirconia and hafnia
Authors: Sharma Geetu , Ushakov Sergey V. , Navrotsky Alexandra
Published: September 2017

Hafnia (HfO2) and zirconia (ZrO2) are of great interest in the quest for replacing silicon oxide in semiconductor field effect transistors because of their high permittivity. Both exhibit extensive polymorphism and understanding the energetics of their transitions is of major fundamental and practical importance. In this study, we present a systematic thermodynamic summary of the influence of particle size on thermodynamic phase stability in hafnia and zirconia using recently measured enthalpy data from the literature. The amorphous phase is found to be the most energetically stable above 165 and 363 m2/g of surface area for HfO2 and ZrO2, respectively. Below 16 and 20.3 m2/g of surface area, respectively, the monoclinic phase is the most energetically stable for HfO2 and ZrO2. At intermediate sizes there are closely balanced energetics among monoclinic, tetragonal, and cubic phases. The energy crossovers reflect decreasing surface enthalpy in the order monoclinic, tetragonal, cubic and amorphous for both hafnia and zirconia.
Assessment of the Environmental Sustainability of a Treatment Aimed at Soil Reuse in a Brownfield Regeneration Context
Authors: Capobianco Oriana , Costa Giulia , Baciocchi Renato
Published: September 2017

A combined stabilization/solidification (S/S) and granulation treatment was shown to be effective, at lab scale, to produce secondary aggregates from a Brownfield soil slightly contaminated by metals. This treatment, as opposed to the frequently adopted “dig and dump” option, allows to combine soil management with site regeneration, minimizing landfill disposal. But is this treatment actually more environmentally sustainable than excavated soil management by dig and dump? To answer this question, we analyzed and compared by life cycle assessment the environmental impacts resulting from the application of the above‐mentioned treatment versus dig and dump on the basis of the results of lab tests performed on a Brownfield soil sample, including leaching test results. The impacts related to the production of all the reagents used in the on‐site treatment, as well as the avoided impacts due to the replacement of raw aggregates with recycled ones, were included. Results showed that the proposed S/S‐granulation process may allow a drastic decrease of the impacts related to land use and resource depletion in comparison to dig and dump, with beneficial effects also with regard to toxicity‐related impact categories. Conversely, the proposed treatment yielded higher impacts, in terms of acidification, water resource depletion, and, in particular, climate change, almost entirely related to the manufacturing of the cement employed for stabilization. However, an average 40% reduction of overall impacts was noted when fly ash cement was assumed to be used as binder instead of Portland cement.
Use of the RenalGuard system to prevent contrast‐induced AKI: A meta‐analysis
Authors: Mattathil Stephanie , Ghumman Saad , Weinerman Jonathan , Prasad Anand
Published: September 2017

Background

Contrast‐induced kidney injury (CI‐AKI) following cardiovascular interventions results in increased morbidity and mortality. RenalGuard (RG) is a novel, closed loop system which balances volume administration with forced diuresis to maintain a high urine output. We performed a meta‐analysis of the existing data comparing use of RG to conventional volume expansion.

Methods

Ten studies were found eligible, of which four were randomized controlled trials. Of an aggregate sample size (N) of 1585 patients, 698 were enrolled in the four RCTs and 887 belonged to the remaining registries included in this meta‐analysis. Primary outcomes included CI‐AKI incidence and relative risk. Mortality, dialysis, and major adverse cardiovascular events (MACCE) were secondary outcomes. A random effects model was used and data were evaluated for publication bias.

Results

RG was associated with significant risk reduction in CI‐AKI compared to control (RR: 0.30, 95%CI: 0.18‐0.50, P < 0.01). CI‐AKI in RG was found to be 7.7% versus 23.6% in the control group (P < 0.01). Use of RG was associated with decreased mortality (RR: 0.43, 95%CI: 0.18‐0.99, P = 0.05), dialysis (RR: 0.20, 95%CI: 0.06‐0.61, P = 0.01), and MACCE (RR: 0.42, 95%CI: 0.27‐0.65, P < 0.01) compared to control.

Conclusions

RG significantly reduces rates of CI‐AKI compared to standard volume expansion and is also associated with decreased rates of death, dialysis, and MACCE.
Laboratory‐Based Investigation of Denture Sonication Method in Patients with Candida‐Associated Denture Stomatitis
Authors: Perić Mirjana , Radunović Milena , Pekmezović Marina , Marinković Jelena , Živković Rade , Arsić Arsenijević Valentina
Published: September 2017

Purpose

Denture stomatitis (DS) is a disease characterized by inflammation and erythema of the oral mucosa areas covered by the denture. Multifactorial etiological factors contribute to DS, but it seems that Candida plays the key role. The aim of the study was to evaluate the denture sonication method to: (i) increase the possibility of diagnosing patients with Candida‐associated DS; (ii) detect and identify the mixed Candida spp., and (iii) determine the Candida colony forming units (CFU) and its possible relationship with DS severity, based on Newton's classification.

Materials and Methods

The cross‐sectional study conducted at the Clinic for Dental Prosthetics, Belgrade (Serbia) from June 2013 to December 2014 enrolled edentulous patients with dentures (n = 250). Patients without DS (n = 20) were the control group (CG). The patients’ data were collected, and patients with DS (study group/SG) were selected and divided into SG Candida+ and SG Candida‐. Based on severity of DS, the SG patients were classified in 3 groups (Newton's classification). Four sampling methods were applied to detect patients with Candida‐associated DS: mucosa swab, denture swab, oral rinse, and denture sonication method. The sensitivity and specificity of denture sonication method were shown using the receiver operating characteristic (ROC) curve and the area under the curve (AUC).

Results

In 97 (38.8%), out of 250 clinically examined patients, DS was diagnosed. In 82 (84.5%), out of 97 mycologically examined patients, Candida‐associated DS was detected when denture sonication method was applied. Additionally, using the denture sonication method we observed: (i) the largest number of Candida positive patients compared to other sampling methods (p < 0.0001); (ii) the highest number of Candida CFU/ml (105), and (iii) the possibility to detect mixed Candida cultures. The largest number of patients with Candida‐associated DS showed type II (60%) DS, followed by type I (21%), and type III (19%) DS.

Conclusion

The denture sonication method is easy, accurate, and sensitive, and increases the possibility of diagnosing patients with Candida‐associated DS. Additionally, yeast quantification, mixed Candida spp., and non‐albicans Candida were detectable when cultivation on Candida CHROMagar was performed. It was not possible using conventional methods, such as swab or oral rinse.
Paediatric invasive Haemophilus influenzae in Queensland, Australia, 2002–2011: Young Indigenous children remain at highest risk
Authors: Cleland Gavin , Leung Clare , Wan Sai Cheong Jenny , Francis Joshua , Heney Claire , Nourse Clare
Published: September 2017

Aim

Haemophilus influenzae continues to cause invasive disease in children despite widespread Hib immunisation. The significance of non‐B serotypes continues to be investigated, with evidence of increased invasive non‐typeable H. influenzae (NTHi) world‐wide. The aim of this study was to examine the current epidemiological and clinical features of invasive H. influenzae disease in children in Queensland, Australia.

Methods

A retrospective review was performed of all cases of invasive H. influenzae disease in children <18 years of age in Queensland between January 2002 and December 2011. Cases were identified from pathology records and data requested from treating hospitals.

Results

Laboratory data were obtained for 144 cases and clinical/demographic data for 123 cases. The majority (72%) of cases were children <5 years of age. Annual incidence rate for all children <5 years was 7.4/100 000, and for Aboriginal and Torres Strait Islander children <5 years was 10.2/100 000. Serotype was reported for 132 isolates, 69 NTHi and 63 encapsulated strains. The most common clinical diagnoses were pneumonia, meningitis and bacteraemia without clinical focus. Of the patients, 5 patients died, and 12 had significant morbidity at hospital discharge.

Conclusions

While rates of invasive H. influenzae disease have decreased dramatically following the introduction of Hib vaccination, H. influenzae remains a cause of significant morbidity and mortality, and Aboriginal and Torres Strait Islander children remain particularly vulnerable.
Attributes of Bio‐Oss® and Moa‐Bone® graft materials in a pilot study using the sheep maxillary sinus model
Authors: Smith M. M. , Duncan W. J. , Coates D. E.
Published: September 2017

Background and Objective

The aim of this pilot study was to characterize surface morphology and to evaluate resorption and osseous healing of two deproteinated bovine bone graft materials after sinus grafting in a large animal model.

Material and Methods

Surfaces of a novel particulate bovine bone graft, Moa‐Bone® were compared with Bio‐Oss® using scanning electron microscopy. Six sheep then had maxillary sinus grafting bilaterally, covered with BioGide®. Grafted maxillae were harvested after 4, 6 and 12 weeks. Healing was described for half of each site using resin‐embedded ground sections. For the other half, paraffin‐embedded sections were examined using tartrate resistant acid phosphatase staining for osteoclast activity, runt‐related transcription factor2 immunohistochemistry for pre‐osteoblasts and osteoblasts and proliferating cell nuclear antigen for proliferative cells.

Results

Moa‐Bone® had a smoother, more porous fibrous structure with minimal globular particles compared with Bio‐Oss®. After 4 weeks, woven bone formed on both grafts and the Moa‐Bone® particles also showed signs of resorption. After 12 weeks, Moa‐Bone® continued to be resorbed, however Bio‐Oss® did not; both grafts were surrounded by maturing lamellar bone. Moa‐Bone® was associated with earlier evidence of runt‐related transcription factor 2‐positive cells. Moa‐Bone® but not Bio‐Oss® was associated with strong tartrate resistant acid phosphatase‐positive osteoclasts on the graft surface within resorption lacunae at both 4 and 6 weeks post‐grafting.

Conclusion

Both materials supported osseous healing and maturation without inflammation. Moa‐Bone® showed marked osteoclast activity after 4 and 6 weeks and demonstrated positive attributes for grafting, if complete remodeling of the graft within the site is desired. Further optimization of Moa‐Bone® for maxillofacial applications is warranted.