bluuebunny/crossref_metadata_2025 huggingface dataset:
Polybutadiene rubber/exfoliated graphite nanocomposites: Impact of filler on the thermal, mechanical and permeability characteristics
Authors: George Soney C , Abraham Jiji , Jose Thomasukutty , Thomas Riya , Jacob Teresa , Nair Sangetha , Sasikumar Soumya
Published: May 2019

In this report, we demonstrate that both mechanical behaviour and thermal stability of polybutadiene rubber (PBR) nanocomposites could be improved by incorporating exfoliated graphite (EG) using melt mixing method. Incorporation of the filler EG in the polybutadiene (PBD) matrix is confirmed by infrared spectra and X-ray diffraction analysis. The structural characteristics, mechanical properties and thermal properties of these newly modified PBR nanocomposites were systematically analysed and studied. Thermal properties of the nanocomposites were studied using thermogravimetric analysis under nitrogen atmosphere. Thermogravimetric studies showed that PBR8 is having higher thermal stability than that of the PBR gum sample. Mechanical properties like tensile strength, Young’s modulus, tear strength, hardness and compression set of the nanocomposites were studied. Mechanical properties are also high for the modified PBR nanocomposites with maximum filler content. The permeability of organic vapours such as dichloromethane (CH2Cl2), chloroform (CHCl3) and carbon tetrachloride (CCl4) through PBR/EG nanocomposites was also studied. In vapour permeation studies, PBR4 exhibits the least permeability in CH2Cl2, CHCl3 and CCl4 solvents. Polybutadiene rubber–natural graphite (PBR/NG) nanocomposites were also prepared for comparison.
Urban Unplanning: How Violence, Walls, and Segregation Destroyed the Urban Fabric of Baghdad
Authors: Izady Michael M. R.
Published: May 2019

Baghdad was formerly a relatively well-planned and thriving city, serving as home to a multitude of intertwined ethnoreligious groups. As a result of the American-led invasion, and five years of urban civil war that followed, the city was segregated along ethnic lines. The effects of comprehensive wall building to segregate the warring urban neighborhood have altered the very fabric of the city and have undone the earlier rational urban planning. Contemporary Baghdad shares much with cities like Belfast that have been physically divided due to civil unrest. The author visited Baghdad a number of times following the 2003 invasion, collecting data personally or through hired informants.
A Rare Opportunity: Examining the Experience of a New Institutional Review Board
Authors: Parreco Linda , Rooney Lisa , Hampp Sharon , Brown Amanda , Minasian Lori
Published: May 2019

The process of creating a new Institutional Review Board (IRB) or Research Ethics Committee (REC) presents many challenges; however, little has been published to describe this experience. Thus, many questions about creating a new IRB/REC and the challenges they face remain. The establishment of a new federal-wide single IRB provided a rare opportunity to describe these experience and outcomes. A census of the activity and outcomes of this new board is reported for its first 3 years of operation: The convened board approved 50 protocols, required an average of 93.24 days and 2.76 reviews for protocol approval, and issued an average of 31.82 stipulations per protocol. The census data helped to identify several issues that impacted the board’s outcomes and it serves as a baseline for future comparisons. The overall dynamics, challenges, and outcomes of this new single IRB are discussed.
Complete Coronary Revascularization via Left Anterior Thoracotomy
Authors: Babliak Oleksandr , Demianenko Volodymyr , Melnyk Yevhenii , Revenko Katerina , Pidgayna Liliya , Stohov Oleksii
Published: May 2019

Objective

Our aim was to develop the minimally invasive coronary artery bypass grafting (CABG) technique, which is equally effective and safe compared with conventional coronary grafting technique, is reproducible, and can be applied in the vast majority of patients with isolated coronary artery disease.

Methods

From July 2017 to November 2018 a total of 170 nonselected consecutive patients underwent minimally invasive on-pump multivessel CABG through the left anterior minithoracotomy in the fourth intercostal space using a Chitwood clamp and blood cardioplegia. We named this technique total coronary revascularization via left anterior thoracotomy. The mean number of grafts was 3.1 ± 0.7. Left internal mammary artery was used in 159 (93.5%) patients, right internal mammary artery in 4 (2.4%) patients, radial artery in 25 (14.7%) patients, and veins in 148 (87%) patients.

Results

We had no mortality, no postoperative myocardial infarcts, and no conversion to sternotomy. There were 2 postoperative strokes without residual neurological deficit and 2 revisions for postoperative bleeding. The total operation time was 258.8 ± 43.9 minutes, cardiopulmonary bypass time 135.8 ± 26.6 minutes, and aortic cross-clamp time 71.2 ± 19.4 minutes. The mean intensive care stay was 2.1 ± 0.56 days and mean total hospital stay 6.3 ± 1.3 days.

Conclusions

Complete coronary revascularization could be routinely performed using the above-mentioned technique. No patient selection, based on number of grafts, quality and location of coronary vessels, left ventricle function, age, gender, or body mass index, is required.
Improving the properties of the polyester fabrics by grafting with 3-chloro-2-hydroxypropyl acrylate
Authors: Muresan Emil Ioan , Rosu Genoveva , Danila Angela , Drobota Mioara , Doroftei Florica , Radu Cezar Doru
Published: May 2019

3-chloro-2-hydroxypropyl acrylate obtained by the esterification of epichlorohydrin with acrylic acid in the presence of zirconium silicate as a catalyst was used for grafting of the polyester fabric in order to improve some of its properties. The grafting was performed in the presence of (NH4)2S2O8 as a polymerization initiator. The grafted samples were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, and energy-dispersive X-ray spectroscopy analyses. The effect of grafting on the comfort indices (hygroscopicity and vapor permeability) and the tinctorial properties (color intensity and dyeing fastness) were analyzed. Further addition of AgNO3 in the final reaction mixture used for grafting of polyester fabric confers antibacterial effect to the treated samples. The properties of the polyester fabric were highly improved by grafting with 3-chloro-2-hydroxypropyl acrylate.
Circular RNA ABCB10 promotes tumor progression and correlates with pejorative prognosis in clear cell renal cell carcinoma
Authors: Huang Yunfang , Zhang Yun , Jia Lin , Liu Changxuan , Xu Fang
Published: May 2019

Objective:

Our study aimed to evaluate the effect of circular RNA ABCB10 (circ-ABCB10) on proliferation and apoptosis of clear cell renal cell carcinoma (ccRCC) cells, and its prognostic value in patients with ccRCC.

Methods:

Circ-ABCB10 expression in five ccRCC cell lines and normal kidney epithelial cell line was measured by quantitative polymerase chain reaction (qPCR). Empty overexpression, circ-ABCB10 overexpression, empty shRNA, and circ-ABCB10 shRNA plasmids were transfected into A498 cells as negative control for circ-ABCB10 over expression {NC (+)}, Circ-ABCB10(+), negative control (−){NC(−)}, and Circ-ABCB10(−) groups, then cell proliferation and apoptosis were evaluated by Cell Counting Kit-8 and annexin V/propidium iodide. Meanwhile, apoptotic markers were measured by western blot. Subsequently, circ-ABCB10 expression in tumor tissues and paired adjacent tissues from 120 ccRCC patients was measured by qPCR.

Results:

Circ-ABCB10 expression was elevated in all the ccRCC cell lines compared with the normal kidney cells line. A498 cell proliferation was enhanced in the Circ-ABCB10(+) group compared with the NC(+) group, while it was inhibited in the Circ-ABCB10(−) group compared with the NC (−) group; and A498 cell apoptosis was repressed in the Circ-ABCB10(+) group than the NC(+) group, but was promoted in the Circ-ABCB10(−) group compared with the NC(−) group. In addition, circ-ABCB10 was up-regulated in tumor tissues compared with paired adjacent tissues, and its high expression correlated with the advanced pathological grade and the tumor node metastasis stage as well as independently predicting worse overall survival in ccRCC patients.

Conclusion:

Circ-ABCB10 promotes tumor progression and correlates with pejorative prognosis in ccRCC.
Cancer and breast cancer awareness interventions in an intellectual disability context: A review of the literature
Authors: Walsh S , O’Mahony M , Lehane E , Farrell D , Taggart L , Kelly L , Sahm L , Byrne A , Corrigan M , Caples M , Martin AM , Tabirca S , Corrigan MA , Hegarty J
Published: May 2019

Background:

Women with an intellectual disability (ID) have a similar risk of developing breast cancer as women in the general population yet present with later stage breast cancers, which have poorer outcomes.

Aim:

To identify whether there is a need to develop a breast cancer awareness intervention for women with an ID.

Methods:

Interventions aimed at increasing cancer awareness and breast cancer awareness for people with an ID were identified and critically appraised.

Results:

Five interventions to increase cancer awareness or breast cancer awareness in people with an ID were identified.

Conclusion:

The review highlighted the paucity of theoretically underpinned breast cancer awareness interventions specifically aimed at women with an ID. Facilitating breast cancer awareness for women with an ID could potentially lead to earlier presentation of potential symptoms of breast cancer, earlier treatment, better prognosis and ultimately, improved survival. This article establishes that there is a need for an intervention underpinned by theory to increase breast cancer awareness in women with an ID.
Gender disparities in patient education provided during patient visits with a diagnosis of coronary heart disease
Authors: Hilleary Rebecca S , Jabusch Sarah M , Zheng Becky , Jiroutek Michael R , Carter Charles A
Published: May 2019

Background:

Cardiovascular disease is the leading cause of death in females in the United States. Prior studies have reported that females receive less patient education and preventive counseling for cardiovascular disease as compared with males. The American Heart Association and others have embarked on several initiatives over the last 20 years to narrow this disparity of care. The primary objective of this study was to determine whether a gender disparity remains in the provision of patient education among patients diagnosed with coronary heart disease, a form of cardiovascular disease. The secondary objective was to determine whether there is an association between the provision of patient education and sociodemographic variables and risk factors.

Methods:

This was a retrospective, cross-sectional, observational study of adults (⩾18 years) diagnosed with coronary heart disease who participated in National Ambulatory Medical Care Survey between the years 2005 and 2014, inclusive. Chi-square tests of independence were performed to address the primary objective. A multivariable logistic regression model was constructed to assess the association between gender and provision of patient education while adjusting for sociodemographic variables and risk factors of interest.

Results:

A total raw survey sample size of 17,332 patient visits meeting the study inclusion/exclusion criteria was utilized. Patients were predominately white, male, non-Hispanic, and ⩾75 years of age. Females had 0.86 times the odds of receiving patient education compared with males (95% confidence interval = 0.78–0.95, p = 0.0024). After adjusting for covariates of interest, gender remained statistically significant in the multivariable logistic model. In addition, the variables “other payer” (vs private insurance), tobacco use, primary care physician type, obesity, hyperlipidemia, and hypertension were found to be statistically significantly associated with the provision of patient education (p < 0.05) in the multivariable analysis.

Conclusion:

In the data analyzed, gender disparities exist, as evidenced by a greater proportion of males receiving patient education than females, among coronary heart disease patients during visits seeking medical care. The acceptability of these findings in terms of overall patient management and treatment goals requires further evaluation.
A robust anchoring effect in linear ordering
Authors: von Hecker Ulrich , Klauer Karl Christoph , Aßfalg André
Published: May 2019

The robustness of effects indicating a spatial component associated with abstract reasoning is tested. Judgements regarding hierarchical orderings tend to be faster and more accurate when the dominant element in any pair from the order (e.g., the older, richer) is presented on the left of the screen as compared with the right ( left-anchoring effect). This signature effect is investigated in three conditions (Experiment 1), each implementing a different timing regime for the elements in each pair, during learning. Thereby, the construction of a mental representation of the ordering was exposed to a potentially competing spatial simulation, that is, the well-known “mental timeline” with orientation from left (present) to right (future). First, the left-anchoring effect for order representations remained significant when timeline information was congruent with the presumed left-anchoring process, that is, the dominant element in a pair was always presented first. Second, the same effect remained also significant when the timeline-related information was random, that is, the dominant element being presented either first or second. Third, the same effect was found to be still significant, when the timeline-related information was contrary to the left-anchoring process, that is, the dominant element being presented always second. Experiment 2 replicates the target effect under random timeline information, controlling for colour as a stimulus feature. The results are discussed in the context of a theoretical model that integrates basic assumptions about acquired reading/writing habits as a scaffold for spatial simulation and primacy/dominance representation within such spatial simulations.
A literature review of interventions to reduce stress in doctors
Authors: Locke Rachel , Lees Amanda
Published: May 2019

Aim:

Stress is prevalent among doctors, and interventions are offered, often as part of their continuing professional development, to help doctors learn in the workplace about the recognition, prevention and management of the harmful effects of stress. The aim of this review was to examine existing research to ascertain the features of successful educational interventions with practising doctors and any factors that may affect outcomes.

Methods:

We searched key databases for papers published between 1990 and 2017 on the themes of stress that included an education-based intervention and practising doctors. Using an inclusive approach to the review, a broad evaluation was made of the primary research using both quantitative and/or qualitative evidence where the study reported a positive outcome in terms of stress management.

Results:

Review criteria were met in 31 studies of 1,356 originally retrieved. Three broad categories of interventions emerged from the coding process: mindfulness-type ( n = 12), coping and solutions focused (CSF) ( n = 12) and reflective groups ( n = 7). There is evidence that these interventions can be successful to help doctors deal with stress. Based on the results from this review, an original guide is advanced to help educators choose an educational intervention.

Conclusion:

Although evidence for some interventions may be ‘hierarchically stronger’, it is misleading to assume that interventions can be imported as successfully into any context. Factors such as medical specialty and health care systems may affect which intervention can be used. The guide offers an evidence base on which further research can be built.
Creativity of small firms in creative industry: Initial evidence from Indonesia
Authors: Indriartiningtias Retno , Subagyo  , Hartono Budi
Published: May 2019

This study aims to evaluate the effects of individual creativity, group creativity, internal organizational characteristics, and external factors of knowledge creation toward organizational creativity of small firms in Indonesia creative industry. In addition, it evaluates the relationship between the organizational creativity and the performance. The study was carried out using a cross-sectional survey with 34 samples (convenience sampling). The correlation between key variables was analyzed using path analysis. Results indicate that organizational creativity is significantly influenced by group design creativity, while individual creativity, organizational characteristics, and external factors of knowledge creation have no significant effect on organizational creativity. The results of the study show that if the small creative industry wants to improve its performance, one of the creativity variables that needs to be optimized is the creativity of the design group.
Alkaloids From Zanthoxylum nitidum and Their Cytotoxic Activity
Authors: Nguyen Thi Hong Van , Tran Thi Tuyen , Cam Thi Inh , Pham Minh Quan , Pham Quoc Long , Vu Dinh Hoang , Nguyen Xuan Nhiem , Chau Van Minh , Van Kiem Phan
Published: May 2019

Zanthoxylum nitidum (Roxb.) DC (Rutaceae) is a traditional medicine used for the treatment of various diseases like toothache, gingivitis, fever, colic vomiting, diarrhea, and cholera. Three new alkaloids, zanthocadinanine C (1), 7-methoxy-8-demethoxynitidine (2), and zanthonitiside I (3) were isolated from the stems and twigs of Z. nitidum. Their structures were determined on the basis of extensive spectroscopic, including 1-dimensional and 2-dimensional nuclear magnetic resonance and mass spectroscopy data. Compounds 1–3 were evaluated for cytotoxic activity against 5 human cancer cell lines, KB, MCF-7, LNCaP, HepG-2, and LU-1. Compound 2 showed significant cytotoxic activity against all tested human cancer cell lines with IC50 values ranging from 10.3 to 12.6 µM.
Mock-Ups: Using Experiential Simulation Models in the Healthcare Design Process
Authors: Durham Joyce , Kenyon Ann
Published: May 2019

Purpose:

The purpose of this article was to explore how different types of mock-ups are being used in the healthcare design process and present a methodology framework for the process.

Background:

Historically, physical mock-ups have been used in healthcare design primarily to test construction techniques. Although this historic use of mock-ups assisted the design team in decision-making, newer forms of mock-ups have evolved that expand the input provided into decision-making. These newer techniques, rapid prototyping, early build-out, virtual reality, and enhancements to the traditional physical mock-up focus more on challenging the functionality of the space, testing new operational concepts, and increasing user input.

Method:

This methodology article utilized five case studies in which different types and combinations of mock-ups were used in the design process and then, the methodology compares the realism, immersion, and testability of each mock-up technique.

Results:

For each mock-up type, the case studies described the purpose of the technique, the advantages and disadvantages, the most appropriate phase for its use in the design process, the estimated cost, and the process logistics. These components are compared to assist in developing a methodology for a variety of design situations.

Conclusions:

The findings related to different mock-up techniques are a valuable tool for healthcare design teams to use in selecting the most appropriate mock-up technique and the proposed methodology will assist in executing the mock-up process.
The Distinguishing Clinical Features of Nonallergic Rhinitis Patients
Authors: Hamizan Aneeza W. , Azer Mark , Alvarado Raquel , Earls Peter , Barham Henry P. , Tattersall Jessica , Rimmer Janet , Kalish Larry , Sewell William A. , Harvey Richard
Published: May 2019

Background

Not all rhinitis patients are affected by an immunoglobulin E (IgE)-mediated inflammatory process. Skin and serum allergy assessments are limited in their ability to define local allergic rhinitis (LAR). Thus, patients with negative systemic allergy assessments comprise a mix of those who truly have nonallergic rhinitis (NAR) and patients with LAR.

Objective

To determine the clinical characteristics of patients with NAR.

Methods

A cross-sectional study was performed on consecutive adults with rhinitis symptoms who underwent turbinate surgery. NAR patients were defined by excluding allergy using both systemic (serum-specific IgE and/or skin prick test) and local (inferior turbinate tissue-specific IgE) tests. Allergic rhinitis (AR) patients were defined by any positive systemic or local test toward aeroallergens. The clinical characteristics studied included allergic comorbidities (asthma, eczema, allergic conjunctivitis), inhalant allergen triggers (dust, pollen, animal dander), and environmental triggers (Cincinnati Irritant Index [CII]).

Results

There were 154 participants (41.79 ± 14.78 years, 37.7% female). NAR patients (11.7%) were older (49.33 ± 15.99 vs 40.78 ± 14.38 years, P = .02), had less self-reported asthma (5.6% vs 36.3%, P < .01) and house dust inhalant trigger (38.9 vs 65.2%, P = .03) compared to AR patients. The CII score was similar for NAR and AR (31.06 ± 28.88 vs 35.49 ± 24.70, P = .61).

Conclusion

Patients who were older, without asthma, and lacked an inhalant allergy trigger were more likely to have true NAR. Environmental triggers are not distinguishing features of NAR. This may be used as a guide to identify rhinitis patients whose symptoms are truly nonallergic etiology compared to those with falsely negative systemic allergy assessment but may still need management for LAR.
Transcriptome Analysis Reveals Novel Genes Associated with Cartilage Degeneration in Posttraumatic Osteoarthritis Progression
Authors: Liu Chih-Chung , Lee Hoong-Chien , Peng Yi-Shian , Tseng Ailun Heather , Wu Jia-Lin , Tsai Wei-Yuan , Wong Chih-Shung , Su Li-Jen
Published: May 2019

Objective

The current therapeutic strategy for posttraumatic osteoarthritis (PTOA) focuses on early intervention to attenuate disease progression, preserve joint function, and defer joint replacement timing. Sequential transcriptomic changes of articular cartilage in a rat model were investigated to explore the molecular mechanism in early PTOA progression.

Design

Anterior cruciate ligament transection and medial meniscectomy (ACLT + MMx)–induced PTOA model was applied on male Wistar rats. Articular cartilages were harvested at time 0 (naïve), 2 week, and 4 weeks after surgery. Affymetrix Rat genome 230 2.0 array was utilized to analyze the gene expression changes of articular cartilages.

Results

We identified 849 differentially expressed genes (DEGs) at 2 weeks and 223 DEGs at 4 weeks post–ACLT + MMx surgery compared with time 0 (naïve group). Gene ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were performed to gain further insights from these DEGs. 22 novel genes and 1 novel KEGG pathway (axon guidance) in cartilage degeneration of osteoarthritis were identified. Axon guidance molecules— Gnai1, Sema4d, Plxnb1, and Srgap2 commonly dysregulated in PTOA progression. Gnai1 gene showed a concordant change in protein expression by immunohistochemistry staining.

Conclusions

Our study identified 22 novel dysregulated genes and axon guidance pathway associated with articular cartilage degeneration in PTOA progression. These findings provide the potential candidates of biomarkers and therapeutic targets for further investigation.
Current organization of specialist pulmonary hypertension clinics: results of an international survey
Authors: Doyle‐Cox Carolyn , Nicholson Gail , Stewart Traci , Gin‐Sing Wendy
Published: May 2019

Optimal pulmonary hypertension (PH) management relies on a timely, accurate diagnosis and follow‐up in specialized clinics by multidisciplinary teams that have clearly defined responsibilities and protocols. Internationally agreed criteria for expert center staff are lacking, particularly with respect to nurses, who often act as a central component of the team. This survey aimed to evaluate the current organization of PH clinics and the role of nurses. The survey (35 questions) was online February–December 2015 and was advertised at international PH nurse meetings and through international PH organizations to their corresponding clinics. In total, 126 healthcare professionals from 32 countries responded. According to respondents, 54% of clinics managed >200 patients, of whom 49% had a pulmonary arterial hypertension (PAH) diagnosis, on average. In terms of staff, 66% had a dedicated program administrator, 35% had one full‐time nurse coordinator/practitioner/specialist, and 57% had a nurse attend outpatient clinic alongside a physician. Crucially, not all centers had a nurse in their team. The role of a nurse coordinator/practitioner/specialist varied with 51% taking patient histories/examinations and 66% managing outpatients. In 34% of clinics, nurses were involved in their own research. Protocols were available for PH therapies (81%), management of heart failure (37%) and pain (26%), and referring patients who did not have PAH/chronic thromboembolic PH back to their specialist (62%). Not all clinics are meeting all of the standards outlined in the latest guidelines with key areas of improvement being level of support from/for nurses, clear protocols, and referral pathways.
Is Singapore on track to eliminate tuberculosis by 2030? A policy case study
Authors: Tam Greta , Lai Shuk Wun
Published: May 2019

Tuberculosis remains the top 10 causes of death worldwide in 2015, with the largest number of new tuberculosis cases occurring in Asia. Singapore, a high-income Asian country, still has an intermediate tuberculosis burden. This study is to determine Singapore’s tuberculosis policy with regard to achieving tuberculosis elimination goals. This is a case study of tuberculosis elimination policy in Singapore. Data were collected by policy review and literature review. Policy documents and reports were gathered from the websites of the Ministry of Health and the World Health Organization for policy review. The literature review was carried out through PubMed and Google Scholar to identify articles on epidemiology, treatment, and prevention of tuberculosis in Singapore. Data analysis of policy reports revealed that despite the overall downwards trend in the tuberculosis incidence rates between 2000 and 2015, the tuberculosis incidence rates reversed in 2008. Singapore tuberculosis policies are mostly consistent with the World Health Organization Stop TB Strategy, although over half of the performance indicators were not achieved by 2015. After screening 1014 articles, 18 studies were included in the literature review. The rapidly ageing population, great population mobility, and continuous community transmission were found to be major obstacles to achieving Millennium Development Goals in Singapore. Singapore is lagging in achieving the targets. Scaling up the existing tuberculosis programme to accelerate the tuberculosis decline is required to meet Sustainable Development Goals 2030. Unlike other high-income countries with an intermediate tuberculosis burden in Asia, Singapore has increasing tuberculosis incidence rates. While other countries face the burden of an ageing population, Singapore faces an additional burden of an influx of migrants from high-incidence countries. Singapore will need to control tuberculosis in both these demographic groups to reverse the increasing incidence trend.
Odontogenic keratocysts located in the buccal mucosa: A description of two cases and review of the literature
Authors: Witteveen M Emma , Flores Isadora Luana , Karssemakers Luc HE , Bloemena Elisabeth
Published: May 2019

Odontogenic keratocysts make up 4%–12% of all odontogenic cysts. Most cysts are sporadic but sometimes they arise in the context of basal cell nevus syndrome (Gorlin syndrome). Most odontogenic keratocysts arise in the posterior region of the mandible, but they can occur anywhere in the jaw. In rare instances, they are located peripherally in the gingiva. Even more rare, they are found in the soft tissues of the mouth. There have been a few case reports and small case series of such peripheral odontogenic keratocysts. Some controversy exists as to whether these truly represent a peripheral counterpart of the intraosseous odontogenic keratocysts and if their origin is at all odontogenic. We hereby present two cases of peripheral odontogenic keratocysts, both being located in the soft tissue of the buccal mucosa, and review the literature on peripheral odontogenic keratocysts.
A novel nonsense mutation in exon 9 in the extracellular matrix protein 1 gene associated with lipoid proteinosis: A case report
Authors: Ghazawi Feras M , Proulx Etienne Saint-Cyr , Jafarian Fatemeh
Published: May 2019

Lipoid proteinosis is a rare autosomal recessive genodermatosis that is caused by loss-of-function mutations in the extracellular matrix protein 1 gene. This study identifies a novel nonsense mutation in exon 9 of the extracellular matrix protein 1 gene associated with lipoid proteinosis, contributing to recent advances in our understanding of the molecular genetics underlying this disease. It is important to identify the mutations in the extracellular matrix protein 1 gene that are associated with lipoid proteinosis and how these affect protein function. Understanding the molecular basis for such genetic disorders may lead to novel therapeutic approaches for treating hereditary genodermatoses.
Repair of Rare Vascular Ring: Circumflex Aortic Arch with Associated Hypoplasia and Coarctation
Authors: Mauchley David C. , Stiegler Julia Massey , Padilla Luz A. , Aburjania Zviadi , Dabal Robet , Cleveland David
Published: May 2019

We describe a neonate with an unusual vascular ring formed by a right-sided aortic arch with associated coarctation and distal hypoplasia in the presence of an aberrant left subclavian artery. The descending aorta traveled behind the esophagus to descend on the left side of the spine. A left ductus arteriosus connected to the descending aorta completing the vascular ring, with notable esophageal compression. Surgical correction was accomplished through median sternotomy, resection of the hypoplastic circumflex arch, aortic arch advancement, and end-to-side anastomosis.
Outcomes and Quality of Life Improvement After Multilevel Spinal Fusion in Elderly Patients
Authors: Ibrahim John M. , Singh Paramjit , Beckerman Daniel , Hu Serena S. , Tay Bobby , Deviren Vedat , Burch Shane , Berven Sigurd H.
Published: May 2019

Study Design:

Retrospective case series.

Objectives:

Both the rate and complexity of spine surgeries in elderly patients has increased. This study reports the outcomes of multilevel spine fusion in elderly patients and provides evidence on the appropriateness of complex surgery in elderly patients.

Methods:

We identified 101 patients older than70 years who had ≥5 levels of fusion. Demographic, medical, and surgical data, and change between preoperative and >500 days postoperative health survey scores were collected. Health surveys were visual analogue scale (VAS), EuroQoL 5 Dimensions (EQ-5D), Oswestry Disability Index (ODI), Scoliosis Research Society questionnaire (SRS-30), and Short Form health survey (SF-12) (physical composite score [PCS] and mental composite score [MCS]). Minimal clinically important differences (MCIDs) were defined for each survey.

Results:

Complications included dural tears (19%), intensive care unit admission (48%), revision surgery within 2 to 5 years (24%), and death within 2 to 5 years (16%). The percentage of patients who reported an improvement in health-related quality of life (HRQOL) of at least an MCID was: VAS Back 69%; EQ-5D 41%; ODI 58%; SRS-30 45%; SF-12 PCS 44%; and SF-12 MCS 48%. Improvement after a primary surgery, as compared with a revision, was on average 13 points higher in ODI ( P = .007). Patients who developed a surgical complication averaged an improvement 11 points lower on ODI ( P = .042). Patients were more likely to find improvement in their health if they had a lower American Society of Anesthesiologists or Charlson Comorbidity Index score or a higher metabolic equivalent score.

Conclusions:

In multilevel surgery in patients older than 70 years, complications are common, and on average 77% of patients attain some improvement, with 51% reaching an MCID. Physiological status is a stronger predictor of outcomes than chronological age.
Lateral condylar retrograde humeral nail for management of high-energy distal humeral fractures
Authors: Sadek Ahmed Fathy , Ahmed Mohamed Atef , Kader Moustafa Abdel , El-shafie Mohamed Bahey Eldeen
Published: May 2019

Purpose:

Distal metaphyseo-diaphyseal humeral fractures are challenging particularly if open, comminuted, or associated with nerve injury. In cases of open distal complex metaphyseo-diaphyseal humeral fractures inamenable for traditional methods of fixation, retrograde intramedullary locked humeral nail with a new lateral condylar point of entry has been proposed.

Methods:

Two phases of study were conducted; phase I comprised computerized tomography evaluation of right humeri of 120 adult subjects, while phase II entailed prospective analysis of 18 patients who sustained firearm injuries resulting in open distal metaphyseo-diaphyseal humeral fractures associated with radial nerve injuries. All patients were surgically managed using lateral condylar retrograde humeral nailing with primary radial nerve exploration.

Results:

Distal sagittal medullary diameter of the humeral medulla was the narrowest in comparison to axial and coronal medullary diameters in phase II, which matched the results of phase I. The mean postoperative disability of the arm, shoulder, and hand score was 11.2 ± 6.4. Only five patients underwent subsequent successful tendon transfer.

Conclusions:

Lateral condylar retrograde humeral nail with early radial nerve exploration in cases of high-energy distal metaphyseo-diaphyseal humeral fractures yielded good results regarding union and spontaneous radial nerve recovery or later on reconstruction.
Accuracy of cup orientation and learning curve of the accelerometer-based portable navigation system for total hip arthroplasty in the supine position
Authors: Kamenaga Tomoyuki , Hayashi Shinya , Hashimoto Shingo , Matsumoto Tomoyuki , Takayama Koji , Fujishiro Takaaki , Hiranaka Takafumi , Niikura Takahiro , Kuroda Ryosuke
Published: May 2019

Purpose:

To assess the accuracy of cup orientation and learning curve of the disposable accelerometer-based portable navigation system for total hip arthroplasty (THA) in the supine position.

Methods:

A total of 75 patients who underwent THA through the anterolateral supine approach (ALS) with an accelerometer-based portable navigation system for the supine position (HipAlign®) between July 2017 and October 2018 were analyzed in this study. We compared the intraoperative cup angles using navigation records with the postoperative angles using postoperative computed tomography (CT) data. All patients were categorized into the following groups according to the course of three discrete, sequential operative time periods: 1–25 (initial group), 26–50 (intermediate group), and 51–75 (recent group). We compared the accuracy of cup inclination and anteversion among the three groups. The time required for navigation and the operative time of all patients were measured.

Results:

The average absolute error in measurement (postoperative CT-navigation record) was 2.6° ± 2.7° (inclination) and 2.8° ± 2.7° (anteversion). There were no significant differences among the three groups. The average time required for navigation and the operative time were 365.1 ± 90.3 s and 76.1 ± 1.6 min, respectively. The required time for HipAlign® navigation and operative time were constant in most patients, except for those of the initial five cases.

Conclusion:

The accelerometer-based portable navigation system provides good accuracy of cup orientation, has a short learning curve, and requires a minimal surgical time for THA in supine position.
Advanced HIV Disease among Males and Females Initiating HIV Care in Rural Ethiopia
Authors: Lifson Alan Raymond , Workneh Sale , Hailemichael Abera , MacLehose Richard Fleming , Horvath Keith Joseph , Hilk Rose , Sites Anne Redmond , Shenie Tibebe
Published: May 2019

Despite recommendations for rapidly initiating HIV treatment, many persons in sub-Saharan Africa present to care with advanced HIV disease. Baseline survey and clinical data were collected on 1799 adults newly enrolling at 32 district hospitals and local health HIV clinics in rural Ethiopia. Among those with complete HIV disease information, advanced HIV disease (defined as CD4 count <200 cells/mm3 or World Health Organization [WHO] HIV clinical stage III or IV disease) was present in 66% of males and 56% of females ( P < .001). Males (compared to females) had lower CD4 counts (287 cells/mm3 versus 345 cells/mm3), lower body mass index (19.3 kg/m2 versus 20.2 kg/m2), and more WHO stage III or IV disease (46% versus 37%), ( P < .001). Men reported more chronic diarrhea, fevers, cough, pain, fatigue, and weight loss ( P < .05). Most initiating care in this resource-limited setting had advanced HIV disease. Men had poorer health status, supporting the importance of earlier diagnosis, linkage to care, and initiation of antiretroviral therapy.
The observed effect of adverse drug reactions on the length of hospital stay among medical inpatients in a Nigerian University Teaching Hospital
Authors: Fasipe Olumuyiwa John , Akhideno Peter Ehizokhale , Owhin Omagbemi Sampson
Published: May 2019

Background:

The potential impact of an adverse drug reaction (ADR) is multidimensional, and includes prolonged length of hospitalization which significantly increased morbidity, mortality, and economic burden with additional intense medical care.

Aim:

This study was designed to characterize and evaluate the potential effect of ADRs on the length of hospital stay among adult medical inpatients in an academic teaching hospital in a large West African nation. The overarching goal of the study is to highlight approaches toward mitigating the sequelae of ADRs in this setting, and improving their recognition and timely optimal management.

Methods:

The patients admitted into the adult medical wards of a Nigerian University Teaching Hospital over a 9-month period from December 2013 to August 2014 were prospectively recruited for the study and followed up till discharge.

Results:

A total of 507 patients were evaluated during the study, out of which 269 (53.1%) of them were males and 238 (46.9%) were females. The mean age of the study population was 48.9 ± 17.8 years (median of 46 years). In this study, the mean duration of hospital stay for all patients was 11.9 ± 11.3 days (median of 9 days). Females had a mean duration stay of 12.9 ± 12.3 days (median of 10 days) and stayed significantly longer than males who stayed a mean duration of 10.9 ± 10.2 days with a median of 7 days ( t = −1.985, df = 505, p = 0.048). Furthermore, patients admitted solely because of ADRs (ADR-out) had a significantly shorter duration of stay with a mean duration stay of 6.1 ± 3.7 days (median duration stay of 7 days) when compared to those without ADRs whose mean duration of stay was 11.6 ± 11.0 days (median duration stay of 8 days), and this was found to be statistically significant ( t = 2.110, df = 472, p = 0.035). Those patients who developed ADRs during admission (ADR-in) had a mean duration of stay of 18.3 ± 14.8 (median of 15 days). This was significantly longer than the duration of stay for patients without ADRs ( t = −3.398, df = 487, p = 0.001) and also significantly longer than the duration for those who were admitted solely because of ADRs ( t =3.432, df = 49, p = 0.001).

Conclusion:

In this study, ADRs were associated with a significantly prolonged length of hospital stay for adult medical inpatients in this Nigerian University Teaching Hospital.
Spending for Advanced Cancer Diagnoses: Comparing Recurrent Versus De Novo Stage IV Disease
Authors: Hassett Michael J. , Banegas Matthew , Uno Hajime , Weng Shicheng , Cronin Angel M. , O’Keeffe Rosetti Maureen , Carroll Nikki M. , Hornbrook Mark C. , Ritzwoller Debra P.
Published: May 2019

PURPOSE:

Spending for patients with advanced cancer is substantial. Past efforts to characterize this spending usually have not included patients with recurrence (who may differ from those with de novo stage IV disease) or described which services drive spending.

METHODS:

Using SEER-Medicare data from 2008 to 2013, we identified patients with breast, colorectal, and lung cancer with either de novo stage IV or recurrent advanced cancer. Mean spending/patient/month (2012 US dollars) was estimated from 12 months before to 11 months after diagnosis for all services and by the type of service. We describe the absolute difference in mean monthly spending for de novo versus recurrent patients, and we estimate differences after controlling for type of advanced cancer, year of diagnosis, age, sex, comorbidity, and other factors.

RESULTS:

We identified 54,982 patients with advanced cancer. Before diagnosis, mean monthly spending was higher for recurrent patients (absolute difference: breast, $1,412; colorectal, $3,002; lung, $2,805; all P < .001), whereas after the diagnosis, it was higher for de novo patients (absolute difference: breast, $2,443; colorectal, $4,844; lung, $2,356; all P < .001). Spending differences were driven by inpatient, physician, and hospice services. Across the 2-year period around the advanced cancer diagnosis, adjusted mean monthly spending was higher for de novo versus recurrent patients (spending ratio: breast, 2.39 [95% CI, 2.05 to 2.77]; colorectal, 2.64 [95% CI, 2.31 to 3.01]; lung, 1.46 [95% CI, 1.30 to 1.65]).

CONCLUSION:

Spending for de novo cancer was greater than spending for recurrent advanced cancer. Understanding the patterns and drivers of spending is necessary to design alternative payment models and to improve value.
Autoimmune Polyendocrinopathy
Authors: Frommer Lara , Kahaly George J
Published: May 2019

Context

This mini-review offers an update on the rare autoimmune polyendocrinopathy (AP) syndrome with a synopsis of recent developments.

Design and Results

Systematic search for studies related to pathogenesis, immunogenetics, screening, diagnosis, clinical spectrum, and epidemiology of AP. AP (orphan code ORPHA 282196) is defined as the autoimmune-induced failure of at least two glands. AP is divided into the rare juvenile type I and the adult types II to IV. The prevalence is 1:100,000 and 1:20,000 for types I and types II to IV, respectively. Whereas type I (ORPHA 3453) is a monogenetic syndrome with an autosomal recessive transmission related to mutations in the autoimmune regulator (AIRE) gene, types II to IV are genetically complex multifactorial syndromes that are strongly associated with certain alleles of HLA genes within the major histocompatibility complex located on chromosome 6, as well as the cytotoxic T lymphocyte antigen 4 and the protein tyrosine phosphatase nonreceptor type 22 genes. Addison disease is the major endocrine component of type II (ORPHA 3143), whereas the coexistence of type 1 diabetes and autoimmune thyroid disease is characteristic for type III (ORPHA 227982). Genetic screening for the AIRE gene is useful in patients with suspected type I, whereas serological screening (i.e., diabetes/adrenal antibodies) is required in patients with monoglandular autoimmunity and suspected AP. If positive, functional endocrine testing of the antibody-positive patients as well as serological screening of their first-degree relatives is recommended.

Conclusion

Timely diagnosis, genetic counseling, and optimal long-term management of AP is best offered in specialized centers.
A V0-ATPase-dependent apical trafficking pathway maintains the polarity of the intestinal absorptive membrane
Authors: Bidaud-Meynard Aurélien , Nicolle Ophélie , Heck Markus , Le Cunff Yann , Michaux Grégoire
Published: May 2019

Intestine function relies on the strong polarity of intestinal epithelial cells and the array of microvilli forming a brush border at their luminal pole. Combining genetic RNAi screen and in vivo super-resolution imaging in the C. elegans intestine, we uncovered that the V0 sector of the V-ATPase (V0-ATPase) controls a late apical trafficking step, involving RAB-11+ endosomes and the SNARE SNAP-29, necessary to maintain the polarized localization of both apical polarity modules and brush border proteins. We show that the V0-ATPase pathway also genetically interacts with glycosphingolipids and clathrin in enterocyte polarity maintenance. Finally, we demonstrate that silencing of the V0-ATPase fully recapitulates the severe structural, polarity and trafficking defects observed in enterocytes from patients with Microvillus inclusion disease (MVID) and used this new in vivo MVID model to follow the dynamics of microvillus inclusions. Hence, we describe a new function for the V0-ATPase in apical trafficking and epithelial polarity maintenance and the promising use of the C. elegans intestine as an in vivo model to better understand the molecular mechanisms of rare genetic enteropathies.
Effects of early nutritional stress on physiology, life-histories and their trade-offs in a model ectothermic vertebrate
Authors: Holden Kaitlyn G. , Reding Dawn M. , Ford Neil B. , Bronikowski Anne M.
Published: May 2019

Early-life experiences can have far-reaching consequences for phenotypes into adulthood. The effect of early-life experiences on fitness, particularly under adverse conditions, is mediated by resource allocation to particular life-history traits. Reptiles exhibit great variation in life-histories (e.g., indeterminate growth) thus selective pressures often mitigate the effects of early-life stress, particularly on growth and maturation. We examined the effects of early-life food restriction on growth, adult body size, physiology and reproduction in the checkered garter snake. Animals were placed on one of two early-life diet treatments: normal-diet (approximating ad libitum feeding) or low-diet (restricted to 20% of body mass in food weekly). At 15 weeks of age low-diet animals were switched to the normal-diet treatment. Individuals fed a restricted diet showed reduced growth rates, depressed immunocompetence and a heightened glucocorticoid response. Once food restriction was lifted, animals experiencing nutritional stress early in life (low-diet) caught up to the normal-diet group by increasing their growth, and were able to recover from the negative effects of nutritional stress on immune function and physiology. Growth restriction and the subsequent allocation of resources into increasing growth rates, however, had a negative effect on fitness. Mating success was reduced in low-diet males, while low-diet females gave birth to smaller offspring. In addition, although not a direct goal of our study, we found a sex-specific effect of early-life nutritional stress on median age of survival. Our study demonstrates both immediate and long-term effects of nutritional stress on physiology and growth, reproduction, and trade-offs among them.