bluuebunny/crossref_metadata_2025 huggingface dataset:
Small–City Gay Bars, Big–City Urbanism
Authors: Mattson Greggor
Published: October 2019

Despite the widely hailed importance of gay bars, what we know of them comes largely from the gayborhoods of four “great cities.” This paper explores the similarities of 55 lone small–city gay bars to each other and the challenges they pose to the sexualities and urban literatures. Small–city gay bars have long been integrated with straight people in their often red–state communities; they are undifferentiated and unspecialized subcultural amenities not just for LGBT people, but for straights as well, fostering cosmopolitan lifestyles for large geographical regions whose residents nevertheless prefer small–city living for reasons, including proximity to kin or nature, and the fact that many big–city pleasures can be found everywhere. Contrasts between these findings and previous scholarship reveal the ways in which the latter has often implicitly defined urbanism and cosmopolitanism in terms of commercial diversity, as do studies of gentrification or gayborhoods. Small cities provide a way to integrate studies along the urban–rural interface, including places left to rural studies by both sexualities and urban scholarship. As an analytic object of comparison, small cities can help to disentangle urban effects from the cosmopolitanism of modern life generally.
“Because the World Consists of Everybody”: Understanding Parents’ Preferences for Neighborhood Diversity
Authors: Darrah–Okike Jennifer , Harvey Hope , Fong Kelley
Published: October 2019

Previous research, primarily using survey data, highlights preferences about neighborhood racial composition as a potential contributor to residential segregation. However, we know little about how individuals, especially parents, understand neighborhood racial composition. We examine this question using in–depth interview data from a racially diverse sample of 156 parents of young children in two metropolitan areas. Prior scholarship on neighborhood racial preferences has mostly been animated by expectations about in–group attraction, out–group avoidance, the influence of stereotypes, and perceived associations between race and status. However, we find that a substantial subset of parents expressed a desire for racially and ethnically mixed neighborhoods—a residential preference at odds with racial segregation. Parents across race conceptualized neighborhood diversity as beneficial for children's development. They expressed shared logics, reasoning that neighborhood diversity cultivates skills and comfort interacting with racial others; teaches tolerance; and provides cultural enrichment. However, these ideas intersected with racial segregation and stratification to shape parents’ understandings of diversity and hinder the realization of parents’ aspirations. Beliefs about the benefits of neighborhood diversity were rarely a primary motivation for residential choices. Nonetheless, parents’ perceptions of the advantages of neighborhood racial mixing reveal the reach of discourse on the value of diversity and suggest a potential opportunity to advance residential desegregation.
Impact of insurance on survival in patients < 65 with head & neck cancer treated with radiotherapy
Authors: Sittig Mark P. , Luu Michael , Yoshida Emi J. , Scher Kevin , Mita Alain , Shiao Stephen L. , Lu Diana J. , Mallen‐St. Clair Jon , Ho Allen S. , Zumsteg Zachary S.
Published: October 2019

Objectives

The United States has a heterogenous health insurance landscape for patients <65 years. We sought to characterise the impact of primary payer on overall survival (OS) in insured patients younger than 65 with head and neck squamous cell carcinoma (HNSCC) treated with definitive radiotherapy.

Design/Study/Participants

The National Cancer Database was queried for patients <65 years old diagnosed from 2004 to 2014 undergoing definitive radiotherapy ± chemotherapy for cancers of the nasopharynx, oropharynx, hypopharynx and larynx. Uninsured patients and oropharyngeal cancers without known HPV status were excluded.

Main outcome

Overall survival.

Results

Overall, 27 292 insured patients were identified, including 17 060 (62.5%) with private insurance. Median follow‐up was 52.1 months. In multivariable models, patients receiving Medicaid (HR = 1.66, 95% CI 1.57‐1.75,P < .001), Medicare (HR = 1.64, 95% CI 1.55‐1.73,P < .001) and other government insurance (HR = 1.44, 95% CI 1.29‐1.,P < .001) had independently increased mortality in comparison to those with private insurance. In propensity score‐matched cohorts, 5‐year OS was 65.5% vs 50.6% for privately vs government‐insured patients, respectively (P < .001). In multivariable subgroup analysis, private insurance was associated with improved survival in all subgroups. However, the magnitude of this effect was most pronounced in patients with HPV‐positive oropharyngeal cancer vs non‐HPV‐related cancer (interactionP < .001), younger patients (interactionP = .001), and those without comorbidity (interactionP < .001).

Conclusions

Patients <65 with HNSCC undergoing definitive radiation with private health insurance have markedly longer survival relative to patients with government‐sponsored insurance. This illustrates that increasing access to care may be necessary, but is not sufficient, to mitigate the significant disparities in the US healthcare system.
A simple technique for bedside estimation of left atrial pressure
Authors: Pressman Gregg S. , Ranjan Rupesh , Olex Stephen
Published: October 2019

Background

Distinguishing cardiac from noncardiac causes of dyspnea is clinically important, and a reliable noninvasive measure of left atrial pressure (LAP) is needed. Subtracting the peak systolic gradient between left ventricle (LV) and left atrium (LA) from the central systolic blood pressure (BP) should provide this measure. Using a commercially available blood pressure system incorporating applanation tonometry and bedside echocardiography, we tested this hypothesis in a broad spectrum of patients.

Methods

A total of 75 stable patients, scheduled for right heart catheterization for any reason, were included. Central systolic pressure was measured by a Sphygmocor® tonometry system; peak LV‐LA gradient was calculated as 4*(peak mitral regurgitation (MR) velocity)2. Microbubble contrast was used as needed to augment the MR signal. LAP estimates using central BP were compared with wedge pressure as were LAP estimates using brachial BP.

Results

Left atrial pressure estimates using central BP showed a good correlation with wedge pressure (r2 = 0.774, P < .0001) while estimates using brachial systolic BP did not (r2 = 0.157, P = .0006). Using central BP, correlations between LAP and wedge were similar among groups with varying degrees of MR and normal vs reduced ejection fraction.

Conclusions

The use of central systolic BP and peak LV‐LA gradient by bedside echocardiography holds promise as a noninvasive measure of LAP. Our results are similar to those provided using current guidelines for echocardiographic estimation of LAP. Increased precision in the measurement of LV‐LA gradient would improve the accuracy of this new technique.
Plasma levels of the cardiovascular protective endogenous nucleoside adenosine are reduced in patients with primary aldosteronism without affecting ischaemia‐reperfusion injury: A prospective case‐control study
Authors: van den Berg T. N. A. (Daniëlle) , Thijssen Dick H. J. , van Mil Anke C. C. M. , van den Broek Petra H. , Rongen Gerard A. , Monajemi Houshang , Deinum Jaap , Riksen Niels P.
Published: October 2019

Background

Patients with primary aldosteronism (PA) experience more cardiovascular events compared to patients with essential hypertension (EHT), independent from blood pressure levels. In animals, mineralocorticoid receptor antagonists limit ischaemia‐reperfusion (IR) injury by increasing extracellular adenosine formation and adenosine receptor stimulation. Adenosine is an endogenous compound with profound cardiovascular protective effects. Firstly, we hypothesized that patients with PA have lower circulating adenosine levels which might contribute to the observed increased cardiovascular risk. Secondly, we hypothesized that by this mechanism, patients with PA are more susceptible to IR compared to patients with EHT.

Design

In our prospective study in 20 patients with PA and 20 patients with EHT, circulating adenosine was measured using a pharmacological blocker solution that halts adenosine metabolism after blood drawing. Brachial artery flow‐mediated dilation (FMD) before and after forearm IR was used as a well‐established method to study IR injury.

Results

Patients with PA had a 33% lower adenosine level compared to patients with EHT (15.3 [13.3‐20.4] vs 22.7 [19.4‐36.8] nmol/L, respectively, P < .01). The reduction in FMD after IR, however, did not differ between patients with PA and patients with EHT (−1.0 ± 2.9% vs −1.6 ± 1.6%, respectively, P = .52).

Conclusions

As adenosine receptor stimulation induces various powerful protective cardiovascular effects, its lower concentration in patients with PA might be an important novel mechanism that contributes to their increased cardiovascular risk. We suggest that modulation of the adenosine metabolism is an exciting novel pharmacological opportunity to limit cardiovascular risk in patients with PA that needs further exploration.
Impact of active smoking on the immature platelet fraction and its relationship with the extent of coronary artery disease
Authors: Nardin Matteo , Verdoia Monica , Negro Federica , Rolla Roberta , Tonon Francesco , De Luca Giuseppe
Published: October 2019

Introduction

Smoking represents a major cardiovascular risk factor, due to the induction of oxidative stress and low‐grade, continuous, inflammation that contribute to promote atherothrombosis. However, the mechanisms leading to increased platelet aggregability associated with smoking are only partially defined. A potential role has been hypothesized for immature platelets, a younger and potentially more reactive fraction, previously associated with the main determinants of coronary artery disease (CAD). Therefore, the aim of our study was to define the impact of smoking on the immature platelet fraction (IPF) and its relationship with prevalence and extent of coronary artery disease.

Methods

We enrolled a cohort of consecutive patients undergoing coronary angiography in a single centre. Significant CAD was defined as at least 1 vessel stenosis >50%, while severe CAD was defined as left main and/or three‐vessel disease. IPF was measured at admission by routine blood cell count (Sysmex XE‐2100).

Results

We included in our study 2553 patients who were divided according to smoking status (active smokers: 512; nonactive smokers: 2041). Smokers were younger, more frequent males, with lower rate of diabetes mellitus, previous PCI and previous CABG (P < .001, respectively) and were in treatment less often with ARB, BB, nitrates, statins, ASA, clopidogrel, CCB and diuretics (P < .001, respectively) as compared to nonactive smokers. Higher percentage of smokers was observed in patients with higher IPF values, and at multivariate analysis, active smoking resulted as an independent predictor of higher IPF (adjusted OR [95% CI] = 1.59[1.03‐2.45], P = .035). Among smokers, higher IPF was associated with lower ejection fraction (P = .034), percentage of acute coronary syndrome (P = .002) and platelet count (P < .001) compared to ones with lower IPF. However, the IPF (according to quartiles values) was not associated with the prevalence and extent of CAD (82.5%, 80.4%, 86.1% and 80.9%, from 1st to 4th quartile, respectively, adjusted OR[95% CI] = 0.98[0.79‐1.23], P = .89) and severe CAD (31%, 31.1%, 39.1% and 35.2%, from 1st to 4th quartile, respectively, adjusted OR[95% CI] = 1.03[0.86‐1.23], P = .76).

Conclusion

The present study shows an independent association between active smoking and the levels of immature platelet fraction in patients undergoing coronary angiography. However, among active smokers, IPF did not result as an independent predictor of CAD or severe CAD.
Urbanisation affects the diet and feeding selectivity of the invasive guppy Poecilia reticulata
Authors: Ganassin Maria J. M. , Frota Augusto , Muniz Carolina M. , Baumgartner Matheus T. , Hahn Norma S.
Published: October 2019

The process of urbanisation is increasing the frequency and magnitude of fluctuations in the availability of food resources for fish. In this study, we investigated whether the diet and prey selected by the guppy Poecilia reticulata reflect the different levels of urbanisation using the total area of impervious surface soil as the metric. Rural streams (low percentage of urbanisation—LPU) and urban streams (high percentage of urbanisation—HPU) were sampled during both the rainy and dry seasons. The hypothesis tested was that the diet and selective behaviour differ spatially and seasonally between LPU and HPU streams. Among the analysed items, seasonal significant differences were only observed in HPU streams. In LPU streams, the trophic spectrum was wider, and a higher diversity of prey was selected. In HPU streams, the diet richness was lower with a dominance of Chironomidae, and there was also less variability in selected prey. Ephemeroptera and Trichoptera were always avoided, but Coleoptera were avoided only in LPU, while Oligochaeta were avoided in HPU streams. Thus, the diet and prey selected by P. reticulata were different between LPU and HPU streams, and this species has potential to compete for food with the native fauna in a wide variety of environmental conditions and available resources. Therefore, this dietary flexibility probably offers competitive advantages when colonising and establishing in a new habitat.
Prevalence of equine ulcerative keratomycosis in Colorado and association of environmental factors: A retrospective and descriptive study (2002–2017)
Authors: Martabano B. B. , de Linde Henriksen M. , Powell C. C.
Published: October 2019

Equine ulcerative keratomycosis is relatively commonly presented to teaching hospitals in North America, with a prevalence from 24 to 86%. Horses in Colorado may have lower risk due to the dry mountain climate, but data are lacking. This study aimed to determine the prevalence of ulcerative keratomycosis amongst horses with ulcerative keratitis presented to Colorado State University Veterinary Teaching Hospital (CSU‐VTH) ophthalmology service and to evaluate environmental factors (season, temperature, humidity, wind speed and elevation) associated with ulcerative keratomycosis in Colorado. A database search identified horses with ulcerative keratitis presented to the ophthalmology service at CSU‐VTH from January 2002 to August 2017. Sixty‐one horses met the inclusion criteria of a corneal cytology and/or culture or histopathology at the time of diagnosis; cases lacking that were excluded. Environmental factors at the boarding sites, including season, temperature, humidity, wind speed and elevation and clinical outcomes for fungal cases, were recorded. Prevalence of fungal infection amongst equine ulcerative keratitis was 16.4% (10/61), suggesting that CSU‐VTH has considerably fewer ulcerative keratomycosis cases than other veterinary teaching hospitals in North America. Spring (50%, 5/10) and fall (40%, 4/10) had the highest prevalence of fungal ulcerative keratitis in Colorado. Only one case was reported in summer (10%, 1/10); no horses were positive (0%, 0/10) in winter. Only wind speed seemed to influence the development of ulcerative keratomycosis with higher wind speeds associated with greater rates of fungal involvement (P = 0.047). Other environmental factors did not show a detectable association (all P‐values >0.05). Outcomes were variable. It was concluded that horses from the area of CSU‐VTH appear to be at lower risk for ulcerative keratomycosis than from the areas around other North American veterinary teaching hospitals that have reported data. Most horses with keratomycosis in this area present in the spring and fall.
Neuropeptide‐S‐receptor deficiency affects sex‐specific modulation of safety learning by pre‐exposure to electric stimuli
Authors: Kreutzmann Judith C. , Khalil Radwa , Köhler Jana C. , Mayer Dana , Florido Antonio , Nadal Roser , Andero Raül , Fendt Markus
Published: October 2019

Neuropeptide S (NPS) is a neuropeptide involved in the regulation of fear. Because safety learning is impaired in patients suffering from anxiety‐related psychiatric disorders, and polymorphisms of the human neuropeptide S receptor (NPSR) gene have also been associated with anxiety disorders, we wanted to investigate whether NPSR‐deficiency interferes with safety learning, and how prior stress would affect this type of learning. We first investigated the effect of pre‐exposure to two different types of stressors (electric stimuli or immobilization) on safety learning in female and male C57Bl/6 mice, and found that while stress induced by electric stimuli enhanced safety learning in males, there were no differences in safety learning following immobilization stress. To further investigate the role of the NPS system in stress‐induced modulation of safety learning, we exposed NPSR‐deficient mice to stress induced by electric stimuli 10 days before safety learning. In nonstressed male mice, NPSR‐deficiency enhanced safety learning. As in male C57Bl/6 mice, pre‐exposure to electric stimuli increased safety learning in male NPSR +/+ mice. This pre‐exposure effect was blocked in NPSR‐deficient male mice showing impaired, but still intact, safety learning in comparison to their NPSR +/+ and NPSR +/− littermates. There was neither a pre‐exposure nor a genotype effect in female mice. Our findings provide evidence that pre‐exposure to stress induced by electric stimuli enhances safety learning in male mice, and that NPSR‐deficiency prevents the beneficial effect of stress exposure on safety learning. We propose an inverted U‐shape relationship between stress and safety learning.
CD133 and epithelial cell adhesion molecule expressions in the cholangiocarcinoma component are prognostic factors for combined hepatocellular cholangiocarcinoma
Authors: Wakizaka Kazuki , Yokoo Hideki , Kamiyama Toshiya , Kakisaka Tatsuhiko , Ohira Masafumi , Tani Michio , Kato Koichi , Fujii Yuki , Sugiyama Ko , Nagatsu Akihisa , Shimada Shingo , Orimo Tatsuya , Kamachi Hirofumi , Matsuoka Ryosuke , Taketomi Akinobu
Published: October 2019

Aim

A new classification of combined hepatocellular cholangiocarcinoma (CHC) was recently reported. Cancer stem cells have been associated with CHC carcinogenesis. This study examined the association of cancer stem cell marker expression and prognosis in CHC classified using the new classification.

Methods

We enrolled 26 CHC patients and classified them according to the new classification. We evaluated the expression of cancer stem cell markers (CD56, CD133, and epithelial cell adhesion molecule [EpCAM]) by immunohistochemical staining in each component. We analyzed the association between expressions and prognosis.

Results

Seven cases were hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) (cHCC‐CCA), 12 were HCC and intermediate cell carcinoma (HCC‐INT), and seven were intermediate cell carcinoma (INT). The CD133‐positive rate tended to be higher in the CCA (42.9%) and INT component (50.0%) than the HCC component (14.3%) in cHCC‐CCA. In HCC‐INT, the CD133‐positive rate in the INT component (83.3%) was significantly higher than the HCC component (8.3%; P = 0.001). For EpCAM, the positive rate in the CCA component (71.4%) and INT component (50.0%) tended to be higher than the HCC component (14.3%) in cHCC‐CCA. Overall survival and disease‐free survival were significantly worse in cases with CD133‐positive (P = 0.048 and P = 0.048, respectively) or EpCAM‐positive (P = 0.041 and P = 0.041, respectively) CCA component in cHCC‐CCA.

Conclusions

INT and CCA components showed higher expression rates of cancer stem cell markers than the HCC component. CD133 or EpCAM expression in the CCA component was associated with poor prognosis in cHCC‐CCA.
Changes of gut microbiota during silybin‐mediated treatment of high‐fat diet‐induced non‐alcoholic fatty liver disease in mice
Authors: Li Xiuxia , Wang Yanping , Xing Yilan , Xing Renxin , Liu Yongsheng , Xu Yinsheng
Published: October 2019

Aim

Gut microbiota are involved in the pathogenesis of non‐alcoholic fatty liver disease (NAFLD). Silybin (Sil), a naturally occurring hepatoprotective agent, is widely used for treating NAFLD. Whether Sil affects gut microbiota during its actions in treating NAFLD is unknown. We aimed to examine the effect of Sil on intestinal flora dysbiosis induced by a high‐fat diet (HFD).

Methods

After 10 weeks of feeding normal chow diet or HFD, mice were given a daily gavage for 8 weeks. Cecal contents were harvested for study of short‐chain fatty acids, bile acids, and gut microbiota alteration.

Results

Sil showed protective effects against dietary‐induced obesity and liver steatosis; accordingly, gut microbiota composition changed. At the phylum level, compared with the HFD group, mice in the Sil‐treated group had significantly lower levels of Firmicutes, and the ratio of Firmicutes‐to‐Bacteroidetes was lower (P < 0.05). At the genus level, the Sil‐treated group have significantly lower levels of Lachnoclostridium, Lachnospiraceae_UCG‐006, and Mollicutes_RF9, which were reported to be potentially related to diet‐induced obesity, and increased levels of Blautia (P < 0.05), Akkermansia (P < 0.05), and Bacteroides (P < 0.05), which are known to have a beneficial effect on improving NAFLD. Sil also showed an inhibitory effect on well‐known beneficial bacteria, such as Alloprevotella and Lactobacillus. Furthermore, the production of acetate, propionate, and butyrate increased, whereas the generation of formate and conversion of cytotoxic secondary metabolites (lithocholic acid and deoxy‐cholic acid) decreased in mice treated with Sil.

Conclusions

Sil might have beneficial effects on ameliorating NAFLD and mediating HFD‐induced change of gut microbiota composition, followed by major changes in secondary metabolites, such as short‐chain fatty acids and bile acids.
Preferences for interventions designed to increase cervical screening uptake in non‐attending young women: How findings from a discrete choice experiment compare with observed behaviours in a trial
Authors: Campbell Helen E. , Gray Alastair M. , Watson Judith , Jackson Cath , Moseley Carly , Cruickshank Margaret E. , Kitchener Henry C. , Rivero‐Arias Oliver
Published: October 2019

Background

Young women’s attendance at cervical screening in the UK is continuing to fall, and the incidence of invasive cervical cancer is rising.

Objectives

We assessed the preferences of non‐attending young women for alternative ways of delivering cervical screening.

Design

Postal discrete choice experiment (DCE) conducted during the STRATEGIC study of interventions for increasing cervical screening uptake. Attributes included action required to arrange a test, location of the test, availability of a nurse navigator and cost to the National Health Service.

Setting and participants

Non‐attending young women in two UK regions.

Main outcome measures

Responses were analysed using a mixed multinomial logit model. A predictive analysis identified the most preferable strategy compared to current screening. Preferences from the DCE were compared with observed behaviours during the STRATEGIC trial.

Results

The DCE response rate was 5.5% (222/4000), and 94% of respondents agreed screening is important. Preference heterogeneity existed around attributes with strong evidence for test location. Relative to current screening, unsolicited self‐sampling kits for home use appeared most preferable. The STRATEGIC trial showed this same intervention to be most effective although many women who received it and were screened, attended for conventional cytology instead.

Conclusions

The DCE and trial identified the unsolicited self‐sampling kit as the most preferred/effective intervention. The DCE suggested that the decision of some women receiving the kit in the trial to attend for conventional cytology may be due to anxieties around home testing coupled with a knowledge that ignoring the kit could potentially have life‐changing consequences.
Promoting self‐regulation in low achievers: A case study of Japanese university EFL students
Authors: Nakata Yoshiyuki
Published: October 2019

This paper reports on a multiple case study made of 15 EFL university students who failed the required English course and thus had to take part in a repeaters' class. It aims to explore the process by which low achievers can become better self‐regulated learners if given pedagogical intervention to assist their style of language learning. Qualitative analysis of multiple data sources (closed−/open‐ended questionnaires, review sheets) on individual learners highlighted the idiosyncratic nature of learner development. Results suggest that, though many of the learners were in the preparatory stage of self‐regulation, the degree to which they retained low self‐regulation characteristics and manifested the sheer variety of its aspects differed in each individual.
Does asymptomatic bacteriuria affect the response to intravesical bacillus Calmette–Guérin?
Authors: Herr Harry
Published: October 2019

Objective

To determine the initial response to intravesical bacillus Calmette–Guérin and the 3‐year recurrence rate of high‐risk non‐muscle‐invasive bladder cancer in patients who have asymptomatic bacteriuria.

Methods

Response and recurrence rates were investigated in 505 patients with high‐risk non‐muscle‐invasive bladder cancer after treatment with induction bacillus Calmette–Guérin (TICE strain) therapy. Initial response was determined after 3 months and patients were followed every 3–6 months for 3 years. Before bacillus Calmette–Guérin and each follow‐up cystoscopy, urine cultures were obtained, stratified as no growth, <104, >104 or >105 colony‐forming unit/mL. Any degree of bacteriuria on culture was classified as asymptomatic bacteriuria.

Results

Of the 505 cases, 270 (53%) had asymptomatic bacteriuria. A total of 89% of patients with asymptomatic bacteriuria showed a complete response to bacillus Calmette–Guérin versus 76% of uninfected patients (P = 0.001), and 75% of bacteriuric patients survived tumor‐free for 3 years versus 65% of uninfected patients.

Conclusions

Chronic bacteriuria might enhance the response of high‐risk non‐muscle‐invasive bladder cancer to intravesical bacillus Calmette–Guérin and result in longer tumor‐free survival than uninfected patients.
Goals of care conversations and documentation in patients triggering medical emergency team calls
Authors: Kerkham Telena , Brain Matthew
Published: October 2019

Background

It is widely accepted that early discussions about goals of care (GOC) should occur during a hospital admission. Whilst rapid response systems such as Medical Emergency Team (MET) calls were designed to identify patients at risk of deterioration early enough in their illness to intervene, it is becoming apparent that these teams frequently diagnose the dying patient.

Aims

To determine how frequently Launceston General Hospital MET doctors are involved in discussions surrounding GOC.

Methods

A retrospective audit of all MET calls and Code Blues at the Launceston General Hospital over an 18 month period was performed.

Results

50% of MET calls occurred in patients with no valid GOC form completed prior. At 3% of events, the GOC form was completed for the first time, and at 3% it was modified. At a further 3% the notes implied there had been a modification to the GOC but the form had not been completed.

Conclusions

This audit confirms that documentation surrounding GOC is inadequate, and that at 9% of MET calls, MET doctors are involved in discussions surrounding treatment limitations. This suggests that further education and training is required for doctors working in inpatient care, including those who staff the MET.
Tocilizumab therapy in rheumatoid arthritis with interstitial lung disease: a multicentre retrospective study
Authors: Manfredi Andreina , Cassone Giulia , Furini Federica , Gremese Elisa , Venerito Vincenzo , Atzeni Fabiola , Arrigoni Eugenio , Della Casa Giovanni , Cerri Stefania , Govoni Marcello , Petricca Luca , Iannone Florenzo , Salvarani Carlo , Sebastiani Marco
Published: October 2019

Background

Interstitial lung disease (ILD) is the most severe extra‐articular manifestation of rheumatoid arthritis (RA). Although it is responsible of 10–20% of all RA mortality, no controlled studies are available for the treatment of RA‐ILD and its therapeutic approach is still debated.

Aims

To analyse the evolution of ILD in a population of RA patients treated with tocilizumab (TCZ).

Methods

In this national multicentre study, we retrospectively collected patients with RA‐ILD treated with at least one dose of TCZ. For each patient, disease activity and serological data were evaluated. Moreover, we analysed the evolution of high‐resolution computed tomography (HRCT) and pulmonary function tests, including forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (DLCO).

Results

Twenty‐eight RA‐ILD patients were identified (females/males 18/10, mean age 61.6 years), with a mean follow up for TCZ therapy of 30 months. At the end of follow up, FVC remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%). DLCO remained stable in 14 (56%) patients, improved in 5 (20%) and worsened in 6 (24%), even though in 3 patients DLCO and FVC showed an opposite trend. HRCT remained stable in the majority (25) of cases, worsened in two patients with a usual interstitial pneumonia pattern and improved in only one case with a non‐specific interstitial pneumonia pattern.

Conclusions

The management of RA‐ILD patients remains a critical unmet need. TCZ demonstrated a good safety profile in patients with RA‐ILD and a potential effect on the stabilisation of lung involvement.
Clinical relevance of bilateral pleural effusion in patients with acute pulmonary embolism
Authors: Levy Ofer , Fux Daniel , Bartsikhovsky Tetiana , Vosko Sergei , Tishler Moshe , Copel Laurian
Published: October 2019

Background

The clinical relevance of bilateral pleural effusion (BPE) in patients with acute pulmonary embolism (PE) is unclear.

Aims

To describe characteristics of patients with acute PE that present with BPE.

Methods

Patients with acute PE were retrospectively analysed and divided into three groups: without pleural effusion, unilateral pleural effusion and bilateral effusion. Clinical, laboratory and radiological characteristics were compared between the three groups.

Results

The study population (n = 343) consisted of unilateral effusion group (n = 83), BPE group (n = 94) and without effusion group (n = 166). Several variables were noted in higher proportion (%), in the BPE group in comparison to both the unilateral effusion and without effusion groups: heart failure (17.0 vs 7.2 vs 6.7, P = 0.017), hypoalbuminaemia (59.3 vs 39.5 vs 25.6, P ˂ 0.001), PE occurrence in‐hospital setting (51 vs 25.6 vs 15.1, P ˂ 0.001), major operation (31 vs 19.2 vs 15.2, P = 0.01) and mechanical ventilation (13.0 vs 4.9 vs 4.2, P = 0.019). Norton scale scores were found to be lower among patients with BPE in comparison to both patients with unilateral and without pleural effusion (15.55 vs 16.92 vs 17.36, P = 0.006). After adjusting confounding variables, patients with BPE have lower probability for in‐hospital survival in comparison to both patients with unilateral pleural effusion (odds ratio = 0.30, 95% confidence interval 0.12–0.79), and patients without pleural effusion (odds ratio = 0.26, 95% confidence interval 0.11–0.61).

Conclusions

BPE in patients with acute PE may have significant clinical implications. It may signify serious underlying comorbidities which contribute to higher in‐hospital mortality in comparison to both patients with unilateral pleural effusion and patients without pleural effusion.
Long‐term care nurses’ attitudes and the incidence of voluntary stopping of eating and drinking: A cross‐sectional study
Authors: Stängle Sabrina , Schnepp Wilfried , Büche Daniel , Fringer André
Published: October 2019

Aims

To assess the incidence of voluntary stopping of eating and drinking (VSED) in long‐term care and to gain insights into the attitudes of long‐term care nurses about the VSED.

Design

A cross‐sectional study.

Methods

Heads of Swiss nursing homes (535; 34%) answered the Online‐Survey between June – October 2017, which was evaluated using descriptive data analysis.

Results

The incidence of patients who died in Swiss nursing homes by voluntarily stopping eating and drinking is 1.7% and 67.5% of participants consider this phenomenon highly relevant in their daily work. Most participants (64.2%) rate VSED as a natural death accompanied by health professionals and patients are also granted the right to care (91.9%). This phenomenon is expected by the participants less at a young age and more in old age.

Conclusion

Participants’ overall views on the VSED are very positive, whereas it is assumed that VSED is a phenomenon of old age. Professionals still lack sufficient knowledge about this phenomenon, which could be clarified through training.

Impact

Voluntary stopping of eating and drinking is much discussed interprofessional, but there is a lack of knowledge on how this is perceived in the context of long‐term care and about the incidence of the phenomenon. Voluntary stopping of eating and drinking is rare but noticeable end‐of‐life practises that is considered by professionals to be mainly dignified and peaceful, although moral concerns make it difficult to accompany. These findings call on long‐term care institutions to discuss VSED as an end‐of‐life practice. Positioning on the issue provides clarity for staff and patients and promotes to develop standardized care.

International Registered Report Identifier (IRRID): DERR1‐10.2196/10358.
Haemin pre‐treatment augments the cardiac protection of mesenchymal stem cells by inhibiting mitochondrial fission and improving survival
Authors: Deng Rui , Liu Yaming , He Haiwei , Zhang Hao , Zhao Chenling , Cui Zhen , Hong Yimei , Li Xin , Lin Fang , Yuan Dongsheng , Liang Xiaoting , Zhang Yuelin
Published: October 2019

The cardiac protection of mesenchymal stem cell (MSC) transplantation for myocardial infarction (MI) is largely hampered by low cell survival. Haem oxygenase 1 (HO‐1) plays a critical role in regulation of cell survival under many stress conditions. This study aimed to investigate whether pre‐treatment with haemin, a potent HO‐1 inducer, would promote the survival of MSCs under serum deprivation and hypoxia (SD/H) and enhance the cardioprotective effects of MSCs in MI. Bone marrow (BM)‐MSCs were pretreated with or without haemin and then exposed to SD/H. The mitochondrial morphology of MSCs was determined by MitoTracker staining. BM‐MSCs and haemin‐pretreated BM‐MSCs were transplanted into the peri‐infarct region in MI mice. SD/H induced mitochondrial fragmentation, as shown by increased mitochondrial fission and apoptosis of BM‐MSCs. Pre‐treatment with haemin greatly inhibited SD/H‐induced mitochondrial fragmentation and apoptosis of BM‐MSCs. These effects were partially abrogated by knocking down HO‐1. At 4 weeks after transplantation, compared with BM‐MSCs, haemin‐pretreated BM‐MSCs had greatly improved the heart function of mice with MI. These cardioprotective effects were associated with increased cell survival, decreased cardiomyocytes apoptosis and enhanced angiogenesis. Collectively, our study identifies haemin as a regulator of MSC survival and suggests a novel strategy for improving MSC‐based therapy for MI.
Association between cancer antigen 19‐9 and diabetes risk: A prospective and Mendelian randomization study
Authors: Li Zhaoyang , Wang Jing , Han Xu , Wang Fei , Hu Hua , Yuan Jing , Yao Ping , Wei Sheng , Guo Huan , Zheng Dan , Tang Yuhan , Yang Handong , He Meian
Published: October 2019

Aims/Introduction

Elevated serum cancer antigen 19‐9 (CA19‐9) levels have been found in diabetes patients in most observational studies; however, whether there is a causal association between CA19‐9 and diabetes mellitus is unclear.

Materials and Methods

Our study was carried out based on the Dongfeng‐Tongji cohort comprising 27,009 individuals. We first investigated the associations between serum CA19‐9 levels and incident diabetes mellitus risk in a prospective cohort study (12,700 individuals). Then, we explored the potential causal relationship between CA19‐9 and diabetes mellitus risk in a cross‐sectional study (3,349 diabetes mellitus patients and 8,341 controls) using Mendelian randomization analysis. A weighted genetic risk score was calculated by adding the CA19‐9 increasing alleles in five single‐nucleotide polymorphisms (rs17271883, rs3760776 and rs3760775 in FUT6, rs11880333 in CA11, rs265548 in B3GNT3, and rs1047781 in FUT2), which were identified in a previous genome‐wide association study on serum CA19‐9 levels.

Results

In the prospective study, a total of 1,004 incident diabetes mellitus patients were diagnosed during a mean 4.54‐year follow‐up period. Elevated serum CA19‐9 level was associated with a higher incident diabetes risk after adjustment for confounders, with a hazard ratio of 1.20 (95% confidence interval 1.11–1.30) per standard deviation (12.17 U/mL) CA19‐9 increase. Using the genetic score to estimate the unconfounded effect, we did not find a causal association of CA19‐9 with diabetes risk (odds ratio per weighted CA19‐9‐increasing allele: 0.99, 95% confidence interval 0.94–1.04; P = 0.61).

Conclusions

The present study did not support a causal association of serum CA19‐9 with diabetes risk. CA19‐9 might be a potential biomarker of incident diabetes mellitus risk.
Zoon Balanitis: misdiagnosis or missed diagnosis?
Authors: Piaserico S. , Orlando G. , Linder M.D.
Published: October 2019

Linked article: C.B. Bunker. J Eur Acad Dermatol Venereol 2020; 34: e116–e117. https://doi.org/10.1111/jdv.16037.
Thermal habitat of adult Atlantic salmon Salmo salar in a warming ocean
Authors: Strøm John Fredrik , Thorstad Eva Bonsak , Rikardsen Audun Håvard
Published: October 2019

The year‐round thermal habitat at sea for adult Atlantic salmon Salmo salar (n = 49) from northern Norway was investigated using archival tags over a 10 year study period. During their ocean feeding migration, the fish spent 90% of the time in waters with temperatures from 1.6–8.4°C. Daily mean temperatures ranged from −0.5 to 12.9°C, with daily temperature variation up to 9.6°C. Fish experienced the coldest water during winter (November–March) and the greatest thermal range during the first summer at sea (July–August). Trends in sea‐surface temperatures influenced the thermal habitat of salmon during late summer and autumn (August–October), with fish experiencing warmer temperatures in warmer years. This pattern was absent during winter (November–March), when daily mean temperatures ranged from 3.4–5.0°C, in both colder and warmer years. The observations of a constant thermal habitat during winter in both warmer and colder years, may suggest that the ocean distribution of salmon is flexible and that individual migration routes could shift as a response to spatiotemporal alterations of favourable prey fields and ocean temperatures.
Potential for children with intellectual disability to engage in cognitive behaviour therapy: the parent perspective
Authors: Hronis A. , Roberts R. , Roberts L. , Kneebone I.
Published: October 2019

Background

This study aimed to obtain the opinions of parents and carers of children with intellectual disability (ID) as to whether cognitive behaviour therapy (CBT) could be useful for their children.

Methods

A mixed qualitative and quantitative method was employed. Twenty‐one carers of children aged 10 to 17 having borderline to moderate intellectual functioning responded to an online questionnaire. Participants were provided with information about CBT and asked to respond to open‐ended questions. Quantitative data pertained to questions about their child's ability to identify and describe thoughts, feelings and behaviours. Thematic analysis of responses was conducted using an inductive method of identifying themes from the qualitative data collected.

Results

Five themes emerged from the qualitative analysis: Emotional Attunement (i.e. parent's understanding and recognition of their child's emotions), Role of the Therapist (i.e. ways therapists could facilitate the intervention), Role of the Parent (i.e. ways parents could engage in the therapy process), Anticipated Obstacles (i.e. what may get in the way of the therapy) and Suggested Adaptations for Therapy (i.e. how CBT can be adapted to suit the needs of children with ID). Seventy‐six per cent agreed that their child would be able to engage in CBT with assistance.

Conclusions

The majority of parents believed that CBT is an intervention that children with ID could engage in, provided the therapy is adapted, and the therapist accommodates their needs.
Efficacy of a skin care cream with TRPV1 inhibitor 4‐t‐butylcyclohexanol in the topical therapy of perioral dermatitis
Authors: Srour Jerome , Bengel Julia , Linden Teresa , Jovanovic Zorica , Roggenkamp Dennis , Reinholz Markus , Rothenberger Christoph , Neufang Gitta , Wollenberg Andreas
Published: October 2019

Background

Perioral dermatitis is a clinically distinctive reaction pattern of facial dermatitis, including redness, dryness, burning, pruritus and skin tightness. A gold standard treatment remains unclear.

Objectives

Our study evaluates the clinical value of a skin care cream with the transient receptor potential vanilloid type 1 inhibitor 4‐t‐butylcyclohexanol in POD patients over 8 weeks.

Methods

This open, unblinded 8‐week clinical trial included 48 patients. A skin care cream containing 4‐t‐butylcyclohexanol was applied over a period of 8 weeks. Standardized questionnaires were used at baseline, 4 and 8 weeks, for history documentation, objective and subjective severity scores, and quality of life assessments. Six different skin physiology parameters were assessed at all timepoints.

Results

The perioral dermatitis severity score decreased significantly during the treatment period. This was mirrored by significantly lower patients’ subjective numerical rating score and an improved quality of life score. Transepidermal water loss, stratum corneum hydration and skin erythema improved significantly during the treatment period.

Conclusion

This transient receptor potential vanilloid type 1 inhibitor‐based skin care cream improved subjective and objective parameters of perioral dermatitis. Decreased transepidermal water loss values and increased stratum corneum hydration demonstrate a restored skin barrier function. Consequently, the topical inhibition of these receptors is a promising management option for POD.
A secondary discoid lupus erythematosus induced by scald of edible oil: An illustration of Koebner phenomenon
Authors: Ji Yong‐Zhi , Mei Xiang‐Lin , Wei Fang‐Li , Liu Shi‐Rui , Ji You‐Bo
Published: October 2019

Background

Discoid lupus erythematosus (DLE) is a most well‐known clinical variation of chronic cutaneous lupus erythematosus inside the spectrum of lupus erythematosus (LE). Cutaneous trauma remains a significant and peculiar causative factor for DLE.

Aims

We present a case wherein the patient demonstrated unilateral distribution of DLE on a clinically normal appearing occult facial scald of edible oil, representing Koebner phenomenon (KP) i.e. occurrence of a new skin disease at the site of an unrelated and already healed one.

Patient/Methods

The 53 years old female patient was unique because she experienced DLE on the nasal back.

Results

The injury was totally settled following a month treatment of oral hydroxychloroquine and topical 0.03% tacrolimus ointment. After three months, she encountered an accidental edible oil scald on the right upper cheek. Several small vesicles appeared on a soybean‐sized erythema base with a burning sensation.

Conclusion

We review the literature and conclude by discussing important histologic highlights to think about while endeavoring to perceive the fundamental character and pathogenicity of such sores.
Patients' and nurses' experiences of fundamental nursing care: A systematic review and qualitative synthesis
Authors: Pentecost Claire , Frost Julia , Sugg Holly V. R. , Hilli Angelique , Goodwin Victoria A. , Richards David A.
Published: October 2019

Aims and objectives

To systematically identify, appraise and synthesise patients', residents' and nurses' experiences of fundamental nursing care for nutrition, elimination, mobility and hygiene.

Background

The evidence base for effective nursing behaviours to assist people with their fundamental care needs is sparse, hampering the development of effective interventions. Synthesising data on patients' and nurses' experiences of fundamentals of nursing care could contribute to the development of such an intervention.

Methods

Systematic review and synthesis of qualitative data from qualitative studies on patients' and nurses' experiences of fundamental nursing care behaviours addressing peoples' nutrition, elimination, mobility and hygiene needs. We appraised study quality and relevance and used a narrative approach to data synthesis, fulfilling PRISMA criteria (Appendix S2).

Results

We identified 22,374 papers, and 47 met our inclusion criteria. Most papers were of low quality. Sixteen papers met our quality and relevance criteria and were included for synthesis. Papers were about nutrition (2) elimination (2), mobility (5), hygiene (5) and multiple care areas (2). We found nurses and patients report that fundamental nursing care practices involve strong leadership, collaborative partnerships with patients and cohesive organisational practices aligned to nursing care objectives and actions.

Conclusions

To improve fundamental care and interventions suitable for testing may require attention to leadership, patient–nurse relationships and organisational coherence plus the fundamentals of care nursing interventions themselves.

Relevance to clinical practice

More rigorous mixed methods research about fundamental nursing care is needed to inform nursing practice and improve patient's experience. Nursing interventions should include effective nurse leadership and nurse–patient collaboration and a focus on fundamental care by the host organisation.