bluuebunny/crossref_metadata_2025 huggingface dataset:
Study of the use of complementary and alternative medicine by cancer patients at Kenyatta National Hospital, Nairobi, Kenya
Authors: Ong’udi Maryanne , Mutai Pegotty , Weru Irene
Published: October 2018

Introduction

Cancer is not only a burden in the country but also a global burden with among the highest rate of mortality. In spite of the great strides made by the conventional therapy, many cancer patients have resorted to using complementary and alternative medicine (CAM) as human beings have an innate urge to try new and alternative ways to relieve their suffering.

Objectives

There is a need for us to establish if the cancer patients at Kenyatta National Hospital, Nairobi use CAM, to establish the socio-demographic characteristics of patients in the oncology clinic, to establish the types and patterns of CAM use, to establish the reasons and factors that may contribute to CAM use and if the primary health care provider is aware that they are using CAM.

Methodology

Face-to-face interviews using semi-structured questionnaires were used to determine the use of CAM by the cancer patients. All consenting cancer patients who satisfied the inclusion criteria were interviewed as they presented to the oncology clinic.

Results

A total of 78 respondents were interviewed during the study out of which 35 (44.9%) were male, while 43 (55.1%) were female. The age distribution was from 18 to above. Eleven patients (14.1%) have used CAM at one point during their treatment. The use of CAM was not affected by the age, gender, and marital status, level of education and level of income. The most frequently used CAM was herbal medicine; 64.0% of the patients used CAM with the hope of curing their disease, while 36.0% used it with the hope of getting symptomatic relief. Among the CAM users, only 45.0% were satisfied with the use of it, while 55.0% were disappointed as it did not meet their expectations and would therefore never recommend the of CAM to anyone else; 27.0% obtained some benefit from the use of CAM, 27.0% did not experience any benefit and a further 46.0% were unclear about any notable benefit experienced; 55.0% of the CAM users had disclosed their use of CAM to the doctor, while 45.0% did not disclose this reason mostly because they do not feel it is important to let the doctor know as he/she never asks.

Conclusion

The prevalence of CAM use among cancer patients in Kenyatta National Hospital ranks lower compared to other countries. The most common type of CAM in use is herbal medicine. However, most patients do not obtain the expected benefits and do not disclose this information to the doctors as they feel it is not important.
Inverse problem of contact fracture mechanics for a hub of friction pair taking into account thermal stresses
Authors: Mirsalimov Vagif M , Akhundova Parvana E
Published: October 2018

Methods of fracture mechanics enable a new approach to the design of structures, ensuring prevention of crack development. The plane problem of mechanics of contact fracture for the hub of a friction pair during operation is studied. It is accepted that near the rough friction surface, the hub has a rectilinear crack. A criterion and a method for solving the inverse problem of the mechanics of contact fracture on definition of the function of displacements of external contour points of the hub of a friction pair with regard to temperature drop and inequalities of the contact surface in friction pair components is given. The found function of displacements of the external contour points of the hub provides an increase of the load-bearing capacity of the hub of a friction pair. The problem of prevention of the fracture of the hub of a friction pair with allowance for the real friction surface was first posed and then solved.
A comparison of two optical coherence tomography–angiography devices in pseudoexfoliation glaucoma versus primary open-angle glaucoma and healthy subjects
Authors: Rebolleda Gema , Pérez-Sarriegui Ane , De Juan Victoria , Ortiz-Toquero Sara , Muñoz-Negrete Francisco J
Published: October 2018

Purpose:

To compare peripapillary vascular parameters derived from two optical coherence tomography angiography devices in pseudoexfoliation glaucoma, primary open-angle glaucoma, and healthy controls and to evaluate their diagnostic accuracy.

Methods:

Observational, cross-sectional study. In total, 20 eyes with pseudoexfoliation glaucoma, 20 primary open-angle glaucoma eyes matched by peripapillary retinal nerve fiber layer thickness, and 20 control eyes were recruited. Participants underwent standard automated perimetry and peripapillary retinal nerve fiber layer analysis by Optovue and Cirrus optical coherence tomography. Vascular parameters provided by Angiovue and Angioplex optical coherence tomography angiography were compared. Their diagnostic accuracy and correlation with structural and functional parameters were assessed.

Results:

All peripapillary optical coherence tomography angiography vascular parameters were significantly different among groups (all p < 0.05). The whole image capillary density and peripapillary capillary density by Angiovue were significantly lower in pseudoexfoliation glaucoma compared with primary open-angle glaucoma (p = 0.009 and p = 0.001, respectively). Conversely, vascular parameters by Angioplex were not statistically different between primary open-angle glaucoma and pseudoexfoliation glaucoma. A good correlation was found using Angiovue between whole image capillary density and visual field mean deviation (0.758, p < 0.001), peripapillary capillary density and visual field mean deviation (0.729, p = 0.001), and peripapillary capillary density and peripapillary retinal nerve fiber layer thickness in eyes with pseudoexfoliation glaucoma (0.716, p = 0.001). Angiovue parameters showed higher area under the receiver operating characteristic curves than Angioplex to discriminate among groups.

Conclusion:

Only Angiovue detected a significantly lower capillary density in pseudoexfoliation glaucoma compared to primary open-angle glaucoma at similar glaucoma damage. Both, Angiovue and Angioplex demonstrated a decreased capillary density in glaucoma eyes compared to healthy eyes. Furthermore, Angiovue-derived vascular parameters showed better correlation with functional and structural parameters and a higher diagnostic capacity to discriminate among groups compared to Angioplex.
Training a Drug to Do New Tricks: Insights on Stability of Meropenem Administered as a Continuous Infusion
Authors: Venugopalan Veena , Manigaba Kayihura , Borgert Samuel J , Cope Jessica , Peloquin Charles A , Klinker Kenneth P
Published: October 2018

Background:

The antibiotic armamentarium used to combat multi-drug resistant organisms (MDROs) include carbapenems. Continuous infusion (CI) dosing is frequently employed to maximize beta-lactam efficacy; however, use of meropenem CI has been limited due to concerns with product instability.

Objective:

The primary objective of this study was to quantify meropenem serum concentrations to reflect drug stability when administered as CI over 8- or 12-h exchanges. In addition, a stability experiment was performed to further establish meropenem integrity over 12 h. The secondary objectives were to assess the ability of meropenem to achieve target pharmacokinetic/pharmacodynamic (PK/PD) exposures relative to the minimum inhibitory concentration (MIC) of the pathogen, and to determine clinical cure.

Methods:

This was a retrospective, observational study on use of CI meropenem (infused either over 8- or 12- h) at a 1% concentration. The stability experiment was conducted on 1% meropenem at room temperature.

Results:

In 22 patients, a median meropenem daily dose of 6 g/day (range 2-6 g/day) resulted in a median serum concentration of 17.8 mg/L (interquartile range, 9.3-27.8 mg/L). In 95% of cases, meropenem delivered as CI resulted in free drug concentrations at or above the MIC of the pathogen for the entire dosing interval. Clinical cure was achieved in 80% of patients included in this review. The stability experiment revealed negligible drug degradation at the end of the 12-h dosing interval.

Conclusions:

The data from this study provides compelling evidence for the use of meropenem as CI utilizing either a 12- or 8-h exchange process.
Evaluating opportunities in Dutch EFL course books for developing pre-vocational learners’ oral interactional ability
Authors: van Batenburg Eline SL , Oostdam Ron J , van Gelderen Amos JS , Fukkink Ruben G , de Jong Nivja H
Published: October 2018

Course materials play a vital role in the foreign language classroom. Relatively little attention has been paid, however, to analyzing the activities that foster oral interactional ability in course materials for English as a foreign language (EFL). For the purpose of this study, a coding scheme was designed that focuses specifically on the development of interactional ability. This was used to analyse the three most commonly used EFL course books for pre-vocational learners in the Netherlands. The analysis revealed that course books focus more on developing language knowledge than on developing the ability to use this knowledge in interaction, that interactional strategies practice is missing, and that interactional practice is limited to the personal and public context. We conclude that EFL course books lag behind current theories of second language acquisition (SLA) in the practical application of activities focused on developing interactional ability. Recommendations to strengthen the link between theory and practice are made.
Prevalence and correlates of stimulant and depressant pharmacological cognitive enhancement among Norwegian students
Authors: Myrseth Helga , Pallesen Ståle , Torsheim Torbjørn , Erevik Eilin Kristine
Published: October 2018

Aims:

To assess the prevalence and factors associated with stimulant and depressant pharmacological cognitive enhancement (PCE) drug use among Norwegian students.

Design:

In the first wave (T1), 28,553 students were invited to participate, of whom 9370 (32.8%) responded and completed the survey (mean age = 24.9 years, 63.5% female). One year later (T2) those who had responded to some items at T1 were invited to participate in a follow-up survey, where 4783 (47.2%) responded and completed the survey (mean age = 24.8 years, 64.8% female).

Results:

Lifetime prevalence of stimulant PCE drug use was 2.1% at T1 and 3.6% at T2. The lifetime prevalence of depressant PCE drug use was 1.5% at T1 and 3.3% at T2. Stimulant PCE drug use at T2 was predicted by low scores on agreeableness and anxiety, high scores on intellect/openness, and alcohol use, and stimulant and depressant PCE drug use at T1; while depressant PCE drug use at T2 was predicted by low scores on extroversion, high scores on conscientiousness, intellect/openness, and anxiety, and stimulant and depressant PCE drug use at T1.

Conclusions:

The rates of stimulant and depressant PCE drug use increased from T1 to T2. Pharmacological cognitive enhancement drug use may be explained by a combination of a motivation for improving academic achievements and a general inclination towards substance use. The current results may suggest that stimulant PCE drug users are more antisocial and indifferent to rules, while depressant PCE drug users are more motivated by coping with stress.
Killing secrets from Panama to Paradise: Understanding the ICIJ through bifurcating communicative and political affordances
Authors: Heemsbergen Luke
Published: October 2018

This Machine Kills Secrets is how Greenberg explains the widespread adoption of digital encryption and anonymity tools in practices of disclosure. We consider how that machine works, to the extent that new and sustained political practices in society have emerged through digital disclosures. We offer the International Consortium of Investigative Journalists (ICIJ) as a paradigmatic case to inform new metaphors of what disclosure is and what it does in democratic governing. The empirical work focuses on how ICIJ’s data mining, manipulation and visualisation interface with traditional governing institutions of accountability. The article relates the affordances present in the ICIJ to modes of societal control that are available through Brighenti’s consideration of visibility as a social category and governmentality scholarship through three theoretical moves: bifurcating affordance theory on communicative and political planes, relaying a complimentarily delineated model of media apparatus and considering how such apparatuses shift towards proto-institutions.
‘I felt uncomfortable because I know what it can be’: The emotional geographies and implicit activisms of reflexive practices for early childhood teachers
Authors: Albin-Clark Jo
Published: October 2018

Reflexivity is recognized as an important constituent in how teachers build their professional knowledge and develop their pedagogical practice. However, less is known about the function that emotions play in the reflexive process and how these emotions can act as a catalyst to mobilize action that can create spaces for small activisms. Implicit activisms are here understood to involve small-scale gestures, such as speaking against discrimination, that can support notions of social justice. In this article, a reading of emotions is undertaken to explore how emotions such as discomfort can influence the speed and type of reaction for an early childhood specialist teacher during peer-to-peer mentoring. The concept of emotional geography is used to understand the way emotions relate to the distancing of others in one teacher’s professional life and mobilize small-scale activism that can be interpreted as politically motivated.
Restorying the image of the child’s body in early childhood education
Authors: Antonsen Connie M
Published: October 2018

This article emerged through the author’s involvement with the University of Victoria’s Investigating Quality in Early Learning Environments project in British Columbia. During an eight-month internship, the author had the opportunity to collaborate with community facilitators in the province; participate in monthly learning-circle discussions with educators and researchers; share pedagogical narrations; connect theory to practice explicitly; and think with children’s bodily encounters. This article contributes to broader and deeper discussions about children’s bodies by placing value on reflective thought, decision-making, and action. While unpacking her own tensions of letting go of common assumptions about children’s bodies, the author considers the ethical and political implications of bodily encounters. To do this, she teases out the growing discourse of risky play and describes the value of thinking in moments of not knowing. Then, the author considers how early childhood education might restory the image of children’s bodies through conversations with other educators in a particular setting, while complexifying young bodies during a risky-play scenario of pulling loose boards onto a staircase. Through post-foundational theory, the educators and the author advocate for bodies by contesting the powers of dominant discourse and considering how bodies might search for meaning in the world. By opening space to think differently, by noticing, and by paying deep attention to the corporeal as it explores and generates truths that bring forth creative evolution, the author was taken by surprise to see what lies beyond that which she thought was possible.
Controlling social desirability bias
Authors: Larson Ronald B.
Published: October 2018

Social desirability bias can change the results from marketing experiments and surveys. However, there are few illustrations that show how serious social desirability bias can be. This research starts by reviewing the options for identifying and reducing social desirability bias in experiments and surveys and for controlling its effects. Then two examples that use a social desirability bias scale or a transformation of it (that may improve its utility) as control variables are described. Data from a national panel survey in the United States is used to show that controlling social desirability bias can change the set of demographic variables that are judged to be statistically significant and can have important effects on coefficient sizes. These illustrations will hopefully stimulate more consideration of social desirability bias, more use of bias measures in marketing studies, and more research on the control options.
Readiness to Adopt Physical Activity Policies in Rural Communities
Authors: Ickes Melinda J. , Wiggins Amanda , Hahn Ellen J.
Published: October 2018

The purpose was to explore community readiness to adopt physical activity (PA) policies by adapting and pilot testing an online survey (Physical Activity Readiness Survey [PARS]). PARS was adapted from the previously tested Community Readiness Survey-Short. In February/April 2016, key informants ( N = 17) involved in PA activities from two rural communities were invited to complete the PARS, representing six dimensions: knowledge, leadership, resources, community climate, existing voluntary PA policies, and political climate. First, participants were asked to respond to a presurvey to screen for overall readiness for up to four evidence-based PA policies. A main survey readiness score (0-6) was determined by averaging the key informants’ ratings across items: Raw scores were rescaled to range from 0 to 1, and dimension scores were summed. Participants identified two PA policies in the presurvey: neighborhood availability and point-of-decision prompts. For both policies, political climate had the highest dimension score (1.0) and the knowledge dimension scored lowest (0.05-0.38). Overall readiness scores ranged from 3.19 to 3.62, revealing the preparation stage for both policies. Readiness for the two PA policies were similar, but specific dimension scores varied by policy type and community, reinforcing the need for tailored interventions.
Vehicle-to-vehicle based multi-objective coordinated adaptive cruise control considering platoon stability
Authors: Zhang Junhui , Li Qing , Chen Dapeng
Published: October 2018

Currently, there is a widespread concern over cooperative driving based on vehicle-to-vehicle communication due to its considerable potential to improve the increased traffic safety, efficiency, costs, and intellectualization. In this article, a multi-objective coordinated adaptive cruise control algorithm for a string of adaptive cruise control–equipped vehicles is thus proposed, which can comprehensively address issues regarding homogeneous/heterogeneous features, road capacity, in addition to driver desired response. The practical platoon stability of adaptive cruise control–equipped vehicles employing constant time headway spacing policy is investigated by taking into account the parasitic time delays of wireless communication modules and time lags of automotive actuators. The simulations show that the control algorithm utilizing model predictive control framework reaps significant benefits in terms of driver desired response, platoon stability as well as road capacity, while at the same time providing a reasonable proposal on the design of adaptive cruise control controller with better adaptability from the perspective of practical platoon stability.
Progesterone Antagonizes Dexamethasone-Regulated Surfactant Proteins In Vitro
Authors: Kunzmann Steffen , Ottensmeier Barbara , Speer Christian P. , Fehrholz Markus
Published: October 2018

Pregnant women at risk of preterm labor routinely receive glucocorticoids (GCs) and frequently also progesterone. Administration of GCs accelerates intrauterine surfactant synthesis and lung maturation, thereby reducing the incidence of neonatal respiratory distress syndrome; progesterone has the potential to prevent preterm birth. Little is known about possible interactions of GCs and progesterone. Our aim was to clarify whether progesterone can affect dexamethasone (DXM)-regulated expression of surfactant protein A (SP-A), SP-B, and SP-D in lung epithelial cells. H441 cells were exposed to DXM and progesterone and expression of SPs was analyzed by quantitative real-time polymerase chain reaction and immunoblotting. Although progesterone had no direct effect on the expression of SP-B, DXM-mediated induction was inhibited dose dependently on the transcriptional (64 µM [ P < .0001], 32 µM [ P = .0005], 16 µM [ P = .0019]) and the translational level. Furthermore, progesterone inhibited stimulatory effects of other GCs as well. While exogenous tissue growth factor β1 (TGF-β1) inhibited DXM-induced SP-B expression (messenger RNA [mRNA]: P = .0014), progesterone itself did not influence TGF-β1 mRNA expression and/or TGF-β1/Smad signaling, demonstrating that TGF-β1 and/or Smad activation is not involved. The inhibitory effect of progesterone could be imitated by the GC and progesterone receptor (PR) antagonist RU-486, but not by the specific PR antagonist PF-02413873, indicating that progesterone acts as a competitive antagonist of DXM. The effect of progesterone on DXM-regulated genes was not specific for SP-B, as expression of SP-A and SP-D mRNAs was also antagonized. The present study highlights a new action of progesterone as a potential physiological inhibitor of GC-dependent SP expression in lung epithelial cells. The clinical relevance of this in vitro finding is currently unknown.
The efficacy and safety of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation and coronary artery disease: A meta-analysis of randomized trials
Authors: Zelniker Thomas A , Ruff Christian T , Antman Elliott M , Giugliano Robert P
Published: October 2018

Background:

Patients with atrial fibrillation and concomitant coronary artery disease (CAD) are at higher risk for myocardial infarction or cardiovascular death, often require antiplatelet therapy and are therefore exposed to an increased risk of bleeding. This meta-analysis aimed to compare the efficacy and safety profile of non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin in patients with atrial fibrillation and concomitant CAD.

Materials and methods:

We performed a trial-level meta-analysis of CAD subgroups from four trials of NOAC versus warfarin in patients with atrial fibrillation, comparing the primary trial endpoints (efficacy: stroke or systemic embolic event; safety: International Society on Thrombosis and Haemostasis major bleeding) in patients with versus those without CAD, and used interaction testing to assess for treatment effect modification.

Results:

In total, 58,606 patients with established CAD were included in this meta-analysis. NOACs reduced the risk of stroke/systemic embolic event irrespective of presence of CAD (CAD: 0.76 (0.56–1.04); no CAD: hazard ratio 0.77 (0.56–1.06); p-INT 0.93). Similarly, there was no effect modification by presence of CAD for major bleeding (CAD: hazard ratio 0.92 (0.65–1.32), no CAD: 0.83 (0.61–1.12); p-INT 0.46) or myocardial infarction (CAD: hazard ratio 0.95 (0.62–1.44); no CAD: hazard ratio 0.95 (0.60–1.50); p-INT = 0.98). While NOACs reduced all-cause mortality in patients without CAD compared with warfarin (hazard ratio 0.85 (0.71–1.02)), there was no difference in mortality between NOACs and warfarin in the CAD group (hazard ratio 0.99 (0.82–1.20); p-INT 0.01).

Conclusion:

The present meta-analysis of four trials supports that NOACs are safe and at least as effective as warfarin in patients with atrial fibrillation and established CAD.
Comparing Five Comorbidity Indices to Predict Mortality in Chronic Kidney Disease: A Retrospective Cohort Study
Authors: McArthur Eric , Bota Sarah E. , Sood Manish M. , Nesrallah Gihad E. , Kim S Joseph , Garg Amit X. , Dixon Stephanie N.
Published: October 2018

Background:

Several different indices summarize patient comorbidity using health care data. An accurate index can be used to describe the risk profile of patients, and as an adjustment factor in analyses. How well these indices perform in persons with chronic kidney disease (CKD) is not well known.

Objective:

Assess the performance of 5 comorbidity indices at predicting mortality in 3 different patient groups with CKD: incident kidney transplant recipients, maintenance dialysis patients, and individuals with low estimated glomerular filtration rate (eGFR).

Design:

Population-based retrospective cohort study.

Setting:

Ontario, Canada, between 2004 and 2014.

Patients:

Individuals at the time they first received a kidney transplant, received maintenance dialysis, or were confirmed to have an eGFR less than 45 mL/min per 1.73m2.

Measurements:

Five comorbidity indices: Charlson comorbidity index, end-stage renal disease-modified Charlson comorbidity index, Johns Hopkins’ Aggregated Diagnosis Groups score, Elixhauser score, and Wright-Khan index. Our primary outcome was 1-year all-cause mortality.

Methods:

Comorbidity indices were estimated using information in the prior 2 years. Each group was randomly divided 100 times into derivation and validation samples. Model discrimination was assessed using median c-statistics from logistic regression models, and calibration was evaluated graphically.

Results:

We identified 4111 kidney transplant recipients, 23 897 individuals receiving maintenance dialysis, and 181 425 individuals with a low eGFR. Within 1 year, 108 (2.6%), 4179 (17.5%), and 17 898 (9.9%) in each group had died, respectively. In the validation sample, model discrimination was inadequate with median c-statistics less than 0.7 for all 5 comorbidity indices for all 3 groups. Calibration was also poor for all models.

Limitations:

The study used administrative health care data so there is the potential for misclassification. Indices were modeled as continuous scores as opposed to indicators for individual conditions to limit overfitting.

Conclusions:

Existing comorbidity indices do not accurately predict 1-year mortality in patients with CKD. Current indices could be modified with additional risk factors to improve their performance in CKD, or a new index could be developed for this population.
Effects of combined use of atorvastatin and losartan in treating patients with diabetic nephropathy
Authors: Ding Chao , Hu Xiaohua
Published: October 2018

This study is to investigate the effect of atorvastatin combined with losartan on inflammatory factors, vascular endothelial function, and cardiovascular events in patients with diabetic nephropathy. A total of 128 patients with diabetic nephropathy treated in our hospital from January 2014 to December 2015 were selected as the study subjects, and 64 cases were randomly divided into observation group and 64 cases in the control group. The control group was treated with losartan on the basis of routine treatment, and the observation group was treated with atorvastatin on the basis of the control group. The blood lipid, inflammatory factors, changes in vascular endothelial function and cardiovascular events were compared between the two groups. The levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were not significantly different between the two groups before treatment ( P > 0.05); after treatment, the levels of TC, TG, and LDL-C in the observation group were significantly lower than those of the control group, and the level of HDL-C was significantly higher than that of the control group ( P < 0.05). The levels of high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-α), and interleukin 6 (IL-6) were not statistically different between the two groups before treatment ( P > 0.05); after treatment, the levels of hs-CRP, TNF-α, and IL-6 in the observation group were significantly lower than those of the control group ( P < 0.05), the level of HDL-C was significantly higher than that of the control group ( P < 0.05). There were no significant differences in the levels of endothelin-1 (ET-1) and nitric oxide (NO) between the two groups before treatment ( P > 0.05). After treatment, the level of ET-1 in the observation group was significantly lower than that of the control group ( P < 0.05), and the level of NO was significantly higher than that of the control group ( P < 0.05). After treatment, all patients were followed up for 2 years, and the incidence of secondary cardiovascular events in the observation group was 12.50% (8/64), which was significantly lower than 29.69% (19/64) of the control group ( P < 0.05). Combination of atorvastatin and losartan can significantly improve the levels of blood lipid, inflammatory factors, and vascular endothelial function in patients with diabetic nephropathy and can effectively reduce the incidence of cardiovascular events.
Effect of radiotherapy and chemotherapy on levels of serum S100B, IL-6, and IL-17 in patients with malignant glioma
Authors: Xiang Chao , Zha Yunfei , Chen Qianxue
Published: October 2018

From February 2014 to 2016, we recruited 80 patients with malignant glioma in the Renmin Hospital of Wuhan University. To study the effect of radiotherapy and chemotherapy on the levels of serum S100 calcium-binding protein B (S100B), interleukin 6 (IL-6), and interleukin 17 (IL-17), all patients were divided into two groups randomly and evenly. In one group, all 40 patients received the three-dimensional conformal radiotherapy (3D-CRT). In another group, all patients received combinatorial treatment of 3D-CRT and temozolomide (TMZ). The therapeutic effect, immune function index before and after the treatment, change of serum S100B, IL-6, and IL-17 levels as well as adverse reactions were analyzed and compared between those two groups. We found that the effective rate of the combination group was 82.5%, which is significantly higher than 52.5% in the control group. After treatment, the number of CD3+, CD4+, and NK cells in the combination group was higher. But, CD8+ cells were lower compared with those before treatment. The levels of serum S100B, IL-6, and IL-17 in both groups were lower than those before treatment. In conclusion, radiotherapy combined with chemotherapy is more effective than radiotherapy alone in the treatment of malignant cerebral gliomas and is worthy of clinical spreading.
Motivations to Experience Happiness or Sadness in Depression: Temporal Stability and Implications for Coping With Stress
Authors: Millgram Yael , Joormann Jutta , Huppert Jonathan D. , Lampert Avital , Tamir Maya
Published: October 2018

Difficulties with emotion regulation in depression may be linked not only to emotion regulation strategies but also to the motivation to experience certain emotions. We assessed the degree of motivation to experience happiness or sadness in major depressive disorders outside the laboratory and prospective links to clinical outcomes over time. Depressed individuals were consistently less motivated to experience happiness and more motivated to experience sadness than nondepressed individuals. The less motivated participants were to experience happiness, the less they tried to upregulate happiness in an emotion regulation task and downregulate negative emotions during real-life stress. Importantly, the less motivated depressed participants were to experience happiness, the more clinical symptoms they exhibited months later during a stressful period, even after controlling for initial levels of symptoms. These findings demonstrate that individual differences in the degree of motivation to experience happiness in depression may carry clinical implications.
Reliability and Validity of the AOSpine Thoracolumbar Injury Classification System: A Systematic Review
Authors: Abedi Aidin , Mokkink Lidwine B. , Zadegan Shayan Abdollah , Paholpak Permsak , Tamai Koji , Wang Jeffrey C. , Buser Zorica
Published: October 2018

Study Design:

Systematic review.

Objectives:

The AOSpine thoracolumbar injury classification system (ATLICS) is a relatively simple yet comprehensive classification of spine injuries introduced in 2013. This systematic review summarizes the evidence on measurement properties of this new classification, particularly the reliability and validity of the main morphologic injury types with and without inclusion of the subtypes.

Methods:

A literature search was performed using PubMed and Embase in September 2016. A revised version of the COSMIN checklist was used for evaluation of the quality of studies. Two independent reviewers performed all steps of the review.

Results:

Nine articles were included in the final review, all of which evaluated the reliability of the ATLICS and had a fair methodological quality. The reliability of the modifiers was unknown. Overall, the quality of evidence for reliability of the morphologic and neurologic classification sections was low. However, there was moderate evidence for poor interobserver reliability of the morphologic classification when all subtypes were included, and moderate evidence for good intraobserver reliability with exclusion of subtypes. The reliability of the morphologic classification was independent of the observer’s experience and cultural background.

Conclusions:

ATLICS represents the most current system for evaluation of thoracolumbar injuries. Based on this review, further studies with robust methodological quality are needed to evaluate the measurement properties of ATLICS. Shortcomings of the reliability studies are discussed.
Inverted C-arm Orientation During Simulated Hip Arthroscopic Surgery
Authors: Nadig Nischal , Shaw Kenneth Aaron , Mottern Edward , Bojescul John , Mueller Terry
Published: October 2018

Background:

Fluoroscopic guidance is routinely utilized during hip arthroscopic surgery. Previous studies have shown that the C-arm orientation can significantly affect radiation exposure for both the surgeon and the patient during orthopaedic procedures. However, this has not been previously assessed for hip arthroscopic surgery.

Hypothesis:

Using an inverted C-arm during hip arthroscopic surgery will reduce radiation exposure to the patient and surgeon.

Study Design:

Descriptive laboratory study.

Methods:

A simulation study measured scatter radiation during hip arthroscopic surgery performed in the supine position under fluoroscopic guidance with an anthropomorphic pelvic phantom on a radiolucent operating table. Radiation exposure tested 2 different C-arm orientations: standard and inverted. Testing was performed at 6 locations corresponding to the patient, surgeon’s neck, surgeon’s waist, surgical technician, anesthesiologist, and radiology technician. Statistical analysis was performed using univariate and multivariate analyses assessing radiation exposure between the C-arm orientations. A risk calculation for carcinogenesis was performed based on reported radiation dosages.

Results:

Radiation exposure (in mGy/min) was more than 100-fold higher for the patient compared with the surgeon in both C-arm orientations. The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure when compared with the standard orientation (10.8 mGy/min vs 26.8 mGy/min, respectively). There was a small but significant increase in surgeon radiation exposure in the inverted orientation compared with the standard orientation (0.072 vs 0.067 mGy/min, respectively). The patient’s carcinogenesis risk was decreased 2.64-fold with the inverted orientation compared with the standard orientation (1.4 × 10–5 vs 3.7 × 10–5, respectively).

Conclusion:

The inverted C-arm orientation resulted in a 2.48-fold decrease in patient radiation exposure with a 2.64-fold decrease in the carcinogenesis risk compared with the standard orientation. Inadvertently, the inverted orientation provided a 9-cm increase in the surgeon’s working area. Our data supported the clinical utilization of the inverted C-arm orientation during hip arthroscopic surgery to minimize patient radiation exposure. Although there was a minimal but significant increase in surgeon radiation exposure with the inverted orientation, we believe that this is negligible when incorporated with standard leaded protective equipment as contrasted with the significant dose reduction for the patient as well as the decreased risk of carcinogenesis and hereditary disorders.

Clinical Relevance:

Patients undergoing hip arthroscopic surgery routinely acquire radiation exposure during the use of the C-arm. Measures to minimize radiation via the inverted C-arm orientation will decrease the unnecessary risk to the patient while continuing to allow for optimal treatment.
Three Iranian voices in the Renaissance under Akbar
Authors: Moosvi Shireen
Published: October 2018

If by its distinctive features in thought, art and literature, the reign of Akbar (1556–1605) deserves to be called a period of Renaissance, and one then begins to look for its major figures. Even a short list of such Renaissance men must include three Iranian immigrants, the scholar Abū’l Fatḥ Gīlānī, the scientist and administrator Fatḥullāh Shīrāzī and the radical poet ‘Urfī Shīrāzī. This article reconstructs their biographies and assesses their contributions to the ideological and cultural flowering of Akbar’s time.
District-wise Comparative Study of Banking Penetration and Financial Inclusion in Odisha
Authors: Behera Suchitra , Behera Samir Ranjan
Published: October 2018

This article attempts to analyze the economic growth in the districts of Odisha by compiling an index for financial inclusion which included various dimensions of financial inclusion and resulted in a number between 0 and 1, where 0 is the worst condition of a district and 1 gives complete financial inclusion. The indicators used here are banking penetration, availability of banking services and usage of banking system. The study shows that Khurda district leads with the highest value, followed by Ganjam and Cuttack districts. The results were in accordance with the Planning Commission, Government of India, in defining underdeveloped districts. Some empirical findings were also conducted to examine the dynamic relationship between the financial inclusion indicators such as credit flows to the districts of Odisha, deposits in the banking sector and presence of bank branches per 1,000 sq km, and growth indicators like gross domestic product (GDP) in the case of districts of Odisha.
Dynamics of DNA Methylation Reprogramming Influenced by X Chromosome Dosage in Induced Pluripotent Stem Cells
Authors: Janiszewski Adrian , Song Juan , Vanheer Lotte , De Geest Natalie , Pasque Vincent
Published: October 2018

How the epigenome of one cell type is remodeled during reprogramming into another unrelated type of cell remains unclear. Overexpression of transcription factors in somatic cells enables the induction of induced pluripotent stem cells (iPSCs). This process entails genome-wide remodeling of DNA methylation, chromatin, and transcription. Recent work suggests that the number of active X chromosomes present in a cell influences remodeling of DNA methylation during somatic cell reprogramming to mouse iPSCs. Female iPSCs with 2 active X chromosomes display global DNA hypomethylation, whereas male XY iPSCs show DNA methylation levels similar to the somatic cells they are derived from. Global DNA methylation erasure in female iPSCs takes place genome-wide and involves repression of DNA methyltransferases. However, on loss of one X chromosome, female iPSCs acquire a DNA methylation landscape resembling that of XY iPSCs. Therefore, it is the X chromosome dosage that dictates global DNA methylation levels in iPSCs. Here, we discuss the evidence that links X chromosome dosage with the regulation of DNA methylation in pluripotent stem cells. We focus on iPSCs reprogramming studies, where X chromosome status is a novel factor impacting our understanding of epigenetic remodeling.
Monocyte-derived macrophages expand the murine stress erythropoietic niche during the recovery from anemia
Authors: Liao Chang , Prabhu K. Sandeep , Paulson Robert F.
Published: October 2018

Anemic stress induces a physiological response that includes the rapid production of new erythrocytes. This process is referred to as stress erythropoiesis. It is best understood in the mouse where it is extramedullary and utilizes signals and progenitor cells that are distinct from bone marrow steady-state erythropoiesis. The development of stress erythroid progenitors occurs in close association with the splenic stress erythropoiesis niche. In particular, macrophages in the niche are required for proper stress erythropoiesis. Here we show that the expansion of the niche occurs in concert with the proliferation and differentiation of stress erythroid progenitors. Using lineage tracing analysis in 2 models of anemic stress, we show that the expansion of the splenic niche is due to the recruitment of monocytes into the spleen, which develop into macrophages that form erythroblastic islands. The influx in monocytes into the spleen depends in part on Ccr2-dependent signaling mediated by Ccl2 and other ligands expressed by spleen resident red pulp macrophages. Overall, these data demonstrate the dynamic nature of the spleen niche, which rapidly expands in concert with the stress erythroid progenitors to coordinate the production of new erythrocytes in response to anemic stress.
Targeted inhibition of PI3Kα/δ is synergistic with BCL-2 blockade in genetically defined subtypes of DLBCL
Authors: Bojarczuk Kamil , Wienand Kirsty , Ryan Jeremy A. , Chen Linfeng , Villalobos-Ortiz Mariana , Mandato Elisa , Stachura Joanna , Letai Anthony , Lawton Lee N. , Chapuy Bjoern , Shipp Margaret A.
Published: October 2018

Inhibition of the B-cell receptor (BCR) signaling pathway is a promising treatment strategy in multiple B-cell malignancies. However, the role of BCR blockade in diffuse large B-cell lymphoma (DLBCL) remains undefined. We recently characterized primary DLBCL subsets with distinct genetic bases for perturbed BCR/phosphoinositide 3-kinase (PI3K) signaling and dysregulated B-cell lymphoma 2 (BCL-2) expression. Herein, we explore the activity of PI3K inhibitors and BCL-2 blockade in a panel of functionally and genetically characterized DLBCL cell line models. A PI3K inhibitor with predominant α/δ activity, copanlisib, exhibited the highest cytotoxicity in all BCR-dependent DLBCLs. The proapoptotic effect of copanlisib was associated with DLBCL subtype-specific dysregulated expression of BCL-2 family members including harakiri (HRK) and its antiapoptotic partner BCL extra large (BCL-xL), BCL2 related protein A1, myeloid cell leukemia 1 (MCL-1), and BCL2 interacting mediator of cell death. Using functional BH3 profiling, we found that the cytotoxic activity of copanlisib was primarily mediated through BCL-xL and MCL-1–dependent mechanisms that might complement BCL-2 blockade. For these reasons, we evaluated single-agent activity of venetoclax in the DLBCLs and identified a subset with limited sensitivity to BCL-2 blockade despite having genetic bases of BCL-2 dysregulation. As these were largely BCR-dependent DLBCLs, we hypothesized that combined inhibition of PI3Kα/δ and BCL-2 would perturb BCR-dependent and BCL-2–mediated survival pathways. Indeed, we observed synergistic activity of copanlisib/venetoclax in BCR-dependent DLBCLs with genetic bases for BCL-2 dysregulation in vitro and confirmed these findings in a xenograft model. These results provide preclinical evidence for the rational combination of PI3Kα/δ and BCL-2 blockade in genetically defined DLBCLs.
PANOPLY: Omics-Guided Drug Prioritization Method Tailored to an Individual Patient
Authors: Kalari Krishna R. , Sinnwell Jason P. , Thompson Kevin J. , Tang Xiaojia , Carlson Erin E. , Yu Jia , Vedell Peter T. , Ingle James N. , Weinshilboum Richard M. , Boughey Judy C. , Wang Liewei , Goetz Matthew P. , Suman Vera
Published: October 2018

Purpose

The majority of patients with cancer receive treatments that are minimally informed by omics data. We propose a precision medicine computational framework, PANOPLY (Precision Cancer Genomic Report: Single Sample Inventory), to identify and prioritize drug targets and cancer therapy regimens.

Materials and Methods

The PANOPLY approach integrates clinical data with germline and somatic features obtained from multiomics platforms and applies machine learning and network analysis approaches in the context of the individual patient and matched controls. The PANOPLY workflow uses the following four steps: selection of matched controls to the patient of interest; identification of patient-specific genomic events; identification of suitable drugs using the driver-gene network and random forest analyses; and provision of an integrated multiomics case report of the patient with prioritization of anticancer drugs.

Results

The PANOPLY workflow can be executed on a stand-alone virtual machine and is also available for download as an R package. We applied the method to an institutional breast cancer neoadjuvant chemotherapy study that collected clinical and genomic data as well as patient-derived xenografts to investigate the prioritization offered by PANOPLY. In a chemotherapy-resistant patient-derived xenograft model, we found that that the prioritized drug, olaparib, was more effective than placebo in treating the tumor ( P < .05). We also applied PANOPLY to in-house and publicly accessible multiomics tumor data sets with therapeutic response or survival data available.

Conclusion

PANOPLY shows promise as a means to prioritize drugs on the basis of clinical and multiomics data for an individual patient with cancer. Additional studies are needed to confirm this approach.
Results From a Health Insurer's Clinical Pathway Program in Breast Cancer
Authors: Gautam Santosh , Sylwestrzak Gosia , Barron John , Chen Xiaoxue , Eleff Michael , Debono David , Nguyen Ann , Fisch Michael
Published: October 2018

Purpose:

Pathway regimens are value-driven, evidence-based therapies that aim at high-quality, affordable cancer care. There are few real-world data to support the value of such regimens, especially for patients with breast cancer.

Materials and Methods:

Using nationally representative claims data from Anthem, together with clinical data from its Cancer Care Quality Program, we identified patients with breast cancer for whom chemotherapy was initiated between January 2015 and October 2016. On the basis of demographic and clinical characteristics, patients receiving a pathway regimen (on-pathway cohort) were matched to those who did not (off-pathway cohort) using 1:1 propensity score matching. We compared post–6-month quality-of-care outcomes including hospitalization, emergency department visits, need for supportive drugs such as granulocyte colony-stimulating factor, and cost outcomes between the cohorts.

Results:

There were 959 patients in each cohort after matching. Patients in both cohorts had a similar age distribution (median age, 52 years in the off-pathway cohort v 53 years in the on-pathway cohort), and most presented with stage II disease (49.4% in the off-pathway cohort v 49.8% in the on-pathway cohort); nearly two thirds of each cohort had hormone receptor positive cancer (67.3% in the off-pathway cohort v 64.9% in the on-pathway cohort). The two cohorts had similar rates of hospitalization and emergency department visits; however, the rate of granulocyte colony-stimulating factor use was significantly lower in the on-pathway cohort (72.5% in the on-pathway cohort v 82.8% in the off-pathway cohort; odds ratio, 0.55; P ≤ .0001). The average post–6-month cost of care was $16,176 lower (95% CI, −$24,291 to −$8,061; P ≤ .0001) in the on-pathway cohort.

Conclusion:

Pathway regimens for breast cancer demonstrate an example of high-value care. They are associated with a reduced cost of care without compromising quality of care.