bluuebunny/crossref_metadata_2025 huggingface dataset:
“LATE” NEONATAL JAUNDICE IN INFANTS WITH GLUCOSE‐6‐PHOSPHATE DEHYDROGENASE‐DEFICIENT ERYTHROCYTES
Authors: HARLEY JOHN D. , ROBIN HELEN
Published: September 2017

A review has been made of certain clinical features of the episodes of “late” neonatal jaundice sustained by five infants, who appeared to be either hemizygous or heterozygous for the gene responsible for an erythrocytic defect of the enzyme glucose‐6‐phosphate dehydrogenase (G6PD). Each of these infants seemed well on discharge from the obstetric hospital, but was subsequently readmitted to hospital as a result of the appearance of jaundice. The age of onset of these episodes ranged from 10 to 23 days.

Four infants were males of Italian extraction, with erythrocytes grossly deficient in G6PD activity. Each was receiving maternal breast milk over the period preceding the onset of jaundice. One mother was concurrently taking phenacetin and acetylsalicylic acid, and another was receiving sulphamethoxypyridazine for a mild urinary tract infection. One male infant was found to be suffering from an inflamed umbilicus, from which Escherichia coli was grown on culture, at the same time as the episode of jaundice.

Subsequently, each of the four males developed anæmia, with or without evidence of excessive haemolysis; possible ætiological factors included Vicia fava, chloramphenicol, sulphamethoxypyridazine and bacterial or viral infections. Two brothers were found to have hypochromic microcytic anæmia, which appears to be responding to oral iron therapy; radiological evidence of cholelithiasis was demonstrated, at the age of 22 years, in the G6PD‐deficient mother of these brothers.

The fifth infant was a female of Maltese extraction. The G6PD activity was within the normal range in the child, but very low in her father's erythrocytes. In this infant, jaundice of mild degree was accompanied by evidence of slightly increased hæmolysis, and persisted for approximately 13 weeks.

These episodes of neonatal jaundice have been discussed in terms of current concepts of the clinical significance of G6PD deficiency, with emphasis on the interrelations between the syndromes which may occur in individuals with enzyme‐deficient erythrocytes.
THE VARIABLE FUNCTIONAL PROGRESSION OF CHRONIC OBSTRUCTIVE LUNG DISEASE
Authors: PAIN M. C. F. , READ D. J. C. , COLEBATCH H. J. H. , READ JOHN
Published: September 2017

Studies of respiratory function in three patients with chronic obstructive lung disease over periods of two and a half to five years are reported to illustrate the variability of functional progression in this condition. One patient showed little or no change over five years; one showed deterioration from an initial state of respiratory and cardiac failure, but has survived for four years; the third showed no change in overall ventilatory function, but changes in the distribution of ventilation and blood flow led to a worsening of blood gas disturbances. The importance of the latter factor in determining functional progression is emphasized; serial studies which do not include accurate measurement of blood gases may be misleading.

Accurate prediction of functional prognosis for the individual patient is not possible in our present state of knowledge. The observations in one case reemphasize that survival after the onset of cur pulmonale heart failure is not necessarily limited to two years.
GOODPASTURE'S SYNDROME AND WEGENER'S GRANULOMATOSIS
Authors: JOHNSON J. R. , MCGOVERN V. J.
Published: September 2017

The case histories of six patients with Goodpasture's syndrome are contrasted with those of three patients with Wegener's granulomatosis. There is a similarity between the two, because each is initially a respiratory disorder complicated by glomerulonephritis. In each the glomerular lesions vary from deposits of fibrinoid material through exudative and proliferative reactions towards complete obliteration of all glomeruli. The pulmonary lesions, however, differ markedly. The typical lesion in Goodpasture's syndrome is hæmorrhage into the lungs giving rise eventually to pulmonary siderosis, whereas in Wegener's syndrome there is replacement of the lining of bronchi and of accessory nasal sinuses by necrotizing granulomatous tissue which may simulate carcinoma or tuberculosis. Widespread arteritis is a constant feature of Wegener's granulomatosis, but is seldom found in Goodpasture's syndrome. It was present in one of the six examples of Goodpasture's syndrome, but was of only minor importance.

Although renal biopsy cannot distinguish between the two conditions, it is helpful in directing attention to these disorders. Biopsy of the upper air passages, however, may be diagnostic in Wegener's granulomatosis, as it was in two of the three cases in this survey.

In one case of Goodpasture's syndrome, corticosteroids may have caused some mitigation of the disorder, but in the other five cases of Goodpasture's syndrome and in the case of Wegener's granulomatosis in which corticosteroids were used, any benefit was only temporary.
REDUCTION OF PLASMA CHOLESTEROL LEVELS IN ATHERO‐SCLEROSIS BY DIET AND DRUG TREATMENT
Authors: BARNETT A. J. , CARSON VALERIE J.
Published: September 2017

A trial has been conducted of the following methods for the reduction of serum cholesterol level in patients with atherosclerosis: (i) The use of a low‐fat, low‐cholesterol diet with the addition of corn oil; (ii) the exhibition of triparanol (0·25 to 0·5 gramme per day); (iii) the administration of nicotinic acid (up to 3 grammes per day); (iv) the administration of a combination of nicotinic acid and triparanol. The results were as follows.

With the dietetic method, a fall in plasma cholesterol level usually occurred. However, this was only of very modest degree (mean of 42 mg. per 100 ml. in 10 patients). Although a proportion of the patients treated by diet considered that their vascular symptoms were relieved, this could not be confirmed by step tests or by clinical examination.

When triparanol was used, significant lowering of the plasma cholesterol level (determined by the Bloor method) was observed in 17 of 22 patients treated for six months (mean lowering, 69 mg. per 100 ml.). Desmosterol accumulated in the plasma, and the true lowering of the cholesterol level was somewhat greater than this; the lowering of the total plasma sterol levels was somewhat less. We were unable to demonstrate desmosterol in the intimas of patients treated with triparanol. Treatment was not associated with any clinical benefit, nor were there any side effects which could be attributed to the drug.

The administration of nicotinic acid was associated with a moderate lowering of the plasma cholesterol level (mean of 38 mg. per 100 ml. in 10 patients). Although a few patients said that they had experienced clinical benefit, this was of doubtful significance. Side effects were common and prevented the administration of a full dose in most cases. No toxicity was demonstrated.

The use of a combination of nicotinic acid and triparanol produced an additional fall in the plasma cholesterol level (mean of 60 mg. per 100 ml. in nine patients). The addition of triparanol treatment to nicotinic acid treatment also produced an additional fall (mean of 44 mg. per 100 ml. in five patients).

These findings are discussed, and it is concluded that it is possible to lower the plasma cholesterol level by diet or drug treatment, but that this is not of great clinical value if it is employed for a relatively short period or in the treatment of elderly patients. Treatment is more likely to be of value in younger men with early atherosclerosis or a raised plasma cholesterol level, but, as treatment must be carried on over many years, the method used must be devoid of serious toxicity.
DIAGNOSIS AND TREATMENT OF STROKES: CLINICAL ASPECTS
Authors: BILLINGS JOHN
Published: September 2017

A detailed investigation of patients admitted to St. Vincent's Hospital, Melbourne, with the diagnosis of “cerebrovascular accident” has been carried out. The radiological studies in particular have demonstrated that clinical diagnosis is very inadequate. A common mistake is the diagnosis of infarction in the presence of localized intracerebral hæmorrhage.

The variable symptomatology of apparently identical vascular lesions can be understood only when the whole of the vascular tree from the aortic arch upwards is displayed by arteriography. In more than 20% of cases of cerebral infarction, no evidence of vascular obstruction could be obtained. A “flow‐failure” theory is postulated in some of these cases ; in the presence of generalized degenerative changes in the vessels of the neck and the brain, a transient fall of blood pressure, possibly due to weakened left ventricular contraction, may cause cerebral infarction.
THE LEAD CONTENT OF BONE IN SUBJECTS WITHOUT RECOGNIZED PAST LEAD EXPOSURE AND IN PATIENTS WITH RENAL DISEASE
Authors: EMMERSON B. T. , LECKY D. S.
Published: September 2017

In 18 subjects without renal disease and without any history of significant past lead exposure, the mean lead content of skull bone was 2·1±1·0 mg. per 100 grammes, the values varying from 0·7 to 4·0 mg. per 100 grammes. The upper figure for the mean plus two standard deviations was 4·1 mg. per 100 grammes. It is suggested that a value close to this be taken as a suitable upper limit of normal for the lead content of skull bone.

As a test of the suitability of such a value, it was found that patients with renal disease not caused by lead all had a mean lead content of skull bone less than this figure, while patients with renal disease caused by childhood lead poisoning all had a mean lead content of skull bone greater than this figure. Renal failure of itself, therefore, does not result in accumulation of lead in bone.
THE USE OF DTPA IN THE DIAGNOSIS AND MANAGEMENT OF IDIOPATHIC HÆMOCHROMATOSIS
Authors: WALSH R. J. , PERKINS K. W. , BLACKBURN C. R. B. , SANFORD RONA , CANTRILL SHIRLEY
Published: September 2017

A test to measure the extent of iron overload in patients with idiopathic hæmochromatosis was developed with the chelating agent diethylene triamine penta‐acetic acid (DTPA). One gramme of DTPA in 100 ml. of saline was injected intravenously, and the iron excreted in the urine during the next five hours was measured. Normal subjects excreted less than 0·25 mg. of iron, and six untreated patients who had been diagnosed as suffering from hæmochromatosis excreted between 4·0 and 16·1 mg.

The test was also performed on 51 patients who had been treated by removal of blood for varying periods, and who were divided into three groups. Sixteen who still had saturated transferrin excreted between 0·6 and 9·4 mg. of iron in the urine. The second group of 29 patients, whose transferrin had been unsaturated for varying periods, excreted between 0 and 1·5 mg. The remaining six patients had been adequately treated, but had not attended for some time, and the transferrin had again become saturated. Only one excreted less than 0·6 mg. The DTPA test was also performed on 13 asymptomatic relatives of patients with hæmochromatosis, all of whom had saturated transferrin, and some excreted abnormal amounts of iron.

It is suggested that the DTPA test provides a measure of iron overload in patients with hæmochromatosis and gives a better guide to the progress of therapy than do serum iron and transferrin values. The test is simple to perform, is safe, and causes little inconvenience to the patient.
MACROGLOBULINÆMIA WITH CHROMOSOMAL ANOMALY
Authors: FERGUSON JEAN , MACKAY IAN R.
Published: September 2017

In one case of Waldenström's macroglobulinæmia with myelosclerosis, approximately half the blood cells had a normal chromosome complement of 46 and the remainder contained a large extra “W” chromosome; the chromosomes of the skin cells were normal. The chromosomes of the blood cells of two other patients were normal. Chromosomal anomalies may reflect the occurrence of somatic mutation in cases of macroglobulinæmia; but whether this is an essential cellular genetic lesion for pathological macroglobulin synthesis is still undetermined.
THE ISOLATION OF SALMONELLAE FROM MEAT PRODUCTS AND FERTILIZERS IN ADELAIDE
Authors: ANDERSON KEVIN , CROWDER ERNEST F. , GIBBS MALCOLM H.
Published: September 2017

Reports by American authors that a significant proportion of meat purchased in the retail market is contaminated with salmonellæ have been confirmed in South Australia. The distribution of various intestinal pathogens in meat and meat products is noted, and attention is drawn to the hazards which may arise during storage and cooking.

An investigation into a variety of domestic fertilizers containing animal residues has failed to reveal any significant contamination with intestinal pathogens. The apparent discrepancy between the high yield of salmonellæ from meatmeal samples and the absence of these organisms from mixtures of meatmeal and inorganic salts may be explained by the low pH of the latter.
CALCIUM METABOLISM AND THE BONES AFTER PARTIAL GASTRECTOMY
Authors: DELLER D. J. , EDWARDS R. G. , ADDISON M.
Published: September 2017

Some aspects of calcium metabolism were investigated in 100 patients after partial gastrectomy in an endeavour to define the nature of the skeletal abnormality and to detect factors responsible for its development. Fifty subjects not operated upon were used as the control group. The following abnormal biochemical values were found in the patients after partial gastrectomy : low serum calcium levels in six patients ; low serum phosphate levels in six patients ; raised serum alkaline phosphatase levels in 15 patients ; low serum total protein level in one patient ; and low serum albumin level in one patient. In addition, the excretion of calcium in the urine was lower in the patients after gastrectomy than in the control subjects, and the “clearance” of phosphate was higher in the patients after gastrectomy. Patients with changes in the bones after gastrectomy differed from the patients with normal bones after operation in having a higher mean serum level of alkaline phosphatase and a lower mean urinary excretion of calcium.

Twenty‐two patients after partial gastrectomy were further investigated by bone biopsy, the calcium infusion test and fæcal fat determination. Eight control subjects also underwent the calcium infusion test. On the basis of these investigations, 13 patients were considered to have an “osteomalacic” syndrome. The main features of the syndrome were generalized skeletal pain, bone tenderness, skeletal rarefaction and histological changes of osteoporosis and early osteomalacia. We have used the term “osteomalacic” syndrome to describe this condition, because the classical biochemical features of osteomalacia were only infrequently present, and because osteomalacia and osteoporosis were present together. The biochemical changes that were present in the 13 patients with the syndrome were elevation of the serum alkaline phosphatase levels in five patients, increased retention of infused calcium in the calcium infusion test in seven patients, hypocalcæmia in one patient and hypophosphatæmia in another patient. Anæmia, steatorrhœa and an inadequate diet were frequently present in these cases.

Factors that appeared to be of importance in the pathogenesis of the bone disorder following gastrectomy were inadequate intake of calcium and protein in the diet, and steatorrhœa. A deficiency of vitamin D also was inferred to account for the changes that were detected.

The observations made in the present investigation suggest that bone disease is relatively common after gastric surgery, but that in most cases the disorder is only of moderate severity and does not constitute a serious disability to the patient. However, an awareness of the association of bone disease and gastric surgery is important, as some patients after gastrectomy may require treatment with calcium, vitamin D and an anabolic steroid.
EXPERIMENTAL ENCEPHALOMYELITIS: ITS RELATION TO DISSEMINATED SCLEROSIS1
Authors: SZEGO G. , ANDERSON R. MCD. , ROBERTS J. T.
Published: September 2017

Experimental allergic encephalomyelitis was produced in guinea‐pigs, rabbits and ferrets, whilst an attempt in mice was not successful. The clinical and histological responses in these groups of animals differed, and in the animals with a more highly developed central nervous system the lesions were more demyelinating in character. A combination of intracerebral injection of herpes simplex virus and experimental allergic encephalomyelitis, in ferrets, produced demyelination resembling that seen in disseminated sclerosis. A similar procedure carried out in guinea‐pigs was unsuccessful.
IRON ABSORPTION IN HÆMOCHROMATOSIS AND CIRRHOSIS OF THE LIVER
Authors: DAVIS A. E. , BIGGS J. C.
Published: September 2017

The absorption of iron with and without a preceding dose of pancreatic extract has been studied in patients with hæmochromatosis and cirrhosis of the liver. The addition of pancreatic extract caused a significant reduction in iron absorption in both groups of patients.

It is proposed that a specific derangement of pancreatic function leads to the excess absorption of iron which occurs in these conditions.
RADIOLOGICALLY DEMONSTRABLE ARTERIAL CALCIFICATION IN DIABETES MELLITUS
Authors: FERRIER T. M.
Published: September 2017

A radiological study of the lower limbs of 250 diabetics and 250 controls has shown that medial arterial calcification at the knee and foot level is some two and a half times more frequent in the diabetic group. The incidence of intimal calcification at the knee level was higher in the diabetic group, but the difference was not statistically significant. Intimal calcification was not seen in the small arteries of the feet.

In the diabetic group, there was correlation between the incidence of medial arterial calcification in the feet and the incidence of medial arterial calcification at the knee, but not with the incidence of intimal calcification at the knee.

The incidence of arterial calcification in the feet of the diabetics bore a definite relationship to increasing patient age, sex (males being more affected), duration of the diabetes in the under‐fifty‐years age group, the presence of retinopathy and the incidence of gangrene. There was no correlation with the severity of, or control of, the diabetes.

In a small group of non‐diabetic patients showing advanced arterial calcification in the feet, fasting blood sugar levels were slightly higher than in a control group, but response to a sugar load was similar. This did not support the hypothesis that advanced arterial calcification in arteries of the feet was a manifestation of the prediabetic state.
CRYPTOCOCCOSIS (TORULOSIS) : SOME PROBLEMS IN DIAGNOSIS AND MANAGEMENT
Authors: HICKIE JOHN B. , WALKER THOMAS
Published: September 2017

Ten cases of cryptococcosis (torulosis) are described to illustrate some of the difficulties in the diagnosis and management of this disease. Seven patients had nervous involvement with headache the commonest symptom, and seven had pulmonary involvement. Skin lesions occurred in two cases, and a bone lesion in one case. Demonstration of the organism in the cerebro‐spinal fluid was the most useful diagnostic measure (six cases). Sputum examination provided the diagnoses in one case, and a smear from the skin lesions in two cases. There was a reasonable possibility that the infection had been transmitted from patient to patient in one case. This has not previously been recorded. Seven patients were treated with amphotericin B, with improvement or remission in six. Two patients had remissions after the resection of a pulmonary lesion. The techniques, advantages and disadvantages of intravenous and intrathecal therapy are discussed. The side effects are mainly inflammatory, hæmatological, cerebral and renal. It is concluded that amphotericin B therapy is beneficial and may be curative.
RESIN UPTAKE OF 131I‐LABELLED TRIIODOTHYRONINE AS A TEST OF THYROID FUNCTION
Authors: TAYLOR KATHLEEN , WINIKOFF DORA , DAVIES WANDA
Published: September 2017

A simple in‐vitro test of thyroid function based on the uptake of 131I‐labelled‐l‐triiodothyronine (T3) by an anion exchange resin is described.

Aliquots of serum equilibrated with T3 are incubated with “Amberlite” resin; 24·7 % to 36 % of the T3 is taken up by the resin in the euthyroid state, in hyperthyroidism the figure is 34·5 % to 55%, and in hypothyroidism it is 16·5 % to 26%. In pregnancy the resin uptake is 15·5 % to 26%.

Studies have been made on variations in technique.

A protein‐bound iodine (P.B.I.) estimation is performed on all patients investigated, including those receiving treatment for disorders of thyroid function. Results of both tests are compared.
MACROCYTIC, NON‐MEGALOBLASTIC, FOLIC‐ACID‐RESPONSIVE ANÆMIAS OF CHILDHOOD
Authors: LOVRIC V. A.
Published: September 2017

The clinical and hæmatological features of six children who presented with a “refractory” macrocytic type of anæmia are described. The anæmia was not associated with megaloblastosis. Furthermore, in the group as a whole the condition clinically differed from the commonly‐recognized syndrome of nutritional megaloblastic anæmia of childhood. That this anæmia was due to lack of folic acid was proved through a clinical trial in one case, though in the others the evidence of folic‐acid deficiency was circumstantial.

It is suggested that marginal intake of folic acid through defective diet contributed to the development of anæmia in all cases.
CHRONIC PNEUMONITIS OF THE CHOLESTEROL TYPE
Authors: ARDLIE N. G. , MATZ L. R.
Published: September 2017

A case is recorded of chronic pneumonitis of the cholesterol type, in association with both “ incomplete” and complete pulmonary infarction and pulmonary embolism. The hypothesis is offered that ischæmic changes in the lung parenchyma can produce the characteristic changes of cholesterol pneumonitis. Previous case reports have not shown this association.
Trajectory ofAffordances: Insights from a case of telemedicine in Nepal
Authors: Thapa Devinder , Sein Maung K.
Published: September 2017

Although Affordance Theory has become increasingly influential in the Information Systems (IS) literature, the exact process through which the affordances of IT are actualised is less studied. In this paper, we build on a realist ontology of affordance and an interpretive epistemology of how affordances are perceived and actualised to trace the process of actualisation. On the basis of insights drawn from a case study of a telemedicine project in a remote mountainous region of Nepal, we develop a concept, which we call the “Trajectory of Affordances.” Trajectory of Affordances captures the complex relations between affordances of IT and the role of goal‐oriented actors who perceive and then play a vital role in actualising them, using capabilities that are enabled by facilitating conditions to take the necessary action. Trajectory of Affordances shows that the affordances of IT can travel from perception to actualisation through multiple paths, sometimes clustering together, and in the process, often lead to the emergence of new affordances.
The experience of palliative care service provision for people with non‐malignant respiratory disease and their family carers: An all‐Ireland qualitative study
Authors: Mc Veigh Clare , Reid Joanne , Larkin Philip , Porter Sam , Hudson Peter
Published: September 2017

Aim

To explore specialist and generalist palliative care provision for people with non‐malignant respiratory disease, in rural and urban areas in the North and Republic of Ireland.

Background

Globally, palliative care is recommended as an appropriate healthcare option for people with advanced non‐malignant lung disease. Yet, there is limited evidence regarding the integration of palliative care for this client group.

Design

Qualitative study.

Methods

Convenience sample of 17 bereaved carers and 18 healthcare professionals recruited from two rural and two urban sites on the Island of Ireland. Data were collected throughout 2012 and 2013 through semi‐structured interviews with carers of patients with Chronic Obstructive Pulmonary Disease (N = 12), interstitial lung disease (N = 4) or bronchiectasis (N = 1) who had died 3–18 months previously; and four focus groups with healthcare professionals. Data were analysed using a thematic analysis framework.

Results

Carers’ interviews yielded three overarching themes: (1) lack of preparedness for death, due to ambiguity regarding disease trajectory; (2) lack of consistency in palliative care delivery, in relation with the receipt of generalist and specialist palliative care; and (3) role ambiguity, related to their caregiving role. Focus groups identified two overarching themes: (1) barriers to appropriate palliative care; and (2) the future direction of palliative care for patient with non‐malignant respiratory disease.

Conclusion

The uncertain disease trajectory was not only experienced by carers but also healthcare professionals. Although referral to specialist palliative care services was perceived as increasing, the availability and coordination of generalist and specialist palliative care services were fragmented and varied dependent on geographical location.
Interactions between range‐expanding tropical fishes and the northern Gulf of Mexico red snapper Lutjanus campechanus
Authors: Marshak A. R. , Heck K. L.
Published: September 2017

Experimental investigation of the intensity of potential competitive interactions among increasingly abundant tropically‐associated grey Lutjanus griseus and lane snapper Lutjanus synagris and resident northern Gulf of Mexico (nGOM) red snapper Lutjanus campechanus was undertaken in large outdoor mesocosms. In pair‐wise interaction trials, compared with L. synagris, L. campechanus demonstrated significantly increased roving behaviour and predatory activity. While no significant difference in these activities was observed between L. campechanus and L. griseus, when all three snappers (Lutjanidae) were grouped together L. campechanus swimming activity significantly decreased in the presence of both tropically‐associated species. Overall, L. campechanus were more active and aggressive predators and appear to be competitively resistant to L. griseus and L. synagris. As lower latitude species have continued to become increasingly prevalent in nGOM habitats and regional warming continues to affect resident reef‐associated fishes, these findings contribute to the assessment of the effects of warming‐related species shifts upon nGOM fishes and document current partial resilience of L. campechanus to climate‐related expansions of tropical confamilials.
Dentition of the apron ray Discopyge tschudii (Elasmobranchii: Narcinidae)
Authors: Spath M. C. , Deli Antoni M. , Delpiani G.
Published: September 2017

The present study provides quantitative and qualitative analyses of the dentition of Discopyge tschudii. Overall, 193 individuals (99 males and 94 females) of D. tschudii were collected on scientific trawl surveys conducted by the National Institute for Fisheries Research and Development (INIDEP) and commercial vessels in Argentina. Discopyge tschudii has rhombic‐shaped teeth, arranged in a semipavement‐like dentition; each tooth has an erect cusp slightly inclined posteriorly and holaulachorized root. Mature males have greater tooth lengths than females and immature specimens. Discopyge tschudii exhibits dignathic homodonty and gradient monognathic heterodonty where teeth of the commissural row are shorter than those of the symphyseal and internal rows.
Squalus bassi sp. nov., a new long‐snouted spurdog (Chondrichthyes: Squaliformes: Squalidae) from the Agulhas Bank
Authors: Viana S. T. de. F. L. , de Carvalho M. R. , Ebert D. A.
Published: September 2017

The long‐snouted African spurdog Squalus bassi sp. nov. is described based on material collected from the outer shelf and upper continental slope off South Africa and Mozambique. Squalus bassi shares with S. mitsukurii, S. montalbani, S. chloroculus, S. grahami, S. griffini, S. edmundsi, S. quasimodo and S. lobularis a large snout with prenarial length greater than distance between nostrils and upper labial furrows, dermal denticles tricuspidate and rhomboid and elevated number of vertebrae. Squalus bassi can be distinguished from all its congeners by a combination of body and fin colouration, external morphometrics, vertebral counts and shape of dermal denticles. Similar long‐snouted congeners from the Indo‐Pacific region, including S. montalbani, S. edmundsi and S. lalannei are compared in detail with the new species. This new species has been misidentified as the Japanese S. mitsukurii and the Mediterranean S. blainvillei due to the lack of comparative morphological analyses. The validity of the nominal species S. mitsukurii in the south‐eastern Atlantic Ocean and western Indian Ocean is also clarified herein, indicating it has a more restricted geographical distribution in the North Pacific Ocean.
Efficacy of hemostatic powder in preventing bleeding after gastric endoscopic submucosal dissection in high‐risk patients
Authors: Hahn Kyu Yeon , Park Jun Chul , Lee Yong Kang , Shin Sung Kwan , Lee Sang Kil , Lee Yong Chan
Published: September 2017

Background and Aim

The prevention of post‐endoscopic submucosal dissection (ESD) bleeding in high‐risk patients is an important problem. This study evaluated the efficacy of polysaccharide hemostatic powder in preventing post‐ESD bleeding in high‐risk patients.

Methods

Patients at high risk for post‐ESD bleeding were prospectively enrolled between December 2015 and July 2016. A high risk of post‐ESD bleeding was considered if the patients were taking antithrombotic agents or had undergone a large resection (specimen size ≥ 40 mm). The endpoints were Forrest classification of the post‐ESD ulcer on second‐look endoscopy 2 days after the procedure and bleeding rates within 48 h and at 4 weeks.

Results

Forty‐four patients underwent gastric ESD and treatment with hemostatic powder. Among them, 33 patients (70.5%) underwent large resection (≥ 40 mm) without antithrombotic therapy, and 13 patients (29.5%) received antithrombotic therapy. The mean resected specimen size was 55.3 ± 13.9 mm. The proportion of high‐risk delayed bleeding lesions (Forrest IIa) at second‐look endoscopy was 4.5% (2/44). The overall bleeding rate was 9.1% (4/44). There was no early bleeding event. The median (interquartile range) timing of bleeding after the procedure was 12.5 (interquartile range 10.3–15.5) days. The bleeding rate in the large resection (≥ 40 mm) group without antithrombotic therapy and the antithrombotic therapy group was 3.2% (1/33) and 23.1% (3/13), respectively.

Conclusions

Hemostatic powder may be a promising new simple and effective method to prevent early post‐ESD bleeding in high‐risk patients, especially for those with larger resection.

(Clinical trial registration number: NCT02625792).
Endogenous neurosteroids influence synaptic GABAA receptors during postnatal development
Authors: Belelli D. , Brown A. R. , Mitchell S. J. , Gunn B. G. , Herd M. B. , Phillips G. D. , Seifi M. , Swinny J. D. , Lambert J. J.
Published: September 2017

GABA plays a key role in both embryonic and neonatal brain development. For example, during early neonatal nervous system maturation, synaptic transmission, mediated by GABAA receptors (GABAARs), undergoes a temporally specific form of synaptic plasticity to accommodate the changing requirements of maturing neural networks. Specifically, the duration of miniature inhibitory postsynaptic currents (mIPSCs), resulting from vesicular GABA activating synaptic GABAARs, is reduced, permitting neurones to appropriately influence the window for postsynaptic excitation. Conventionally, programmed expression changes to the subtype of synaptic GABAAR are primarily implicated in this plasticity. However, it is now evident that, in developing thalamic and cortical principal‐ and inter‐neurones, an endogenous neurosteroid tone (eg, allopregnanolone) enhances synaptic GABAAR function. Furthermore, a cessation of steroidogenesis, as a result of a lack of substrate, or a co‐factor, appears to be primarily responsible for early neonatal changes to GABAergic synaptic transmission, followed by further refinement, which results from subsequent alterations of the GABAAR subtype. The timing of this cessation of neurosteroid influence is neurone‐specific, occurring by postnatal day (P)10 in the thalamus but approximately 1 week later in the cortex. Neurosteroid levels are not static and change dynamically in a variety of physiological and pathophysiological scenarios. Given that GABA plays an important role in brain development, abnormal perturbations of neonatal GABAAR‐active neurosteroids may have not only a considerable immediate, but also a longer‐term impact upon neural network activity. Here, we review recent evidence indicating that changes in neurosteroidogenesis substantially influence neonatal GABAergic synaptic transmission. We discuss the physiological relevance of these findings and how the interference of neurosteroid‐GABAAR interaction early in life may contribute to psychiatric conditions later in life.
The vertebrate heart: an evolutionary perspective
Authors: Stephenson Andrea , Adams Justin W. , Vaccarezza Mauro
Published: September 2017

Convergence is the tendency of independent species to evolve similarly when subjected to the same environmental conditions. The primitive blueprint for the circulatory system emerged around 700–600 Mya and exhibits diverse physiological adaptations across the radiations of vertebrates (Subphylum Vertebrata, Phylum Chordata). It has evolved from the early chordate circulatory system with a single layered tube in the tunicate (Subphylum Urchordata) or an amphioxus (Subphylum Cephalochordata), to a vertebrate circulatory system with a two‐chambered heart made up of one atrium and one ventricle in gnathostome fish (Infraphylum Gnathostomata), to a system with a three‐chambered heart made up of two atria which maybe partially divided or completely separated in amphibian tetrapods (Class Amphibia). Subsequent tetrapods, including crocodiles and alligators (Order Crocodylia, Subclass Crocodylomorpha, Class Reptilia), birds (Subclass Aves, Class Reptilia) and mammals (Class Mammalia) evolved a four‐chambered heart. The structure and function of the circulatory system of each individual holds a vital role which benefits each species specifically. The special characteristics of the four‐chamber mammalian heart are highlighted by the peculiar structure of the myocardial muscle.
Merkel cells and Meissner's corpuscles in human digital skin display Piezo2 immunoreactivity
Authors: García‐Mesa Y. , García‐Piqueras J. , García B. , Feito J. , Cabo R. , Cobo J. , Vega J. A. , García‐Suárez O.
Published: September 2017

The transformation of mechanical energy into electrical signals is the first step in mechanotransduction in the peripheral sensory nervous system and relies on the presence of mechanically gated ion channels within specialized sensory organs called mechanoreceptors. Piezo2 is a vertebrate stretch‐gated ion channel necessary for mechanosensitive channels in mammalian cells. Functionally, it is related to light touch, which has been detected in murine cutaneous Merkel cell–neurite complexes, Meissner‐like corpuscles and lanceolate nerve endings. To the best of our knowledge, the occurrence of Piezo2 in human cutaneous mechanoreceptors has never been investigated. Here, we used simple and double immunohistochemistry to investigate the occurrence of Piezo2 in human digital glabrous skin. Piezo2 immunoreactivity was detected in approximately 80% of morphologically and immunohistochemically characterized (cytokeratin 20+, chromogranin A+ and synaptophisin+) Merkel cells. Most of them were in close contact with Piezo2− nerve fibre profiles. Moreover, the axon, but not the lamellar cells, of Meissner's corpuscles was also Piezo2+, but other mechanoreceptors, i.e. Pacinian or Ruffini's corpuscles, were devoid of immunoreactivity. Piezo2 was also observed in non‐nervous tissue, especially the basal keratinocytes, endothelial cells and sweat glands. The present results demonstrate the occurrence of Piezo2 in cutaneous sensory nerve formations that functionally work as slowly adapting (Merkel cells) and rapidly adapting (Meissner's corpuscles) low‐threshold mechanoreceptors and are related to fine and discriminative touch but not to vibration or hard touch. These data offer additional insight into the molecular basis of mechanosensing in humans.
“It just made me feel so desolate”: Patients’ narratives of weight gain following laparoscopic insertion of a gastric band
Authors: Lloyd Frances Marjorie May , Hewison Alistair , Efstathiou Nikolaos
Published: September 2017

Aims and objectives

To describe the experiences of patients who have failed to maintain weight loss following the insertion of a laparoscopic adjustable gastric band (LAGB) for the treatment of morbid obesity.

Background

Obesity is a global health problem resulting in physical, psychological and economic problems and presenting challenges for health services. Surgical intervention is an increasingly common approach to treatment; however, some patients do not sustain their weight loss following bariatric surgery and little is known about people's longer‐term experiences following LAGB insertion.

Design

A narrative‐based qualitative interview study.

Methods

A purposive sample of ten participants who had undergone LAGB insertion for morbid obesity was recruited. Semistructured interviews were conducted in 2014. Thematic analysis identified codes and emerging themes common to the participants’ experiences.

Findings

Three major themes emerged: living with the side effects, regret and lack of support. These reflect the difficulties participants experienced and provide new insights on why weight loss is not sustained after 2 years following surgery.

Conclusion

Participants reported that the surgery had a detrimental effect on their lives and some regretted having the band inserted. These findings identify areas of care that need to be addressed if patients undergoing LAGB are to experience its potential benefits and indicate that further research is needed into the long‐term effects of gastric band insertion. Patients need to be better informed about the consequences of bariatric surgery if it is to have a lasting impact on their weight reduction.

Relevance to clinical practice

Patients require comprehensive information and support before and after LAGB insertion to develop strategies which will help them lose weight and sustain it over the longer term. Clinicians need to be sensitive to patients’ needs when weight loss plateaus or weight is regained and intensify support during these periods.
A systematic review to explore influences on parental attitudes towards antibiotic prescribing in children
Authors: Bosley Helen , Henshall Catherine , Appleton Jane V , Jackson Debra
Published: September 2017

Aims and objectives

To understand the factors influencing parental attitudes towards antibiotic prescribing.

Background

Overuse of antibiotics and inappropriate prescribing has resulted in rapid development of antimicrobial resistance (AMR) and is a significant global threat to patient safety. In primary care settings, substantial numbers of antibiotics are prescribed for young children, despite viral nature of illness for which antibiotics are ineffective. Parents play a vital role in decision‐making regarding accessing healthcare services and requesting treatment for their children.

Design

A systematic review was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) statement (Moher et al., Systematic Reviews, 4, 2015, p. 1).

Methods

The CINAHL, MEDLINE, PsycINFO, The Cochrane Library, BRITISH NURSING INDEX, EMBASE and PUBMED databases were searched for primary research published between 2006–2016. All types of primary research were searched and screened against inclusion criteria. The Critical Appraisal Skills Programme tool was used to appraise identified publications. Quantitative data were summarised descriptively, and qualitative data were thematically analysed.

Results

A total of 515 publications were initially screened, and 55 full‐text articles were eligibility assessed. Twenty papers met inclusion criteria. Four main themes were identified: the quality of relationships with healthcare providers, dealing with conflicting messages, rationalising antibiotic use and parental practices informed by past experience.

Conclusions

Parents wanted reassurance and advice regarding children's illnesses, had poor antibiotic knowledge and were influenced by personal past experiences. More accessible education, including simple information leaflets, is required. Further research on the influence of culture, ethnicity and socio‐economic factors would be beneficial.

Relevance to clinical practice

Healthcare professionals must provide adequate time for reassurance and explanations of decision‐making. Easy‐to‐read information regarding appropriate antibiotic usage should be easily accessible for parents.
Assessment of the quality of neonatal care in the Solomon Islands
Authors: Tosif Shidan , Nasi Titus , Gray Amy , Sadr‐Azodi Nahad , Ogaoga Divi , Duke Trevor
Published: September 2017

Aim

To identify strengths and obstacles for improving the quality of newborn care in the Solomon Islands. Improving the quality of newborn care is a priority in the Sustainable Development Goals and the Action Plan for Healthy Newborns in the Western Pacific. The neonatal mortality rate in the Solomon Islands, a lower‐middle‐income country, has improved slower than overall child mortality. In 2013, neonatal mortality (13.2/1000) constituted 44% of under‐5 deaths (30.1/1000).

Methods

A cross‐sectional study of newborn care in five provincial hospitals using a World Health Organization assessment tool for hospital quality of care. Twelve months of neonatal records of the National Referral Hospital (NRH) labour ward and nursery were audited.

Results

Essential medications and basic equipment were generally available. Challenges included workforce shortages and lack of expertise, high costs, organisation and maintenance of equipment, infection control and high rates of stillbirth. Over 12 months at the NRH labour ward, there were 5412 live births, 65 (1.2%) ‘fresh’ stillbirths and 96 (1.8%) ‘macerated’ stillbirths. Over the same period, there were an associated 779 nursery admissions, and the main causes of mortality were complications of prematurity, birth asphyxia, congenital abnormalities and sepsis. Total neonatal mortality at NRH was 16 per 1000 live births, and 77% of deaths occurred in the first 3 days of life.

Conclusions

Infrastructure limitations, technical maintenance and equipment organisation were obstacles to newborn care. Greater health‐care worker knowledge and skills for early essential newborn care, infection control and management of newborn complications is needed.
Institutional review boards’ attitudes towards remuneration in paediatric research: Ethical considerations
Authors: Flege Marius M , Thomsen Simon F
Published: September 2017

Remuneration in paediatric research poses an ethical dilemma. Too large a sum might cause parents to enrol their children in research projects with no benefit for the child, whereas too modest a sum might hamper recruitment. The institutional review boards have the responsibility to only approve remuneration in paediatric trials with ethically sound research plans. However, little is known about which factors influence institutional review boards’ evaluation of remuneration in paediatric research.
Families living with parental mental illness and their experiences of family interventions
Authors: Afzelius M. , Plantin L. , Östman M.
Published: September 2017

Accessible summary

What is known on the subject?

Coping with parental mental illness in families can be challenging for both children and parents.

Providing evidence‐based family interventions to families where a parent has a mental illness can enhance the relationships in the family.

Although psychiatric research has shown that evidence‐based family interventions may improve the communication and understanding of parental mental illness, there is a lack in this area of research from an everyday clinical context.

What does this paper add to existing knowledge?

Our study reinforces the fact that parents with mental illnesses are searching for support from psychiatric services in order to talk to their children about their illness.

The finding that under‐age children comply when they are told by their parents to join an intervention in psychiatric services supporting the family is something not observed earlier in research.

This study once more illuminates the fact that partners of a person with parental mental illness are seldom, in an obvious way, included in family support interventions.

What are the implications for practice?

Psychiatric services, and especially mental health nurses, have an important task in providing families with parental mental illness with support concerning communication with their children and in including the “healthy” partner in family support interventions.

Introduction

Although research has shown that evidence‐based family interventions in research settings improve the communication and understanding of parental mental illness, there is a lack of knowledge about interventions in an everyday clinical context.

Aim

This study explores how families with parental mental illness experience family interventions in a natural clinical context in psychiatric services.

Method

Five families with children aged 10–12 were recruited from psychiatric services in southern Sweden and interviewed in a manner inspired by naturalistic inquiry and content analysis. Both family and individual interviews were performed.

Results

In striving to lead an ordinary life while coping with the parental mental illness, these families sought the support of the psychiatric services, especially in order to inform their children about the mental illness. Despite different family interventions, the family members felt supported and reported that the number of conflicts in the family had decreased. The parents were appreciative of help with child‐rearing questions, and the children experienced a calmer family atmosphere. However, the partner of the person with mental illness experienced being left without support.

Implications for practice

Our study shows that psychiatric services, and especially mental health nurses, are in a position to more regularly offer family interventions in supporting the children and the healthy partners.
The Role of Primary Care for the Oral Health of Rural and Urban Older Adults
Authors: Caldwell Julia T. , Lee Haena , Cagney Kathleen A.
Published: September 2017

Context

Rural populations often have restricted access to dental care and poor oral health. These problems may disproportionately affect older blacks in rural areas. Little is known about how access to primary health care may improve the oral health of rural seniors.

Purpose

This study examines whether the relationship between having a usual source of health care and oral health varies for white and black older adults in rural and urban areas in the United States.

Methods

We draw on cross‐sectional data of adults (50 years+) from the nationally representative Health and Retirement Study (n = 15,473). Multivariate logistic regression examined the role of a usual source of health care in conditioning racial differences in complete tooth loss and a dental visit in the past 2 years. A usual source of health care is a place, not including an emergency room, where a person goes when he or she is sick or needs health advice.

Findings

In rural areas, blacks had high rates of tooth loss (28%) and low rates of dental visits (34%). Having a usual source of health care was associated with higher odds of a dental visit for all adults. In rural areas, the association between a usual source of health care and tooth loss varied by race (P < .001); blacks had more tooth loss than whites even with a usual source of health care.

Conclusions

Access to primary health care was associated with improved oral health outcomes, but it did not close the gap between whites and blacks in rural areas.