bluuebunny/crossref_metadata_2025 huggingface dataset:
Discharge Plans for Geriatric Inpatients with Delirium: A Plan to Stop Antipsychotics?
Authors: Johnson Kim G. , Fashoyin Adedayo , Madden‐Fuentes Ramiro , Muzyk Andrew J. , Gagliardi Jane P. , Yanamadala Mamata
Published: August 2017

Background

Studies show inpatient geriatric patients with reversible conditions like delirium may continue on antipsychotic medications without clear indications after hospital discharge. We conducted this study to determine how often geriatric patients were discharged on a newly started antipsychotic during admission with a plan for discontinuation of the antipsychotic documented in the discharge summary.

Design

We conducted retrospective chart review identifying geriatric inpatients in our health system started on a new antipsychotic during admission. In patients discharged from the hospital on a new antipsychotic, we examined the discharge summary for a discontinuation treatment plan.

Results

Of 487 patients started on a new antipsychotic, 147 (30.2%) were discharged on the antipsychotic. Of those, 121 (82.3%) had a diagnosis of delirium. Discharge summaries of 15 (12.4%) patients discharged on an antipsychotic with a diagnosis of delirium included instructions for discontinuation of the antipsychotic. Of those patients discharged with instructions for discontinuation, 12 (80%) received a psychiatric or geriatric medicine consult.

Conclusion

In our health system, the majority of geriatric patients with delirium, discharged on a new antipsychotic had no instructions outlined to outpatient providers for discontinuation management. Further interventions could target increasing antipsychotic guidance at transitions of care.
A review of the literature on symptom clusters in studies that included oncology patients receiving primary or adjuvant chemotherapy
Authors: Ward Sullivan Carmen , Leutwyler Heather , Dunn Laura B , Miaskowski Christine
Published: August 2017

Aims and objectives

To summarise the current state of knowledge of symptom clusters research from studies that included, as part of their sample, patients who were receiving primary or adjuvant chemotherapy.

Background

Since the concept of a symptom cluster was first introduced into the oncology literature in 2001, only four comprehensive reviews of symptom clusters research in oncology patients were identified that provide insights into this important concept in symptom management research.

Design

A comprehensive review of the literature.

Methods

A comprehensive literature search was conducted for the years 2000 to 2016. Only 19 studies met the inclusion criteria for this literature review. These studies were evaluated in terms of the symptom assessment instruments used; the statistical analysis methods used; the symptom dimension(s) used to create the symptom cluster(s); the number and types of symptom clusters identified; and whether the specific symptom clusters changed over time.

Results

The number of symptom clusters identified ranged from one–seven. The majority of the studies used some type of factor analysis to create the symptom clusters. The most common symptom dimension used to create the clusters was symptom severity. A “gastrointestinal symptom cluster” was the most common symptom cluster identified. Across the eight longitudinal studies, for half of these studies the symptom clusters remained relatively stable over time.

Conclusions

Additional research is needed in oncology patients to address the assessment of symptom clusters, the specific nature of symptom clusters and whether symptom clusters change over time.
A protective role of IRF3 and IRF7 signalling downstream TLRs in the development of vein graft disease via type I interferons
Authors: Simons K. H. , Peters H. A. B. , Jukema J. W. , de Vries M. R. , Quax P. H. A.
Published: August 2017

Background

Toll like receptors (TLR) play an important role in vein graft disease (VGD). Interferon regulatory factors (IRF) 3 and 7 are the transcriptional regulators of type I interferons (IFN) and type I IFN responsive genes and are downstream factors of TLRs. Relatively little is known with regard to the interplay of IRFs and TLRs in VGD development. The aim of this study was to investigate the role of IRF3 and IRF7 signaling downstream TLRs and the effect of IRF3 and IRF7 in VGD.

Methods and Results

In vitro activation of TLR3 induced IRF3 and IRF7 dependent IFNβ expression in bone marrow macrophages and vascular smooth muscle cells. Activation of TLR4 showed to regulate pro‐inflammatory cytokines via IRF3. Vein graft surgery was performed in Irf3−/−, Irf7−/− and control mice. After 14 days Irf3−/− vein grafts had an increased vessel wall thickness compared to both control (P = 0.01) and Irf7−/− (P = 0.02) vein grafts. After 28 days, vessel wall thickness increased in Irf3−/− (P = 0.0003) and Irf7−/− (P = 0.04) compared to control vein grafts and also increased in Irf7−/− compared to Irf3−/− vein grafts (P = 0.02). Immunohistochemical analysis showed a significant higher influx of macrophages after 14 days in Irf3−/− vein grafts and after 28 days in Irf7−/− vein grafts compared to control vein grafts.

Conclusions

The present study is the first to describe a protective role of both IRF3 and IRF7 in VGD. IRFs regulate VGD downstream TLRs since Irf3−/− and Irf7−/− vein grafts show increased vessel wall thickening after respectively 14 and 28 days after surgery.
Identification and validation of reference genes for RT‐qPCR analysis in banana (Musa spp.) under Fusarium wilt resistance induction conditions
Authors: Zhang Lucheng , Liu Lan , Cheng Ping , Shen Hanguo , Rong Biao , Liu Wen , Yu Guohui
Published: August 2017

Banana (Musa spp.) is severely damaged by Fusarium wilt caused by Fusarium oxysporum f. sp. cubense (Foc). Biocontrol by inducing systemic resistance has been considered as one of the most important strategies to improve plant health. Very few studies have investigated appropriate reference gene selection for RT‐qPCR (quantitative real‐time polymerase chain reaction) analysis suitable for conditions of systemic activated resistance. In this study, we assessed over a time‐course the expression of seven candidate reference genes (EF1, TUB, ACT1, ACT2, L2, RPS2 and RAN) for Cavendish cultivar Brazilian (Musa spp. AAA) and dwarf banana cultivar Guangfen No. 1 (Musa spp. ABB) that were inoculated by Bacillus subtilis strain TR21 and Foc. We choose these plants because they are commonly planted in Southern China. Expression stability of the candidate genes was evaluated using various software packages (GeNorm, NormFinder and BestKeeper). L2 and TUB genes displayed maximum stability in Guangfen No. 1. In Brazilian, ACT1 and TUB were the most stable genes. To further validate the suitability of the reference genes identified in this study, the expression of pathogenesis‐related 1 (PR1) gene under TR21 and Foc strains Foc004/Foc009 treatments was also studied. Identified reference genes in this work that are most suitable for normalizing gene expression data in banana under Fusarium wilt resistance induction conditions will contribute to the understanding of disease resistance mechanisms induced by biocontrol strains in banana.
In vitro selection of resistant/tolerant mutants lines of Citrus jambhiri Lush. using crude culture filtrate of Phytophthora parasitica and their randomly amplified polymorphic DNA analysis
Authors: Savita   , Pati Pratap K. , Virk Gurdeep S. , Nagpal Avinash
Published: August 2017

This study deals with in vitro‐induced mutagenesis and selection of Phytophthora tolerant lines of Citrus jambhiri and their regeneration. For in vitro‐induced mutagenesis, cotyledons were treated with ethyl methane sulfonate (EMS) 100, 200 and 300 mm for different time durations viz. 1, 3, 6 and 9 hr. Callus cultures were established from EMS treated cotyledon explants on MS medium supplemented with 2.0 mg/L of 2,4‐D and 500 mg/L of malt extract. Calli derived from cotyledon were challenged in vitro on selective MS medium containing 5%–100% of culture filtrate (CF) of the Phytophthora parasitica. Selected mutagen‐treated calli showed resistance in vitro on media containing CF. Calli treated with 100 mm EMS for 6‐hr duration showed tolerance (24%) up to 75% CF after 4th selection cycle. While, calli treated with 200 mm for 6‐hr duration showed maximum tolerance (76%) up to 75% CF. Resistant calli were then transferred to MS regeneration medium for shoot bud regeneration. A dose‐dependent decrease in the regeneration capacity of the selected calli was observed with the increasing concentration of the CF. In randomly amplified polymorphic DNA analysis, plantlets showed different banding pattern in comparison with the control plant, which confirms the presence of variations at genetic level.
Tumor necrosis factor‐alpha inhibits osteogenic differentiation of pre‐osteoblasts by downregulation of EphB4 signaling via activated nuclear factor‐kappaB signaling pathway
Authors: Wang L. M. , Zhao N. , Zhang J. , Sun Q. F. , Yang C. Z. , Yang P. S.
Published: August 2017

Background and Objective

The majority of experiments show that tumor necrosis factor‐alpha (TNF‐α) inhibits osteogenic differentiation of mesenchymal stem cells and pre‐osteoblasts by activated nuclear factor‐kappaB (NF‐κB) signaling. However, the underlying mechanisms by which NF‐κB signaling inhibits osteogenic differentiation are not fully understood. The aim of the present study was to investigate whether EphB4 signaling inhibition mediates the effects of TNF‐α‐activated NF‐κB signaling on osteogenic differentiation of pre‐osteoblasts.

Material and Methods

Murine MC3T3‐E1 pre‐osteoblasts were treated with 10 ng/mL of TNF‐α. NF‐κB inhibitor, pyrrolidine dithiocarbamate, was used to achieve NF‐κB signaling inhibition. EphB4 signaling was activated using ephrinB2‐fc. The mRNA expressions of runt related transcription factor 2 (Runx2), bone sialoprotein (BSP) and EphB4 were determined using reverse transcription‐polymerase chain reaction. The protein levels of Runx2, BSP, Col Ia1, osteopontin, EphB4, p‐NF‐κB p65 and NF‐κB p65 were evaluated using western blot assays. Alkaline phosphatase (ALP) activity in MC3T3‐E1 cells was evaluated by ALP activity kit, and mineral nodule formation was evaluated by Alizarin Red S staining.

Results

TNF‐α inhibited EphB4 expression, while it suppressed Runx2, BSP expression from gene and protein levels as well as ALP activity and mineral nodule formation in MC3T3‐E1 cells. Activation of EphB4 signaling by ephrinB2‐fc promoted osteogenic differentiation of MC3T3‐E1 cells, whereas TNF‐α impaired the osteogenic differentiation enhanced by ephrinB2‐fc. Pyrrolidine dithiocarbamate blocked the activation of NF‐κB signaling induced by TNF‐α, while it prevented the downregulation of Runx2, BSP and EphB4, induced by TNF‐α.

Conclusion

TNF‐α inhibits osteogenic differentiation of pre‐osteoblasts by downregulation of EphB4 signaling via activated NF‐κB signaling pathway.
UGT1As and predisposition to liver cancer: Still important, more elusive
Authors: Pineau Pascal
Published: August 2017

See Article on Page 1345
Two problems in Armenian phonology
Authors: Baronian Luc
Published: August 2017

The author surveys 2 major phenomena in Armenian phonology. The first is schwa epenthesis in Western Armenian, which is known to break up the impressive consonant clusters of the language. Before looking at the synchronically epenthetic schwas in Western Armenian, it is important to first distinguish schwas that are unambiguously part of lexical representations then to recognize schwas that have led, over time, to different allomorphs. A fourth category is left to explain: schwas that break up attested clusters, but only in derived morphological environments. After listing known facts about the syllabic nature of Armenian, the author shows that motivated prosodic specifications can account for the derived environment schwas (simplifying somewhat the previous account by Vaux,). The second phonological phenomenon surveyed is the voicing and aspiration patterns found in Armenian dialects. While the patterns neatly divide the linguistic domain into seven groups, the standard classifications rely on present‐tense formation as a primary divider between larger groups of dialects. The author, however, highlights that the phonological division between voicing and aspiration patterns should be considered a more fundamental one, once textbook notions of geolinguistics are applied to reduce the 7‐way division to a more ancient 3‐way division of dialects. Indeed, sound change is a more common type of innovation used for grouping related languages and dialects, and the territorial divisions thus obtained correspond to more ancient political divisions than the morphological ones.
New speakers: Challenges and opportunities for variationist sociolinguistics
Authors: Kasstan Jonathan
Published: August 2017

While the field of variationist sociolinguistics has advanced rapidly since Labov (1966), it remains the case that a socially informed theory of language change continues to be influenced by only very few languages, typically English and a handful other dominant European languages. This article considers recent work on the emergence ofnew speakersin (severely) endangered or minority language communities, and what they might have to offer variationist theory. Although definitions can vary, it has become convention to describe new speakers as individuals ‘with little or no home or community exposure to a minority language but who instead acquire it through immersion or bilingual education programs, revitalization projects or as adult language learners’ (O'Rourke, Pujolar, & Ramallo, 2015: 1). There is now a wealth of literature available on new speakers in typologically dissimilar language contexts, though, so far, very little work has adopted the variationist paradigm. This article will argue that new speakers can figure prominently in variationist models of diffusion and change, taking the classic sociolinguistic factor of social networks as an example. The article ends by proposing a manifesto of potential research trajectories, based on current gaps in the literature.
Experts’ Perceptions Versus Firms’ Experiences of Corruption and Foreign Direct Investment
Authors: Gillanders Robert , Parviainen Sinikka
Published: August 2017

This paper documents that standard measures of corruption based on the perceptions of experts and opinion surveys and measures based on the experiences of firms can in some cases lead to quite different conclusions as to how much of a problem corruption is in a country. We then show that while perceptions of corruption are significantly associated with the amount of foreign direct investment that a country attracts, the experience on the ground is not. We find some evidence that greenfield investment is significantly associated with the experience of corruption while mergers and acquisitions is driven by perceptions.
Adaptation despite gene flow? Low recombination helps
Authors: Marques David A.
Published: August 2017

About 15,000 years earlier, the Northern half of Europe and North America was buried under a few kilometres of ice. Since then, many organisms have colonized and rapidly adapted to the new, vacant habitats. Some, like the threespine stickleback fish, have done so more successfully than others: from the sea, stickleback have adapted to a multitude of lake and stream habitats with a vast array of complex phenotypes and life histories. Previous studies showed that most of these “ecotypes” differ in multiple divergently selected genes throughout the genome. But how are well‐adapted ecotypes of one habitat protected from maladaptive gene flow from ecotypes of another, adjacent habitat? According to a From the Cover meta‐analysis in this issue of Molecular Ecology (Samuk et al., 2017), low recombination rate regions in the genome offer such protection. While inversions have often been highlighted as an efficient way to maintain linkage disequilibrium among sets of adaptive variants in the face of gene flow, Samuk et al. (2017) show that variation in recombination rate across the genome may perform a similar role in threespine stickleback. With this study, theoretical predictions for the importance of low recombination regions in adaptation are for the first time tested with a highly replicated population genomic data set. The findings from this study have implications for the adaptability of species, speciation and the evolution of genome architecture.
Variable Neighborhood Search for Multistage Train Classification at Strategic Planning Level
Authors: Belošević Ivan , Ivić Miloš
Published: August 2017

Considerations on influences and interrelations between structural design and functional planning are imperative for raising the cost and operational effectiveness of marshaling yards in the context of managing wagonload services. This article focuses on multistage train classification, which rearranges a set of wagons from inbound trains to create a set of multigroup outbound trains in a proper form. Previous papers on the subject of multistage train classification were limited to considerations on the optimal classification schedule addressing the number of sorting steps as a primary objective. In contrast, this article proposes a model for overall optimization of the classification schedule and sidings layout, simultaneously addressing the number of sorting steps and the total number of wagon movements in the objective function. The model is created on a binary integer programming formulation. A Variable Neighborhood Search (VNS) heuristic is developed due to the computational complexity of the problem. Numerical experiments validate the formulated model and demonstrate the efficiency of the VNS meta‐heuristic approach.
Beyond Global English: Motivation to Learn Languages in a Multicultural World: Introduction to the Special Issue
Authors: USHIODA EMA , DÖRNYEI ZOLTÁN
Published: August 2017

This special issue takes a critical look at a largely uncharted area of language learning motivation: the motivation to learn languages other than English (LOTEs) in an era of globalization and multilingualism. Most 21st‐century literature on motivation in second language acquisition has focused on the learning of English, whose dominant status as a global language has significantly shaped current conceptualizations of second language motivation in relation to notions of self and identity. In an effort to redress this balance, the articles in this special issue critically examine two key questions: (a) How far are current theoretical perspectives adequate to account for motivation to learn LOTEs? and (b) What impact does global English have on motivation to learn other second or foreign languages in a globalized yet multicultural and multilingual world? In examining these core questions across a range of sociopolitical and educational settings, this issue brings together broader sociological as well as individual–psychological perspectives on motivation to learn LOTEs.
Cryptococcosis in patients with diabetes mellitus II in mainland China: 1993‐2015
Authors: Li Yingfang , Fang Wenjie , Jiang Weiwei , Hagen Ferry , Liu Jia , Zhang Lei , Hong Nan , Zhu Yu , Xu Xiaoguang , Lei Xia , Deng Danqi , Xu Jianping , Liao Wanqing , Boekhout Teun , Chen Min , Pan Weihua
Published: August 2017

Diabetes mellitus II (DM II) is a newly defined independent factor contributing to the morbidity and mortality of cryptococcosis. This retrospective case analysis aims to explore the epidemiology, clinical profile and strain characteristics of cryptococcosis in Chinese DM II patients. This study included 30 cases of cryptococcosis with DM II occurring from 1993 to 2015 in mainland China. The hospital‐based prevalence of cryptococcosis in DM II was 0.21%. The mean age of the patients was 56.1 years (95% confidence interval: 51.5, 60.6), and 93% of the patients were older than 40 years. Sixty‐two per cent of the patients experienced untreated or poorly controlled blood glucose before infection. Multilocus sequence typing analysis categorised all cultured strains as Cryptococcus neoformans and sequence type 5. Sixty‐nine per cent of pulmonary cryptococcosis patients experienced misdiagnoses and treatment delays. Sixty per cent of cryptococcal meningitis patients received substandard antifungal therapy. The overall death rate was 33%. Considering the large population size of DM II patients in China, improved attention should be paid to the high prevalence of cryptococcosis as revealed by us. We also emphasised the importance of blood glucose control for infection prevention, especially among the elderly.
Modulation of VIPergic phenotype of enteric neurons by colonic biopsy supernatants from patients with inflammatory bowel diseases: Involvement of IL‐6 in Crohn's disease
Authors: Soufflet F. , Biraud M. , Rolli‐Derkinderen M. , Lardeux B. , Trang C. , Coron E. , Bruley des Varannes S. , Bourreille A. , Neunlist M.
Published: August 2017

Background

Neuroplastic changes in the enteric nervous system (ENS) observed during IBD might participate in physiopathological processes. Vasoactive intestinal polypeptide has been shown to be involved in intestinal inflammation and barrier functions. We aimed to investigate the modulation of VIP expression in colonic biopsies of IBD patient, the ability of soluble factors from biopsies to reproduce in vitro these modulations and identify soluble factors responsible.

Methods

VIP and cytokines mRNA expressions were assessed in colonic biopsies of healthy subjects (HS) and IBD patients from inflamed (I) and non‐inflamed areas (NI). Supernatants (SUP) of biopsies were applied to primary culture of ENS and VIP and cytokines mRNA expressions were assessed. The role of cytokines in SUP induced changes in VIP expression was evaluated.

Key Results

VIP mRNA expression was lower in biopsies of patients with Crohn's disease (CD) than Ulcerative Colitis (UC) but unchanged as compared to HS. VIP mRNA and protein expression were lower in primary culture of ENS incubated with SUP‐CD than with SUP‐UC. Furthermore, in CD but not UC, SUP‐I reduced VIP expression in the ENS as compared to SUP‐NI. Next, IL‐6 but not IL‐5, IL‐10, IL‐17, IFN‐γ or TNF‐α reduced VIP expression in the ENS. Finally, in CD, SUP‐I incubated with anti‐IL‐6 antibody increased VIP expression as compared to SUP‐I alone.

Conclusions & Inferences

Mucosal soluble factors from IBD induce VIP neuroplastic changes in the ENS. IL‐6 was identified as a putative soluble factor responsible in part for changes in VIP expression in CD.
Seeing is believing: imaging the delivery of pathogen effectors during plant infection
Authors: Van den Ackerveken Guido
Published: August 2017

This article is a Commentary on Wang et al., 216: 205–215.
Morphometric analysis of the maxillary root apex positions according to crowding severity
Authors: Kim S. H. , Shin S. M. , Choi Y. S. , Ko C. C. , Kim S. S. , Park S. B. , Son W. S. , Kim Y.‐I.
Published: August 2017

Structured Abstract

Objectives

To determine differences in arch forms derived from the root apices locations between individuals with <2 mm maxillary crowding and controls.

Setting and Sample Population

The Department of Orthodontics, Pusan National University. Cone‐beam computed tomography (CBCT) images of 102 patients in the control group and 95 patients in the crowding group.

Materials and Methods

X, Y and Z coordinates of the tip of the crowns and the apex of the root of the maxillary teeth (except second molars) were determined on the CBCT images. The acquired three‐dimensional (3D) coordinates were converted into two‐dimensional (2D) coordinates via projection on the palatal plane, and the Procrustes analysis was employed to process the converted 2D coordinates. The mean shape of the arch form derived from the location of the tip of the crowns and the apex of the root was compared between groups using the statistical shape analysis.

Results

There was a statistically significant difference (P = .046) between the groups for the mean shape of the root apex arch form, but the difference was small and clinically irrelevant as it is minor compared to the degree of crowding.

Conclusions

Maxillary arch from at the level of the maxillary apices only shows minor differences between crowded and non‐crowded dentitions.
Citizen perceptions of procedural fairness and the moderating roles of ‘belief in a just world’ and ‘public service motivation’ in public hiring
Authors: Pedersen Mogens Jin , Stritch Justin M. , Taggart Gabel
Published: August 2017

This article expands our knowledge of how variation in public administrative processes affects citizen perceptions of procedural fairness (CPPF). Focusing on a specific administrative process—the selection and hiring process—we use a survey experimental design among 823 US citizens and examine the effect of a public hiring process involving the appearance of advocacy from an applicant's social contacts on CPPF. Moreover, we theoretically and empirically examine the moderating effects of two psychological constructs: ‘belief in a just world’ and ‘public service motivation’. We find that citizens rate the procedural fairness of a hiring situation much lower when the situation appears to be influenced by an applicant's social contacts. However, citizens who report stronger ‘belief in a just world’ have less concern with a hiring process marked by advocacy, whereas citizens with higher levels of ‘public service motivation’ have more concern.
Public service motivation and continuous organizational change: Taking charge behaviour at police services
Authors: Homberg Fabian , Vogel Rick , Weiherl Julia
Published: August 2017

Building change capabilities into public organizations is a challenge for strategic management. This study focuses on the micro‐level of extra‐role behaviours that contribute to continuous improvements in working procedures at the front‐end of organizations (i.e., taking charge behaviour; TCB). More particularly, we examine public service motivation (PSM) as a key variable mediating between perceived practices and TCB of street‐level bureaucrats. The analyses are based on survey data from a state police force in Germany (N = 1,165). Results confirm the role of PSM as full mediator, but this mediation is limited to the relationship between leadership behaviours and TCB, while perceived organizational characteristics—except for red tape—have direct positive impact on TCB.
Anesthesia‐related and perioperative mortality: An audit of 8493 cases at a tertiary pediatric teaching hospital in South Africa
Authors: Meyer Heidi M. , Thomas Jenny , Wilson Graeme S. , de Kock Marianna
Published: August 2017

Aim

This study aimed to quantify the incidence of anesthesia‐related and perioperative mortality at a large tertiary pediatric hospital in South Africa.

Methods

This study included all children aged <18 years who died prior to discharge from hospital and within 30 days of their last anesthetic at the Red Cross War Memorial Children's Hospital between January 1, 2015 to December 31, 2015. A panel of three senior anesthetists reviewed each death to reach a consensus as to whether: (i) anesthesia caused the death; (ii) anesthesia may have contributed to or influenced the timing of death; or (iii) anesthesia was entirely unrelated to the death.

Results

There were 47 deaths within 30 days of anesthesia prior to discharge from hospital during this 12‐month period. The in‐hospital mortality within 24 h of administration of anesthesia was 16.5 per 10 000 cases (95% confidence intervals [CI]=7.8‐25.1) and within 30 days of administration of anesthesia was 55.3 per 10 000 cases (95% CI=39.5‐71.2). Age under 1 year (OR 4.5; 95% CI=2.5‐8.0, P=.012) and cardiac surgery and interventional cardiology procedures (OR 2.5; 95% CI=1.2‐5.2, P<.01) were both independent predictors of increased risk of perioperative mortality.

Conclusion

The overall 24‐h and 30‐day anesthesia‐related and in‐hospital perioperative mortality rates in our study are comparable with other similar studies from tertiary pediatric centers.
Anesthetic considerations for a novel anterior surgical approach to pediatric scoliosis correction
Authors: Gal Jonathan S. , Curatolo Christopher J. , Zerillo Jeron , Hill Bryan , Lonner Baron , Cuddihy Laury A. , Antonacci M. D. , Betz Randal R. , DeMaria Samuel , Khelemsky Yury
Published: August 2017

Background

Idiopathic scoliosis is a condition that may require surgical correction. Limitations of previous surgical modalities, however, created the need for novel methods of repair. One such technique, a newer form of anterolateral scoliosis correction, has shown considerable promise, which our center has had substantial experience performing.

Aim

In this article, we present the case details of our first 105 patients for the purposes of describing the evolution and details of the anesthetic management and considerations for this procedure.

Methods

A retrospective review of medical records for 105 patients undergoing anterolateral instrumentation procedure for idiopathic scoliosis correction done at a single institution from May 2014 to June 2016 was performed. The details of perioperative management as well as surgical technique were reported for all patients.

Results

The mean age for patients was 14.8 years (range 10‐18); the mean weight was 49.9 kg (range 25‐82). Unilateral procedures were performed on 46.7%, with bilateral and hybrid procedures performed on 50.5% and 4.7%, respectively. The median number of levels corrected was 8 (interquartile range [IQR] 7‐9) for unilateral, right 7 (IQR 6‐7) and left 5 (IQR 4‐5) for bilateral, and 4 (IQR 4‐4.5) for hybrids. The average estimated blood loss (EBL) was 310 mL±138, with cell salvaged blood transfused in 61% of patients, and allogenic blood transfusion required in only two patients.

Conclusions

The described anesthetic and analgesic management provides a framework for delivering perioperative care for this challenging procedure, which is gaining popularity as a modality for scoliosis correction.
Different predictivity of fluid responsiveness by pulse pressure variation in children after surgical repair of ventricular septal defect or tetralogy of Fallot
Authors: Han Ding , Pan Shoudong , Wang Xiaonan , Jia Qingyan , Luo Yi , Li Jia , Ou‐Yang Chuan
Published: August 2017

Background

Pulse pressure variation derived from the varied pulse contour method is based on heart‐lung interaction during mechanical ventilation. It has been shown that pulse pressure variation is predictive of fluid responsiveness in children undergoing surgical repair of ventricular septal defect. Right ventricle compliance and pulmonary vascular capacitance in children with tetralogy of Fallot are underdeveloped as compared to those in ventricular septal defect. We hypothesized that the difference in the right ventricle‐pulmonary circulation in the two groups of children would affect the heart‐lung interaction and therefore pulse pressure variation predictivity of fluid responsiveness following cardiac surgery.

Methods

Infants undergoing complete repair of ventricular septal defect (n=38, 1.05±0.75 years) and tetralogy of Fallot (n=36, 1.15±0.68 years) clinically presenting with low cardiac output were enrolled. Fluid infusion with 5% albumin or fresh frozen plasma was administered. Pulse pressure variation was recorded using pressure recording analytical method along with cardiac index before and after fluid infusion. Patients were considered as responders to fluid loading when cardiac index increased ≥15%. Receiver operating characteristic curves analysis was used to assess the accuracy and cutoffs of pulse pressure variation to predict fluid responsiveness.

Results

The pulse pressure variation values before and after fluid infusion were lower in tetralogy of Fallot children than those in ventricular septal defect children (15.2±4.4% vs 19.3±4.4%, P<.001; 11.6±3.8 vs 15.4±4.3%, P<.001, respectively). In ventricular septal defect children, 27 were responders and 11 nonresponders. Receiver operating characteristic curve area was 0.89 (95% confidence interval, 0.77‐1.01) and cutoff value 17.4% with a sensitivity of 0.89 and a specificity of 0.91. In tetralogy of Fallot children, 26 were responders and 10 were nonresponders. Receiver operating characteristic curve area was 0.79 (95% CI, 0.64‐0.94) and cutoff value 13.4% with a sensitivity of 0.81 and a specificity of 0.80.

Conclusion

Pulse pressure variation is predictive of fluid responsiveness in ventricular septal defect and tetralogy of Fallot patients following cardiac surgery.
Effectiveness of quantitative resistance conferred by the genetic background of pepper in the control of root‐knot nematodes and influence onto durability of Me1‐ and Me3‐resistant genes in greenhouse conditions
Authors: Sánchez‐Solana Fulgencio , Ros Caridad , Guerrero María del Mar , Martínez Victoriano , Lacasa Carmen María , Hernández Ana , Palloix Alain , Lacasa Alfredo
Published: August 2017

In pepper (Capsicum annuum), the major genes (R‐genes) Me1 and Me3 confer resistance against root‐knot nematodes (Meloidogyne spp.). The combination of R‐genes and quantitative resistance factors in the same genotype is considered a good breeding strategy for increasing the durability of R‐genes. To ascertain this hypothesis, five pepper inbred lines, differing in their quantitative resistance level, were combined with Me1 or Me3 genes in F1 hybrids. The resistance of inbred lines and F1 hybrids was evaluated in a greenhouse with soil naturally infected by M. incognita in two successive growing years. In both years, lines carrying Me3 were less infected by the nematode when combined with quantitative resistance. An increase in nematode infection was observed in the second growing year in lines carrying Me1 or Me3, independently of quantitative resistance. The infection level recorded in inbred lines without R‐genes was similar in both years. The effectiveness of quantitative resistance controlling M. incognita is confirmed in greenhouse conditions, although the durability of Me1 and Me3 when combined with quantitative resistance factors was not seen to increase.
Nitric oxide is essential for the development of aerenchyma in wheat roots under hypoxic stress
Authors: Wany Aakanksha , Kumari Aprajita , Gupta Kapuganti Jagadis
Published: August 2017

In response to flooding/waterlogging, plants develop various anatomical changes including the formation of lysigenous aerenchyma for the delivery of oxygen to roots. Under hypoxia, plants produce high levels of nitric oxide (NO) but the role of this molecule in plant‐adaptive response to hypoxia is not known. Here, we investigated whether ethylene‐induced aerenchyma requires hypoxia‐induced NO. Under hypoxic conditions, wheat roots produced NO apparently via nitrate reductase and scavenging of NO led to a marked reduction in aerenchyma formation. Interestingly, we found that hypoxically induced NO is important for induction of the ethylene biosynthetic genes encoding ACC synthase and ACC oxidase. Hypoxia‐induced NO accelerated production of reactive oxygen species, lipid peroxidation, and protein tyrosine nitration. Other events related to cell death such as increased conductivity, increased cellulase activity, DNA fragmentation, and cytoplasmic streaming occurred under hypoxia, and opposing effects were observed by scavenging NO. The NO scavenger cPTIO (2‐(4‐carboxyphenyl)‐4,4,5,5‐tetramethylimidazoline‐1‐oxyl‐3‐oxide potassium salt) and ethylene biosynthetic inhibitor CoCl2 both led to reduced induction of genes involved in signal transduction such as phospholipase C, G protein alpha subunit, calcium‐dependent protein kinase family genes CDPK, CDPK2, CDPK 4, Ca‐CAMK, inositol 1,4,5‐trisphosphate 5‐phosphatase 1, and protein kinase suggesting that hypoxically induced NO is essential for the development of aerenchyma.
Randomized, double‐blind, placebo‐controlled 8‐week trial of the efficacy, safety, and tolerability of 5, 10, and 20 mg/day vortioxetine in adults with major depressive disorder
Authors: Nishimura Akira , Aritomi Yutaka , Sasai Kiyofumi , Kitagawa Tadayuki , Mahableshwarkar Atul R.
Published: August 2017

Aim

This study assessed the efficacy and safety of vortioxetine in adults with major depressive disorder.

Methods

In this double‐blind, placebo‐controlled study, 600 patients with major depressive disorder were randomly assigned (1:1:1:1) to receive vortioxetine 5, 10, or 20 mg, or placebo once daily for 8 weeks. The primary end‐point was change from baseline in Montgomery–Åsberg Depression Rating Scale (MADRS) total score at week 8, evaluated by the last‐observation‐carried‐forward method. Secondary end‐points included response (≥ 50% decrease in the MADRS total score from baseline) and remission (MADRS total score ≤ 10), Clinical Global Impression Scale‐Improvement, and change from baseline in Sheehan Disability Scale. Adverse events were summarized.

Results

Vortioxetine failed to show significant differences from placebo in the primary end‐point. Nominally significant improvements over placebo were observed for vortioxetine doses of 10 and 20 mg when the primary end‐point was evaluated using the mixed model for repeated measures as the secondary analysis, and 10 mg in secondary measures of response and patient functioning. Vortioxetine was well tolerated. Nausea, constipation, dry mouth, dizziness, and insomnia each occurred at a >twofold higher rate than placebo. Discontinuation symptom scores were comparable between all groups after 1 and 2 weeks following withdrawal of the study drug.

Conclusion

While vortioxetine failed to meet significance versus placebo in the primary efficacy analysis, there was evidence of efficacy for the 10‐ and 20‐mg doses in secondary analyses. Vortioxetine was safe and well tolerated. Additional studies appear warranted.
Antischistosome antibodies change NTPDase 1 activity from macrophages
Authors: Marconato D. G. , Gusmão M. A. do N. , Melo J. , Castro J. M. de A. , Macedo G. C. , Vasconcelos E. G. , Faria‐Pinto P.
Published: August 2017

NTPDases are enzymes that hydrolyse diphosphate and triphosphate nucleosides, regulating purinergic signalling in many organisms. The Schistosoma mansoni NTPDases, SmATPDases 1 and 2, are antigenic proteins and display a significant homology with the isoforms found in mammalian cells. In this work, we investigated whether anti‐SmATPDase antibodies from S. mansoni‐infected mice sera show cross‐reactivity with the NTPDase 1 isoform from macrophages and how this event affects the cell proliferation. By Western blot, anti‐SmATPDase antibodies present in serum from infected mice recognized 2 bands with approximately 53 and 58 kDa, corresponding to NTPDase 1. Additionally, the enzyme was identified in macrophages by immunofluorescence and the anti‐SmATPDase antibodies were able to reduce activity enzyme (22%). Macrophages incubated with commercial polyclonal antibodies reactive with NTPDase 1 (anti‐CD39) showed a reduction of 40% of the enzyme activity. In proliferation assays, macrophage proliferation was inhibited 11% and 90% by pooled sera from infected animals and anti‐CD39, respectively. The results suggest that inhibition of NTPDase 1 in macrophages by antibodies produced against the isoforms of the S. mansoni ATPDases could be a mechanism of regulation in the immune response during experimental schistosomiasis.
Detection of tumor spread through airspaces by airway secretion cytology from resected lung cancer specimens
Authors: Isaka Tetsuya , Yokose Tomoyuki , Miyagi Yohei , Washimi Kota , Nishii Teppei , Ito Hiroyuki , Nakayama Haruhiko , Yamada Kouzo , Masuda Munetaka
Published: August 2017

It currently remains unclear whether tumor spread through airspaces (STAS) actually exist in vivo or are an artifact. The morphologies of STAS and tumor cell clusters in airway secretions collected from the segmental or lobar bronchus of resected lung adenocarcinomas and squamous cell carcinomas were compared among 48 patients. The EGFR status of tumor cell clusters in airway secretions was also compared with that of the main tumor in EGFR mutant adenocarcinomas. Tumor cell clusters were observed in the airway secretion cytology of ten patients (20.8%), and eight patients were adenocarcinoma (20.0% of adenocarcinoma). The morphology of STAS closely resembled that of tumor cell clusters detected in airway secretion cytology. The positive rates of airway secretion cytology were 83.3%, 100%, and 50% in papillary adenocarcinoma, micropapillary adenocarcinoma, and invasive mucinous adenocarcinoma, respectively. Among three EGFR mutant adenocarcinomas, the EGFR mutation subtypes of the main tumors in FFPE sections and tumor cell clusters in airway secretions were identical. These indicate that STAS may be detected in the airway secretion cytology. STAS is common in papillary or micropapillary adenocarcinoma and may spread as far as the segmental or lobar bronchus at the time of surgery.
China's desertification deconstructed: towards a scientists' model based on long‐term perceptions of grassland restoration (1995–2011)
Authors: Zhao Heng , Zhao Ying , Gao Guiying , Ho Peter
Published: August 2017

There is considerable debate about the causes of grassland degradation and desertification in China. The discussion is rekindled by recent studies that claim restoration. The reversal in degradation is attributed to policies, which include the grazing ban and the pasture contract system. Contrarily, this article maintains that these studies disregard the complexity and multilayered nature of grassland degradation, and questions whether aforementioned policies have had this effect. In this context, we report on one of the first long‐term surveys (1995 and 2011) of herders' perceptions. The survey (492 valid responses) represents two ecoregions: the semiarid desert/steppe and Loess Plateau pasture. Based on the data, we adopted a renewed analytical model for scientists, termed theCCC‐Framework. The model calls for caution in proposing certain restoration measures when uncertainties are identified around a “triple C”: (1) condition of vegetation; (2) causality of degradation; and (3) costs of implementation. According to this framework, we establish uncertainty about theconditionof allegedly restored vegetation, with particular reference to herders' perceived rise in nonpalatable grass species. Moreover,causalitybetween grassland restoration and effect is difficult to ascertain due the short time frame in which most studies have been conducted. Lastly, it is doubtful whether to date undetermined ecological benefits outweigh implementationcosts, especially as the survey pinpointed herders' loss of livelihood without alternative income, illegal grazing, low legal understanding, and limited access to grassland rights.
Diagnostic performance of endobronchial ultrasound‐guided mediastinal lymph node sampling in early stage non‐small cell lung cancer: A prospective study
Authors: Vial Macarena R. , O'Connell Oisin J. , Grosu Horiana B. , Hernandez Mike , Noor Laila , Casal Roberto F. , Stewart John , Sarkiss Mona , Jimenez Carlos A. , Rice David , Mehran Reza , Ost David E. , Eapen George A.
Published: August 2017

Background and objective

Standard nodal staging of lung cancer consists of positron emission tomography/computed tomography (PET/CT), followed by endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) if PET/CT shows mediastinal lymphadenopathy. Sensitivity of EBUS‐TBNA in patients with N0/N1 disease by PET/CT is unclear and largely based on retrospective studies. We assessed the sensitivity of EBUS‐TBNA in this setting.

Methods

We enrolled patients with proven or suspected lung cancer staged as N0/N1 by PET/CT and without metastatic disease (M0), who underwent staging EBUS‐TBNA. Primary outcome was sensitivity of EBUS‐TBNA compared with a composite reference standard of surgical stage or EBUS‐TBNA stage if EBUS demonstrated N2/N3 disease.

Results

Seventy‐five patients were included in the analysis. Mean tumour size was 3.52 cm (±1.63). Fifteen of 75 patients (20%) had N2 disease. EBUS‐TBNA identified six while nine were only identified at surgery. Sensitivity of EBUS‐TBNA for N2 disease was 40% (95% CI: 16.3–67.7%).

Conclusion

A significant proportion of patients with N0/N1 disease by PET/CT had N2 disease (20%) and EBUS‐TBNA identified a substantial fraction of these patients, thus improving diagnostic accuracy compared with PET/CT alone. Sensitivity of EBUS‐TBNA however appears lower compared with historical data from patients with larger volume mediastinal disease. Therefore, strategies to improve EBUS‐TBNA accuracy in this population should be further explored
Learning and transforming conventional wisdom: Reading and rhetoric in the Elizabethan grammar school
Authors: Mack Peter
Published: August 2017

This paper examines the question of the contribution of rhetorical training to Elizabethan culture and writing in the light of our developing understanding of renaissance rhetoric. It argues that the rhetorical skills taught in the grammar school provided pupils with ways of both elaborating and transforming conventional wisdom. It begins with some general observations about rhetorical theory and the Elizabethan classroom. It considers the way in which the texts and practices of the Elizabethan grammar school inculcated rhetorical skills. It considers the contribution of rhetorical training and conventional wisdom to new thinking in some sonnets by Sidney and some Speeches from Hamlet. It concludes with some comments on the relationship between reading, writing and new thinking in Elizabethan culture.
What is the postpartum experience of Danish women following gestational diabetes? A qualitative exploration
Authors: Svensson Line , Nielsen Karoline Kragelund , Maindal Helle Terkildsen
Published: August 2017

Background

Women with gestational diabetes mellitus (GDM) receive acute but short‐term care during pregnancy. There is less direct support during the postpartum period; women are offered general advice on how to follow a healthy lifestyle to avoid developing future type 2 diabetes. Observational studies suggest that a substantial proportion of women with prior GDM do not sustain recommended lifestyle changes postpartum. In a qualitative study, we examined how Danish women diagnosed with GDM experience the transition from a GDM‐affected pregnancy to the postpartum period.

Methods

Semistructured interviews with six women diagnosed with GDM. Data were analysed using qualitative content analysis.

Results

A GDM diagnosis was accompanied by worries about the health of the woman's baby. This was also the driving force behind the women's motivation to engage in lifestyle changes during pregnancy. The outpatient treatment was perceived to be strict and associated with various challenges, including cravings and discomfort. After the delivery, taking care of the baby became the women's dominant focus. Social and emotional support from partners were needed to maintain motivation and prioritise a healthy lifestyle. The women's experience of the health system varied. However, in the postpartum period all the women experienced limited interaction and initiative from their healthcare providers in supporting them to engage in a healthy lifestyle.

Conclusions

This study identified barriers and facilitators to sustaining a healthy lifestyle postpartum. Efforts at multiple levels – including the individual, family and health system – are needed to facilitate and support a healthy lifestyle among women with prior GDM.