bluuebunny/crossref_metadata_2025 huggingface dataset:
Heparin‐bridging therapy is associated with a high risk of post‐polypectomy bleeding regardless of polyp size
Authors: Ishigami Hideaki , Arai Makoto , Matsumura Tomoaki , Maruoka Daisuke , Minemura Shoko , Okimoto Kenichiro , Kasamatsu Shingo , Saito Keiko , Nakagawa Tomoo , Katsuno Tatsuro , Yokosuka Osamu
Published: July 2016

Background and Aim

Evidence regarding safety and efficacy of heparin‐bridging therapy for colonoscopic polypectomy remains scarce. The aim of the present study was to evaluate the risk of post‐polypectomy bleeding (PPB) in patients receiving heparin‐bridging therapy.

Methods

We retrospectively reviewed the database of patients who underwent colonoscopic polypectomy with prophylactic clip closure between January 2007 and December 2014 at our institution. We evaluated patients receiving heparin‐bridging therapy (HB group) compared with those who did not receive antithrombotic therapy (No‐HB group).

Results

A total of 1421 polypectomies were carried out on 773 patients; 45 patients were in the HB group and 728 patients were in the No‐HB group. The incidence of PPB per patient was significantly higher in the HB group (22.2% vs 1.9%, P < 0.0001), and multivariate analysis showed that heparin‐bridging therapy was an independent risk factor for PPB (OR 9.80, 95% CI 4.23–22.3, P < 0.0001). In the HB group, the polyp size was not a risk factor for PPB (OR 0.67, 95% CI 0.19–2.26, P = 0.55); the incidence of PPB in lesions of <10 mm and ≥10 mm in size was 14.6% and 10.2% respectively. In contrast, that was a significant risk factor in the No‐HB group (OR 4.71, 95% CI 1.41–21.3, P = 0.011). Activated partial thromboplastin time and international normalized ratio were in or under the therapeutic range in the HB group when PPB occurred.

Conclusions

Heparin‐bridging therapy is associated with a high risk of PPB regardless of polyp size.
Reputation in an economic game modulates premotor cortex activity during action observation
Authors: Farmer Harry , Apps Matthew , Tsakiris Manos
Published: July 2016

Our interactions with other people – and our processing of their actions – are shaped by their reputation. Research has identified an Action Observation Network (AON) which is engaged when observing other people's actions. Yet, little is known about how the processing of others’ actions is influenced by another's reputation. Is the response of the AON modulated by the reputation of the actor? We developed a variant of the ultimatum game in which participants watched either the visible or occluded actions of two ‘proposers’. These actions were tied to decisions of how to split a pot of money although the proposers’ decisions on each trial were not known to participants when observing the actions. One proposer made fair offers on the majority of trials, establishing a positive reputation, whereas the other made predominantly, unfair offers resulting in a negative reputation. We found significant activations in two regions of the left dorsal premotor cortex (dPMC). The first of these showed a main effect of reputation with greater activation for the negative reputation proposer than the positive reputation proposer. Furthermore individual differences in trust ratings of the two proposers covaried with activation in the right primary motor cortex (M1). The second showed an interaction between visibility and reputation driven by a greater effect of reputation when participants were observing an occluded action. Our findings show that the processing of others’ actions in the AON is modulated by an actor's reputation, and suggest a predictive role for the PMC during action observation.
High post‐movement parietal low‐beta power during rhythmic tapping facilitates performance in a stop task
Authors: Fischer Petra , Tan Huiling , Pogosyan Alek , Brown Peter
Published: July 2016

Voluntary movements are followed by a post‐movement electroencephalography (EEG) beta rebound, which increases with practice and confidence in a task. We hypothesized that greater beta modulation reflects less load on cognitive resources and may thus be associated with faster reactions to new stimuli. EEG was recorded in 17 healthy subjects during rhythmically paced index finger tapping. In a STOP condition, participants had to interrupt the upcoming tap in response to an auditory cue, which was timed such that stopping was successful only in ~ 50% of all trials. In a second condition, participants carried on tapping twice after the stop signal (CONTINUE condition). Thus the conditions were distinct in whether abrupt stopping was required as a second task. Modulation of 12–20 Hz power over motor and parietal areas developed with time on each trial and more so in the CONTINUE condition. Reduced modulation in the STOP condition went along with reduced negative mean asynchronies suggesting less confident anticipation of the timing of the next tap. Yet participants were more likely to stop when beta modulation prior to the stop cue was more pronounced. In the STOP condition, expectancy of the stop signal may have increased cognitive load during movement execution given that the task might have to be stopped abruptly. However, within this condition, stopping ability was increased if the preceding tap was followed by a relatively larger beta increase. Significant, albeit weak, correlations confirmed that increased post‐movement beta power was associated with faster reactions to new stimuli, consistent with reduced cognitive load.
Wounds to the dorsal carpus (coronation injury) in horses: Treatment, complications and survival
Authors: Butz N. , Dreyfus A. , Fürst A. E. , Bischofberger A. S.
Published: July 2016

Studies evaluating complications, treatment and survival following wounds to the dorsal carpus (coronation injuries), despite being frequent injuries in equine practice, are lacking. The aim was to describe clinical features and identify risk factors associated with short‐ and long‐term outcomes following coronation injury in horses. Clinical data were obtained for horses undergoing treatment of unilateral or bilateral coronation injuries in a single hospital population. Descriptive data were generated for the clinical variables. Multivariable linear or logistic regression analyses was used to generate six models with short‐term outcomes defined as hospitalisation time and hospital survival; and long‐term outcomes (>6 months) defined as coronation specific mortality, sound and return to intended use, increased post‐injury stumbling and recurrence of coronation injury. One hundred and thirty‐eight horses were included. In 15.9% an extensor tendon and in 17.4% a carpal joint was involved. The prognosis for hospital survival was 97.8% and the long‐term coronation specific mortality risk was 4.3%. 87.5% were sound and returned to intended use. Risk factors for prolonged hospitalisation time were extensor tendon involvement (4.2 days), carpal joint involvement (3.8 days) and complications (skin necrosis [9.5 days] and local infection [3.2 days]. Coronation injuries reccurred in 8.8% and 20% had evidence of increased post‐injury stumbling. Administration of intra‐articular antimicrobials (7.8 times) (likely reflecting injury severity grade) and bilateral coronation injury (6.7 times) increased the odds for increased post‐injury stumbling. This study has identified risk factors for increased hospitalisation time and post‐injury stumbling, which clinicians managing coronation injuries should be aware of.
The Impact of Transparency on the Cost of Sovereign Debt in Times of Economic Crisis
Authors: Benito Bernardino , Guillamón María‐Dolores , Bastida Francisco
Published: July 2016

This paper analyses which factors determine the cost of debt, specifically in the light of the deep economic crisis the world is facing today. We evaluate the impact of transparency, financial indicators and sovereign ratings on public debt interest. We consider several measures related to transparency: transparency index, corruption index and public trust in politicians’ financial honesty index. We work with 2008 (the beginning of the economic crisis) and 2012 data for OECD and BRICS countries. Our results show that all measures connected with fiscal transparency negatively impact the cost of sovereign debt, increasing therefore the financing costs of the government in 2008. A comparison of 2008 with 2012 reveals a substitution effect. On the one hand, transparency, corruption and public trust indexes explain interest rates in the first year considered. On the other, in 2012, when the crisis started to be overcome, the fiscal situation, rather than transparency indexes, explains interest rates. In the whole time window, sovereign rating holds its explanatory power.
A Private Sector Failure, a Public Sector Crisis – Reflections on the Great Recession
Authors: Hodges Ron , Lapsley Irvine
Published: July 2016

The Great Recession from 2007/08 to date (2016) has challenged policymakers in significant ways. The initial challenge became a mission to rescue the banking sector, which had major implications for public services. The severe constraints on public finances after the rescue resulted in cutbacks in public services; an example of financial conservatism in action. Neoliberalism is the dominant mode of thinking by central governments, but its application has been questioned both on its rigour and on the evidence which is available to inform this policy. This paper examines the UK experiences of financial conservatism by mobilising ideas of failure, hope and bricolage.
Protein folding on biosensor tips: folding of maltodextrin glucosidase monitored by its interactions with GroEL
Authors: Pastor Ashutosh , Singh Amit K. , Fisher Mark T. , Chaudhuri Tapan K.
Published: July 2016

Protein folding has been extensively studied for the past six decades by employing solution‐based methods such as solubility, enzymatic activity, secondary structure analysis, and analytical methods like FRET, NMR, and HD exchange. However, for rapid analysis of the folding process, solution‐based approaches are often plagued with aggregation side reactions resulting in poor yields. In this work, we demonstrate that a bio‐layer interferometry (BLI) chaperonin detection system can identify superior refolding conditions for denatured proteins. The degree of immobilized protein folding as a function of time can be detected by monitoring the binding of the high‐affinity nucleotide‐free form of the chaperonin GroEL. GroEL preferentially interacts with proteins that have hydrophobic surfaces exposed in their unfolded or partially folded form, so a decrease in GroEL binding can be correlated with burial of hydrophobic surfaces as folding progresses. The magnitude of GroEL binding to the protein immobilized on bio‐layer interferometry biosensor inversely reflects the extent of protein folding and hydrophobic residue burial. We demonstrate conditions where accelerated folding can be observed for the aggregation‐prone protein maltodextrin glucosidase (MalZ). Superior immobilized folding conditions identified on the bio‐layer interferometry biosensor surface were reproduced on Ni‐NTA sepharose bead surfaces and resulted in significant improvement in folding yields of released MalZ (measured by enzymatic activity) compared to bulk refolding conditions in solution.
Investigating patterns of straying and mixed stock exploitation of sea trout, Salmo trutta, in rivers sharing an estuary in south‐west England
Authors: King R. A. , Hillman R. , Elsmere P. , Stockley B. , Stevens J. R.
Published: July 2016

For effective management, information on the stock composition of a fishery is essential. Here, the utility of a resident trout, Salmon trutta L, microsatellite baseline to determine the origins of sea trout entering the rivers Tamar, Tavy and Lynher in south‐west England is highlighted – all share a common estuary and have major runs of sea trout. There is a high degree of geographical structuring of the genetic variation in the baseline rivers. Testing with simulated and real data sets showed fish can be assigned to reporting group with a high degree of accuracy. Mixed stock analysis of >1000 sea trout showed that fish entering the Tamar and Tavy constituted mixed stocks. Significantly, in the Tamar, non‐natal origin sea trout are restricted to the lower catchment. As well as providing insight into sea trout behaviour, this study also has important implications for the management of recreational rod and line fisheries.
ECOWAS and Regional Integration in West Africa: From State to Emerging Private Authority
Authors: Oloruntoba Samuel O
Published: July 2016

The Economic Community of West African States was established in 1975 due to the leadership initiative of Nigeria and Togo as well as the cooperation of other Heads of State and Governments in the subregion. It was established within the framework of the consciousness of the need to develop a regional platform for cooperation and development. Since inception various institutions have been established, treaties and protocols have been signed and deadlines have been set for realising the objective conditions for which the subregional body was set up. Integration and regionalism in Africa have seen some twists and turns depending on the prevailing socio‐economic and ideological conditions both at the domestic and international environments. Various efforts have been made towards building regionalism in West Africa, especially within the context of neoliberal economic paradigm in which removal of barriers to market access and other factors of production is the main concern. Despite some successes, the effectiveness of the subregional body has been hampered through both domestic and external factors. News actors in form of private authority of indigenous multinational companies and other non‐state actors are emerging which could facilitate integration in the sub‐region in a more sublime and functional sense than the approach taken by political elites over the past 50 years. This paper discusses these new trends in integration within the theoretical prisms of networked political economy, private authority and regional identity. I also examine the institutional developments that have taken place since it was formed about 40 years ago.
The Truth of the Matter
Authors: Mussell Helen
Published: July 2016

Feminist standpoint theory (FST) has a troubled history that has limited its use and development as a core feminist epistemological project. This article revisits debates from its past, and re‐examines an apparent central problem: that of the realism identifiable in FST. Looking closely at the criticism leveled against one particular standpoint theorist—Nancy Hartsock—I show the criticism not only to be unfounded, as has previously been argued, but also unnecessary. I demonstrate that the accusations of supposedly realist contradictions in Hartsock's work are easily resolvable by engagement with critical realism (CR). I argue that CR not only accommodates Hartsock's conception of realism, and so dissolves any contention, but that CR complements and shores up FST's central claim: that situated knowledge carries with it an epistemic privilege. Another contemporary conception of realism is being developed—New Materialism (NM)—that, it could be argued, would also be a suitable ontology with which to develop FST. I show how NM could present problems for FST as a fundamentally political project, and conclude that CR offers a more fruitful future collaboration for FST.
Polymerization and Rheological Behavior of the Thermoresponsive Gelcasting System Based on N‐isopropylacrylamide
Authors: Wang Xiaofeng , Peng Chaoqun , Wang Richu , Zhang Dou , Zeng Jing , Feng Yan
Published: July 2016

Recently, we developed an efficient method for rapid drying and improving relative density of the gelcast green body. In this work, polymerization and rheological behavior of the thermoresponsive gelcasting system based on N‐isopropylacrylamide were investigated. To initiate reaction of the system with 4 mL/L of catalyst, 0.25–0.5 mg/mL of initiator is considered optimal in the optimized temperature range 15–20°C. Suspensions with 40–55 vol.% solid loading still show shear‐thinning behavior, which is favorable for mixing, degassing, and casting. The final storage moduli of consolidated suspensions are approximately 104 Pa, which is sufficiently high for gelcast green bodies.
The impact of support at the workplace on transfer of training: a study of an Indian manufacturing unit
Authors: Chauhan Ragini , Ghosh Piyali , Rai Alka , Shukla Divya
Published: July 2016

This study aims to assess the individual impacts of two components of support at the workplace, namely, support from peers and supervisor, on transfer of training in a post‐training environment. Mediation by motivation to transfer in the relationship of supervisor and peer support with transfer of training has also been examined. Data on 149 respondent employees working in a manufacturing unit owned by a leading player in the power transmission business in India has been subject to hierarchical regression analysis. Results confirm the key role of supervisor support in transfer of learned skills. However, the impact of peers on transfer is found to be greater than that of supervisors. The findings prompt us to recommend that peers should be involved in publicizing post‐training experiences and benefits. Organizations and supervisors should encourage peers to motivate employees in applying training skills to the job by means of rewards and recognition. Overall the results contribute to a better understanding of support at workplace as a predictor of transfer.
A case study of the introduction of the International Classification for Nursing Practice® in Poland
Authors: Kilańska D. , Gaworska‐Krzemińska A. , Grabowska H. , Gorzkowicz B.
Published: July 2016

Introduction

The development of a nursing practice, improvements in nurses’ autonomy, and increased professional and personal responsibility for the medical services provided all require professional documentation with records of health status assessments, decisions undertaken, actions and their outcomes for each patient. The International Classification for Nursing Practice is a tool that meets all of these needs, and although it requires continuous evaluation, it offers professional documentation and communication in the practitioner and researcher community.

Aim

The aim of this paper is to present a theoretical critique of an issue related to policy and experience of the current situation in Polish nursing – especially of the efforts to standardize nursing practices through the introduction and development of the Classification in Poland.

Discussion

Despite extensive promotion and training by International Council of Nurses members worldwide, there are still many countries where the Classification has not been implemented as a standard tool in healthcare facilities. Recently, a number of initiatives were undertaken in cooperation with the local and state authorities to disseminate the Classification in healthcare facilities.

Conclusions

Thanks to intense efforts by the Polish Nurses Association and the International Council of Nurses Accredited Center for ICNP® Research & Development at the Medical University of Łódź, the Classification is known in Poland and has been tested at several centres. Nevertheless, an actual implementation that would allow for national and international interoperability requires strategic governmental decisions and close cooperation with information technology companies operating in the country.

Implications for nursing & health policy

Discussing the barriers to the implementation of the Classification can improve understanding of it and its use. At a policy level, decision makers need to understand that use Classification in eHealth services and tools it is necessary to achieve interoperability.
Sex Difference in the Association Between Brachial Pulse Pressure and Coronary Artery Disease: The Korean Women's Chest Pain Registry (KoROSE)
Authors: Kim Hack‐Lyoung , Kim Myung‐A , Shim Wan‐Joo , Oh Sohee , Kim Mina , Park Seong Mi , Kim Yong Hyun , Na Jin Oh , Shin Mi Seung , Yoon Hyun Ju , Shin Gil Ja , Cho Yunkyung , Kim Sung‐Eun , Hong Kyung‐Soon , Cho Kyoung Im
Published: July 2016

This study was performed to investigate the association between brachial pulse pressure (PP) and the presence/extent of obstructive coronary artery disease (CAD) in men and women. Study data were obtained from a nation‐wide registry composed of 632 patients (173 men and 459 women, 58.1±10.5 years) with suspected CAD who underwent invasive coronary angiography. PP was higher in patients with obstructive CAD (≥50% stenosis) than those without CAD in both sexes (P=.032 in men; P<.001 in women). However, PP increased proportionally with the increasing number of obstructed coronary arteries in women (P<.001) but not in men (P=.070). Multiple logistic‐regression analyses demonstrated that higher PP (≥50.5 mm Hg) was an independent factor for determining obstructive CAD even after controlling for potential confounders in women (odds ratio, 2.83; 95% confidence interval, 1.40–5.73; P=.004). These results were consistent in 173 selected women matched with 173 men based on age and CAD severity. In conclusion, the association between brachial PP and obstructive CAD was more pronounced in women than in men. Brachial PP can be a simple and useful indicator of CAD especially in women.
Severity of Alopecia Predicts Coronary Changes and Arterial Stiffness in Untreated Hypertensive Men
Authors: Triantafyllidi Helen , Grafakos Agis , Ikonomidis Ignatios , Pavlidis George , Trivilou Paraskevi , Schoinas Antonis , Lekakis John
Published: July 2016

An association between androgenic alopecia (AGA), coronary artery disease, and hypertension has been reported in previous epidemiological studies. The authors evaluated the relationship of target organ damage caused by hypertension with AGA in 101 newly diagnosed and untreated hypertension men with mild to moderate AGA (AGAm), severe AGA (AGAs), and non‐AGA. Pulse wave velocity (PWV), office and 24‐hour pulse pressure (PP), carotid intima‐media thickness (IMT), left ventricular hypertrophy (LVH), coronary flow reserve (CFRd), and AGA severity by Hamilton‐Norwood scale were estimated. CFRd was significantly impaired in AGAs patients compared with AGAm (P=.007) and non‐AGA patients (P=.02). No differences were found within groups regarding PWV, PP, IMT, and LVH. AGA severity was related to CFRd (independently) and PP while AGA duration and age of onset were related to CFRd and PP, respectively. The authors conclude that impaired coronary microcirculation and aortic stiffness might precede the appearance of significant stenotic coronary lesions in hypertensive patients with severe AGA. In addition, hypertensive patients with severe and early AGA onset seem to be exposed to an augmented cardiovascular risk.
Hybrid dynamics in a species group of swallowtail butterflies
Authors: Dupuis J. R. , Sperling F. A. H.
Published: July 2016

Hybrid zones provide unique natural laboratories for studying mechanisms of evolution. But identification and classification of hybrid individuals (F1, F2, backcross, etc.) can be complicated by real population changes over time as well as by use of different marker types, both of which challenge documentation of hybrid dynamics. Here, we use multiple genetic markers (mitochondrial DNA, microsatellites and genomewide single nucleotide polymorphisms) to re‐examine population structure in a hybrid zone between two species of swallowtail butterflies in western Canada, Papilio machaon and P. zelicaon. Our aim was to test whether their hybrid dynamics remain the same as found 30 years ago using morphology and allozymes, and we compared different genetic data sets as well as alternative hybrid identification and classification methods. Overall, we found high differentiation between the two parental species, corroborating previous research from the 1980s. We identified fewer hybrid individuals in the main zone of hybridization in recent years, but this finding depended on the genetic markers considered. Comparison of methods with simulated data sets generated from our data showed that single nucleotide polymorphisms were more powerful than microsatellites for both hybrid identification and classification. Moreover, substantial variation among comparisons underlined the value of multiple markers and methods for documenting evolutionarily dynamic systems.
Otolith shape lends support to the sensory drive hypothesis in rockfishes
Authors: Tuset V. M. , Otero‐Ferrer J. L. , Gómez‐Zurita J. , Venerus L. A. , Stransky C. , Imondi R. , Orlov A. M. , Ye Z. , Santschi L. , Afanasiev P. K. , Zhuang L. , Farré M. , Love M.S. , Lombarte A.
Published: July 2016

The sensory drive hypothesis proposes that environmental factors affect both signalling dynamics and the evolution of signals and receivers. Sound detection and equilibrium in marine fishes are senses dependent on the sagittae otoliths, whose morphological variability appears intrinsically linked to the environment. The aim of this study was to understand if and which environmental factors could be conditioning the evolution of this sensory structure, therefore lending support to the sensory drive hypothesis. Thus, we analysed the otolith shape of 42 rockfish species (Sebastes spp.) to test the potential associations with the phylogeny, biological (age), ecological (feeding habit and depth distribution) and biogeographical factors. The results showed strong differences in the otolith shapes of some species, noticeably influenced by ecological and biogeographical factors. Moreover, otolith shape was clearly conditioned by phylogeny, but with a strong environmental effect, cautioning about the use of this structure for the systematics of rockfishes or other marine fishes. However, our most relevant finding is that the data supported the sensory drive hypothesis as a force promoting the radiation of the genus Sebastes. This hypothesis holds that adaptive divergence in communication has significant influence relative to other life history traits. It has already been established in Sebastes for visual characters and organs; our results showed that it applies to otolith transformations as well (despite the clear influence of feeding and depth), expanding the scope of the hypothesis to other sensory structures.
Automated otolith image classification with multiple views: an evaluation onSciaenidae
Authors: Wong J. Y. , Chu C. , Chong V. C. , Dhillon S. K. , Loh K. H.
Published: July 2016

Combined multiple2Dviews (proximal, anterior and ventral aspects) of the sagittal otolith are proposed here as a method to capture shape information for fish classification. Classification performance of single view compared with combined2Dviews show improved classification accuracy of the latter, for nine species of Sciaenidae. The effects of shape description methods (shape indices, Procrustes analysis and elliptical Fourier analysis) on classification performance were evaluated. Procrustes analysis and elliptical Fourier analysis perform better than shape indices when single view is considered, but all perform equally well with combined views. A generic content‐based image retrieval (CBIR) system that ranks dissimilarity (Procrustes distance) of otolith images was built to search query images without the need for detailed information of side (left or right), aspect (proximal or distal) and direction (positive or negative) of the otolith. Methods for the development of this automated classification system are discussed.
Factors Associated With Ineligibility for PCI Differ Between Inpatient and Outpatient ST‐Elevation Myocardial Infarction
Authors: Jaski Brian E. , Grigoriadis Christopher E. , Dai Xuming , Meredith Richard D. , Ortiz Bryan C. , Stouffer George A. , Thomas Lorie , Smith Sidney C.
Published: July 2016

Objectives

Without early revascularization, both inpatient and outpatient STEMIs have poor outcomes. Reasons for denying PCI for STEMI, however, remain uncertain. This single‐center retrospective cohort study compares factors and outcomes associated with ineligibility for PCI between inpatients and outpatients following ST‐elevation myocardial infarction (STEMI).

Methods

A total of 1,759 STEMI patients between June 2009 and January 2015 were assessed. Individual medical records were reviewed to obtain reasons for PCI ineligibility for STEMI patients who did not receive reperfusion therapy.

Results

Compared to outpatients with STEMI (n = 1,688), inpatients (n = 71) were less likely to receive coronary angiography (60.6% vs 95.9%; P < 0.001) or PCI (50.7% vs 80.9%; P < 0.001), with longer ECG/door to first device activation times (97 [78, 131] vs 63 [49, 78] minutes; P < 0.001). When coronary angiography was performed, however, similar rates of PCI and procedural success were seen in both groups. Principal contraindication for PCI was risk of bleeding within the inpatient population and complex coronary artery disease within the outpatient population. Total in‐hospital mortality was higher in inpatient STEMIs compared to outpatients (42.2% vs 10.0%; P < 0.001), but lower for patients eligible for PCI in both groups.

Conclusions

Reasons for PCI ineligibility differ between inpatient and outpatient STEMIs. Inpatients have increased risks of bleeding, lower coronary angiography and PCI use, and higher in‐hospital mortality. Especially for inpatients, specific PCI STEMI protocols that anticipate and overcome types of ineligibility and delay for cardiac catheterization may improve outcomes.
OLDER PEOPLE WITH CHRONIC KIDNEY DISEASE: DEFINITION, AND INFLUENCE OF BIOMARKERS AND MEDICATIONS UPON CARDIOVASCULAR AND RENAL OUTCOMES
Authors: Raman Maharajan , Green Darren , Middleton Rachel J. , Kalra Philip A.
Published: July 2016

Background

Chronic kidney disease (CKD) is a global problem. With an ageing population the burden on the health services has increased due to the growing number of older people with CKD. This group of individuals is far different to the younger CKD population and their risk of cardiovascular death is far greater than the risk of progressing to end stage kidney disease (ESKD).

Objective

In this review we explore the role of certain biomarkers and medications in predicting the risk of progression to ESKD and death in old people with CKD.

Methods

An electronic literature search of EMBASE and MEDLINE databases was performed using Healthcare Databases Advanced Search (HDAS) in December 2014.

Results

Albuminuria is a key biomarker in predicting the risk of death and progression to ESKD. Cystatin C appears to be superior in predicting the risk of cardiovascular and non‐cardiovascular death compared to GFR or creatinine. Several inflammatory biomarkers can be used to predict the risk of death and progression to CKD but measuring and monitoring them in routine clinical practice will be expensive and impractical. The effects of long‐term RAAS inhibition in older people are not well established. Older people especially those with CKD receive suboptimal secondary preventive measures. Due to multiple comorbidities older people with CKD are usually receiving a number of medications. This can potentially lead to significant adverse drug events (ADE) due to drug interactions.

Conclusion

Novel non‐traditional risk factors like albuminuria, Cystatin C and inflammatory biomarkers play an important role in predicting their risk of death and progression to ESKD. The efficacy and safety of medications in older people with CKD is not well established and requires more extensive, focused study.
NURSE STAFFING AND RENAL ANAEMIA OUTCOMES IN HAEMODIALYSIS CARE
Authors: Erlingmark Julia , Hedström Mariann , Lindberg Magnus
Published: July 2016

Background

Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes.

Objectives

To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management.

Design

Cross‐sectional audit.

Participants

Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data.

Measurements

The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management.

Results

The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse‐driven anaemia management, compared with 47.3% at physician‐driven centres.

Conclusions

These cross‐sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation.
Ellagic acid confers protection against gentamicin-induced oxidative damage, mitochondrial dysfunction and apoptosis-related nephrotoxicity
Authors: Sepand Mohammad Reza , Ghahremani Mohammad Hossein , Razavi-Azarkhiavi Kamal , Aghsami Mehdi , Rajabi Jalil , Keshavarz-Bahaghighat Hedieh , Soodi Maliheh
Published: July 2016

Objectives

The aim of this study was to investigate the possible protective effect of ellagic acid (EA) against gentamicin (GEN)-induced nephrotoxicity using biochemical, molecular and histopathological approaches.

Methods

Rats (n = 24) were divided into four groups: control, GEN (100 mg/kg, i.p.), EA (10 mg/kg, p.o.) and GEN plus EA. The regimes were administered for 10 successive days. 24 h after last treatment, kidney and blood samples were collected.

Key findings

Ellagic acid treatment significantly reduced plasma creatinine and urea levels, which were initially increased due to GEN administration. Also, EA significantly ameliorated oxidative stress markers including lipid peroxidation, catalase (CAT) and superoxide dismutase (SOD) enzyme activity as well as glutathione (GSH) content in kidney tissue. Activation of caspase-3 and increase in the ratio of Bcl-2/Bax expression observed in GEN-treated group were significantly ameliorated by EA treatment. EA also protected GEN-induced mitochondrial damages as indicated by decreasing the mitochondrial ROS content, preventing of mitochondrial membrane potential (MMP) loss, reducing mitochondrial swelling and decreasing cytochrome c release. In addition, histopathological findings revealed that EA ameliorates GEN-induced kidney injury.

Conclusions

Our findings suggest that EA treatment attenuates GEN-induced nephrotoxicity, which may be ascribed to its antioxidant and anti-apoptotic properties.
Chlorogenic acid inhibits cholestatic liver injury induced by α-naphthylisothiocyanate: involvement of STAT3 and NFκB signalling regulation
Authors: Tan Zhen , Luo Min , Yang Julin , Cheng Yuqing , Huang Jing , Lu Caide , Song Danjun , Ye Meiling , Dai Manyun , Gonzalez Frank J , Liu Aiming , Guo Bin
Published: July 2016

Objectives

Chlorogenic acid (CGA) is one of the most widely consumed polyphenols in diets and is recognized to be a natural hepatoprotective agent. Here, we evaluated the protective effect and the potential mechanism of CGA against ɑ-naphthylisothiocyanate (ANIT)-induced cholestasis and liver injury.

Methods

Twenty-five male 129/Sv mice were administered with CGA, and ANIT challenge was performed at 75 mg/kg on the 4th day. Blood was collected and subjected to biochemical analysis; the liver tissues were examined using histopathological analysis and signalling pathways.

Key findings

Chlorogenic acid almost totally attenuated the ANIT-induced liver damage and cholestasis, compared with the ANIT group. Dose of 50 mg/kg of CGA significantly prevented ANIT-induced changes in serum levels of alanine aminotransferase, alkaline phosphatases, total bile acid, direct bilirubin, indirect bilirubin (5.3-, 6.3-, 18.8-, 158-, 41.4-fold, P<0.001) and aspartate aminotransferase (4.6-fold, P<0.01). Expressions of the altered bile acid metabolism and transport-related genes were normalized by cotreatment with CGA. The expressions of interleukin 6, tumour necrosis factor-α and suppressor of cytokine signalling 3 were found to be significantly decreased (1.2-fold, ns; 11.0-fold, P<0.01; 4.4-fold, P<0.05) in the CGA/ANIT group. Western blot revealed that CGA inhibited the activation and expression of signal transducer and activator of transcription 3 and NFκB.

Conclusions

These data suggest that CGA inhibits both ANIT-induced intrahepatic cholestasis and the liver injury. This protective effect involves down-regulation of STAT3 and NFκB signalling.
The influence of non-ionisable excipients on precipitation parameters measured using the CheqSol method
Authors: Etherson Kelly , Halbert Gavin , Elliott Moira
Published: July 2016

Objectives

The aim of this study was to determine the influence of non-ionisable excipients hydroxypropyl-β-cyclodextrin (HPβCD) and poloxamers 407 and 188 on the supersaturation and precipitation kinetics of ibuprofen, gliclazide, propranolol and atenolol induced through solution pH shifts using the CheqSol method.

Methods

The drug's kinetic and intrinsic aqueous solubilities were measured in the presence of increasing excipient concentrations using the CheqSol method. Experimental data rate of change of pH with time was also examined to determine excipient-induced parachute effects and influence on precipitation rates.

Key findings

The measured kinetic and intrinsic solubilities provide a determination of the influence of each excipient on supersaturation index, and the area under the CheqSol curve can measure the parachute capability of excipients. The excipients influence on precipitation kinetics can be measured with novel parameters; for example, the precipitation pH or percentage ionised drug at the precipitation point, which provide further information on the excipient-induced changes in precipitation performance.

Conclusion

This method can therefore be employed to measure the influence of non-ionisable excipients on the kinetic solubility behaviour of supersaturated solutions of ionisable drugs and to provide data, which discriminates between excipient systems during precipitation.
Oral delivery of insulin for treatment of diabetes: status quo, challenges and opportunities
Authors: Wong Chun Y , Martinez Jorge , Dass Crispin R
Published: July 2016

Objectives

Diabetes mellitus is characterised by progressive β-cell destruction and loss of function, or loss of ability of tissues to respond to insulin. Daily subcutaneous insulin injection is standard management for people with diabetes, although patient compliance is hard to achieve due to the inconvenience of injections, so other forms of delivery are being tested, including oral administration. This review summarises the developments in oral insulin administration.

Methods

The PubMed database was consulted to compile this review comparing conventional subcutaneous injection of insulin to the desired oral delivery.

Key findings

Oral administration of insulin has potential benefits in reducing pain and chances of skin infection, improving the portal levels of insulin and avoiding side effects such as hyperinsulinemia, weight gain and hypoglycaemia. Although oral delivery of insulin is an ideal administration route for patients with diabetes, several physiological barriers have to be overcome. An expected low oral bioavailability can be attributed to its high molecular weight, susceptibility to enzymatic proteolysis and low diffusion rate across the mucin barrier.

Conclusions

Strategies for increasing the bioavailability of oral insulin include the use of enzyme inhibitors, absorption enhancers, mucoadhesive polymers and chemical modification for endogenous receptor-mediated absorption. These may help significantly increase patient compliance and disease management.
Diabetes may affect the expression of matrix metalloproteinases and their inhibitors more than smoking in chronic periodontitis
Authors: Bastos M. F. , Tucci M. A. , de Siqueira A. , de Faveri M. , Figueiredo L. C. , Vallim P. C. , Duarte P. M.
Published: July 2016

Background and Objective

No previous study has directly compared the levels of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) between smokers and individuals with diabetes mellitus (DM) with periodontitis. Therefore, the aim of this study was to evaluate the gene expression of MMP‐1, MMP‐2, MMP‐8, MMP‐9, TIMP‐1 and TIMP‐2 in tissues with chronic periodontitis (ChP) of smokers and individuals with type 2 DM.

Material and Methods

Gingival biopsies were harvested from: non‐smokers and non‐diabetic individuals with ChP (n = 18) (ChP group); non‐diabetic smokers (≥ 10 cigarettes per day for at least the past 5 years) with ChP (n = 18) (SChP group); non‐smoking individuals with type 2 diabetes (glycated hemoglobin levels ≥ 7.5%) and ChP (n = 18) (DMChP group). The tissue levels of mRNA of MMP‐1, MMP‐2, MMP‐8, MMP‐9, TIMP‐1 and TIMP‐2 were evaluated by quantitative real‐time polymerase chain reaction.

Results

The MMP‐8 expression was the lowest in the ChP group (p < 0.05). The DMChP group presented increased mRNA levels of MMP‐2 and MMP‐9, when compared to the SChP group (p < 0.05). MMP‐1 expression and the MMP‐1/TIMP‐1, MMP‐2/TIMP‐1, MMP‐8/TIMP‐1, MMP‐9/TIMP‐1, MMP‐1/TIMP‐2 and MMP‐2/TIMP‐2 ratios were higher in the DMChP group than in the ChP and SChP groups (p < 0.05). The DMChP group presented lower mRNA levels of TIMP‐1 than the ChP group (p < 0.05). The MMP‐8/TIMP‐2 ratio was the highest in the SChP group (p < 0.05).

Conclusion

Uncontrolled type 2 DM upregulates the ratio of MMP/TIMPs in sites with ChP more than smoking, which may contribute to a greater extracellular matrix degradation and periodontal breakdown in DM‐related periodontitis.
Experiences of Korean adolescent renal transplant recipients
Authors: Kim Sumi , Choi Heeseung
Published: July 2016

Purpose

To understand the experiences of Korean adolescents who have undergone a renal transplant.

Design and Methods

Nine adolescents aged 12–18 who received a renal transplant participated in this qualitative descriptive study. Using content analysis, we analyzed in‐depth interview data from individual adolescents.

Results

The main themes extracted were “being different from others,” “not being invited as a decision maker,” “becoming one of them,” “still being different from others,” “having mixed feeling toward mothers,” and “coping with new circumstances.”

Practice Implications

Interventions designed to improve adolescent renal transplant recipients’ sense of autonomy and belongingness are needed.
The impact of infection by multidrug‐resistant agents in patients with cirrhosis. A multicenter prospective study
Authors: Salerno Francesco , Borzio Mauro , Pedicino Claudia , Simonetti Rosa , Rossini Angelo , Boccia Sergio , Cacciola Irene , Burroughs Andrew K. , Manini Matteo A. , La Mura Vincenzo , Angeli Paolo , Bernardi Mauro , Dalla Gasperina Daniela , Dionigi Elena , Dibenedetto Clara , Arghittu Milena ,   the AISF Investigators
Published: July 2016

Background & Aims

Bacterial strains resistant to antibiotics are a serious clinical challenge. We assessed the antibiotic susceptibility of bacteria isolated from infections in patients with cirrhosis by a multicentre investigation.

Results

Three hundred and thirteen culture‐positive infections (173 community acquired [CA] and 140 hospital acquired [HA]) were identified in 308 patients. Urinary tract infections, spontaneous bacterial peritonitis and bacteremias were the most frequent. Quinolone‐resistant Gram‐negative isolates were 48%, 44% were extended‐spectrum beta‐lactamase producers and 9% carbapenem resistant. In 83/313 culture‐positive infections (27%), multidrug‐resistant agents (MDRA) were isolated. This prevalence did not differ between CA and HA infections. MDRA were identified in 17 of 37 patients on quinolone prophylaxis, and in 46 of 166 not on prophylaxis (45% vs 27%; P<.03). In 287 cases an empiric antibiotic therapy was undertaken, in 37 (12.9%) this therapy failed. The in‐hospital mortality rate of this subset of patients was significantly higher compared to patients who received an effective broad(er)‐spectrum therapy (P=.038). During a 3‐month follow‐up, 56/203 culture‐positive patients (27.6%) died, 24/63 who have had MDRA‐related infections (38%) and 32/140 who have had antibiotic‐susceptible infections (22.8%) (P=.025). Multivariate analysis disclosed MDRA infection, age, hepatocellular carcinoma, bilirubin, international normalized ratio and the occurrence of portal hypertension‐related complications independent predictors of death.

Conclusions

Infection by MDRA is frequent in patients with cirrhosis and the prognosis is severe, especially in patients unresponsive to empiric antibiotic therapy.
Clusterin expression is upregulated following acute head injury and localizes to astrocytes in old head injury
Authors: Troakes Claire , Smyth Rachel , Noor Farzana , Maekawa Satomi , Killick Richard , King Andrew , Al‐Sarraj Safa
Published: July 2016

There is mounting evidence linking traumatic brain injury (TBI) to neurodegeneration. Clusterin (apolipoprotein J or ApoJ) is a complement inhibitor that appears to have a neuroprotective effect in response to tissue damage and has been reported to be upregulated in Alzheimer's disease. Here we investigated the time course and cellular expression pattern of clusterin in human TBI. Tissue from 32 patients with TBI of varying survival times (from under 30 min to 10 months) was examined using immunohistochemistry for clusterin alongside other markers of neurodegeneration and neuroinflammation. TBI cases were compared to ischemic brain damage, Alzheimer's disease and controls. Double immunofluorescence was carried out in order to examine cellular expression. Clusterin was initially expressed in an axonal location less than 30 min following TBI and increased in intensity and the frequency of deposits with increasing survival time up to 24 h, after which it appeared to reduce in intensity but was still evident several weeks after injury. Clusterin was first evident in astrocytes after 45 min, being increasingly seen up to 48 h but remaining intense in TBI cases with long survival times. Our results suggest clusterin plays a role in modulating the inflammatory response of acute and chronic TBI and that it is a useful marker for TBI, particularly in cases with short survival times. Its prominent accumulation in astrocytes, alongside a mounting inflammatory response and activation of microglial cells supports a potential role in the neurodegenerative changes that occur as a result of TBI.
Nutrition meets the microbiome: micronutrients and the microbiota
Authors: Biesalski Hans K.
Published: July 2016

There is increasing evidence that food is an important factor that influences and shapes the composition and configuration of the gut microbiota. Most studies have focused on macronutrients (fat, carbohydrate, protein) in particular and their effects on the gut microbiota. Although the microbiota can synthesize different water‐soluble vitamins, the effects of vitamins synthesized within the microbiota on systemic vitamin status are unclear. Few studies exist on the shuttling of vitamins between the microbiota and intestine and the impact of luminal vitamins on the microbiota. Studying the interactions between vitamins and the microbiota may help to understand the effects of vitamins on the barrier function and immune system of the intestinal tract. Furthermore, understanding the impact of malnutrition, particularly low micronutrient supply, on microbiota development, composition, and metabolism may help in implementing new strategies to overcome the deleterious effects of malnutrition on child development. This article reviews data on the synthesis of different micronutrients and their effects on the human microbiota, and further discusses the consequences of malnutrition on microbiota composition.