bluuebunny/crossref_metadata_2025 huggingface dataset:
In utero Partial Exchange Transfusion Combined with in utero Blood Transfusion for Prenatal Management of Twin Anemia-Polycythemia Sequence
Authors: Bahtiyar Mert Ozan , Ekmekci Emre , Demirel Emine , Irani Roxanna A. , Copel Joshua A.
Published: March 2018

Monochorionic twin pregnancies are at risk of unique complications due to placental sharing and vascular connections between placental territories assigned for each twin. Twin anemia-polycythemia sequence (TAPS) is an infrequent but potentially dangerous complication of abnormal placental vascular connections. TAPS occurs due to very-small-caliber (< 1 mm) abnormal placental vascular connections which lead to chronic anemia in the donor twin and polycythemia in the recipient twin. TAPS may occur spontaneously or following fetoscopic laser photocoagulation of communicating placental vessels for twin-twin transfusion syndrome. One of the hallmarks of TAPS is the absence of polyhydramnios and oligohydramnios. The postnatal diagnosis is based on significant hemoglobin discrepancy between the twins. Middle cerebral artery peak systolic velocity Doppler ultrasound allows for the prenatal diagnosis of TAPS. The optimal prenatal treatment and intervention timing has not been established. Here, we report 3 spontaneous TAPS cases diagnosed and managed in the prenatal period with a combination of in utero blood transfusion for the anemic twin (donor) and in utero partial exchange transfusion for the polycythemic twin (recipient). These cases contribute to the limited outcome data of this underutilized method for the management of TAPS.
An Arabic Version of the Geriatric Depression Scale (30 Items): Psychometric Properties and Some Findings in a Lebanese Elderly Sample
Authors: Hallit Souheil , Hallit Rabih , Daher Marie-Claude , Hachem Dory , Kheir Nelly , Salameh Pascale
Published: March 2018

Background/Aim: Although the rates of depression and anxiety disorders have been shown to be higher in older people, especially those living in institutional settings, most of this population remains undiagnosed and untreated. The objective is to translate the full-scale Geriatric Depression Scale (30 items, GDS) into Arabic for use in elderly patients in Lebanon, to check its validity and reproducibility in comparison to the original version of the questionnaire, and assess the risk factors associated with depression in the Lebanese geriatric population. Methods: This case-control study was conducted between June and August 2016 and included 500 patients aged more than 60 years (250 living inside and 250 outside a nursing home). Results: Strongly positive correlations (p < 0.001 for all items of the scale) were found between each item of the scale and the total scale. The mean inter-item correlation for our scale was 0.51, higher than that of the original scale (0.36), with an excellent internal consistency (Cronbach α = 0.901). Living in a nursing home, stress, anxiety, being married, age, and the primary level of education would significantly increase depression (β = 2.211, β = 0.223, β = 0.041, β = 0.902, β = 0.118, and β = 3.533, respectively). A normal nutritional status and a university level of education would significantly decrease depression (β = –0.732; β = –1.961). Conclusion: The Arabic version of the GDS can be used to estimate the severity of depression in the Lebanese elderly population. Periodic screening for anxiety, nutritional status, and stress is also recommended among geriatric people living in Lebanon.
Tissue Plasminogen Activator as an Antiangiogenic Agent in Experimental Corneal Neovascularization in Rabbits
Authors: Arai Kon-ichi , Yasukawa Tsutomu , Kato Aki , Kubota Ayae , Usui Hideaki , Takase Noriaki , Kuwayama Soichiro , Ogura Yuichiro
Published: March 2018

Aims: Anti-vascular endothelial growth factor agents effectively treat age-related macular degeneration and myopic choroidal neovascularization (CNV). Tissue plasminogen activator (tPA), a fibrinolytic compound, is used as an adjuvant to displace submacular hemorrhage and to treat type 2 CNV. The purpose of this study was to investigate in in vitro and in vivo experiments the antiangiogenic impact of tPA itself. Methods: The impact of tPA on the proliferation of human umbilical vein endothelial cells (HUVECs) was assessed by an XTT assay [2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide]. A basic fibroblast growth factor-impregnated gelatin hydrogel sheet was implanted into the rabbit cornea to induce corneal neovascularization. Immediately postoperatively, tPA or buffered saline solution (control) was injected intravitreally. Results: The growth and viability of the HUVECs were unaffected by tPA at clinical concentrations. In the control group, the mean lengths of the new vessels were 1.0 ± 0.41, 1.6 ± 0.75, and 3.6 ± 2.1 mm at weeks 1, 2, and 4, respectively. In contrast, tPA significantly (p < 0.01) reduced the corneal neovascularization. Conclusion: Although tPA has no direct impact on the vascular endothelial cells in vitro, the fibrinolytic effects of tPA might markedly suppress neovascularization in vivo.
Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal
Authors: Simões Carolina , Santos Sara , Vicente Madalena , Sousa Cardoso Filipe
Published: March 2018

Background and Aims: Acute liver failure (ALF) is a rare disease with potentially high mortality rates. We aimed to study the recent epidemiology of ALF in one of the Portuguese liver transplant (LT) regions. Methods: We assessed a retrospective cohort including 34 consecutive patients with ALF admitted to the intensive care unit (ICU) of Curry Cabral Hospital (Lisbon, Portugal) between October 2013 and December 2016. Results: The median age (IQR) was 49 (31–67) years, and 21 (62%) of the cohort were female. Non-paracetamol etiologies were found in 29 patients (85%). On ICU admission, grade 3–4 hepatic encephalopathy developed in 10 patients (29%); invasive mechanical ventilation, vasopressors, and renal replacement therapy were required for 8 (24%), 7 (21%), and 5 (15%) of the patients, respectively; the King’s College criteria (KCC) were fulfilled by 16 patients (47%). Of the 15 (44%) nontransplanted patients, 11 (73%) died during their hospital stay. Of the 19 (56%) transplanted patients, 4 (21%) died during their hospital stay. KCC were not associated with hospital mortality (p = 0.97), but they were significantly associated with LT (p = 0.008). Conclusions: In a Portuguese cohort of patients with ALF, non-paracetamol etiologies were predominant. Hospital mortality was much lower amongst transplanted patients.
Maternal and Foetal Health Implications of Vitamin D Status during Pregnancy
Authors: Larqué Elvira , Morales Eva , Leis Rosaura , Blanco-Carnero José E.
Published: March 2018

Background: To what extent does the circulating 25-hydroxyvitamin D (25[OH]D) concentration help to meet the physiological needs of humans is an ongoing subject of debate. Remaining unexposed to the sun to reduce melanoma cancer risk, current lifestyle with less out door activities, and increasing obesity rates, which in turn increases the storage of vitamin D in the adipose tissue, are presumably factors that contribute to the substantial upsurge in the prevalence of vitamin D deficiency in humans. Since evidence is lacking regarding the appropriate cut-off points to define vitamin D status during pregnancy, references used to establish the intake recommendations and vitamin D content of prenatal vitamin supplements are quite conservative. Summary: The foetus depends fully on maternal 25(OH)D supply. 25(OH)D readily crosses the placenta and it is activated into 1,25(OH)2D by foetal kidneys. Moreover, 1,25(OH)2D can also be synthesized within the placenta to regulate placental metabolism. The importance of vitamin D during pregnancy for maintaining maternal calcium homeostasis and therefore for foetal bone development is well recognized; major discussions are in progress regarding the potential maternal detrimental effects on pregnancy outcomes, foetal development, and the long-term health of children. Interventional studies have also evaluated the effect of vitamin D for reduction on preterm birth and asthma programming. Key Messages: Clinically, by understanding the effects of vitamin D on perinatal outcomes, we could individualize antenatal counselling regarding vitamin D supplementation to ensure vitamin D repletion without increasing the risk of foetal hypercalcemia.
Atypical Hemolytic Uremic Syndrome in Children Aged <2 Years
Authors: Çakar Nilgun , Ozcakar Z. Birsin , Ozaltin Fatih , Koyun Mustafa , Celikel Acar Banu , Bahat Elif , Gulhan Bora , Korkmaz Emine , Yurt Ayşe , Yılmaz Songül , Soylemezoglu Oğuz  , Yalcinkaya Fatoş
Published: March 2018

Background: There are limited data on infants with atypical hemolytic uremic syndrome (aHUS). The aim of this study was to determine the clinical and laboratory features, and to evaluate treatment modalities and outcomes in infants with aHUS. Materials and Methods: Relevant data on patients with onset of aHUS at age <2 years were obtained from the Turkish Pediatric aHUS Registry. Results: Among the 146 patients included in the Registry, 53 (36%) (23 male and 30 female) were enrolled for the study. Age at disease onset was ≤1 year in 29 of the patients. In all, 21 (40%) of the patients developed neurological symptoms. Disease-causing mutations were noted in 14 (36%) of the 39 patients in which genetic analysis was performed. Plasma therapy was performed in 42 (79%) patients; eculizumab therapy was administered to treat the first episode of aHUS in 33 (62%) patients and in 5 patients as the first- line therapy. In total, 38 (72%) patients received renal replacement therapy (RRT), 3 (6%) died due to acute illness, and 4 (8%) were discharged from hospital with RRT. Follow-up visit data were available for 46 patients and the median duration was 23 months (range 3–129 months). End-stage renal disease developed only in 1 patient. Proteinuria and hypertension persisted in 17 (37%) and 20 patients (44%) respectively. Eculizumab treatment was continued in 25 of the 39 patients during the follow-up period. Conclusion: One-third of the aHUS patients had disease onset during infancy. The prognosis of this life-threatening disease seems to get better with improved treatment modalities.
Sleep-Related Leg Movements in Patients with Transient Ischemic Attack and Controls
Authors: Schipper Mirjam H. , Jellema Korné , Alvarez-Estevez Diego , Verbraecken Johan , Rijsman Roselyne M.
Published: March 2018

Background: Periodic leg movements during sleep (PLMS) have been associated with an increased risk for cardiovascular diseases and there is a high prevalence of PLMS found in patients with obstructive sleep apnea syndrome (OSAS). We evaluated patients with transient ischemic attack (TIA) for PLMS and respiratory related leg movements (RRLM), versus a control group without TIA. Methods: Twenty-five patients with TIA and 34 patients with no vascular diagnosis were referred for polysomnography. Diagnosis of PLMS was made if the periodic leg movement index (PLMI) was ≥5 and clinical significant as PLMI ≥15. Results: There was no significant difference in PLMI ≥5 and ≥15 between patients with and without TIA. In the absence of OSAS, 2 out of 5 TIA patients (40%) had a PLMI ≥15 compared to 1 of the 19 patients without TIA (5%; p = 0.037). There was no increase in RRLMs when OSAS was present. Conclusions: TIA patients did not have higher PLMI compared to controls, and in the presence of OSAS, there was no increase in RRLMs compared to patients without TIA. In selective patients, PLMS could be associated with cardiovascular diseases, since PLMS was clinically more often found in the TIA group without OSAS.
N-Acetyl-Glucosamine Sensitizes Non-Small Cell Lung Cancer Cells to TRAIL-Induced Apoptosis by Activating Death Receptor 5
Authors: Liang Ye , Xu Wenhua , Liu Shihai , Chi Jingwei , Zhang Jisheng , Sui Aihua , Wang Liping , Liang Zhijuan , Li Dan , Chen Yuanbin , Niu Haitao
Published: March 2018

Background/Aims: Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a potential anti-cancer agent due to its selective toxicity. However, many human non-small cell lung cancer (NSCLC) cells are partially resistant to TRAIL, thereby limiting its clinical application. Therefore, there is a need for the development of novel adjuvant therapeutic agents to be used in combination with TRAIL. Methods: In this study, the effect of N-acetyl-glucosamine (GlcNAc), a type of monosaccharide derived from chitosan, combined with TRAIL was evaluated in vitro and in vivo. Thirty NSCLC clinical samples were used to detect the expression of death receptor (DR) 4 and 5. After GlcNAc and TRAIL co-treatment, DR expression was determined by real-time PCR and western blotting. Cycloheximide was used to detect the protein half-life to further understand the correlation between GlcNAc and the metabolic rate of DR. Non-reducing sodium dodecyl sulfate-polyacrylamide gel electrophoresis was used to detect receptor clustering, and the localization of DR was visualized by immunofluorescence under a confocal microscope. Furthermore, a co-immunoprecipitation assay was performed to analyze the formation of death-inducing signaling complex (DISC). O-linked glycan expression levels were evaluated following DR5 overexpression and RNA interference mediated knockdown. Results: We found that the clinical samples expressed higher levels of DR5 than DR4, and GlcNAc co-treatment improved the effect of TRAIL-induced apoptosis by activating DR5 accumulation and clustering, which in turn recruited the apoptosis-initiating protease caspase-8 to form DISC, and initiated apoptosis. Furthermore, GlcNAc promoted DR5 clustering by improving its O-glycosylation. Conclusion: These results uncovered the molecular mechanism by which GlcNAc sensitizes cancer cells to TRAIL-induced apoptosis, thereby highlighting a novel effective agent for TRAIL-mediated NSCLC-targeted therapy.
Upregulation of Long Non-Coding RNA Small Nucleolar RNA Host Gene 12 Contributes to Cell Growth and Invasion in Cervical Cancer by Acting as a Sponge for MiR-424-5p
Authors: Dong Jing , Wang Qing , Li Li , Xiao-jin Zhang
Published: March 2018

Background/Aims: Cervical cancer, which is one of the most aggressive cancers affecting females, has high rates of recurrence and mortality. Small nucleolar RNA host gene 12 (SNHG12) is known to promote the progression of several cancers; however, its exact effects and molecular mechanisms in cervical cancer remain unknown. Methods: Real-time quantitative PCR was used to determine the expression level of SNHG12 in cervical cancer tissues and cell lines. Loss-of-function assays were performed to examine the effect of SNHG12 on the proliferation, apoptosis, migration and invasion of cervical cancer cells in vitro and tumor growth in vivo. Luciferase experiments were employed to explore the interactions between SNHG12 and miR-424-5p. Results: SNHG12 was found to be abnormally elevated in human cervical cancer tissues compared with paired adjacent normal tissues. Moreover, high SNHG12 expression in tumor tissues was significantly correlated with vascular involvement, lymph node metastasis, advanced FIGO stage and poor prognosis. Furthermore, the knockdown of SNHG12 was found to inhibit proliferation, migration and invasion of cervical cancer cells in vitro, and silencing SNHG12 was shown to suppress tumor growth in a nude mouse model. Mechanistic studies showed that SNHG12 functioned as an endogenous sponge for miR-424-5p, thereby downregulating the expression of miR-424-5p in cervical cancer. Furthermore, the inhibition of miR-424-5p in SNHG12-depleted cells partially reversed the effects on cervical cancer cell apoptosis, adhesion and invasion. Conclusion: In summary, our findings suggest that the tumor-promoting role of SNHG12 is to function as a molecular sponge, which negatively regulates miR-424-5p. These findings may provide a potent therapeutic target for cervical cancer.
Repeated Non-Invasive Limb Ischemic Preconditioning Confers Cardioprotection Through PKC-Ԑ/STAT3 Signaling in Diabetic Rats
Authors: Wang Chunyan , Li Haobo , Wang Sheng , Mao Xiaowen , Yan Dan , Wong Stanley S. , Xia Zhengyuan , Irwin Michael G.
Published: March 2018

Background/Aims: Protein kinase C(PKC)-ε activation is a mechanism of preconditioning cardioprotection but its role in repeated non-invasive limb ischemic preconditioning (rNLIP) mediated cardioprotection against myocardial ischemia/reperfusion (I/R) injury in diabetes is unknown. Methods: Eight-week streptozotocin-induced diabetic and non-diabetic Sprague-Dawley rats were subjected to I/R without or with rNLIP. In vitro, H9C2 cells were cultured with high glucose (HG) and subjected to hypoxia/re-oxygenation (H/R) without or with PKC-ε or STAT3 gene knock-down in the absence or presence of remote time hypoxia preconditioning (HPC). Results: Diabetic rats displayed larger post-ischemic myocardial infarct size and higher troponin-I release with concomitant cardiac PKC-ԑ overexpression and activation manifested as increased membrane translocation, while phosphorylated STAT3 (p-STAT3) and Akt (p-Akt) were lower compared to non-diabetic rats (all P<0.05). rNLIP reduced infarct size in both non-diabetic and diabetic rats. rNLIP reduced post-ischemic cardiac PKC-ԑ activation in diabetic while increased PKC-ԑ activation in non-diabetic rats, resulting in increased cardiac p-STAT3 and p-Akt. In H9C2 cells, HG increased PKC-ԑ expression and exacerbated post-H/R injury, accompanied with reduced p-STAT3 and p-Akt, which were all reverted by HPC. These HPC protective effects were abolished by either PKC-ԑ or STAT3 gene knock-down, except that PKC-ԑ gene knock-down reverted HG and H/R-induced reduction of p-STAT3. Conclusion: rNLIP attenuates diabetic heart I/R injury by mitigating HG-induced PKC-ԑ overexpression and, subsequently, activating STAT3.
Uric Acid Induces Cardiomyocyte Apoptosis via Activation of Calpain-1 and Endoplasmic Reticulum Stress
Authors: Yan Meiling , Chen Kankai , He Li , Li Shuai , Huang Dong , Li Jingbo
Published: March 2018

Background/Aims: Hyperuricemia is associated with an increased risk for multiple cardiovascular diseases, but the underlying mechanisms remain largely elusive. Calpain-1 is a protease that is implicated in several pathological conditions that affect the heart. The aim of this current study was to test the effects of uric acid (UA) on cardiomyocyte survival and cardiac function and to investigate the role of calpain-1 in the UA-induced effects in the heart and their underlying mechanisms. Methods: In vivo, hyperuricemia was induced by oxonic acid (OA) administration in Sprague-Dawley rats for 16 weeks; TUNEL staining was used to identify apoptotic cells. Left ventricular (LV) sections were stained with Sirius Red to evaluate interstitial fibrosis. Cardiac catheterization was performed to evaluate cardiac function. In vitro, cultured H9c2 cells were incubated with different UA concentrations. MTT assays and flow cytometry were used to evaluate cell viability and apoptosis. All related gene expression levels were analyzed by quantitative real-time PCR (qRT-PCR), and all protein expression levels were analyzed by western blotting. Results: Hyperuricemia induction in vivo resulted in cellular apoptosis, interstitial fibrosis and diastolic dysfunction in the rat hearts, as well as increased activation of calpain-1 and endoplasmic reticulum (ER) stress, while allopurinol treatment mitigated the above changes. UA administration in vitro increased apoptosis and decreased H9c2 cell viability in a dose-dependent manner. Increased activation of calpain-1 and ER stress was also observed in the groups with high UA levels. Calpain-1 siRNA and the calpain inhibitor CI-III alleviated UA-induced ER stress and apoptosis, while inhibiting ER stress by tauroursodeoxycholic acid (TUDCA) mitigated UA-induced apoptosis without affecting calpain-1 expression or activity. Conclusions: These findings suggest that UA induces cardiomyocyte apoptosis through activation of calpain-1 and ER stress. These results may provide new insights into the mechanisms of hyperuricemia-associated cardiovascular risks and hopefully identify new treatment targets.
Unilateral surgical maxillary expansion with palatal distractor allowing traction of impacted canine
Authors: D'Avila Ricardo Pimenta , Espinola Lilian Victoria Perez , Silva Alessandro Costa da , Luz João Gualberto Cerqueira
Published: March 2018

Objectives: Bone-to-bone or palatal distractor has as the main advantage the fact that mechanical forces act directly on the bone in the desired area, thereby avoiding dental inclinations or undesirable movements of the maxillary segments, as well as causing no damage to the periodontium. The aim of this study is to present a case report of treatment for unilateral maxillary discrepancy associated with the presence of an impacted maxillary left canine with this type of device. Methods: A 23-year-old man was diagnosed with unilateral maxillary discrepancy associated with an impacted maxillary left canine. He was treated using unilateral subtotal LeFort I osteotomy with a palatal distractor tool associa­ted with traction of the impacted maxillary left canine. Results: The results obtained were satisfactory and the desired amount of unilateral transverse skeletal correction was achieved without any complications. Conclusion: The authors could conclude that unilateral surgically assisted maxillary expansion with the aid of palatal distractor was efficient and promoted good occlusion with reduced morbidity.
Molar-incisor enamel hypomineralization cross-sectional prevalence evaluation in oral-breathing allergic children
Authors: Frascino Silvana , Frascino Alexandre , Rezende Karla Mayra , Imparato José Carlos , Pignatari Shirley
Published: March 2018

Objective: Molar-incisor hypomineralization (MIH) is a highly prevalent dental development disturbance caused by dis­rupted ameloblast maturation. This condition affects up to 44% of children around the world and several systemic con­ditions have been associated with MIH, including Mouth-Breathing. It is important to show that MIH has multifacto­rial etiology and is associated with allergic mouth-breathing children. Methods: To evaluate MIH prevalence in MBCS children with positive and negative allergic response to the skin prick test, a cross-sectional quantitative and qualitative comparative assessment was conducted in 23 mouth-breathing children and 25 sex/age-matched siblings. Enamel defects were classified by the modified rate of FDI Development Defects of Enamel. Statistical Student’s t tests were applied to ve­rify the relevance of the data. Results: MIH prevalence showed significant statistical differences in the comparison betwe­en molars, independently of individual age (p = 0.01513474). MBCS children under 5 years old had higher statistical preva­lence of MIH (p = 0.00594). MBCS children with positive skin reactions to the prick test had higher prevalence of MIH (p = 0,023). MBCS children had statistically significant higher prevalence of demarcated opacity (p = 0.00012). Conclusions: Finally, MBCS children with positive skin reactions to the prick test had higher prevalence of MIH (p = 0,023), indicating that mouth-breathing allergy-responsive children had higher MIH prevalence. Our results corroborate our previous hypo­thesis that MBCS children have increased MIH prevalence in comparison to their siblings, with statistical significance (p = 0.01513474). Further investigations with larger samples may enhance and confirm the accuracy of our results.
Accuracy of self-perforating impression tray for maxillary dental implant
Authors: Oliveira Lima Bohner Lauren , Marques André Duarte Azevedo , Keedi Caroline Bosque , Steagall Washington , Tortamano Neto Pedro
Published: March 2018

Objectives: To analyze the accuracy of a pre-fabricated self-perforating tray for implant impression in an edentulous maxilla. Methods: Four implants (13, 16, 23, 26) were placed in an acrylic resin model of an edentulous maxilla. Implant impressions (n = 7) were taken using a customized open tray (Control Group) and a pre-fabricated self-perforating tray (Test Group). A metal bar was fabricated and screw-retained on implant 13 and the vestibular gap between the framework and implants was measured by stereomicroscopy on implants 16, 23, and 26. Data were analyzed by ANOVA repeated measures and Tukey tests with a significance level (α) of 0.05. Results: There was no statistical difference between self-perforating and customized open tray groups. Control group showed a gap of 73.31± 26.01 for I1; 149.16± 53.90 for I2; and 115.46± 73.34 for I3. Whereas Test Group showed a gap of 154.41± 74.64 for I1; 159.45± 87.64 for I2; and 109.28± 49.18 for I3. Conclusion: The pre-fabricated self-perforating and custom trays showed a similar accuracy for implant impression of edentulous maxilla.
Major salivary glands magnetic resonance imaging
Authors: Kim Jun Ho , Silva Renan Lúcio Berbel da , Warmling Luiza , Chilvarquer Israel , Munhoz Luciana
Published: March 2018

Objectives: To provide basic information on the magnetic resonance imaging modalities, emphasizing the diffusion-weighted imaging technique, as well as to clarify its applicability to diagnose major salivary gland disorders. Methods: The PRISMA statement was used during data assessment and extraction. The MEDLINE (PubMed) database was searched for the period from 2010 to November 2017, for studies providing basic information on the MRI modalities as well its applicability to diagnose salivary gland disorders. Data extraction included information regarding: application of MRI modalities especially ADC and DWI to diagnose major salivary gland disorders. Results: The search yielded 58 publications in MEDLINE (PubMed). The initial screening of the publications was performed using abstracts and keywords. After application of exclusion criteria, we identified a total of 9 studies as eligible to be discussed. Studies revealed two main types of MRI modalities: ADC and DWI. Most of the studies suggest that MRI can be useful as a diagnostic tool for major salivary glands. Conclusion: MRI modalities are advantageous tools for salivary gland tissue evaluations. To demonstrate the accuracy of the distinct approach methods and modalities, more studies involving a larger number of patients studied are necessary.
Uso de próteses removíveis em pacientes com necessidades especiais: risco associado ao diagnóstico
Authors: Kapicius Patricia , Nunes Fabio Daumas , Arriaga Marcel Lautenschlager , Freitas Ana Lúcia Aparecida Bronzo de , Simões Júnior João Jurandir , Carlini Regiana de Souza
Published: March 2018

Objetivos: Avaliar variáveis associadas à necessidade do uso de prótese dos pacientes com necessidades especiais (PNE) do Centro de Especialidades Odontológicas da Estância Hidromineral de Poá (CEO-Poá). Materiais e métodos: A amostra total foi composta por 514 PNE do CEO-Poá, e a variável dependente foi a necessidade de uso de prótese estabelecida entre janeiro de 2011 e dezembro de 2016. As variáveis foram gênero, idade, diagnóstico principal, quantidade de medicação utilizada usualmente e aspectos comportamentais e foram compiladas do prontuário físico para o formulário eletrônico desenvolvido para este estudo. Dados foram tabulados e analisados. Resultados: Foram encaminhados 88 indivíduos (17,11%) à reabilitação protética. Prevaleceu o gênero feminino e o avanço da idade aumentou a necessidade de uso de prótese, de forma semelhante à população geral. O diagnóstico principal foi uma variável influenciadora, a maioria (47,72%) apresentou alterações sistêmicas, seguido de deficiência física (18,18%) e distúrbios psiquiátricos (11,36%). Quanto ao comportamento, todos indivíduos foram atendidos em âmbito ambulatorial, a maioria (71,59%) já havia recebido anestesia em tratamentos anteriores, e apenas 7,95% precisou de condicionamento psicológico. Grande parte dos PNE (89,77%) chegou a receber e utilizar as próteses. Conclusões: O diagnóstico principal e variáveis do perfil comportamental foram influenciadores na necessidade de próteses dos PNE do CEO-Poá. Gênero e idade igualmente influenciam a indicação, assim como na população em geral. Esse estudo poderá nortear a implementação de projetos tanto no setor privado como no público.
Aferição do pH de diferentes agentes clareadores indicados para o clareamento intracoronário
Authors: Besegato João Felipe , Rocha Gabriela dos Santos Ribeiro , Amorim Marlene de Sousa , Salomão Fabio Martins , Poletto Daniel , Aida Kelly Limi , Caldarelli Pablo Guilherme , Hoeppner Márcio Grama
Published: March 2018

Objetivo: Aferir os valores de pH de diferentes produtos clareadores indicados para uso na técnica intracoronária em diferentes intervalos de tempo. Materiais e métodos: Para cada grupo experimental (G), foram preparadas cinco amostras (n=5): G1 – água destilada (AD); G2 – peróxido de hidrogênio (H2O2) a 30%; G3 – perborato de sódio (PbS) + AD; G4 – PbS + H2O2 a 30%; G5 – percarbonato de sódio (PcS) + AD; e G6 – PcS + H2O2 a 30%. O pH foi determinado por um pHmetro digital, em diferentes intervalos de tempo: imediatamente após a manipulação (T0), 24 horas (T1) e 168 horas após a manipulação (T2). Os dados obtidos foram submetidos à análise estatística por meio do teste de Kruskal-Wallis, seguido pelo teste de Mann Whitney para comparações múltiplas entre os grupos. Para verificar o efeito do tempo em cada grupo, foi aplicado o teste de Friedman. Resultados: Na avaliação do efeito do tempo em cada grupo, observou-se que G2 apresentou comportamento ácido, enquanto os demais grupos exibiram valores de pH próximos da neutralidade ou alcalinos. Conclusão: H2O2 30% foi o único agente que apresentou comportamento ácido em todos os tempos de avaliação, e a mistura PcS + H2O foi a que apresentou os maiores valores de pH.
Association Between 30-Day Episode Payments and Acute Myocardial Infarction Outcomes Among Medicare Beneficiaries
Authors: Wadhera Rishi K. , Joynt Maddox Karen E. , Wang Yun , Shen Changyu , Bhatt Deepak L. , Yeh Robert W.
Published: March 2018

Background:

Recent policy efforts have focused on improving the value of acute myocardial infarction (AMI) care. Medicare payment programs, for example, increasingly evaluate hospital performance based on spending, as determined by payments made to institutions and providers, and outcome measures for a longitudinal episode of AMI care. Little is known about the relationship between total 30-day payments—both in the inpatient and immediate postdischarge timeframe—and outcomes after an admission for AMI.

Methods and Results:

Using Medicare claims data, we identified Medicare fee-for-service beneficiaries ≥65 years of age who were hospitalized at an acute-care hospital for AMI between July 1, 2011, and June 30, 2014, and examined the association between hospital-level 30-day payments for an episode of AMI care and patient 30-day mortality using mixed regression models with a logit link function and random hospital intercepts. Our cohort included 642 105 index hospitalizations for AMI at 2319 acute-care hospitals. Overall mean 30-day episode payments per beneficiary were $22 128 (SD, $1750). The observed 30-day mortality rate was 12.9%. Higher 30-day payments were associated with lower 30-day mortality after adjustment for patient characteristics and comorbidities (adjusted odds ratio for additional $1000 payments, 0.986; 95% confidence interval, 0.979–0.992;
P
<0.001). Additional adjustment for potential mediating factors, including hospital characteristics, coronary revascularization rates, and discharge disposition, did not significantly attenuate the relationship (adjusted odds ratio for additional $1000 payments, 0.987; 95% confidence interval, 0.980–0.994;
P
<0.001).

Conclusions:

Higher hospital-level 30-day payments—both inpatient and in multiple settings after discharge—for AMI care were associated with lower 30-day mortality among beneficiaries. This may have implications for payment programs that incent reduction in payments without considering value.
Glycosylation Profile of Immunoglobulin G Is Cross-Sectionally Associated With Cardiovascular Disease Risk Score and Subclinical Atherosclerosis in Two Independent Cohorts
Authors: Menni Cristina , Gudelj Ivan , Macdonald-Dunlop Erin , Mangino Massimo , Zierer Jonas , Bešić Erim , Joshi Peter K. , Trbojević-Akmačić Irena , Chowienczyk Phil J. , Spector Tim D. , Wilson James F. , Lauc Gordan , Valdes Ana M.
Published: March 2018

Rationale:

One measure of protein glycosylation (GlycA) has been reported to predict higher cardiovascular risk by reflecting inflammatory pathways.

Objective:

The main objective of this study is to assess the role of a comprehensive panel of IgG glycosylation traits on traditional risk factors for cardiovascular disease and on presence of subclinical atherosclerosis in addition to GlycA.

Methods and Results:

We measured 76 IgG glycosylation traits in 2970 women (age range, 40–79 years) from the TwinsUK cohort and correlated it to their estimated 10-year atherosclerotic cardiovascular disease risk score and their carotid and femoral plaque measured by ultrasound imaging. Eight IgG glycan traits are associated with the 10-year atherosclerotic cardiovascular disease risk score after adjusting for multiple tests and for individual risk factors—5 with increased risk and 3 with decreased risk. These glycans replicated in 967 women from ORCADES cohort (Orkney Complex Disease Study), and 6 of them were also associated in 845 men. A linear combination of IgG glycans and GlycA is also associated with presence of carotid (odds ratio, 1.55; 95% confidence interval, 1.25–1.93;
P
=7.5×10
-5
) and femoral (odds ratio, 1.32; 95% confidence interval, 1.06–1.64;
P
=0.01) plaque in a subset of women with atherosclerosis data after adjustment for traditional risk factors. One specific glycosylation trait, GP18-the percentage of FA2BG2S1 glycan in total IgG glycans, was negatively correlated with very-low-density lipoprotein and triglyceride levels in serum and with presence of carotid plaque (odds ratio, 0.60; 95% confidence interval, 0.50–0.71;
P
=5×10
-4
).

Conclusions:

We find molecular pathways linking IgG to arterial lesion formation. Glycosylation traits are independently associated with subclinical atherosclerosis. One specific trait related to the sialylated N-glycan is negatively correlated with cardiovascular disease risk, very-low-density lipoprotein and triglyceride serum levels, and presence of carotid plaque.
Utility-Weighted Modified Rankin Scale as Primary Outcome in Stroke Trials
Authors: Dijkland Simone A. , Voormolen Daphne C. , Venema Esmee , Roozenbeek Bob , Polinder Suzanne , Haagsma Juanita A. , Nieboer Daan , Chalos Vicky , Yoo Albert J. , Schreuders Jennifer , van der Lugt Aad , Majoie Charles B.L.M. , Roos Yvo B.W.E.M. , van Zwam Wim H. , van Oostenbrugge Robert J. , Steyerberg Ewout W. , Dippel Diederik W.J. , Lingsma Hester F. ,   on behalf of the MR CLEAN Investigators*
Published: March 2018

Background and Purpose—

The utility-weighted modified Rankin Scale (UW-mRS) has been proposed as a new patient-centered primary outcome in stroke trials. We aimed to describe utility weights for the mRS health states and to evaluate the statistical efficiency of the UW-mRS to detect treatment effects in stroke intervention trials.

Methods—

We used data of the 500 patients enrolled in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Utility values were elicited from the EuroQol Group 5-Dimension Self-Report Questionnaire assessed at 90 days after inclusion, simultaneously with the mRS. Utility weights were determined by averaging the utilities of all patients within each mRS category. We performed simulations to evaluate statistical efficiency. The simulated treatment effect was an odds ratio of 1.65 in favor of the treatment arm, similar for all mRS cutoffs. This treatment effect was analyzed using 3 approaches: linear regression with the UW-mRS as outcome, binary logistic regression with a dichotomized mRS (0–1/2–6, 0–2/3–6, and 0–4/5–6), and proportional odds logistic regression with the ordinal mRS. The statistical power of the 3 approaches was expressed as the proportion of 10 000 simulations that resulted in a statistically significant treatment effect (
P
≤0.05).

Results—

The mean utility values (SD) for mRS categories 0 to 6 were: 0.95 (0.08), 0.93 (0.13), 0.83 (0.21), 0.62 (0.27), 0.42 (0.28), 0.11 (0.28), and 0 (0), respectively, but varied substantially between individual patients within each category. The UW-mRS approach was more efficient than the dichotomous approach (power 85% versus 71%) but less efficient than the ordinal approach (power 85% versus 87%).

Conclusions—

The UW-mRS as primary outcome does not capture individual variation in utility values and may reduce the statistical power of a randomized trial.
Political Theology between Reason and Will
Authors: Amesbury Richard
Published: March 2018

Contemporary practitioners of political theology make use of Carl Schmitt’s account of sovereignty to criticize liberal political theory. But whereas Schmitt focused on “states of exception,” the new decisionism holds that decision-making is a quotidian feature of jurisprudence: the interpretation of law depends upon judicial decisions that serve to impose meaning on otherwise semantically indeterminate norms. Ironically, it is possible to detect in the contemporary decisionist critique of liberal theory, with its focus on law’s meaning, a liberalizing tendency: by insisting on the ubiquity of decision-making, the exception is made to seem unexceptional. In this way, Schmitt is tamed, and sovereignty is diffused into the mundane world of administrative governance. I want to resist this normalizing account on philosophical grounds: if one is to appreciate the exceptional character of the decision, it is important to retain some background of regularity with which it can be contrasted.
Complete chloroplast genomes of Archiclematis, Naravelia and Clematis (Ranunculaceae), and their phylogenetic implications
Authors: LIU HUI-JIE , DING CHUAN-HUA , HE JIAN , CHENG JIN , PEI LIN YING , XIE LEI
Published: March 2018

Archiclematis and Naravelia were considered to be two small genera closely related to the large cosmopolitan genus Clematis. They have been included into Clematis s.l. in recent years according to molecular phylogenetic evidence. There is still little genomic information available for Archiclematis and Naravelia species. In this study, six complete chloroplast genomes from Archiclematis, Naravelia and Clematis were reported based on Illumina sequencing. The gene order and organization of the chloroplast genomes of Archiclematis and Naravelia are the same with that of Clematis. Analysis of eight complete chloroplast genomes showed that the plastomes of Clematis s.l. are typically circular, with a total length ranging from 159,513 bp to 159,783 bp. The total number of genes is identical within the broadly defined genus Clematis. We also identified variation hotspots, plastid repeats and SSRs for Clematis s.l. species. Our plastid phylogenomic analyses recovered the inclusion of Archiclematis and Naravelia into Clematis. The present study provides important phylogenomic data of Ranunculaceae and illuminates the phylogenetic relationships among Clematis species.
Prodromus of a fern flora for Bolivia. XVIII. Culcitaceae
Authors: KESSLER MICHAEL , SMITH ALAN R.
Published: March 2018

We provide a synopsis to the fern family Culcitaceae in Bolivia, consisting of the single species Culcita coniifolia.
A new species of Cymbella (Cymbellaceae, Bacillariophyceae) from China, possessing valves with both uniseriate and biseriate striae
Authors: LIU BING , WILLIAMS DAVID M. , LIU QINGYU
Published: March 2018

Since scanning electron microscopy was used to study diatoms, many new ultra-structural features have been observed. This paper describes Cymbella distalebiseriata, a new species of Cymbella which has valves with biseriate striae near both apices of the valve and uniseriate striae at the valve centre. Comparison with some similar taxa supports its erection as new by the following combination of characters: two to three stigmata, puncta density 25–30 in 10 μm, and ca. 3 to 11 biseriate striae at both apices. C. distalebiseriata is epilithic and lives in freshwater habitats.
Prodromus of a fern flora for Bolivia. VIII. Marattiaceae
Authors: TUOMISTO HANNA , KESSLER MICHAEL , SMITH ALAN R.
Published: March 2018

The Marattiaceae is a phylogenetically isolated family of eusporangiate ferns. Here we provide a synopsis to the family in Bolivia, where it is represented by five species in the genus Danaea and a single species of Eupodium.
Arge davidsmithi nom. nov. for Arge davidi Shinohara & Hara, 2017 (nec Koch & Liston, 2012) (Hymenoptera, Argidae)
Authors: SHINOHARA AKIHIKO , HARA HIDEHO
Published: March 2018

Koch & Liston (2012) described an argid sawfly from South Africa and named it Arge davidi Koch & Liston, 2012. Shinohara & Hara (2017) very recently described another argid from Taiwan under the same name, Arge davidi Shinohara & Hara, 2017. The latter authors simply overlooked Koch & Liston’s (2012) taxon and Arge davidi Shinohara & Hara, 2017, is a primary junior homonym of Arge davidi Koch & Liston, 2012.
Role of Surface Enthalpy Fluxes in Idealized Simulations of Tropical Depression Spinup
Authors: Murthy Varun S. , Boos William R.
Published: March 2018

An idealized, three-dimensional, cloud-system-resolving model is used to investigate the influence of surface enthalpy flux variations on tropical depression (TD) spinup, an early stage of tropical cyclogenesis in which the role of surface fluxes remains incompletely understood. A range of simulations supports the hypothesis that a negative radial gradient of surface enthalpy flux outside the storm center is necessary for TD spinup but can arise from multiple mechanisms. The negative radial gradient is typically created by the wind speed dependence of surface enthalpy fluxes, consistent with some previous theories for tropical cyclone intensification. However, when surface enthalpy fluxes are prescribed to be independent of wind speed, spinup still occurs, albeit more slowly, with the negative radial gradient of surface enthalpy flux maintained by an enhanced air–sea thermodynamic disequilibrium beneath the cold core of the incipient vortex. Surface enthalpy flux variations seem more important for intensification than initial conditions. For example, a vortex forms and intensifies even from a state of rest when the center of the domain is initialized to be nearly saturated with water vapor, but this intensification is modest in amplitude and transient, lasting less than 12 h, without interactive surface enthalpy flux. Sustained spinup on time scales longer than a day does not occur when surface enthalpy fluxes are horizontally homogeneous or constant, even when fixed at the high value of 200 W m−2. In the ensemble of simulations presented here, the vortex intensification rate scales linearly with the storm-scale surface enthalpy flux anomaly relative to the undisturbed environment.
Primary Atmospheric Drivers of Pluvial Years in the United States Great Plains
Authors: Flanagan Paul X. , Basara Jeffrey B. , Furtado Jason C. , Xiao Xiangming
Published: March 2018

Precipitation variability has increased in recent decades across the Great Plains (GP) of the United States. Drought and its associated drivers have been studied in the GP region; however, periods of excessive precipitation (pluvials) at seasonal to interannual scales have received less attention. This study narrows this knowledge gap with the overall goal of understanding GP precipitation variability during pluvial periods. Through composites of relevant atmospheric variables from the ECMWF twentieth-century reanalysis (ERA-20C), key differences between southern Great Plains (SGP) and northern Great Plains (NGP) pluvial periods are highlighted. The SGP pluvial pattern shows an area of negative height anomalies over the southwestern United States with wind anomalies consistent with frequent synoptic wave passages along a southward-shifted North Pacific jet. The NGP pattern during pluvial periods, by contrast, depicts anomalously low heights in the northwestern United States and an anomalously extended Pacific jet. Analysis of daily heavy precipitation events reveals the key drivers for these pluvial events, namely, an east–west height gradient and associated stronger poleward moisture fluxes. Therefore, the results show that pluvial years over the GP are likely driven by synoptic-scale processes rather than by anomalous seasonal precipitation driven by longer time-scale features. Overall, the results present a possible pathway to predicting the occurrence of pluvial years over the GP and understanding the causes of GP precipitation variability, potentially mitigating the threats of water scarcity and excesses for the public and agricultural sectors.
Workarounds to Intended Use of Health Information Technology: A Narrative Review of the Human Factors Engineering Literature
Authors: Patterson Emily S.
Published: March 2018

Objective

To integrate and synthesize insights from recent studies of workarounds to the intended use of health information technology (HIT) by health care professionals.

Background

Systems are safest when the documentation of how work is done in policies and procedures closely matches what people actually do when they are working. Proactively identifying and managing workarounds to the intended use of technology, including deviations from expected workflows, can improve system safety.

Method

A narrative review of studies of workarounds with HIT was conducted to identify themes in the literature.

Results

Three themes were identified: (1) Users circumvented new additional steps in the workflow when using HIT, (2) interdisciplinary team members communicated via HIT in text fields that were intended for other purposes, and (3) locally developed paper-based and manual whiteboard systems were used instead of HIT to support situation awareness of individuals and groups; an example of a locally developed system was handwritten notes about a patient on a piece of paper folded up and carried in a nurse’s pocket.

Conclusion

Workarounds were employed to avoid changes to workflow, enable interdisciplinary communication, coordinate activities, and have real-time portable access to summarized and synthesized information.

Application

Implications for practice include providing summary overview displays, explicitly supporting role-based communication and coordination through HIT, and reducing the risk to reputation due to electronic monitoring of individual performance.
Leak Detection in Plastic Water Supply Pipes with a High Signal-to-Noise Ratio Accelerometer
Authors: Marmarokopos Konstantinos , Doukakis Dimitrios , Frantziskonis George , Avlonitis Markos
Published: March 2018

A method for detecting leaks in plastic water supply pipes through analysis of the pipe’s surface vibration using a high signal-to-noise ratio accelerometer is proposed and examined. The method involves identification of the changes in vibration frequencies caused on the pipe by the leak and is developed from and examined with respect to detailed experiments. The results are promising, showing that leak detection in plastic pipes is possible provided that the sensor is placed at a small distance from the leak, since wave attenuation in plastic is strong. The results indicate that the methodology has the potential to be a new and competitive type of mobile leak detection system.