bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac stunning during haemodialysis: the therapeutic effect of intra-dialytic exercise
Authors: McGuire Scott , Horton Elizabeth J , Renshaw Derek , Chan Klaris , Jimenez Alfonso , Maddock Helen , Krishnan Nithya , McGregor Gordon
Published: October 2019

Background

Cardiovascular risk is elevated in end-stage renal disease. Left ventricular (LV) dysfunction is linked to repetitive transient ischaemia occurring during haemodialysis (HD). Cardiomyocyte ischaemia results in ‘cardiac stunning’, evidenced by regional wall motion abnormalities (RWMAs). Ischaemic RWMA have been documented during HD resulting in maladaptive cardiac remodelling and increased risk of heart failure. Intra-dialytic exercise is well tolerated and can improve quality of life and functional capacity. It may also attenuate HD-induced cardiac stunning.

Methods

This exploratory study aimed to assess the effect of intra-dialytic cycle ergometry on cardiac stunning. Twenty exercise-naïve participants on maintenance HD (mean ± SD, 59 ± 11 years) underwent resting echocardiography and maximal cardiopulmonary exercise testing. Subsequently, cardiac stunning was assessed with myocardial strain-derived RWMAs at four time points during (i) standard HD and (ii) HD with 30 min of sub-maximal intra-dialytic cycle ergometry at a workload equivalent to 90% oxygen uptake at the anaerobic threshold (VO2AT). Central haemodynamics and cardiac troponin I were also assessed.

Results

Compared with HD alone, HD with intra-dialytic exercise significantly reduced RWMAs after 2.5 h of HD (total 110 ± 4, mean 7 ± 4 segments versus total 77 ± 3, mean 5 ± 3, respectively; P = 0.008). Global cardiac function, intra-dialytic haemodynamics and LV volumetric parameters were not significantly altered with exercise.

Conclusions

Intra-dialytic exercise reduced cardiac stunning. Thirty minutes of sub-maximal exercise at 90% VO2AT was sufficient to elicit acute cardio-protection. These data potentially demonstrate a novel therapeutic effect of intra-dialytic exercise.
Improved standardization of transcribed digital specimen data
Authors: Groom Quentin , Dillen Mathias , Hardy Helen , Phillips Sarah , Willemse Luc , Wu Zhengzhe
Published: October 2019

There are more than 1.2 billion biological specimens in the world’s museums and herbaria. These objects are particularly important forms of biological sample and observation. They underpin biological taxonomy but the data they contain have many other uses in the biological and environmental sciences. Nevertheless, from their conception they are almost entirely documented on paper, either as labels attached to the specimens or in catalogues linked with catalogue numbers. In order to make the best use of these data and to improve the findability of these specimens, these data must be transcribed digitally and made to conform to standards, so that these data are also interoperable and reusable.

Through various digitization projects, the authors have experimented with transcription by volunteers, expert technicians, scientists, commercial transcription services and automated systems. We have also been consumers of specimen data for taxonomical, biogeographical and ecological research. In this paper, we draw from our experiences to make specific recommendations to improve transcription data. The paper is split into two sections. We first address issues related to database implementation with relevance to data transcription, namely versioning, annotation, unknown and incomplete data and issues related to language. We then focus on particular data types that are relevant to biological collection specimens, namely nomenclature, dates, geography, collector numbers and uniquely identifying people. We make recommendations to standards organizations, software developers, data scientists and transcribers to improve these data with the specific aim of improving interoperability between collection datasets.
Inflammation, but Not the Underlying Disease or Its Location, Predicts Oral Iron Absorption Capacity in Patients With Inflammatory Bowel Disease
Authors: Aksan Ayşegül , Wohlrath M , Iqbal Tariq H , Dignass A , Stein J
Published: October 2019

Background and Aims

Anaemia is common in patients with inflammatory bowel disease [IBD], its two main aetiologies being iron deficiency anaemia [IDA] and anaemia of chronic inflammation [ACI]. Impaired intestinal iron absorption due to inflammatory cytokines is thought to play a role in ACI. We undertook for the first time a controlled prospective study investigating effects of differing underlying diseases, disease locations, and types of iron deficiency or anaemia on oral iron absorption in adult IBD patients with and without inflammation.

Methods

This study was a comparative, single-centred open clinical trial in adults with IBD [n = 73] and healthy controls [n = 22]. Baseline parameters included blood count, iron status [ferritin, transferrin, transferrin saturation, soluble transferrin receptor, hepcidin, serum iron], high-sensitivity C-reactive protein [hsCRP] and interleukin-6. Iron absorption was tested using one oral, enteric-coated capsule containing 567.7 mg iron[II]-glycine-sulphate complex. Serum iron was determined 60/90/120/180/240 min after ingestion.

Results

Iron absorption capacity was shown to be influenced by inflammation and anaemia or iron deficiency [ID] type but not by underlying disease type or localisation. The ACI group showed a significantly lower iron absorption capacity than all others. Whereas hsCRP levels [-0.387, p < 0.001], IL-6 [-0.331, p = 0.006], ferritin [-0.531, p < 0.001], and serum hepcidin [-0.353, p = 0.003] correlated negatively with serum iron change at 2 h, transferrin showed a positive correlation at the same time point [0.379, p < 0.001].

Conclusions

Underlying disease type and localisation appear to have little effect on iron absorption capacity, whereas lack of response to oral iron correlates well with serum markers of inflammation. Iron absorption capacity is thus significantly reduced in the presence of inflammation.
A case report: intravalvular regurgitation during percutaneous valve-in-ring implantation due to eccentric bulging of a balloon-expandable valve in a patient with severe right heart failure
Authors: Gerçek Muhammed , Schramm René , Paluszkiewicz Lech , Rudolph Tanja Katharina
Published: October 2019

Background

Severely reduced right heart function and high operative risk are major challenges in the treatment of tricuspid regurgitation (TR) as both can lead to low cardiac output heart failure (LCO-Hf). Alternative methods and criteria for patient selection are actively being sought.

Case summary

We report on a 66-year-old patient with severe right heart failure (rHF) with recurrent TR after prior surgical valve repair with a 32-mm-Edwards-MC3 annuloplasty ring (AR). Surgical revision was discarded due to extreme high surgical risk. A right ventricular assist device was discussed but declined by the patient. Percutaneous edge-to-edge repair was not applicable due to massive tethering of the anterior leaflet and complete lack of coadaptation. According to the Heart team decision, percutaneous tricuspid valve-in-ring implantation was performed using a 29-mm Sapien-3 prosthesis (SP3) under moderate balloon overinflation. Despite satisfying positioning, the prosthesis showed massive intravalvular regurgitation due to immobility of the septally oriented cusp, which was most likely caused by eccentric bulging of the prosthesis in the opening region of the AR. Implantation of a second prosthesis leads to a perfectly functional result. Importantly, no major haemodynamic complications ensued.

Discussion

Although being a potential risk of tricuspid valve repair LCO-hf could not be observed in the present case. Additionally, deformation of the implanted transcatheter aortic valve replacement prosthesis resulting from the regional lack of abutment in AR should be considered as a potential complication. Hence, further careful evaluation of the feasibility of percutaneous tricuspid valve treatment, also in patients with rHF, is needed.
New Dominion constitutionalism at the twilight of the British Empire: An introduction
Authors: Malagodi Mara , McDonagh Luke , Poole Thomas
Published: October 2019

This introduction to the symposium on New Dominion constitutionalism sketches the legal configuration of New Dominion status and the intellectual context from which it emerged. Dominionhood originally represented a halfway house between colonial dependence and postcolonial independence, as developed in Canada, Australia, New Zealand, and South Africa. By contrast, New Dominion constitutionalism refers to the transitional constitutional form developed after World War I in Ireland (1922–1937)—the “Bridge Dominion”—and the post-World War II “New” Dominions of India (1947–1950), Pakistan (1947–1956), and Ceylon (later Sri Lanka, 1948–1972). New Dominion constitutionalism represents the first model designed to manage political transitions on a global scale. Both transitional and transnational, New Dominion constitutions served as a provisional frame of government and the juridical basis for the independent constitution. Although the notion of Dominion fell into disuse, it reemerged as the concept of Commonwealth Realm through which the majority of the remaining British colonies in Asia, Africa, and the Caribbean acquired independence.
The Dominion model of transitional constitutionalism
Authors: Malagodi Mara , McDonagh Luke , Poole Thomas
Published: October 2019

This symposium has explored New Dominion constitutionalism inductively and contextually, placing the phenomenon within a historically nested set of ideas and practices from the Old (Settler) Dominions, through the “Bridge Dominion” of Ireland, before giving detailed attention to the South Asian New Dominions of India, Pakistan, and Ceylon (now Sri Lanka). The articles collectively form a basis from which to analyze the legal configuration of New Dominion status and its legacy by exploring links between New Dominion constitutional framing and post-independence design and practice. Building on the case studies, the principal contention of this summative contribution is that New Dominion constitutionalism should be understood as the first constitutional model of note designed to manage political transitions on a global scale. A product of the twilight of the British Empire, New Dominion constitutionalism represents a model for decolonizing nations and an important antecedent to later post-Cold War transitions. Both transitional and transnational, New Dominion status offered an interim frame of government for political transitions, the fuzzy center of which derived from Westminster-style conventions of political constitutionalism, as well as a template establishing the legal basis for constituting the fully independent state.
A review status on alternative arrangements of power generation energy resources and reserve in India
Authors: Kumar Ravinder , Ojha Kshitij , Ahmadi Mohammad H , Raj Ritu , Aliehyaei Mehdi , Ahmadi Abolfazl , Nabipour Narjes
Published: October 2019

Due to the fast growth of population in India, consumption of energy is growing at a rapid rate. Today’s energy consumption and its utilization at an optimum level is a big challenge in the nation. There are various factors like a demand to mitigate global energy, availability, accessibility, cost, environmental change and storage facility of energy which are important in modern days. Majority of the population is shifting towards the city in comparison to a rural area (town, village and kasbah). According to this fact, the consumption of energy is increasing in cities. The small- and large-scale industries are located nearby the city, because of the easy availability of raw materials, better transportation services and other resources. So, the requirement of energy in a continuous manner is the prime need in these areas. In rural areas, people are using low-grade energy, and thereby there is not so much burden of energy required. It is also observed that there is a maximum loss of electricity due to transmission in India. Oil, gas and electricity are major resources to supply the energy need of the countrymen. However, the fuel situation of the nation with the shortage of fossil fuels creates pressure to drive the nuclear investment for electricity and nearly 25% contribution by 2050. The nation’s dependency on oil and gas is a critical issue, so the country is looking forward to various renewable energy resources. To accomplish this target, various government organizations are investing in solar and wind energy-related projects along with remote location pilot projects. The role of policymakers in this direction is to develop future strategies to decrease the gap between demand and supply of electricity for the growth of sustainable development. In the present work, energy production from various resources, supply, new policy implementation and import of energy is discussed in India. The study concludes that coal and petroleum product import is continuously increasing in the country for power generation and increasing the level of greenhouse gases. So, the Indian government is investing in power generation projects based on renewable energies in the country. ‘Solar Mission’ to achieve a goal of 20 000 MW solar electricity and 60 GW wind power generation by 2022 is already running in this direction.
The effects of improved performance in the U.S. dairy cattle industry on environmental impacts between 2007 and 2017
Authors: Capper Judith L , Cady Roger A
Published: October 2019

The U.S. dairy industry considerably reduced environmental impacts between 1944 and 2007, primarily through improved dairy cow productivity. However, although milk yield per cow has increased over the past decade, whole-system environmental impact analyses have not been conducted over this time period, during which environmental modeling science has improved considerably. The objective of this study was to compare the environmental impact of U.S. dairy cattle production in 2007–2017. A deterministic model based on population demographics, metabolism, and nutrient requirements of dairy cattle was used to estimate resource inputs, nutrient excretion, and greenhouse gas (GHG) emissions per 1.0 × 106 t (one million metric t or MMT) of energy-corrected milk (ECM) produced in 2007 and 2017. System boundaries extended from the manufacture and transport of cropping inputs to milk at the farm gate. Milk transport, processing, and retail were not included. Dairy systems were modeled using typical management practices, herd population dynamics, and production data from U.S. dairy farms. Cropping data were sourced from national databases. The resources required to produce 1.0 MMT ECM in 2017 were considerably reduced relative to those required in 2007, with 2017 production systems using 74.8% of the cattle, 82.7% of the feedstuffs, 79.2% of the land, and 69.5% of the water as compared to 2007. Waste outputs were similarly reduced, with the 2017 U.S. dairy industry producing 79.4%, 82.5%, and 85.7% of the manure, N, and P excretion, respectively. Dairy production in 2017 emitted 80.9% of the CH4 and 81.5% of the N2O per 1.0 MMT ECM compared to 2007. Enteric and manure emissions contributed the major proportion (80%) of GHG emissions per unit of milk, with lesser contributions from cropping (7.6%) and fertilizer application (5.3%). The GHG emissions per 1.0 MMT ECM produced in 2017 were 80.8% of equivalent milk production in 2007. Consequently, although total U.S. ECM production increased by 24.9% between 2007 and 2017, total GHG emissions from this milk production increased by only 1.0%. In line with previous historical analyses, the U.S. dairy industry has made remarkable productivity gains and environmental progress over time. To maintain this culture of continuous improvement, the dairy industry must build on gains made to date and demonstrate its commitment to reducing environmental impacts while improving both economic viability and social acceptability.
Practice, Discourse and Experience: The Relationship Between Design History and Architectural History
Authors: Kelly Jessica , Jamieson Claire
Published: October 2019

This Special Issue explores the relationship between architectural history and design history; two disciplines with close subject areas and methodological links, but which have developed distinct institutional and academic identities that often separate them. This introduction frames the articles contained in the issue—which in different ways demonstrate the compelling nature of research that straddles these disciplines—through an examination of the roots such research approaches have within the recent past of each field. Through a re-reading of key moments within the historiography of each discipline in the UK and USA since the Second World War, it is possible to understand how architectural and design history have evolved in relation to each other, and how the expansion of each into the territory of the other has emerged.
Leadership Lessons From the Field: Leading by Saying “No”
Authors: Jamison Lee S , Neubauer Brian
Published: October 2019

Junior officers readily accept new assignments, projects, and challenges suggested by their superiors. The word “no” is not one we are accustomed to saying. Learning when and how to say no may be one of the most effective strategies for young leaders working to shape the future of their organization.
Discovery of a very young high-mass X-ray binary associated with the supernova remnant MCSNR J0513-6724 in the LMC
Authors: Maitra C , Haberl F , Filipović M D , Udalski A , Kavanagh P J , Carpano S , Maggi P , Sasaki M , Norris R P , O’Brien A , Hotan A , Lenc E , Szymański M K , Soszyński I , Poleski R , Ulaczyk K , Pietrukowicz P , Kozłowski S , Skowron J , Mróz P , Rybicki K , Iwanek P , Wrona M
Published: October 2019

We report the discovery of a very young high-mass X-ray binary (HMXB) system associated with the supernova remnant (SNR) MCSNR J0513-6724 in the Large Magellanic Cloud (LMC), using XMM–Newton X-ray observations. The HMXB is located at the geometrical centre of extended soft X-ray emission, which we confirm as an SNR. The HMXB spectrum is consistent with an absorbed power law with spectral index ∼1.6 and a luminosity of 7 × 1033 erg s−1 (0.2–12 keV). Tentative X-ray pulsations are observed with a periodicity of 4.4 s and the OGLE I-band light curve of the optical counterpart from more than 17.5 yr reveals a period of 2.2324 ± 0.0003 d, which we interpret as the orbital period of the binary system. The X-ray spectrum of the SNR is consistent with non-equilibrium shock models as expected for young/less evolved SNRs. From the derived ionization time-scale we estimate the age of the SNR to be <6 kyr. The association of the HMXB with the SNR makes it the youngest HMXB, in the earliest evolutionary stage known to date. An HMXB as young as this can switch on as an accreting pulsar only when the spin period has reached a critical value. Under this assumption, we obtain an upper limit to the magnetic field of <5 × 1011 G. This implies several interesting possibilities including magnetic field burial, possibly by an episode of post-supernova hyper-critical accretion. Since these fields are expected to diffuse out on a time-scale of 103–104 yr, the discovery of a very young HMXB can provide us the unique opportunity to observe the evolution of the observable magnetic field for the first time in X-ray binaries.
Early-type galaxy density profiles from IllustrisTNG – II. Evolutionary trend of the total density profile
Authors: Wang Yunchong , Vogelsberger Mark , Xu Dandan , Shen Xuejian , Mao Shude , Barnes David , Li Hui , Marinacci Federico , Torrey Paul , Springel Volker , Hernquist Lars
Published: October 2019

We study the evolutionary trend of the total density profile of early-type galaxies (ETGs) in IllustrisTNG. To this end, we trace ETGs from z = 0 to 4 and measure the power-law slope γ′ of the total density profile for their main progenitors. We find that their slopes γ′ steepen on average during z ∼ 4–2, then becoming shallower until z = 1, after which they remain almost constant, aside from a residual trend of becoming shallower towards z = 0. We also compare to a statistical sample of ETGs at different redshifts, selected based on their luminosity profiles and stellar masses. Due to different selection effects, the average slopes of the statistical samples follow a modified evolutionary trend. They monotonically decrease since z = 3, and after z ≈ 1, they remain nearly invariant with a mild increase towards z = 0. These evolutionary trends are mass dependent for both samples, with low-mass galaxies having in general steeper slopes than their more massive counterparts. Galaxies that transitioned to ETGs more recently have steeper mean slopes as they tend to be smaller and more compact at any given redshift. By analysing the impact of mergers and AGN feedback on the progenitors’ evolution, we conjecture a multiphase path leading to isothermality in ETGs: dissipation associated with rapid wet mergers tends to steepen γ′ from z = 4 to 2, whereas subsequent AGN feedback (especially in the kinetic mode) makes γ′ shallower again from z = 2 to 1. Afterwards, passive evolution from z = 1 to 0, mainly through gas-poor mergers, mildly decreases γ′ and maintains the overall mass distribution close to isothermal.
Optimizing neural network techniques in classifying Fermi-LAT gamma-ray sources
Authors: Kovačević M , Chiaro G , Cutini S , Tosti G
Published: October 2019

Machine learning is an automatic technique that is revolutionizing scientific research, with innovative applications and wide use in astrophysics. The aim of this study was to develop an optimized version of an Artificial Neural Network machine learning method for classifying blazar candidates of uncertain type detected by the Fermi Large Area Telescope γ-ray instrument. The final result of this study increased the classification performance by about 80 ${{\ \rm per\ cent}}$ with respect to previous method, leaving only 15 unclassified blazars out of 573 blazar candidates of uncertain type listed in the LAT 4-year Source Catalog.
The Pristine survey – VII. A cleaner view of the Galactic outer halo using blue horizontal branch stars
Authors: Starkenburg Else , Youakim Kris , Martin Nicolas , Thomas Guillaume , Aguado David S , Arentsen Anke , Carlberg Raymond G , González Hernández Jonay I , Ibata Rodrigo , Longeard Nicolas , McConnachie Alan W , Navarro Julio , Sánchez-Janssen Rubén , Venn Kim A
Published: October 2019

We use the Pristine survey CaHK narrow-band photometry, combined with the Sloan Digital Sky Survey (SDSS)ugr photometry, to provide a cleaner sample of blue horizontal branch stars in the Galactic halo out to large distances. We demonstrate a completeness of 91 per cent and a purity of 93 per cent with respect to available spectroscopic classifications. We subsequently use our new clean sample of these standard candles to investigate the substructure in the Galactic halo over the Pristine footprint. Among other features, this allows for a careful tracing of multiple parts of the Sagittarius stream, providing a measurement independent from other tracers used and reaching larger distances. Moreover, we demonstrate with this clean and complete sample that the halo follows a density profile with a negative power-law slope of 3.5–4.0. As the relatively shallow SDSS u band is the limiting factor in this technique, we foresee large potential for combining Pristine survey photometry with the much deeper u-band photometry from the Canada–France–Imaging Survey.
The Impact of Intra-Arterial Papaverine-Hydrochloride on Cerebral Metabolism and Oxygenation for Treatment of Delayed-Onset Post-Subarachnoid Hemorrhage Vasospasm
Authors: Hosmann Arthur , Wang Wei-te , Dodier Philippe , Bavinzski Gerhard , Engel Adrian , Herta Johannes , Plöchl Walter , Reinprecht Andrea , Gruber Andreas
Published: October 2019

BACKGROUND

Delayed posthemorrhagic vasospasm remains among the major complications after aneurysmal subarachnoid hemorrhage (SAH) and can result in devastating ischemic strokes. As rescue therapy, neurointerventional procedures are used for selective vasodilatation.

OBJECTIVE

To investigate the effects of intra-arterial papaverine-hydrochloride on cerebral metabolism and oxygenation.

METHODS

A total of 10 consecutive patients, suffering from severe aneurysmal SAH were prospectively included. Patients were under continuous multimodality neuromonitoring and required intra-arterial papaverine-hydrochloride for vasospasm unresponsive to hypertensive therapy. Cerebral metabolism (microdialysis), brain tissue oxygen tension (ptiO2), intracranial pressure (ICP), and cerebral perfusion pressure (CPP) were analyzed for a period of 12 h following intervention.

RESULTS

A median dose of 125 mg papaverine-hydrochloride was administered ipsilateral to the multimodality probe. Angiographic improvement of cerebral vasospasm was observed in 80% of patients. During intervention, a significant elevation of ICP (13.7 ± 5.2 mmHg) and the lactate-pyruvate ratio (LPR) (54.2 ± 15.5) was observed, whereas a decrease in cerebral glucose (0.9 ± 0.5 mmol/L) occurred. Within an hour, an increase of cerebral lactate (5.0 ± 2.0 mmol/L) and glycerol (104.4 ± 89.8 μmol/L) as well as a decrease of glucose (0.9 ± 0.4 mmol/L) were measured. In 2 to 5 h after treatment, the LPR significantly decreased (pretreatment: 39.3 ± 15.3, to lowest 30.5 ± 6.7). Cerebral pyruvate levels increased in 1 to 10 h (pretreatment: 100.1 ± 33.1 μmol/L, to highest 141.4 ± 33.7 μmol/L) after intervention. No significant changes in ptiO2 or CPP occurred.

CONCLUSION

The initial detrimental effects of the endovascular procedure itself were outweighed by an improved cerebral metabolism within 10 h thereafter. As the effect was very limited, repeated interventions or continuous application should be considered.
Pediatric weight bias in prehealth profession undergraduates: an idiographic approach
Authors: Basch Molly C , Mayer-Brown Sarah , Robinson Michael E , Janicke David M
Published: October 2019

Bias toward individuals with overweight/obesity (OV/OB) exists among health professionals and trainees with the potential to affect the quality of healthcare interactions. Given most research is adult-focused, this study aimed to examine the influence of weight status on clinical judgments in a pediatric context. Sixteen virtual human scenes representing hypothetical medical encounters of pediatric patients and their mothers were presented to prehealth profession undergraduates (n = 92). Characteristics, or cues, of patient and mother weight status (healthy weight vs. obese) and dyad race (Caucasian vs. African American) were manipulated across scenes. Participants provided ratings for assessment questions, including perceived treatment adherence and responsibility for health, for each scene. Data were examined via idiographic (i.e., individual-level) analysis, which involved generation of separate multiple regressions per participant per assessment question to capture the influence of the cues on participants' ratings. Results represent secondary outcomes from another study published elsewhere. Current analyses revealed that 12%–22% of participants relied on cues of weight status when making assessments about patient and mother adherence and responsibility for health. The majority of these participants equated higher weight status with poorer anticipated treatment adherence and greater health responsibility. Results suggest that the weight status of pediatric patients and their mothers' plays a considerable role in prehealth profession undergraduates' clinical judgments, with the future potential to affect disparities in pediatric care. This study highlights the importance of considering child and maternal factors and utilizing a novel approach that may serve as a model for further investigation of this issue.
Nanocrystalline-Coated Silver Dressings for Patients with Type 2 Diabetes after Surgical Coronary Revascularization
Authors: Parys Monika , Jaźwiec Tomasz , Kowalczuk-Wieteska Anetta , Majchrzyk Iwona , Gancarczyk Halina , Skoczeń Aleksandra , Kumor Julita , Mijacz Monika , Kubacki Krzysztof , Zembala Michał Oskar , Zembala Marian
Published: October 2019

OBJECTIVE

To assess the suitability of nanocrystalline-coated silver dressings versus standard wound dressings in patients with type 2 diabetes after coronary revascularization.

METHODS

The study involved 194 patients who were divided into two homogeneous groups. The control group (n = 97) received a standard sterile dressing. The intervention group (n = 97) received silver dressings. Glycosylated hemoglobin, fructosamine, and creatinine were assessed in all patients. The emergence of superficial wound infection within 30 days was the primary endpoint of the study, and deep wound infections were a secondary endpoint.

MAIN RESULTS

Superficial wound infections were documented in 26 patients: 11 patients in the study group and 15 in the control group. There were no statistically significant differences between the analyzed groups regarding the occurrence of the primary endpoint. No deep wound infections were found in either the study or control group.

CONCLUSIONS

The frequency of sternotomy wound infection in patients with type 2 diabetes is comparable between patients treated with traditional dressings and those receiving silver dressings; therefore, to maximize cost savings, providers should consider using standard wound dressings in this patient population.
Validated 60-Second General Foot Screen: A Pilot Trial and Guide to Diagnoses and Treatment
Authors: Sibbald R. Gary , Maliyar Khalad , Persaud-Jaimangal Reneeka , Elliott James A. , Brandon Alisa , Kotru Bharat , Armstrong David G.
Published: October 2019

Foot health is important to overall patient health. Early diagnosis and treatment of diabetes, neuropathy, fungal foot infections, foot deformity, and vascular disease/lower leg edema can improve patient quality of life. One way to achieve this is effective screening. To this end, researchers piloted a validated 10-item screening tool to assess foot health on 120 patients; 74.17% had at least one positive abnormality, demonstrating the critical importance of these early findings. Only 25.83% of individuals had completely low-risk feet. This easy-to-use tool can assist healthcare professionals in the recognition and treatment of common foot problems. The article also outlines the early signs of disease by screening item and provides a guide to treatment to enable effective prevention and quality care.

GENERAL PURPOSE

To provide information on a 60-second General Foot Screen to assist in the prevention and/or identification and management of common foot problems.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant should be better able to:

1. Use the 60-second General Foot Screen to assist healthcare professionals in the recognition of common foot problems.

2. Identify risk factors, causes, and treatment of selected foot problems.
Clinical Reasoning and Diagnostic Error: A Call to Merge Two Worlds to Improve Patient Care
Authors: Durning Steven J. , Trowbridge Robert L. , Schuwirth Lambert
Published: October 2019

Numerous and substantial challenges exist in the provision of safe, cost-effective, and efficient health care. The prevalence and consequences of diagnostic error, one of these challenges, have been established by the literature; however, these errors persist, and the pace of improvement has been slow. One potential reason for the lack of needed progress is that addressing delayed and wrong diagnoses will require contributions from 2 currently distinct worlds: clinical reasoning and diagnostic error. In this Invited Commentary, the authors argue for merging the diagnostic error and clinical reasoning fields as the perspectives, frameworks, and methodologies of these 2 fields could be leveraged to yield a more aligned approach to understanding and subsequently to mitigating diagnostic error. The authors focus on the problem of diagnostic labeling (a categorization task where one has to choose the correct label or diagnosis). The authors elaborate on why this alignment could help guide health care improvement efforts, using the vexing problem of context specificity that leads to unwanted variance in health care as an example.
Sevoflurane-induced inflammation development: involvement of cholinergic anti-inflammatory pathway
Authors: Yin Jian , Zhao Xin , Wang Lijuan , Xie Xiaojuan , Geng Hemei , Zhan Xiandong , Teng Jinliang
Published: October 2019

Chronic inflammation plays an important role in the mechanisms underpinning the development of anesthesia-induced cognitive dysfunction. However, less is known about how anesthesia causes inflammation. One possibility is that the inflammation is related to alteration of the activity of the alpha 7 nicotinic acetylcholine receptor cholinergic anti-inflammatory pathway. This study analyzed the effect of sevoflurane administration on the cognitive function by using a novel object recognition test and Y-maze test, and on acetylcholinesterase activity and expression in hippocampal tissue by using an acetylcholinesterase assay kit and quantitative real-time PCR. This study also evaluated the effect of alpha 7 nicotinic acetylcholine receptor agonist PNU-282987 and antagonist methyllycaconitine on cognitive function and the level of hippocampal tumor necrosis factor-α in aged rats exposed to sevoflurane anesthesia. We found that 3% sevoflurane significantly impaired cognitive function and increased acetylcholinesterase activity by upregulating its expression in hippocampal tissue. Sevoflurane-induced impairment of cognitive function was significantly rescued by PNU-282987 but aggravated by methyllycaconitine. In addition to impairment of cognitive function, sevoflurane also significantly increased tumor necrosis factor-α level in plasma and hippocampal tissue. Similarly, this sevoflurane-induced change of tumor necrosis factor-α level in rats was antagonized by PNU-282987 but amplified by methyllycaconitine. In conclusion, our data show that the development of inflammation in sevoflurane-induced cognitive decline is associated with the downregulation of alpha 7 nicotinic acetylcholine receptor cholinergic anti-inflammatory pathway in aged rats.
Intravenous Artesunate for Imported Severe Malaria in Children Treated in Four Tertiary Care Centers in Germany
Authors: Bélard Sabine , Brand Judith , Schulze-Sturm Ulf , Janda Ales , von Both Ulrich , Tacoli Costanza , Alberer Martin , Kempf Caroline , Stegemann Miriam S. , Krüger Renate , Varnholt Verena , Blohm Martin , Reiter Karl , Zoller Thomas , Suttorp Norbert , Mall Marcus , von Bernuth Horst , Gratopp Alexander , Hübner Johannes , Hufnagel Markus , Kobbe Robin , Kurth Florian
Published: October 2019

Background:

Intravenous artesunate (ivA) is the standard treatment for severe malaria. Data systematically evaluating the use of ivA in pediatric patients outside malaria-endemic regions are limited. The aim of this case series was to summarize efficacy and safety of ivA for imported severe malaria in children in Germany.

Methods:

Our retrospective case series included pediatric patients with imported severe malaria treated with at least 1 dose of ivA (Artesun, Guilin Pharmaceutical; Shanghai, China) at 4 German tertiary care centers. Severe malaria was defined according to World Health Organization criteria.

Results:

Between 2010 and 2018, 14 children with a median [interquartile range (IQR)] age of 6 (1;9.5) years were included. All children were of African descent. All but 2 patients had Plasmodium falciparum malaria; 1 child had P. vivax malaria and 1 child had P. falciparum and P. vivax co-infection. Median (IQR) parasitemia at admission in patients with P. falciparum was 9.5% (3;16.5). Patients were treated with 1–10 [median (IQR) 3 (3;4)] doses ivA. All but one patient received a full course of oral antimalarial treatment. Parasite clearance was achieved within 2–4 days, with the exception of 1 patient with prolonged clearance of peripheral parasitemia. Three patients experienced posttreatment hemolysis but none needed blood transfusion. Otherwise ivA was safe and well tolerated.

Conclusions:

ivA was highly efficacious in this pediatric cohort. We observed episodes of mild to moderate posttreatment hemolysis in approximately one-third of patients. The legal status and usage of potentially lifesaving ivA should be evaluated in Europe.
Clinical value of haptoglobin and soluble CD163 testing for the differential diagnosis of tuberculous and malignant pleural effusions
Authors: Gao Jinying , Song Lei , Li Dan , Peng Liping , Ding Hui
Published: October 2019

This study aims to evaluate the clinical value of haptoglobin (Hp) and sCD163 testing for the differential diagnosis of pleural effusion, and investigate the correlation of Hp and sCD163 with the inflammatory response of the body.

Pleural effusion samples were collected from 78 patients (38 tuberculous pleural effusions [TPE] and 40 malignant pleural effusions [MPE]). The concentrations of Hp and sCD163 in the pleural effusion were measured by enzyme-linked immunosorbent assay (ELISA).

The concentrations of Hp and sCD163 were significantly higher in the TPE group than in the MPE group (P < .05). The sensitivity and specificity of the Hp test for the differential diagnosis of TPE and MPE was 82.4% and 86.1%, respectively (P < .01), while the cut off value was 779.05 ug/mL. Furthermore, the sensitivity and specificity of the sCD163 test for the differential diagnosis of TPE and MPE was 76.3% and 85.0%, respectively (P < .01), while the cut off value was 16,401.11 ng/mL. Moreover, the sensitivity and specificity of the combination of Hp and sCD163 tests for diagnosing TPE was 90.0% and 87.5%, respectively. Hp and IL-1β, TNF-α, CRP and ESR were positively correlated in both the TPE group and MPE group (P < .05). Hp and sCD163 were positively correlated in the TPE group (r = 0.3735, P = .0209), but not in the MPE group (r = 0.22, P = .1684). However, there was no correlation between sCD163 and TNF-α, CRP and ESR in either the TPE group, or the MPE group (P > .05). Furthermore, sCD163 and IL-1β were weakly correlated in the TPE group (r = 0.49, P = .0018), but these had no correlation in the MPE group (r = 0.068, P = .6767).

Hp and sCD163 can be used as biological markers for the differential diagnosis of pleural effusion in clinic, and the level of Hp in pleural effusion may reflect the intensity of inflammation in the body to some extent.
Efficacy of computed tomography in prediction of operability of L5/S1 foraminal stenosis using region of interest
Authors: Shim Dong Woo , Lee Byung Ho , Seo Jiwoon , Hong Hyunjoo , Shin Sung Chul , Kim Hak Sun
Published: October 2019

Symptoms of intervertebral foraminal stenosis are caused by compression of nerve root exiting the intervertebral foramen. Many attempts to measure the size of the neuromuscular exit have been made; however, only a few studies to compare the area differences between foramens by computed tomography (CT) were done. In this retrospective comparative study, we used the region of interest (ROI) in CT to measure and compare the area of intervertebral foramen between the healthy control group and the patient group.

Eighty-one patients who underwent CT of the lumbar spine between May 2014 and December 2017 were enrolled. Using the medical imaging program, the foraminal area between L5 and S1 vertebrae was measured on the sagittal, coronal, and axial planes using ROI. Four groups were established for comparison: those diagnosed with foraminal stenosis by a radiologist and those who were not, those diagnosed with foraminal stenosis by orthopedic surgeons and those who were not. These groups were further divided into subcategories depending on whether the area was operated on for foraminal stenosis. Interobserver and intraobserver agreements were assessed.

The mean age of patients was 56.5 years (range 17–84). The foraminal area of the surgical group on sagittal plane was significantly narrower than the control group (P = .005). However, the difference between the 2 groups on axial and coronal planes was not statistically significant (P > .1). Foraminal area <80 mm2 on sagittal images was a statistically significant risk factor for clinical symptom (P = .028) and that <65 mm2 was a statistically significant risk factor in predicting operability (P = .01). Interobserver and intraobserver agreements were fair to good on axial and coronal planes (about 0.7), whereas the agreements were excellent on sagittal plane (>0.9).

In this study, we proved that measuring the intervertebral foraminal area using the ROI in CT in the lumbar spine is useful for diagnosing L5-S1 foraminal stenosis, especially on sagittal plane. Furthermore, not only does it provide aid in diagnosis, but it also helps predicting the operability of foraminal stenosis.
Vulvar epithelioid leiomyoma with myxoid change
Authors: Jang Si-Hyong , Cho Hyun Deuk , Lee Ji-Hye , Lee Hyun Ju , Hong Soon Auck , Ahn Hyein , Mun Seong Taek , Oh Mee-Hye
Published: October 2019

Rationale:

Smooth muscle tumors of the vulva are infrequent neoplasms with diverse histologic features and unclear biologic behavior. Herein, we report a very rare case of vulvar epithelioid leiomyoma and review of previous reported cases of these tumors. In addition, we have discussed the representative diagnostic criteria of vulvar smooth muscle tumors and prognostic significance of epithelioid morphology.

Patient concerns:

We recently met a 45-year-old woman with complaint of painful vulvar mass.

Interventions:

Excisional biopsy was performed.

Diagnoses:

Pathologic examination revealed a vulvar epithelioid leiomyoma with multinodular growth pattern. Mitotic activity was rare and cellular atypia was not identified. Based on histology and immunohistochemical staining results, the case was diagnosed as vulvar epithelioid leiomyoma.

Outcomes:

After mass excision, the patient was discharged with no complication and there was no evidence recurrence for 6 months.

Lessons:

After reviewing previous papers and diagnostic criterion, we thought that vulvar smooth muscle tumors with predominant epithelioid morphology may be associated with unfavorable prognosis, Therefore, pathologists should examine the epithelioid component in vulvar smooth muscle tumors carefully.
A meta-analysis of cisplatin-based concurrent chemoradiotherapy with or without cetuximab for locoregionally advanced nasopharyngeal carcinoma
Authors: Wang Bi-Cheng , Shi Liang-Liang , Fu Chen , Zhou Hong-Xia , Zhang Zhan-Jie , Ding Qian , Peng Gang
Published: October 2019

Background:

It is unclear whether cetuximab (CTX) plus cisplatin-based concurrent chemoradiotherapy (CCRT) delivers equivalent or improved results over standard CCRT in locoregionally advanced nasopharyngeal carcinoma (NPC).

Methods:

The strategy involved searching the PubMed, Embase, Cochrane Library, and Web of Science. Pooled hazard ratios (HRs) for overall survival (OS), distant metastasis-free survival (DMFS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS), and pooled risk ratios for adverse events were meta-analyzed.

Results:

In all, 1744 patients in 5 clinical trials were included in the analysis. Compared with CCRT group, CTX plus CCRT significantly improved DFS (HR = 0.59, 95% confidence interval [CI]: 0.41–0.86, P = .006) and distant metastasis failure-free survival (HR = 0.54, 95% CI: 0.38–0.76, P = .0004), rather than OS (HR = 0.70, 95% CI: 0.44–1.09, P = .12) and local-regional failure-free survival (HR = 0.82, 95% CI: 0.54–1.22, P = .33).

Conclusions:

CTX plus CCRT might achieve higher DFS and DMFS with no significant difference in OS and LRFS. CTX plus CCRT group was associated with more grade 3-4 skin rash, mucositis and dermatitis. Large randomized trials were urgent to fully explore the usefulness of this treatment in the locally advanced NPC patients.
A systematic review of randomized controlled trials of the Wenyang Huoxue method in treating diabetic peripheral neuropathy
Authors: Deng Zhiyuan , Wang Manjia , Fan Yao-hua , Huang Ruilin , Rao Yawen , Mai Xurong , Liu Min
Published: October 2019

Objective:

To assess the efficacy and safety of the Wenyang Huoxue method for patients with diabetic peripheral neuropathy.

Methods:

A systematic literature search was performed using 7 databases: PUBMED, EMBASE, the Chinese National Knowledge Infrastructure, Wanfang, Chinese BioMedical, and the VIP Chinese Science and Technique Journals. The publication time was from the start of each database up to November 2018. Review Manager 5.3 software was used for assessing potential bias, data synthesis, and the subgroup analysis. Begg and Egger tests were used to assess funnel plot symmetries using Stata 14.0 software. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence.

Results:

A total of 22 trials involving 1835 participants were eligible. There were significant differences in a total effective rate between the Wenyang Huoxue method combined with Western medicine and Western medicine alone (RR = 1.33, 95% CI 1.26–1.41; P < .00001). As for the sensory conduction velocity (SCV) of the peroneal nerve, the Wenyang Huoxue method combined with Western medicine compared with Western medicine alone had a significant increase (weighted mean difference [WMD] = 5.00, 95% CI 3.42–6.57; P < .00001). Also, the Wenyang Huoxue method combined with Western medicine had significant increases in motor conduction velocity (MCV) of the peroneal nerve (WMD = 4.48, 95% CI 3.78–5.19; P < .00001), tibial nerve SCV (WMD = 3.47, 95% CI 2.66–4.28; P < .00001), tibial nerve MCV (4.87, 95% CI 3.21–6.53; P < .00001), median nerve SCV (WMD = 3.78, 95% CI 3.07–4.50; P < .00001), and median nerve MCV (WMD = 4.50, 95% CI 3.40–5.59; P < .00001). However, the effect of the Wenyang Huoxue method on fasting blood glucose, 2-h postprandial blood glucose, and glycosylated hemoglobin was not statistically significant. Egger's test results showed that there was no publication bias (P = .0008), but the trim and filling method showed steady results. An influence analysis showed that no single study affected the overall result. The GRADE quality of the evidence was low to moderate across the different outcomes.

Conclusion:

Despite of the apparently positive findings, the quality of GRADE is not high, suggesting that the Wenyang Huoxue method can improve nerve conduction velocity to a certain extent, but more rigorous literature is needed to support this evidence.