bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of dislocation timing following primary total hip arthroplasty on the risk of redislocation and revision
Authors: Norambuena German A , Wyles Cody C , Van Demark Robert E , Trousdale Robert T
Published: February 2019

Introduction:

There is little data regarding timing of index dislocation in patients who undergo primary total hip arthroplasty (THA) and subsequent risk of redislocation and revision.

Methods:

Between 1992 and 2013, 21,490 primary THAs were performed at a single institution. 189 patients (190 hips) had a first episode of dislocation within one year of index surgery (0.9 %). 32 patients (32 hips) were excluded for the following reasons: complex THA secondary to fracture malunion, Crowe III/IV developmental hip dysplasia, periprosthetic fracture, prior hip surgery, incomplete information, and hip abductor avulsion. The final cohort consisted of 157 patients (158 hips) who experienced dislocation within 1 year of primary non-complex THA. 88 patients were female (56%), mean age was 61 years (SD = 14), and mean follow-up was 76 months (range 0–229). Multivariable Cox proportional-hazards regression models with fractional polynomial models were used to estimate the association between timing of index dislocation and subsequent redislocation and revision surgery.

Results:

69 patients (44%) redislocated at final follow-up. Revision for any cause occurred in 26 out of 157 hips (17%). Time lapse from index THA to first dislocation was significantly associated with the risk of redislocation ( p = 0.004) and with the risk of revision ( p = 0.04). For every additional 7 days from surgery, risk of redislocation increased by a factor of 1.1 and risk of revision was increased by a factor of 1.13.

Conclusion:

This study demonstrates there is a lower risk of redislocation and revision in patients who have a first episode of dislocation closer to primary THA.
Treating to Target(s) With Interleukin-17 Inhibitors
Authors: Lynde Charles W. , Beecker Jennifer , Dutz Jan , Flanagan Cathy , Guenther Lyn C. , Gulliver Wayne , Papp Kim , Rahman Proton , Sholter Dalton , Searles Gordon E.
Published: February 2019

Background:

The treat-to-target (T2T) strategy has become established in several medical specialties as a key guidance to optimal therapeutic decision making. T2T may be effective in the assessment of the biologic class of agents called interleukin (IL)-17 inhibitors, which are emerging as a safe and effective treatment option for autoimmune inflammatory conditions such as plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS).

Objective:

The objective of this article is to use a T2T approach for the evaluation of the effectiveness and safety of IL-17 inhibitors in the management of patients with plaque psoriasis, PsA, and AS.

Methods:

Following a comprehensive literature search, a full-day meeting was convened to discuss and identify the T2T targets for psoriasis, PsA, and AS. Clinical trial evidence was presented for the approved IL-17 inhibitors—secukinumab, ixekizumab, and brodalumab—to assess whether these data meet T2T safety and efficacy targets.

Results:

All 3 approved agents were significantly superior to placebo and active controls in the achievement of T2T targets for psoriasis. Secukinumab and ixekizumab were likewise associated with significantly better outcomes than controls in the PsA targets, and secukinumab resulted in significant AS target improvements vs placebo. The IL-17 inhibitors were also associated with low rates of serious adverse events and exacerbations of common comorbid conditions.

Conclusion:

Phase III trial results support the T2T benefit and safety of IL-17 inhibitors according to their specific indications for the management of patients with plaque psoriasis, PsA, and AS.
High incidence and clinical characteristics of fibromuscular dysplasia in patients with spontaneous cervical artery dissection: The ARCADIA-POL study
Authors: Talarowska Paulina , Dobrowolski Piotr , Klisiewicz Anna , Kostera-Pruszczyk Anna , Członkowska Anna , Kurkowska-Jastrzębska Iwona , Gąsecki Dariusz , Warchoł-Celińska Ewa , Światłowski Łukasz , Florczak Elżbieta , Januszewicz Magdalena , Michałowska Ilona , Józwik-Plebanek Katarzyna , Szczudlik Piotr , Błażejewska-Hyżorek Beata , Protasiewicz Marcin , Odrowąż-Pieniążek Piotr , Tekieli Łukasz , Michel-Rowicka Katarzyna , Hanus Katarzyna , Widecka Krystyna , Sołtysiak Marta , Tykarski Andrzej , Stryczyński Łukasz , Szczerbo-Trojanowska Małgorzata , Hoffman Piotr , Prejbisz Aleksander , Januszewicz Andrzej
Published: February 2019

The association between fibromuscular dysplasia (FMD) and spontaneous cervical artery dissection (SCeAD) has been recognized, but the available evidence on this relationship is scant. Therefore, the main goal of our study was to systematically evaluate FMD frequency, clinical characteristics and vascular bed involvement in patients with SCeAD. Among 230 patients referred to the ARCADIA-POL study, 43 patients (mean age 44.1 ± 8.9 years; 15 men and 28 women) with SCeAD were referred. Also, 135 patients with FMD were compared to patients with and without SCeAD. Patients underwent: ambulatory blood pressure measurements, biochemical evaluation, echocardiographic examination, and whole body computed tomographic angiography. FMD changes were found in 39.5% of patients with SCeAD. There were no differences in clinical characteristics between patients with SCeAD and FMD and those without FMD, except for a tendency towards a higher female ratio in SCeAD patients with FMD. There were no differences in other parameters describing target organ and SCeAD characteristics. Patients with SCeAD and FMD compared to those without SCeAD were characterized by a lower frequency of hypertension and a higher frequency of hyperlipidemia and history of contraceptive hormone use. Our study indicates a high incidence (39.5%) of FMD in subjects with SCeAD. Since there are no distinctive discriminating factors between patients with SCeAD and FMD and those without FMD, FMD should be suspected in all patients with SCeAD.
Increased language co-activation leads to enhanced cross-linguistic phonetic convergence
Authors: Simonet Miquel , Amengual Mark
Published: February 2019

Purpose:

This study investigates the effects of bilingual language modes (or settings) on the speech production patterns of a group of early Catalan/Spanish bilinguals from Majorca, Spain. Our main research question was as follows: are bilingual speech patterns modulated by the level of (co-)activation of a bilingual’s two languages?

Design:

Bilingual participants were classified as a function of their linguistic experience (or dominance), from Catalan- to Spanish-dominant. Subsequently, we recorded their speech in two experimental settings: a unilingual setting in which only Catalan words were uttered, and a bilingual setting in which both Catalan and Spanish words (cognates) were produced in random order.

Data and analysis:

The study examined the acoustic realization of Spanish and Catalan unstressed /a/, which surfaces as [a] in Spanish but is reduced to schwa, [ə], in Catalan. The acoustic characteristics of unstressed /a/ were explored across the two languages and the two experimental settings.

Findings:

Catalan unstressed /a/, which was similarly reduced to schwa in the speech of all participants, became slightly more similar to Spanish unstressed /a/ (i.e., it had a higher first formant) when produced alongside Spanish words (bilingual setting) than when produced in a Catalan unilingual setting. There were no effects of linguistic experience, and the effects of setting did not interact with experience.

Originality:

Very few studies have reported the effects of dynamic cross-linguistic interference in phonetic production, and even fewer have reported them with a phonetic variable resulting from a language-specific phonological process (unstressed vowel reduction) rather than a phonemic contrast.

Implications:

These findings suggest that cross-linguistic interaction is dynamic and modulated by language activation, and that an absence of dominance effects does not necessarily entail an absence of online cross-linguistic phonetic influence.
Genericity in third language English: Acquisition pattern and transfer in ultimate attainment
Authors: Hermas Abdelkader
Published: February 2019

This study investigates the acquisition of genericity in advanced third language (L3) English. The learners are first language (L1) Moroccan Arabic–second language (L2) French adults. They completed an acceptability judgment task testing the interpretation of five count nominal types in noun phrase (NP)-level and sentence-level genericity: definite, indefinite and bare singulars, definite and bare plurals. The study defines the generic or non-generic status of every NP form in the learners’ L3 interlanguage. The results show that the L3 learners are target-like on the generic interpretation of bare plurals, although these are strictly existential in their native language and illicit in L2 French. Definite and bare singulars do not pose any difficulty either. In contrast, non-facilitative L1 transfer induces the generic interpretation of definite plurals and restricts indefinite singulars to the existential interpretation. The results show that the L3 learners do not distinguish NP-level from sentence-level genericity, reflecting L1 Arabic grammar where the two merge. They use the same pattern of NP types for the two types. Thus, knowledge of genericity in L3 English is a patchwork of target-like and non-target-like exponents.
Italian-German bilinguals: The effects of heritage language use on accent in early-acquired languages
Authors: Lloyd-Smith Anika , Einfeldt Marieke , Kupisch Tanja
Published: February 2019

Aims and objectives/purpose/research questions:

This study investigates perceived accent in the two early-acquired languages of 21 adult-aged bilinguals with Italian as the heritage language (HL) and German as the majority language (ML). We test the relative ability of ‘age of onset (AoO) in German’ (range = 0–6 years) and ‘Italian use’ to predict perceived nativeness in Italian and German.

Design/methodology/approach:

Two accent rating experiments were carried out (one in each language) comparing the bilingual speech samples to those of monolingual and second language (L2) control groups. The samples were rated by German and Italian-speaking judges for foreign accent (‘yes’ or ‘no’) and for degree of certainty (‘certain, ‘semi-certain’, ‘uncertain’).

Data and analysis:

The effects of ‘AoO in German’ and ‘Italian Use’ (operationalized as an Italian Use Score) were analysed using correlational analyses and logistic regression.

Findings/conclusions:

Our results show that almost all bilinguals were indistinguishable from monolingual controls in German, and that their perceived accent in Italian lay somewhere between that of the monolingual and L2 controls. Based on regression analyses, we conclude that a later introduction of the ML has neither a negative effect on the ML itself, nor does it show up advantages in the HL. Instead, how native-like the heritage speakers (HSs) sound in the HL largely depends on HL use. No negative effects of HL use are found for German.

Originality:

We test a new population of Italian HSs in South Germany and compare these results to findings from other HS populations in Germany.

Significance/implications:

This study shows that, although it may be the case for child-aged bilinguals that introducing the ML earlier causes more phonological pressure on the HL, this effect seems to have disappeared by adulthood – at least with regards to perceived global accent. Also, accent in the HL depends on HL use across the lifespan.
Investigation of ground-motion spatial variability effects on component and system vulnerability of a floating cable-stayed bridge
Authors: Ma Kai , Zhong Jian , Feng Ruiwei , Yuan Wancheng
Published: February 2019

The effects of ground-motion spatial variability on the seismic vulnerability of a floating cable-stayed bridge with 420-m long main span are investigated using component and system-level fragility analysis methods. Four combinations of the spatial variability components are considered including (a) the incoherence effect; (b) the incoherence and wave-passage effects; (c) the incoherence and site-response effects; and (d) general excitation case including the incoherence, wave-passage, and site-response effects. Parametric study was carried out to assess the sensitivity of seismic fragility to the variation of spatial variability components. The results indicate that the bridge becomes more vulnerable under spatially varying excitations than uniform excitations. The fragile components and the bridge system become more vulnerable with an increase in incoherence level. The component and system-level vulnerabilities are not sensitive to the variation of apparent wave velocities in most cases. However, the site-response effect is more complex than incoherence and wave-passage effects. There is no general trend about its effect on different components, whereas the system fragility increases as the soil conditions of adjacent excitation sites change more significantly and the soil types vary from the soft to the firm along wave-traveling direction. In addition, the bridge tends to be more vulnerable if the soil condition of the reference site becomes softer for the general excitation case. Spatial variability effects, especially incoherence and site-response effects, should be considered in the fragility analyses of this type of bridges.
Safe Introduction of Minimally Invasive Esophagectomy at a Medium Volume Center
Authors: Linder G. , Jestin C. , Sundbom M. , Hedberg J.
Published: February 2019

Background and Aims:

Minimally invasive esophagectomy is a favored alternative in high-volume centers. We evaluated the introduction of, and transition to, minimally invasive esophagectomy at a medium volume tertiary referral center (10–20 esophagectomies annually) with focus on surgical results.

Material and Methods:

Patients who underwent minimally invasive esophagectomy or open transthoracic surgery for carcinoma of the esophagus or gastroesophageal junction (Siewert I and II) during 2007–2016 were retrospectively studied. Sorted on surgical approach, perioperative data, surgical outcomes, and postoperative complications were analyzed and multivariate regression models were used to adjust for possible confounders.

Results:

One hundred and sixteen patients were included, 51 minimally invasive esophagectomy (21 hybrid and 30 totally minimally invasive) and 65 open resections. The groups were well matched. However, higher body mass index, neoadjuvant chemoradiotherapy, and cervical anastomosis were more frequent in the minimally invasive esophagectomy group. Minimally invasive esophagectomy was associated with less peroperative bleeding (384 vs 607 mL, p = 0.036) and reduced length of stay (14 vs 15 days, p = 0.042). Duration of surgery, radical resection rate, and postoperative complications did not differ between groups. Lymph node yield was higher in the minimally invasive esophagectomy group, 18 (13–23) vs 12 (8–16), p < 0.001, confirmed in a multivariate regression model (adjusted odds ratio 3.15, 95% class interval 1.11–8.98, p = 0.032).

Conclusion:

The introduction of minimally invasive esophagectomy at a medium volume tertiary referral center resulted in superior lymph node yield, less peroperative blood loss and shorter length of stay, without compromising the rate of radical resection, or increasing the complication rate.
Six-Month Angiographic and Clinical Outcomes of Therapeutic Ultrasound Pretreatment Associated With Plain Balloon Angioplasty for Below-the-Knee Lesions in Patients With Critical Limb Ischemia: A Prospective, Single-Center Pilot Study
Authors: Del Giudice Costantino , Gandini Roberto
Published: February 2019

Purpose: To evaluate the safety and efficacy of low-frequency, high-intensity ultrasound energy delivered via a new dedicated ultrasound catheter followed by conventional balloon angioplasty to treat calcified infrapopliteal lesions. Materials and Methods: A prospective, nonrandomized, single-center pilot study enrolled 12 patients (mean age 72.2±5.3 years; 8 men) with critical limb ischemia (9 Rutherford category 5 and 3 category 6) between January and November 2017. Of the 19 target lesions, 11 had severe calcification. Patients were treated with the Kapani ultrasound system before conventional balloon dilation. Primary safety endpoints included 30-day death, major target limb amputation, and target vessel acute occlusion. The main efficacy outcome was primary patency at 6 months, defined as freedom from both clinically-driven target lesion revascularization (TLR) and angiographically-defined restenosis (>50% lumen reduction). Results: Technical success (<30% residual stenosis) was achieved in all lesions without complications or stent implantation. Ultrasound energy was delivered over a mean 185.2±67.3 seconds followed by low-pressure dilation (mean 6.1±1.9 atm). Angiography confirmed primary patency at 6 months in 18 (95%) of 19 lesions. No death, TLR, or amputation was reported in follow-up. Complete ulcer healing was observed in all 12 patients at 6 months. Conclusion: This pilot trial with a small number of patients suggests that low-frequency, high-intensity ultrasound energy delivery followed by plain balloon angioplasty is a safe approach to treat infrapopliteal atherosclerotic lesions. Angiographically-documented results at 6 months indicate a potential for this combined therapy in the treatment of CLI patients with calcified BTK lesions. Further studies on a larger randomized cohort are needed to confirm these positive clinical outcomes.
Excessive Daytime Sleepiness in Major Dementia Syndromes
Authors: Boeve Angelica , Ferman Tanis J. , Aakre Jeremiah , St. Louis Erik , Silber Michael , Machulda Mary , Fields Julie , Graff-Radford Neill , Mielke Michelle , Geda Yonas , Jones David , Graff-Radford Jonathon , Knopman David , Petersen Ronald , Boeve Brad
Published: February 2019

There has been no comparison of excessive daytime sleepiness (EDS) in patients with Alzheimer’s disease dementia (AD), dementia with Lewy bodies (DLB), and behavioral variant frontotemporal dementia (bvFTD). We identified patients with mild dementia who met criteria for these disorders who also had the Epworth Sleepiness Scale (ESS) completed. The sample included 17 bvFTD, 111 AD, and 31 DLB. An ESS score ≥10 was considered abnormal and consistent with EDS. Analyses with age and sex as covariates revealed higher mean ESS scores for DLB compared to the other groups (DLB 13.9 [5], bvFTD 9.6 [8], AD 8.8 [5], P < .05). An ESS score ≥10 was significantly more likely to occur in DLB compared to bvFTD or AD (DLB 81% vs bvFTD 47% vs AD 45%, P < .01). In patients with mild dementia, EDS is greatest in DLB and comparably lower in bvFTD and AD.
Impaired Postural Control and Altered Sensory Organization During Quiet Stance Following Neurotoxic Chemotherapy: A Preliminary Study
Authors: Monfort Scott M. , Pan Xueliang , Loprinzi Charles L. , Lustberg Maryam B. , Chaudhari Ajit M. W.
Published: February 2019

Individuals diagnosed with chemotherapy-induced peripheral neuropathy (CIPN) demonstrate impaired balance and carry an increased risk of falling. However, prior investigations of postural instability have only compared these individuals against healthy controls, limiting the understanding of impairments associated with CIPN. Therefore, the purpose of this study was to better isolate postural control impairments that are associated with CIPN. Twenty cancer survivors previously diagnosed with breast or colorectal cancer participated. Participants were separated into 3 groups: no prior chemotherapy exposure (CON, n = 6), and recent treatment with taxane- or oxaliplatin-based chemotherapy with no/mild symptoms of CIPN (−CIPN, n = 8) or moderate/severe symptoms of CIPN (+CIPN, n = 6). Postural control was assessed by measuring center of pressure during standing balance conditions that systematically interfered with somatosensory, visual, and/or vestibular information. The presence of CIPN sensory symptoms was associated with impaired postural control, particularly during eyes-closed balance conditions ( P < .05). Additionally, medial-lateral postural instability was more pronounced in the +CIPN group compared with the −CIPN group and CON participants ( P < .05). Greater postural instability during eyes-closed balance in individuals with CIPN is consistent with impaired peripheral sensation. Balance impairments in cancer survivors with CIPN demonstrate the unique challenges in this population and motivate the need for targeted efforts to mitigate postural control deficits that have previously been associated with fall risk.
Effects of Shen Cao Granules on Chemotherapy-Induced Thrombocytopenia in Gastrointestinal Cancer Patients: A Randomized Controlled Trial
Authors: Yu Chunfeng , Liu Wei , Mu Yuejun , Hou Aihua , Li Yin
Published: February 2019

Background: To observe clinical effects of Shen Cao granules on thrombocytopenia in patients with gastrointestinal cancer undergoing chemotherapy. Patients and Methods: Patients under a FOLFIRI chemotherapy regimen (n = 92) were randomly divided into study and control groups (n = 46 for each group) and were given 10 g of Shen Cao granules and a placebo, respectively, once daily on chemotherapy treatment days. Platelet counts were measured every other day and any adverse reaction recorded during the study and at follow-up. Results: The incidence of thrombocytopenia (grades II-IV) in the study group was significantly decreased, and the length of hospitalization significantly reduced compared with the control group (11.21 ± 2.46 vs 15.34 ± 3.68 days, P < .05). The minimum numbers of post-chemotherapy platelets and the values of platelet counts 21 days after chemotherapy were significantly increased ([100.65 ± 63.16] × 109/L vs [60.21 ±37.22] × 109/L, P < .05; [267.81 ± 81.32] × 109/L vs [146.42 ± 70.54] × 109/L, P < .001), and the duration of thrombocytopenia and treatment with recombinant human interleukin-11 was significantly decreased in the Shen Cao treatment compared with the control group. No serious adverse events were observed. Conclusions: Shen Cao granules were effective in decreasing chemotherapy-induced thrombocytopenia, shortened the duration of thrombocytopenia, and reduced the length of hospital stay and costs.
Epidemiologic Studies Cannot Reveal the True Shape of the Dose–Response Relationship for Radon-Induced Lung Cancer
Authors: Scott Bobby R.
Published: February 2019

A long-standing controversy is the correct shape of the dose-response relationship for lung cancer induction by inhaled radon (eg, residential radon) at low levels. A probabilistic approach is used in this commentary to show that cohort and case-control epidemiologic studies cannot reveal the true shape of the dose-response relationship for radon-induced lung cancer. Using the indicated approach, it is found that while the dose response for radon-induced lung cancer is expected to be threshold-increasing, the dose-response curve for the cancer incidence when cancers caused by smoking and other carcinogens are included is expected to be threshold-decreasing (ie, threshold-hormetic), as low-level radon can protect from cancer induction by other carcinogens via stimulating the body’s natural defenses against cancer. These defenses include DNA damage repair, removal of aberrant cells via apoptosis, suppression of cancer promoting inflammation, and anticancer immunity.
Charles Lyell’s Principles of Geology, the Geological Sublime, and the Romantic Theatre
Authors: Harley Alexis
Published: February 2019

Across the three volumes of his influential Principles of Geology (1830–33), Charles Lyell demonstrates that the scale of earth history is out of all proportion to human temporality. Lyell makes the case that geologists should assume a viewing position outside the drama of geological action. He repeatedly represents this distance through the figure of the theatre, invoking Romantic critiques of theatrical naturalism that aligned with developments in natural philosophy. At the same time, Lyell deployed technologies from the contemporary stage in his public lectures, and in personal correspondence, he reveals promiscuous tastes across genres, forms and sites of performance. Ultimately, I argue, these apparent inconsistencies point to the role of his subjectivity in a project that is deeply ambivalent about human points of view.
Perceptions and experiences of wrist surgeons on the management of triangular fibrocartilage complex tears: a qualitative study
Authors: Robba Vanessa I. , Karantana Alexia , Fowler Andrew P. G. , Diver Claire
Published: February 2019

There is lack of consensus on the management of triangular fibrocartilage injuries. The aim of this study was to investigate wrist surgeons’ experiences and perceptions regarding treatment of triangular fibrocartilage complex injuries and to explore the rationale behind clinical decision-making. A purposive sample of consultant wrist surgeons ( n = 10) was recruited through ‘snow-balling’ until data saturation was reached. Semi-structured interviews were conducted, digitally recorded and transcribed verbatim. Two researchers independently analysed data using an iterative/thematic approach. Findings suggest that surgeons rely more on their own training and experience, and patient-related factors such as individual expectations, to inform their decision-making, rather than on published material. Current classification systems are largely considered to be unhelpful.

Level of evidence: V
The Relationship Between Accelerated Dev-Ed Coursework and Early College Milestones: Examining College Momentum in a Reformed Mathematics Pathway
Authors: Schudde Lauren , Keisler Katherine
Published: February 2019

More than half of community college students fail to meet college-readiness standards in math. Developmental education (dev-ed) aims to help students acquire the knowledge and skills to succeed in college-level math but is plagued with low rates of advancement. We examined the impact of a model that accelerates developmental math coursework so that students can complete dev-ed and college math courses in their programs of study within 1 year. Using data from Texas and a propensity score matching approach, we tested the impact of the model on several college milestones. Results suggest that students in the accelerated model were more likely to persist and accumulate college-level credits during the 1st year than those in traditional dev-ed math. After 3 years, there was a strong positive relationship between participation in the accelerated model and important college milestones, like college math course completion and total accumulated college-level credits.
Nurses' Experiences of Establishing Meaningful and Effective Relationships With American Indian Patients in the Cancer Care Setting
Authors: M. Pool Natalie
Published: February 2019

Introduction

The establishment of caring relationships with racial and ethnic minority populations is challenging for many cancer care nurses. Nurses serving American Indian (AI) patients frequently encounter population-specific issues, yet their experiences are largely unknown.

Objective

The purpose of this study was to describe the meaning of the AI patient–cancer care nurse relationship from nurses' perspectives. The study included three objectives: (a) to describe the immediate experiences of nurses that have engaged in cancer care relationships with AI patients, (b) to identify the underlying structures of the AI patient–cancer care nurse relationship as described by nurses, and (c) to interpret the meaning of the patient–nurse relationship within the context of AI cancer care experiences.

Methods

This was an interpretive phenomenological study using a hermeneutical process for data collection and analysis of multiple, exploratory interviews. Thematic reduction was completed to explicate the fundamental structures of this particular relationship. Reduction of individually situated themes resulted in seven shared meta-themes including from task to connection; unnerving messaging; we are one; the freedom of unconditional acceptance; attuning and opening; atoning for the past, one moment at a time; and humanizing the inhumane.

Results

Nine cancer care nurses participated. Reconstitution of data and reflective writing suggested that the essential meaning of the AI patient–cancer care nurse relationship was expressed in contradictory yet simultaneous patterns for nurses. Nurses sought synchronicity with their AI patients despite their contextual differences and similarities, yet most lacked adequate cultural safety training. Being in relationship provided nurses great purpose within the universal human context of caring.

Conclusions

Results contribute to the development of interventions designed to improve both the AI cancer care experience and the support and training of nurses. The mutually dependent nature of the patient–nurse relationship implies that strengthening and improving support for one entity may in turn positively impact the other.
Clinicopathological features and impact of adjuvant chemotherapy on the long‐term survival of patients with multiple gastric cancers: a propensity score matching analysis
Authors: Lin Jian‐Xian , Wang Zu‐Kai , Xie Jian‐Wei , Wang Jia‐Bin , Lu Jun , Chen Qi‐Yue , Cao Long‐Long , Lin Mi , Tu Ru‐Hong , Huang Ze‐Ning , Lin Ju‐Li , Zheng Chao‐Hui , Huang Chang‐Ming , Li Ping
Published: February 2019

Background

Little is known about the correlation between the clinicopathological features, postoperative treatment, and prognosis of multiple gastric cancers (MGCs). In this study, we aimed to investigate the correlation between these features and the impact of postoperative adjuvant chemotherapy on the long‐term survival of patients with MGC.

Methods

The clinical and pathological data of patients diagnosed with gastric adenocarcinoma who had radical gastrectomy from January 2007 to December 2016 were analyzed. Using propensity score matching, the prognostic differences, and the impact of postoperative adjuvant chemotherapy between those with MGC and solitary gastric cancers (SGC) were compared.

Results

Among the 4107 patients investigated, the incidence of MGC was 3.2% (133/4107). Before matching, patients with MGC and SGC had disparities in the type of gastrectomy, pathological tumor stage (pT), pathological node stage (pN), and pathological tumor‐node‐metastasis stage (pTNM). After a 1:4 ratio matching, the clinical data of 133 cases of MGC and 532 cases of SGC were found to be comparable. The 5‐year overall survival (OS) rate was 56.6% in the entire matched cohort, 48.1% in the MGC group, and 58.7% in the SGC group (P = 0.013). Multivariate analysis revealed that MGC, age, pT stage, pN stage, and adjuvant chemotherapy were independent predictors of OS (all P < 0.05). Stratified analyses demonstrated that for the cohort of advanced gastric cancer (AGC) patients who did not had adjuvant chemotherapy, the 5‐year OS rate of advanced cases of MGC was inferior than that of SGC patients (34.0% vs. 46.1%, respectively; P = 0.025) but there were no significant difference in the 5‐year OS rate between advanced MGC and SGC patients who had adjuvant chemotherapy (48.0% vs. 53.3%, respectively; P = 0.292). Further, we found that the 5‐year OS rate of advanced MGC who had adjuvant chemotherapy was significantly higher than those who did not had adjuvant chemotherapy (48.0% vs. 34.0%, P = 0.026).

Conclusions

Patients with advanced MGC was identified as having a poorer survival as to SGC patients, but the implementation of postoperative adjuvant chemotherapy showed that it had the potential to significantly improve the long‐term prognoses of MGC patients.
Working with MAPPA: ethics and pragmatics
Authors: Taylor Richard , Yakeley Jessica
Published: February 2019

Multi-agency public protection arrangements (MAPPA) have been in operation for around 18 years in England and Wales. The primary purpose is for the sharing of information between agencies regarding the risk management of offenders returning to the community from custodial and hospital settings. The legal framework regarding information by psychiatrists is not dealt with in one single policy or guidance document. Psychiatrists must use their clinical and professional judgement when engaging with the MAPPA process, mindful of guidance available from professional bodies such as the Royal College of Psychiatrists, General Medical Council and British Medical Association.

LEARNING OBJECTIVES

After reading this article you will be able to:

•

Learn the legal and political background that led to the formation of MAPPA

•

Understand the structure and function of MAPPA

•

Understand the role of psychiatrists in the MAPPA process

DECLARATION OF INTEREST

R.T. is a member of the London Strategic Management Board for MAPPA.
The interpersonal dynamics consultation in physical health settings: a model for reflective practice
Authors: Li Ching , Hillen Thomas , Reiss David , Kirtchuk Gabriel , Scott Sandra , Maier Michael
Published: February 2019

The interpersonal dynamics between patient and doctor remain a daily challenge for clinicians, and reflective practice is a tool that allows them better understanding of how patients engage with treatment. The interpersonal dynamics consultation is a form of group-based reflective practice for patients with difficult relational (interpersonal) styles. It includes the whole multidisciplinary team in a systematic consultation in order to arrive at new understanding and management plans for these patients. Interpersonal dynamics consultations have been used successfully for many years in mental healthcare, and this article has arisen from a project exploring their application in physical healthcare settings. The project works to promote effective working at the interface of physical and mental healthcare and facilitates the important translational work of making psychiatry and psychotherapeutic ideas applicable in a broader context. This article outlines the interpersonal dynamics consultation model and illustrates its use in three fictitious cases from different medical specialties.

LEARNING OBJECTIVES

After reading this article you will be able to:

•

describe the ways in which reflective practice is beneficial to clinical work

•

describe the basic structure of the interpersonal dynamics consultation, including the four interpersonal perspectives

•

recognise the types of cases where interpersonal dynamics consultation might be most useful.

DECLARATION OF INTEREST

None.
Questioning the efficacy of predatory journals' blacklists
Authors: Manca Andrea , Cugusi Lucia , Deriu Franca
Published: February 2019

We question whether blacklists are the best answer to the serious problem of predatory journals. In conjunction with the worrying recent rise in the number of predatory journals, a remarkable number of blacklists have been compiled for specific scientific fields. However, predatory journals are continuously changing names and publishers; they are set up to make easy money and buried shortly after. Predatory journals have such a rapidly evolving nature that it is hard to keep track of them and keep blacklists up to date. We therefore propose a focus on ‘whitelists’ and directories of virtuous journals rather than on blacklists of pseudo-journals. We suggest that a set of criteria be determined that journals have to meet to be qualify as legitimate. In addition, the scientific community should come up with strategies to close the established biomedical databases to predatory journals, thus preventing them from achieving global exposure.

DECLARATION OF INTEREST

None.
ARFID: old wine in a new bottle?
Authors: Waller Glenn
Published: February 2019

In this commentary, some aspects of the context of this diagnosis are considered. It is suggested that avoidant/restrictive food intake disorder (ARFID) is principally a reconfiguration of existing problems. However, it is also stressed that we still need to develop treatments that help patients and their families, given the expectation that has been fuelled by the promotion of the new diagnostic scheme. In developing those therapies, we should not forget that we previously had a number of psychosocial treatment approaches that were helpful for such children when their problems were labelled differently.

DECLARATION OF INTEREST

None.
Against the stream: intermittent nurse observations of in-patients at night serve no purpose and cause sleep deprivation
Authors: Veale David
Published: February 2019

This paper argues that intermittent nursing observations of in-patients at night do not reduce the risk of suicide or severe self-harm. Suicides between 23.00 h and 07.00 h are rare, and these overwhelmingly occur under intermittent observations. Such observation is purely a defensive intervention to document that a patient is safe at a particular time, as there is no engagement. For the large majority of in-patients, it has the unintended consequence of causing sleep deprivation. The intervention may cause harm to in-patients by making their disorder worse and increase their risk during the day. If patients are judged to be at immediate risk, then they should be placed on constant observation. If they are not, then optimising sleep is important for treating a psychiatric disorder and they should be placed on general observations.

Declaration of interest

None.
A new hope for early psychosis care: the evolving landscape of digital care tools
Authors: Torous John , Woodyatt Jessica , Keshavan Matcheri , Tully Laura M.
Published: February 2019

Improving understanding of and outcomes for early-course psychosis (ECP) is a recognised global mental health priority. We argue digital health technologies can advance care for ECP by better accounting for clinical heterogeneity, offering better predictive models, increasing access to early interventions and enhancing existing treatment options.

Declaration of interest

L.M.T. owns shares in Safari Health Inc – a digital health technology company.
High Titers of Thyrotropin Receptor Antibodies Are Associated With Orbitopathy in Patients With Graves Disease
Authors: Kahaly George J , Wüster Christian , Olivo Paul D , Diana Tanja
Published: February 2019

Context

Serum TSH receptor autoantibody (TSH-R-Ab) is a biomarker of Graves disease (GD). Studies have shown that the levels of this TSH-R-Ab have clinical significance.

Objective

To differentiate between thyroidal GD only and Graves orbitopathy (GD + GO).

Design

Controlled, follow-up study.

Setting

Academic tertiary referral center for GD + GO.

Subjects

Sixty patients with GD, GD + GO, and controls.

Intervention

Serial serum dilution analyses with six automated, ELISA, and cell-based assays for TSH-R-Ab.

Main Outcome Measure

Differentiation among GD phenotypes.

Results

All undiluted samples of hyperthyroid-untreated GD patients were positive with the six assays but became negative at dilution 1:9 in four of six assays. In contrast, all undiluted samples of hyperthyroid-untreated GD + GO patients remained positive up to dilution 1:81, P < 0.001. At high dilutions 1:243, 1:729, 1:2187, and 1:6561, the rate of stimulating TSH-R-Ab positivity in the bioassay for GD + GO patients was 75%, 35%, 5%, and 0%, respectively (all P < 0.001). The five ELISA and/or automated assays confirmed this marked difference of anti-TSH-R-Ab detection between GD-only and GD + GO. In comparison, the baseline-undiluted samples of GD vs GD + GO showed an overlap in the ranges of TSH-R-Ab levels. Subsequent to 12-month methimazole treatment, samples from euthyroid GD + GO patients were still TSH-R-Ab positive at the high dilution of 1:243. In contrast, all GD samples were negative already at dilution 1:3. A GD patient with TSH-R-Ab positivity at dilution 1:729 developed de novo GO.

Conclusions

TSH-R-Ab titers, as determined by dilution analysis, significantly differentiate between GD and GD + GO.
Subversive Sisterhood
Authors: Saylor Elizabeth Claire
Published: February 2019

This article examines the Arabic fiction of ʿAfifa Karam (1883–1924), an overlooked contributor to the nahda, or the Arabic cultural renaissance of the mid- to late nineteenth and early twentieth centuries. Born in Mount Lebanon, Karam became a novelist, journalist, and translator in the North American mahjar (Arab diaspora). A discussion of Karam’s novel, Fatima al-Badawiyya (Fatima the Bedouin), published in New York City in 1909, explores the author’s engagement with gender politics within a hybridized cultural space. Such attention also reveals the transnational character of nahda literary culture, as readers and writers scattered across four continents interacted in the textual “spaces” of the rapidly expanding print culture in the Arabic-speaking world. As a single player within an international network of Syro-Lebanese women writers, Karam’s foundational feminist fiction reveals her cosmopolitan female subjectivity, offering a radical vision of global sisterhood that transcends geographic, political, and religious boundaries.
Identification of possible hypoxia sensor for behavioral responses in a marine annelid, Capitella teleta
Authors: Ogino Tetsuya , Toyohara Haruhiko
Published: February 2019

Hypoxia often occurs in summer and causes deleterious effects on marine benthic animals. A marine annelid, Capitella teleta, has tolerance to hypoxia, as shown by the fact that it inhabits organically polluted area, where severe hypoxia is often observed. To understand how this species adapts to the environment, we focused on its hypoxia sensor, and we showed that TRPAbasal was a possible contributor to hypoxia detection in C. teleta. To examine the involvement of TRPA1 in the response of C. teleta to hypoxia, we exposed C. teleta to hypoxic water with or without a TRPA1-specific inhibitor, A-967079. Hypoxic stimulation induced escape behavior of C. teleta from the sediment, and this behavior was suppressed by the inhibitor. The cloned TRPA gene from C. teleta was phylogenetically categorized into TRPAbasal, and contains an oxygen-dependent degradation domain, which is important for the detection of hypoxia. Whole-mount in situ hybridization analysis showed that the gene was transcribed in the prostomium, where sensing functions are localized. These results suggested that the worm has a hypoxia-sensing system possibly utilizing CtTRPAbasal, and this system contributes to expanding the organism's niches in hypoxic environments by detecting whether hypoxia exceeds a level that would imperil its survival.
Activated MLKL attenuates autophagy following its translocation to intracellular membranes
Authors: Frank Daniel , Vaux David L. , Murphy James M. , Vince James E. , Lindqvist Lisa M.
Published: February 2019

Necroptosis is an inflammatory form of programmed cell death mediated by the pseudokinase mixed-lineage kinase domain-like protein (MLKL). Upon phosphorylation by receptor-interacting protein kinase-3 (RIPK3), MLKL oligomerizes, and translocates to and disrupts the plasma membrane, thereby causing necroptotic cell lysis. Herein, we show that activation of necroptosis in mouse dermal fibroblasts (MDFs) and HT-29 human colorectal cancer cells results in accumulation of the autophagic marker, lipidated LC3B (also known as MAP1LC3B), in an MLKL-dependent manner. Unexpectedly, the necroptosis-induced increase in lipidated LC3B was due to inhibition of autophagic flux, not the activation of autophagy. Inhibition of autophagy by MLKL correlated with a decrease in autophagosome and/or autolysosome function, and required the association of activated MLKL with intracellular membranes. Collectively, our findings uncover an additional role for the MLKL pseudokinase, namely to inhibit autophagy during necroptosis.
Synthetic lethality of cytolytic HSV-1 in cancer cells with ATRX and PML deficiency
Authors: Han Mingqi , Napier Christine E. , Frölich Sonja , Teber Erdahl , Wong Ted , Noble Jane R. , Choi Eugene H. Y. , Everett Roger D. , Cesare Anthony J. , Reddel Roger R.
Published: February 2019

Cancers that utilize the Alternative Lengthening of Telomeres (ALT) mechanism for telomere maintenance are often difficult to treat and have a poor prognosis. They are also commonly deficient for expression of ATRX protein, a repressor of ALT activity, and a component of PML nuclear bodies (PML NBs) which are required for intrinsic immunity to various viruses. Here we asked whether ATRX-deficiency creates a vulnerability in ALT cancer cells that could be exploited for therapeutic purposes. We showed in a range of cell types that a mutant herpes simplex virus type 1 (HSV-1) lacking ICP0, a protein that degrades PML NB components including ATRX, was ten- to one thousand-fold more effective in killing ATRX-deficient cells. Infection of co-cultured primary and ATRX-null cancer cells revealed that mutant HSV-1 selectively killed ATRX-null cells. Sensitivity to mutant HSV–1 infection also correlated inversely with PML protein levels, and we showed that ATRX upregulates PML expression at both the transcriptional and post-transcriptional levels. These data provide a basis for predicting, based on ATRX or PML levels, which tumors will respond to a selective oncolytic herpesvirus.
An alternative membrane topology permits lipid droplet localization of peroxisomal fatty acyl-CoA reductase 1
Authors: Exner Tarik , Romero-Brey Inés , Yifrach Eden , Rivera-Monroy Jhon , Schrul Bianca , Zouboulis Christos C. , Stremmel Wolfgang , Honsho Masanori , Bartenschlager Ralf , Zalckvar Einat , Poppelreuther Margarete , Füllekrug Joachim
Published: February 2019

Fatty acyl-CoA reductase 1 (Far1) is a ubiquitously expressed peroxisomal membrane protein that generates the fatty alcohols required for the biosynthesis of ether lipids. Lipid droplet localization of exogenously expressed and endogenous human Far1 was observed by fluorescence microscopy under conditions of increased triglyceride synthesis in tissue culture cells. This unexpected finding was supported further by correlative light electron microscopy and subcellular fractionation. Selective permeabilization, protease sensitivity and N-glycosylation tagging suggested that Far1 is able to assume two different membrane topologies, differing in the orientation of the short hydrophilic C-terminus towards the lumen or the cytosol, respectively. Two closely spaced hydrophobic domains are contained within the C-terminal region. When analyzed separately, the second domain was sufficient for the localization of a fluorescent reporter to lipid droplets. Targeting of Far1 to lipid droplets was not impaired in either Pex19 or ASNA1 (also known as TRC40) CRISPR/Cas9 knockout cells. In conclusion, our data suggest that Far1 is a novel member of the rather exclusive group of dual topology membrane proteins. At the same time, Far1 shows lipid metabolism-dependent differential subcellular localizations to peroxisomes and lipid droplets.