bluuebunny/crossref_metadata_2025 huggingface dataset:
One out of four recruits drops out from elite military training due to musculoskeletal injuries in the Netherlands Armed Forces
Authors: Dijksma Iris , Zimmermann WO , Hertenberg E-J , Lucas C , Stuiver MM
Published: March 2020

Introduction

Musculoskeletal injuries (MSIs) are among the main causes of dropout from military training. The main purpose of this study was to provide an overview of dropout rates and MSI incidence rates during elite military training. Second, this study aimed to explore restricted training days due to MSIs and to describe MSI-care by military physicians.

Methods

In a retrospective observational study, we collected dropout rates and injury surveillance data from the electronic patient records of two elite units of the Netherlands Armed Forces (NAF): the Royal Netherlands Marine Corps (RNLMC) and the Airmobile Brigade (AMB), from 1 January 2015 until 31 December 2017.

Results

In the RNLMC, total dropout rate was 53.9% and dropout due to MSIs was 23%. The most frequently affected locations were foot, knee and leg. In the AMB total dropout rate was 52.6% and dropout due to MSIs was 25%. In the AMB, the most frequently affected locations were back, knee and leg. Average restricted training days due to MSIs ranged between 8.3 and 20.8 days/injury. MSI-care by military physicians consisted mostly of the provision of injury-specific information and (self-)management options, imposing a specific activity restriction and referral to physiotherapy.

Conclusion

Our study findings showed that one out of four recruits who dropout from elite military training in the NAF, do so due to MSIs. Redesigning training programmes with the objective to reduce MSIs should be given high priority, as this may reduce dropout substantially.
Development of a core outcome set for lower limb orthopaedic surgical interventions in ambulant children and young people with cerebral palsy: a study protocol
Authors: Almoajil Hajar , Dawes Helen , Hopewell Sally , Toye Francine , Jenkinson Crispin , Theologis Tim
Published: March 2020

Introduction

Musculoskeletal deformities and gait deviations are common features in ambulatory cerebral palsy (CP). Deformity correction through lower limb orthopaedic surgery is the standard form of care aimed at improving or preserving motor function. Current research on CP care does not always take into account individual patients’ expectations and needs. There is a wide range of outcome domains and outcome measures used to assess outcome from treatment. This can lead to reporting bias and make it difficult to compare and contrast studies. A core outcome set (COS) would enhance the efficiency, relevance and overall quality of CP orthopaedic surgery research. The aim of this study is to establish a standardised COS for use in evaluating lower limb orthopaedic surgery for ambulatory children and young people with CP.

Methods/analysis

A set of outcomes domains and outcome measures will be developed as follows: (1) a qualitative evidence synthesis to identify relevant outcomes from children and young people and family perspective; (2) a scoping review to identify relevant outcomes and outcome measures; (3) qualitative research to explore the experience of key stakeholders; (4) prioritisation of outcome domains will be achieved through a two-round Delphi process with key stakeholders; (5) a final COS will be developed at a consensus meeting with representation from key stakeholder groups.

Ethics and dissemination

Ethical approval for this study was granted in the UK by the Oxfordshire Research Ethics Committee B (REC reference 19/SC/0357). Informed consent will be obtained from participants taking part in the qualitative research and Delphi process. Study findings will be published in an open access journal and presented at relevant national and international conferences. Charities and associations will be engaged to promote awareness of the project COS results.

Trial registration number

COMET registration: 1236.

PROSPERO registration number

CRD42018089538.
Distance as a barrier to obstetric care among indigenous women in Panama: a cross-sectional study
Authors: Acevedo Paloma , Martinez Sebastian , Pinzon Leonardo , Sanchez-Monin Emmanuelle , Winters Solis
Published: March 2020

Objectives

We assess the relationship between distance to a woman’s assigned health clinic and obstetric care utilisation.

Design

We employ a cross-sectional study design using baseline data from the evaluation of a conditional cash transfer programme to promote greater utilisation of maternal and infant health services. Data were collected between December 2016 and January 2017.

Setting

The study is conducted in Ngäbe Buglé, the largest of Panama’s three indigenous territories, where maternal mortality is three times the national average.

Participants

We analyse a representative sample of 1336 indigenous women with a birth in the 12 months prior to the survey.

Primary and secondary outcome measures

Primary outcomes include obstetric care utilisation measures for prenatal, childbirth and postpartum events. Secondary outcomes include reasons for not receiving prenatal care, alarming symptoms, child weight at birth and stillbirths or miscarriages.

Results

Compared with women in closest geographic proximity to a health centre (top quintile, Q1), women who lived farthest from a health centre (bottom quintile, Q5) had significantly lower obstetric care utilisation outcomes for critical prenatal, childbirth and postpartum events. Mothers in Q5 were 36 percentage points less likely to have had at least one prenatal care appointment in a hospital, health centre or clinic compared with mothers in Q1 (p<0.01), and 52 percentage points less likely to attend an institutional first appointment (p<0.01). The gap in institutional delivery and postnatal care between mothers in Q1 and Q5 was about 35 percentage points (p<0.01). All utilisation outcomes were negatively correlated with distance, and differences in obstetric care utilisation persisted even when controlling for household wealth, maternal age and maternal education.

Conclusion

Distance is an important barrier to obstetric care utilisation, with women in more distant locations suffering significantly lower use of prenatal, childbirth and postpartum care compared with women in closer vicinity to a health establishment. Expanding the supply of healthcare and implementing demand side incentives to promote the use of health services in remote communities are relevant policies to reduce disparities in obstetric care utilisation.

Trial registration number

AEA Registry (RCT ID AEARCTR-0001751).
Community treatment orders and associations with readmission rates and duration of psychiatric hospital admission: a controlled electronic case register study
Authors: Barkhuizen Wikus , Cullen Alexis E , Shetty Hitesh , Pritchard Megan , Stewart Robert , McGuire Philip , Patel Rashmi
Published: March 2020

Objectives

Limited evidence is available regarding the effect of community treatment orders (CTOs) on mortality and readmission to psychiatric hospital. We compared clinical outcomes between patients placed on CTOs to a control group of patients discharged to voluntary community mental healthcare.

Design and setting

An observational study using deidentified electronic health record data from inpatients receiving mental healthcare in South London using the Clinical Record Interactive Search (CRIS) system. Data from patients discharged between November 2008 and May 2014 from compulsory inpatient treatment under the Mental Health Act were analysed.

Participants

830 participants discharged on a CTO (mean age 40 years; 63% male) and 3659 control participants discharged without a CTO (mean age 42 years; 53% male).

Outcome measures

The number of days spent in the community until readmission, the number of days spent in inpatient care in the 2 years prior to and the 2 years following the index admission and mortality.

Results

The mean duration of a CTO was 3.2 years. Patients receiving care from forensic psychiatry services were five times more likely and patients receiving a long-acting injectable antipsychotic were twice as likely to be placed on a CTO. There was a significant association between CTO receipt and readmission in adjusted models (HR: 1.60, 95% CI 1.42 to 1.80, p<0.001). Compared with controls, patients on a CTO spent 17.3 additional days (95% CI 4.0 to 30.6, p=0.011) in a psychiatric hospital in the 2 years following index admission and had a lower mortality rate (HR: 0.66, 95% CI 0.50 to 0.88, p=0.004).

Conclusions

Many patients spent longer on CTOs than initially anticipated by policymakers. Those on CTOs are readmitted sooner, spend more time in hospital and have a lower mortality rate. These findings merit consideration in future amendments to the UK Mental Health Act.
Development of screening tools to predict the risk of recurrence and related complications following anal fistula surgery: protocol for a prospective cohort study
Authors: Mei Zubing , Li Yue , Zhang Zhijun , Zhou Haikun , Liu Suzhi , Han Ye , Du Peixin , Qin Xiufang , Shao Zhuo , Ge Maojun , Wang Qingming , Yang Wei
Published: March 2020

Introduction

Postoperative recurrence and related complications are common and related to poor outcomes in patients with anal fistula (AF). Due to being associated with short-term and long-term cure rates, perioperative complications have received widespread attention following AF surgery. This study aims to identify a set of predictive factors to develop risk prediction models for recurrence and related complications following AF surgery. We plan to develop and validate risk prediction models, using information collected through a WeChat patient-reported questionnaire system combined with clinical, laboratory and imaging findings from the perioperative period until 3–6 months following AF surgery.

Methods and analysis

This is a prospective hospital-based cohort study using a linked database of collected health data as well as the follow-up outcomes for all adult patients who suffered from AF at a tertiary referral hospital in Shanghai, China. We will perform logistic regression models to predict anal fistula recurrence (AFR) as well as related complications (eg, wound haemorrhage, faecal impaction, urinary retention, delayed wound healing and unplanned hospitalisation) during and after AF surgery, and machine learning approaches will also be applied to develop risk prediction models. This prospective study aims to develop the first risk prediction models for AFR and related complications using multidimensional variables. These tools can be used to warn, motivate and empower patients to avoid some modifiable risk factors to prevent postoperative complications early. This study will also provide alternative tools for the early screening of high-risk patients with AFR and related complications, helping surgeons better understand the aetiology and outcomes of AF in an earlier stage.

Ethics and dissemination

The study was approved by the Institutional Review Board of Shuguang Hospital affiliated with Shanghai University of Traditional Chinese Medicine (approval number: 2019-699-54-01). The results of this study will be submitted to international scientific peer-reviewed journals or conferences in surgery, anorectal surgery or anorectal diseases.

Trial registration number

ChiCTR1900025069; Pre-results.
Primary care treatment of insomnia: study protocol for a pragmatic, multicentre, randomised controlled trial comparing nurse-delivered sleep restriction therapy to sleep hygiene (the HABIT trial)
Authors: Kyle Simon D , Madigan Claire , Begum Nargis , Abel Lucy , Armstrong Stephanie , Aveyard Paul , Bower Peter , Ogburn Emma , Siriwardena Aloysius , Yu Ly-Mee , Espie Colin A
Published: March 2020

Introduction

Insomnia is a prevalent sleep disorder that negatively affects quality of life. Multicomponent cognitive-behavioural therapy (CBT) is the recommended treatment but access remains limited, particularly in primary care. Sleep restriction therapy (SRT) is one of the principal active components of CBT and could be delivered by generalist staff in primary care. The aim of this randomised controlled trial is to establish whether nurse-delivered SRT for insomnia disorder is clinically and cost-effective compared with sleep hygiene advice.

Methods and analysis

In the HABIT (Health-professional Administered Brief Insomnia Therapy) trial, 588 participants meeting criteria for insomnia disorder will be recruited from primary care in England and randomised (1:1) to either nurse-delivered SRT (plus sleep hygiene booklet) or sleep hygiene booklet on its own. SRT will be delivered over 4 weekly sessions; total therapy time is approximately 1 hour. Outcomes will be collected at baseline, 3, 6 and 12 months post-randomisation. The primary outcome is self-reported insomnia severity using the Insomnia Severity Index at 6 months. Secondary outcomes include health-related and sleep-related quality of life, depressive symptoms, use of prescribed sleep medication, diary and actigraphy-recorded sleep parameters, and work productivity. Analyses will be intention-to-treat. Moderation and mediation analyses will be conducted and a cost-utility analysis and process evaluation will be performed.

Ethics and dissemination

Ethical approval was granted by the Yorkshire and the Humber - Bradford Leeds Research Ethics Committee (reference: 18/YH/0153). We will publish our primary findings in high-impact, peer-reviewed journals. There will be further outputs in relation to process evaluation and secondary analyses focussed on moderation and mediation. Trial results could make the case for the introduction of nurse-delivered sleep therapy in primary care, increasing access to evidence-based treatment for people with insomnia disorder.

Trial registration number

ISRCTN42499563
UK Defence Medical Services’ support to the development of a multiagency major incident plan in South Sudan
Authors: Horne Simon , Gurney I , Smith J E
Published: March 2020

UK Defence Medical Services personnel deployed in support of the United Nations Mission in South Sudan as part of Operation TRENTON in 2017–2018. One key contribution was the development of a multiagency major incident plan in collaboration with key stakeholders within the region, including our UN partners, other troop-contributing countries and non-governmental organisations. This paper describes the process and contribution made, with some transferable lessons for future similar operations, such as adaptation of our courses. Major incident management is one of several technical areas ripe for a proactive Defence Healthcare Engagement strategy, seeking to offer capacity building in areas where Defence is rich in expertise that is highly sought after by other sectors.
Case of eosinophilic fasciitis during military training in a Nepalese British infantry soldier
Authors: Sturdy Ann , Stratton R , Perez-Machado M , Lamb L
Published: March 2020

We present the case of a Nepalese British soldier with peripheral oedema and a significantly raised eosinophil count. After extensive investigation looking for a parasitic cause of his illness, he was diagnosed with eosinophilic fasciitis, a connective tissue disorder, often triggered by heavy exertion and responsiveness to immunosuppression. In a military setting, in which clinicians are likely to encounter patients who have spent time in tropical areas, it is important to still consider non-infectious causes of eosinophilia.
Endovascular versus surgical treatment for improvement of oculomotor nerve palsy caused by unruptured posterior communicating artery aneurysms
Authors: Signorelli Francesco , Pop Raoul , Ganau Mario , Cebula Helene , Scibilia Antonino , Gallinaro Paolo , Zaed Ismail , Todeschi Julien , Lefevre Etienne , Nannavecchia Beniamino , Severac Francois , Coca Hugo Andres , Turjman Francis , Maduri Rodolfo , Beaujeux Rémy , Proust Francois , Chibarro Salvatore
Published: March 2020

Background

There is no consensus regarding the best treatment option for unruptured aneurysms of the posterior communicating artery (PCom) presenting with oculomotor nerve palsy (ONP). We aimed to assess predictors of ONP recovery in a multicenter series of consecutive patients.

Materials and methods

A retrospective review of prospective databases in three tertiary neurosurgical centers was carried out, selecting patients with ONP caused by unruptured PCom aneurysms, treated by surgical clipping or embolization, between January 2006 and December 2013. Patient files and imaging studies were used to extract ophthalmological assessments, treatment outcomes, and follow-up data. Predictors of ONP recovery during follow-up were explored using univariate and multivariate analyses.

Results

We identified 55 patients with a median ONP duration before treatment of 11 days (IQR 4.5–18); the deficit was complete in 27 (49.1%) and incomplete in 28 (50.9%) cases. Median aneurysm size was 7 mm (IQR 5–9). Twenty-four (43.6%) patients underwent surgical clipping and 31 (56.4%) embolization as the primary treatment. Overall, ONP improved in 40 (72.7%) patients and persisted/recurred in 15 (27.3 %). Surgery, interval to complete treatment <4 weeks, aneurysm recurrence during follow-up, and retreatment during follow-up were significantly correlated with ONP outcome in the univariate analysis. In the multivariate analysis, independent predictors of ONP improvement were interval to complete treatment <4 weeks (OR 5.15, 95% CI 1.37 to 23.71, p=0.015) and aneurysm recurrence during follow-up (OR 0.1, 95% CI 0.02 to 0.47, p=0.003).

Conclusion

There was no significant difference in ONP recovery between surgical clipping and embolization. The best predictor for ONP recovery was timely, complete, and durable aneurysm exclusion.
Contemporary trends in use of mechanical circulatory support in patients with acute MI and cardiogenic shock
Authors: Helgestad Ole Kristian Lerche , Josiassen Jakob , Hassager Christian , Jensen Lisette Okkels , Holmvang Lene , Udesen Nanna Louise Junker , Schmidt Henrik , Berg Ravn Hanne , Moller Jacob Eifer
Published: March 2020

Objectives

To describe the contemporary trends in the use of mechanical circulatory support (MCS) in patients with acute myocardial infarction and cardiogenic shock (AMICS). To evaluate survival benefit with early application of intra-aortic balloon pump (IABP) or Impella CP.

Methods

A cohort study of all consecutive patients with AMICS undergoing percutaneous coronary intervention (PCI) <24 hours of symptom onset (early PCI) in southeastern Denmark from 2010 to 2017. A matched case–control study comparing 30-day mortality between patients receiving early-IABP or early-Impella CP and their respective control group. Controls were matched on age, left ventricular ejection fraction, arterial lactate, estimated glomerular filtration rate and cardiac arrest before PCI. Early-IABP/Impella CP was defined as applied before PCI if shock developed pre-PCI, or immediately after PCI if shock developed during PCI.

Results

903 patients with AMICS undergoing early PCI were identified. Use of MCS decreased from 50% in 2010 to 25% in 2017, p for trend of <0.001. The IABP was abandoned in 2012 and replaced mostly by Impella CP. Patients receiving MCS in 2013–2017 had more compromised haemodynamics compared with patients receiving MCS in 2010–2012. 40 patients received early IABP, and 40 patients received early Impella CP. Only the group receiving early Impella CP was associated with lower 30-day mortality compared with their matched control group (30-day mortality 40% vs 77.5%,plog-rankof<0.001).

Conclusion

Use of MCS decreased by 50% from 2010 to 2017. Patients receiving MCS had more compromised haemodynamics in recent years. Early application of Impella CP was associated with reduced 30-day mortality compared with a matched control group.
Mechanical adaptations of skinned cardiac muscle in response to dietary-induced obesity during adolescence in rats
Authors: Boldt Kevin , MacDonald Graham , Joumaa Venus , Herzog Walter
Published: March 2020

Childhood obesity is a major risk factor for heart disease during adulthood, independent of adulthood behaviours. Therefore, it seems that childhood obesity leads to partly irreversible decrements in cardiac function. Little is known about how obesity during maturation affects the mechanical properties of the heart. The purpose of this study was to evaluate contractile properties in developing hearts from animals with dietary-induced obesity (high-fat high-sucrose diet). We hypothesized that obesity induced during adolescence results in decrements in cardiac contractile function. Three-week-old rats (n = 16) were randomized into control (chow) or dietary-induced obesity (high-fat high-sucrose diet) groups. Following 14 weeks on the diet, skinned cardiac trabeculae fibre bundle testing was performed to evaluate active and passive force, maximum shortening velocity, and calcium sensitivity. Rats in the high-fat high-sucrose diet group had significantly larger body mass and total body fat percentage. There were no differences in maximal active or passive properties of hearts between groups. Hearts from the high-fat high-sucrose diet rats had significantly slower maximum shortening velocities and lower calcium sensitivity than controls. Decreased shortening velocity and calcium sensitivity in hearts of obese animals may constitute increased risk of cardiac disease in adulthood.

Novelty Cardiac muscle from animals exposed to an obesogenic diet during development had lower shortening velocity and calcium sensitivity than those from animals fed a chow diet. These alterations in mechanical function may be a mechanism for the increased risk of cardiac disease observed in adulthood.
Reactions of POP-pincer rhodium(I)-aryl complexes with small molecules: coordination flexibility of the ether diphosphine
Authors: Curto Sheila G. , de las Heras Laura A. , Esteruelas Miguel A. , Oliván Montserrat , Oñate Enrique , Vélez Andrea
Published: March 2020

Reactions of the aryl complexes Rh(aryl){κ3-P,O,P-[xant(PiPr2)2]} (1; aryl = 3,5-Me2C6H3 (a), C6H5 (b), 3,5-Cl2C6H3 (c), 3-FC6H4 (d); xant(PiPr2)2 = 9,9-dimethyl-4,5-bis-(diisopropylphosphino)xanthene) with O2, CO, and MeO2CC≡CCO2Me have been performed. Under 1 atm of O2, the pentane solutions of complexes 1 afford the dinuclear peroxide derivatives [Rh(aryl){κ2-P,P-xant(PiPr2)2}]2(μ-O2)2 (2a–2d) as yellow solids. In solution, these species are unstable. In dichloromethane, at room temperature, they are transformed into the dioxygen adducts Rh(aryl)(η2-O2){κ3-P,O,P-[xant(PiPr2)2]} (3a–3d), as a result of the rupture of the double peroxide bridge and the reduction of the metal center. Complex 3b decomposes in benzene, at 50 °C, to give diphosphine oxide, phenol, and biphenyl. Complexes 1 react with CO to give the square-planar mono carbonyl derivatives Rh(aryl)(CO){κ2-P,P-[xant(PiPr2)2]} (4a–4d), which under carbon monoxide atmosphere evolve to benzoyl species Rh{C(O)aryl}(CO){κ2-P,P-[xant(PiPr2)2]} (5a–5d), resulting from the migratory insertion of CO into the Rh-aryl bond and the coordination of a second CO molecule. The transformation is reversible; under vacuum, complexes 5 regenerate the precursors 4. The addition of the activated alkyne to complexes 1b and 1d initially leads to the π-alkyne intermediates Rh(aryl){η2-C(CO2Me)≡C(CO2Me)}{κ3-P,O,P-[xant(PiPr2)2]} (6b, 6d), which evolve to the alkenyl derivatives Rh{(E)-C(CO2Me)=C(CO2Me)aryl}{κ3-P,O,P-[xant(PiPr2)2]} (7b, 7d). The diphosphine adapts its coordination mode to the stability requirements of the different complexes, coordinating cis-κ2-P,P in complexes 2, fac-κ3-P,O,P in compounds 3, trans-κ2-P,P in the mono carbonyl derivatives 4 and 5, and mer-κ3-P,O,P in products 6 and 7.
Various crust morphologies of colloidal droplets dried on a super-hydrophobic surface
Authors: Zhang Yongjian , Gao Xin , Chu Hai , Binks Bernard P.
Published: March 2020

We have studied the evaporation of water droplets containing silica nanoparticles of various hydrophobicities deposited on a super-hydrophobic substrate. Evaporation induces particle accumulation at the droplet surface and results in the formation of a crust that buckles during further shrinkage. For droplets containing hydrophilic particles, a bowl-shaped crust was observed. For droplets containing hydrophobic particles, the crust develops a multi-buckled shape that could be completely suppressed by increasing the relative humidity. The varied buckling behavior of droplets may be attributed to the different mechanical properties of the gelled layer where particle hydrophobicity plays a role. Our work highlights the important role of particle hydrophobicity and relative humidity in the final crust morphology, thus shedding light on crust shape control and material design via the droplet evaporation approach.
Origin(s) and geodynamic significance of Archean ultramafic–mafic bodies in the mainland Lewisian Gneiss Complex, North Atlantic Craton
Authors: Guice George L. , McDonald Iain , Hughes Hannah S.R. , MacDonald John M. , Faithfull John W.
Published: March 2020

The geodynamic regime(s) that predominated during the Archean remains controversial, with the plethora of competing models largely informed by the felsic lithologies. Ultramafic–mafic rocks displaying distinctive geochemical signatures are formed in a range of Phanerozoic geotectonic environments. These rocks have high melting points, making them potentially useful tools for investigating Archean geodynamic processes in highly metamorphosed regions. We present the results of field mapping, petrography, traditional bulk-rock geochemistry and platinum group element geochemistry for 12 ultramafic–mafic bodies in the Lewisian Gneiss Complex, which is a highly metamorphosed fragment of the North Atlantic Craton in NW Scotland. Our data indicate that most of these occurrences are layered intrusions emplaced into the tonalite–trondhjemite–granodiorite-dominated crust prior to polyphase metamorphism, representing a significant re-evaluation of the magmatic evolution of the Lewisian Gneiss Complex. Of the other occurrences, two remain ambiguous, but one (Loch an Daimh Mor) has some geochemical affinity with abyssal/orogenic peridotites and may represent a fragment of Archean mantle, although further investigation is required. The ultramafic–mafic bodies in the Lewisian Gneiss Complex thus represent more than one type of event/process. Compared with the tonalite–trondhjemite–granodiorite host rocks, these lithologies may preserve evidence of protolith origin(s), with potential to illuminate the tectonic setting(s) and geodynamic regimes of the early Earth.

Supplementary material:
Bulk rock geochemical data is available at:
https://doi.org/10.6084/m9.figshare.c.4878588
Authoritarian-Led Democratization
Authors: Riedl Rachel Beatty , Slater Dan , Wong Joseph , Ziblatt Daniel
Published: March 2020

Authoritarian regimes become more likely to democratize when they face little choice or little risk. In some cases, the risk of democratization to authoritarian incumbents is so low that ending authoritarianism might not mean exiting power at all. This article develops a unified theory of authoritarian-led democratization under conditions of relatively low incumbent risk. We argue that the party strength of the authoritarian incumbent is the most pivotal factor in authoritarian-led democratization. When incumbent party strength has been substantial enough to give incumbent authoritarian politicians significant electoral victory confidence, nondemocratic regimes have pursued reversible democratic experiments that eventually culminated in stable, thriving democracies. Evidence from Europe's first wave of democratization and more recent democratic transitions in Taiwan and Ghana illustrate how party strength has underpinned authoritarian-led democratization across the world and across modern history.
Quantification of mitochondrial membrane potential in the isolated rat lung using rhodamine 6G
Authors: Audi Said H. , Cammarata Anthony , Clough Anne V. , Dash Ranjan K. , Jacobs Elizabeth R.
Published: March 2020

Mitochondrial membrane potential (Δψm) plays a key role in vital mitochondrial functions, and its dissipation is a hallmark of mitochondrial dysfunction. The objective of this study was to develop an experimental and computational approach for estimating Δψmin intact rat lungs using the lipophilic fluorescent cationic dye rhodamine 6G (R6G). Rat lungs were excised and connected to a ventilation-perfusion system. The experimental protocol consisted of three single-pass phases, loading, washing, and uncoupling, in which the lungs were perfused with R6G-containing perfusate, fresh R6G-free perfusate, or R6G-free perfusate containing the mitochondrial uncoupler FCCP, respectively. This protocol was carried out with lung perfusate containing verapamil vehicle or verapamil, an inhibitor of the multidrug efflux pump P-glycoprotein (Pgp). Results show that the addition of FCCP resulted in an increase in R6G venous effluent concentration and that this increase was larger in the presence of verapamil than in its absence. A physiologically based pharmacokinetic (PBPK) model for the pulmonary disposition of R6G was developed and used for quantitative interpretation of the kinetic data, including estimating Δψm. The estimated value of Δψm[−144 ± 24 (SD) mV] was not significantly altered by inhibiting Pgp with verapamil and is comparable with that estimated previously in cultured pulmonary endothelial cells. These results demonstrate the utility of the proposed approach for quantifying Δψmin intact functioning lungs. This approach has potential to provide quantitative assessment of the effect of injurious conditions on lung mitochondrial function and to evaluate the impact of therapies that target mitochondria.

NEW & NOTEWORTHY A novel experimental and computational approach for estimating mitochondrial membrane potential (Δψm) in intact functioning lungs is presented. The isolated rat lung inlet-outlet concentrations of the fluorescent cationic dye rhodamine 6G were measured and analyzed by using a computational model of its pulmonary disposition to determine Δψm. The approach has the potential to provide quantitative assessment of the effect of injurious conditions and their therapies on lung mitochondrial function.
Kinetic analyses as a tool to examine physiological exercise responses in a large sample of patients with COPD
Authors: Buekers Joren , Aerts Jean-Marie , Theunis Jan , Houben-Wilke Sarah , Franssen Frits M. E. , Uszko-Lencer Nicole H. M. K. , Wouters Emiel F. M. , Simons Sami , De Boever Patrick , Spruit Martijn A.
Published: March 2020

Kinetic features such as oxygen uptake (V̇o2) mean response time (MRT), and gains of V̇o2, carbon dioxide output (V̇co2), and minute ventilation (V̇e) can describe physiological exercise responses during a constant work rate test of patients with chronic obstructive pulmonary disease (COPD). This study aimed to establish simple guidelines that can identify COPD patients for whom kinetic analyses are (un)likely to be reliable and examined whether slow V̇o2 responses and gains of V̇o2, V̇co2, and V̇e are associated with ventilatory, cardiovascular, and/or physical impairments. Kinetic features were examined for 265 COPD patients [forced expiratory volume in 1 s (FEV1): 54 ± 19%predicted] who performed a constant work rate test (duration > 180 s) with breath-by-breath measurements of V̇o2, V̇co2, and V̇e. Negative/positive predictive values were used to define cutoff values of relevant clinical variables below/above which kinetic analyses are (un)likely to be reliable. Kinetic feature values were unreliable for 21% (= 56/265) of the patients and for 79% (= 19/24) of the patients with a peak work rate (WRpeak)< 45 W. Kinetic feature values were considered reliable for 94% (= 133/142) of the patients with an FEV1 > 1.3 L. For patients exhibiting reliable kinetic feature values, V̇o2 MRT was associated with ventilatory (e.g., FEV1 %predicted: P < 0.001; r = −0.35) and physical (e.g., V̇o2peak %predicted: P = 0.009; r = −0.18) impairments. Gains were mainly associated with cardiac function and ventilatory constraints, representing both response efficiency and limitation. Kinetic analyses are likely to be unreliable for patients with a WRpeak < 45 W. Whereas gains enrich analyses of physiological exercise responses, V̇o2 MRT shows potential to serve as a motivation-independent, physiological indicator of physical performance.

NEW & NOTEWORTHY A constant work rate test that is standardly performed during a prerehabilitation assessment is unable to provide reliable kinetic feature values for chronic obstructive pulmonary disease (COPD) patients with a peak work rate below 45 W. For patients suffering from less severe impairments, kinetic analyses are a powerful tool to examine physiological exercise responses. Especially oxygen uptake mean response time can serve as a motivation-independent, physiological indicator of physical performance in patients with COPD.
Long-Term Efficacy and Complications of Radiofrequency Thermocoagulation at Different Temperatures for the Treatment of Trigeminal Neuralgia
Authors: Hong Tao , Ding Yuanyuan , Yao Peng
Published: March 2020

Trigeminal neuralgia (TN) is a common neuropathic pain that seriously affects the daily life of patients. Many invasive treatments are currently available for patients who respond poorly to oral carbamazepine or oxcarbazepine. Among them, radiofrequency (RF) treatment is a viable option with reliable initial and long-term clinical efficacy. The long-term analgesic effects of radiofrequency thermocoagulation (RFT) at high temperatures (≥80°C) are not superior to those at relatively low temperatures (60–75°C). In contrast, the higher the temperature, the greater the risk of complications, especially facial numbness, masticatory muscles weakness, and corneal hypoesthesia. Some patients even experience irreversible lethal complications. Therefore, we recommend low-temperature RFT (60–75°C) for treatment of TN. The therapeutic effects of pulsed radiofrequency (PRF) are controversial, whereas PRF (≤75°C) combined with RFT can improve long-term effects and decrease the incidence of complications. However, large-scale clinical trials are needed to verify the efficacy of the combination of PRF and RFT.
The Effect of Prior Gestational Diabetes on the Shape of the Glucose Response Curve during an Oral Glucose Tolerance Test 3 Years after Delivery
Authors: Tänczer Timea , Svébis Márk M. , Domján Beatrix , Horváth Viktor J. , Tabák Adam G.
Published: March 2020

Objective. Monophasic glucose response (MGR) during an oral glucose tolerance test (OGTT) and gestational diabetes mellitus (GDM) are predictors of type 2 diabetes mellitus (T2DM). We investigated the association between current MGR and (1) glucose tolerance during a pregnancy 3 years before and (2) current glucose tolerance status. We also sought (3) other determinants of MGR. Research Design and Methods. We conducted a nested case-control study of GDM (n=47 early GDM, diagnosed between 16 and 20 weeks of gestation; n=40 late GDM, diagnosed between 24 and 28 weeks of gestation) and matched healthy controls (n=37, normal glucose tolerance during pregnancy) all free from diabetes at follow-up 3.4±0.6 years after delivery. Glucose tolerance was determined by 2-hour 75 g OGTT. Monophasic and biphasic groups were defined based on serum glucose measurements during OGTT. Results. The biphasic group was younger, had lower triglyceride levels and area under the OGTT glucose curve, and was less frequently diagnosed with early GDM (25 vs. 45%, all p<0.05). Women with a biphasic response also tended to have lower systolic blood pressure (p<0.1). No differences were found in fasting and 2-hour glucose and insulin levels, or BMI. According to multiple logistic regression, MGR was associated with prior early GDM (OR 2.14, 95% CI 0.92-4.99) and elevated triglyceride levels (OR 2.28, 95% CI 1.03-5.03/log (mmol/l)). Conclusions. We found that more severe, early-onset GDM was an independent predictor of monophasic glucose response suggesting that monophasic response may represent an intermediate state between GDM and manifest type 2 diabetes.
Analysis of Optimal Health-Related Quality of Life Measures in Patients Waitlisted for Lung Transplantation
Authors: Tokuno Junko , Chen-Yoshikawa Toyofumi F , Oga Toru , Oto Takahiro , Okawa Tomoyo , Okada Yoshinori , Akiba Miki , Ikeda Masaki , Nakajima Daisuke , Hamaji Masatsugu , Motoyama Hideki , Aoyama Akihiro , Isomi Maki , Chin Kazuo , Date Hiroshi
Published: March 2020

Background. Improving health-related quality of life (HRQL) is an important goal of lung transplantation, and St. George’s Respiratory Questionnaire (SGRQ) is frequently used for assessing HRQL in patients waitlisted for lung transplantation. We hypothesized that chronic respiratory failure (CRF)-specific HRQL measures would be more suitable than the SGRQ, considering the underlying disease and its severity in these patients. Methods. We prospectively collected physiological and patient-reported data (HRQL, dyspnea, and psychological status) of 199 patients newly registered in the waiting list of lung transplantation. CRF-specific HRQL measures of the Maugeri Respiratory Failure Questionnaire (MRF) and Severe Respiratory Insufficiency Questionnaire (SRI) were assessed in addition to the SGRQ. Results. Compared to the MRF-26 and SRI, the score distribution of the SGRQ was skewed toward the worse ends of the scale. All domains of the MRF-26 and SRI were significantly correlated with the SGRQ. Multiple regression analyses to investigate factors predicting each HRQL score indicated that dyspnea and psychological status accounted for 12% to 28% of the variance more significantly than physiological measures did. The MRF-26 Total and SRI Summary significantly worsened from the baseline to 1 year (p<0.001 and p=0.010, respectively) in 103 patients who underwent a follow-up assessment without lung transplantation, while the SGRQ showed a marginal significant worsening (p=0.040). Conclusions. The MRF-26 and SRI are valid, discriminative, and responsive in patients waitlisted for lung transplantation. In terms of the score distribution and responsiveness, CRF-specific measures may function better in their HRQL assessment than the currently used measures do.
Electrospun Polystyrene/LDH Fibrous Membranes for the Removal of Cd2+ Ions
Authors: Alnaqbi Mohamed A. , Samson Joel A. , Greish Yaser E.
Published: March 2020

Layered double hydroxides (LDHs) have been extensively studied for a broad range of applications because of their ease of synthesis and chemical modifications. The chemical and crystal structure of LDH provides opportunities of combination with polymers forming nanocomposites. In the current study, MgAl-LDH particulates have been incorporated into micro- and nanofibers of polystyrene (PS) using an electrospinning processing technique of their respective homogeneous solutions. The effect of the varying proportions of LDH and PS on the structure, morphology, and thermal properties of the fabricated LDH-PS fibrous membranes has been investigated. The potential application of the optimally fabricated LDH-PS fibrous membranes in the removal of Cd2+ ions from aqueous media has been evaluated as well. Results showed the possibility of loading the PS fibrous membranes with up to 60 wt% of LDH particulates, which in turn modified the thermal stability and integrity of the produced fibrous membranes. Due to the high hydrophobicity of the PS fibrous matrix, no changes in the crystal structure of the LDH inclusions were observed. Both as-prepared LDH particulates and optimally prepared LDH-PS fibrous membranes showed a high potential for the removal of Cd2+ ions from aqueous media. This is attributed to a cation-exchange mechanism involving the adsorption of Cd2+ ions from a solution with the preferential leakage of Al3+ ions from the crystal structure of LDH.
Synergistic Removal of Bromate and Ibuprofen by Graphene Oxide and TiO2 Heterostructure Doped with F: Performance and Mechanism
Authors: Zhang Yan , Li Jiarong , Liu Hongyuan
Published: March 2020

The batch experiments of photocatalytic oxidation-reduction of bromate and ibuprofen (IBP) by graphene oxide (GO) and TiO2 heterostructure doped with F (FGT) particles were conducted. The performance and mechanism of synergistic removal of bromate and IBP by FGT were discussed. The results show that a demonstrable synergistic effect and excellent removal rate of bromate and IBP by FGT were exhibited. When pH is 5.2 and the dosage of FGT is 0.1 g/L, the reaction rate constants of bromate and IBP increased from 0.0584 min-1 and 0.4188 min-1 to 0.1353 min-1 and 0.4504 min-1, respectively, compared with the degradation of bromate or IBP alone. The reaction of photocatalytic synergistic degradation is appropriately fitted through Langmuir-Hinshelwood first-order kinetics. The mechanism of synergistic removal of bromate and IBP by FGT was discussed. And electrons (e-), hydroxyl radical (⋅OH), and superoxide radical (⋅O2-) are the main active species. The electrons play a main role in the bromate reduction, and bromine is the only reduction product, while the oxidation of IBP is the result of ⋅OH and ⋅O2-, and ⋅OH plays a key role. The recombination of electrons and holes is inhibited by simultaneous consumption of bromate and IBP, which makes full use of the redox properties of FGT and plays a synergistic role in the removal of pollutants. The results indicate that photocatalytic oxidation-reduction by FGT is a promising, efficient, and environmental-friendly method for synchronous removal of combined pollution in water.
Physical Properties of MEA + Water + CO2 Mixtures in Postcombustion CO2 Capture: A Review of Correlations and Experimental Studies
Authors: Karunarathne Sumudu S. , Eimer Dag A. , Øi Lars E.
Published: March 2020

The knowledge of physicochemical properties of a mixture of amine, water, and CO2 is beneficial in evaluating the postcombustion CO2 capture process and process equipment design. This study reviews the literature of density, viscosity, and surface tension measurements with the evaluated measurement uncertainties and proposed correlations for monoethanol amine (MEA), water, and CO2 mixtures. Adequate research has been performed to measure and develop correlations for pure MEA and aqueous MEA mixtures, but further studies are required for CO2-loaded aqueous MEA mixtures. The correlations fit measured properties with an acceptable accuracy, and they are recommended to use in process equipment design, mathematical modelling, and simulations of absorption and desorption.
PARP Inhibition Enhances Radiotherapy of SMAD4-Deficient Human Head and Neck Squamous Cell Carcinomas in Experimental Models
Authors: Hernandez Ariel L. , Young Christian D. , Bian Li , Weigel Kelsey , Nolan Kyle , Frederick Barbara , Han Gangwen , He Guanting , Devon Trahan G. , Rudolph Michael C. , Jones Kenneth L. , Oweida Ayman J. , Karam Sana D. , Raben David , Wang Xiao-Jing
Published: March 2020

Purpose:

SMAD4 loss causes genomic instability and the initiation/progression of head and neck squamous cell carcinoma (HNSCC). Here, we study whether SMAD4 loss sensitizes HNSCCs to olaparib (PARP inhibitor) in combination with radiotherapy (RT).

Experimental Design:

We analyzed HNSCC The Cancer Genome Atlas data for SMAD4 expression in association with FANC/BRCA family gene expression. Human HNSCC cell lines were screened for sensitivity to olaparib. Isogenic HNSCC cell lines were generated to restore or reduce SMAD4 expression and treated with olaparib, radiation, or the combination. HNSCC pretreatment specimens from a phase I trial investigating olaparib were analyzed.

Results:

SMAD4 levels correlated with levels of FANC/BRCA genes in HNSCC. HNSCC cell lines with SMAD4 homozygous deletion were sensitive to olaparib. In vivo, olaparib or RT monotherapy reduced tumor volumes in SMAD4-mutant but not SMAD4-positive tumors. Olaparib with RT dual therapy sustained tumor volume reduction in SMAD4-deficient (mutant or knockdown) xenografts, which exhibited increased DNA damage and cell death compared with vehicle-treated tumors. In vitro, olaparib alone or in combination with radiation caused lower clonogenic survival, more DNA damage–associated cell death, and less proliferation in SMAD4-deficient cells than in SMAD4-positive (endogenous SMAD4 or transduced SMAD4) cells. Applicable to clinic, 5 out of 6 SMAD4-negative HNSCCs and 4 out of 8 SMAD4-positive HNSCCs responded to a standard treatment plus olaparib in a phase I clinical trial, and SMAD4 protein levels inversely correlated with DNA damage.

Conclusions:

SMAD4 levels are causal in determining sensitivity to PARP inhibition in combination with RT in HNSCCs.
A Multimodal Approach to Evaluate for Cardiac Metastasis in a Case of Non-Small Cell Lung Cancer
Authors: Bilani Nadeem , Elson Leah , Martinez Felipe , Sadler Diego , Nahleh Zeina , Elimimian Elizabeth , Alley Evan
Published: March 2020

Malignancies have demonstrated the ability to metastasize to cardiac tissue. However, an optimal diagnostic algorithm for cardiac tumors has not yet been established, due at least in part to the scarcity of symptomatic cases. Several case reports describe how the usage of 18F-labeled fluorodeoxyglucose positron emission tomography (18F-FDG PET) incidentally revealed cardiac neoplasia. This modality, which indicates uptake sites of the radioisotope 18F-FDG, allows for whole-body imaging and is often used for preoperative determination of malignant metastasis or for assessing response to therapy over time. However, findings of false positivity are often reported due to increased FDG avidity caused by a range of other, nonmetastatic processes, most notably inflammation and infection. In this case report, an 84-year-old male with stage IV non-small cell lung cancer presented a clinical course, echocardiogram, and 18F-FDG PET-CT findings that were suggestive of endocardial metastasis. Nine months into therapy, after extensive consultation, the patient finally consented to a more complete workup using cardiac MRI (CMRI), which showed no evidence of cardiac metastasis. This case report supports the utility of CMRI as a means of further interpreting intracardiac, localized FDG uptake foci in PET-CT findings, in order to avoid false positivity and further refine proposed cardiac differential diagnoses in cancer patients.
Towards an Optical Biopsy during Visceral Surgical Interventions
Authors: Ellebrecht David Benjamin , Latus Sarah , Schlaefer Alexander , Keck Tobias , Gessert Nils
Published: March 2020

Background: Cancer will replace cardiovascular diseases as the most frequent cause of death. Therefore, the goals of cancer treatment are prevention strategies and early detection by cancer screening and ideal stage therapy. From an oncological point of view, complete tumor resection is a significant prognostic factor. Optical coherence tomography (OCT) and confocal laser microscopy (CLM) are two techniques that have the potential to complement intraoperative frozen section analysis as in vivo and real-time optical biopsies. Summary: In this review we present both procedures and review the progress of evaluation for intraoperative application in visceral surgery. For visceral surgery, there are promising studies evaluating OCT and CLM; however, application during routine visceral surgical interventions is still lacking. Key Message: OCT and CLM are not competing but complementary approaches of tissue analysis to intraoperative frozen section analysis. Although intraoperative application of OCT and CLM is at an early stage, they are two promising techniques of intraoperative in vivo and real-time tissue examination. Additionally, deep learning strategies provide a significant supplement for automated tissue detection.