bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study
Authors: Spittal Matthew J , Grant Genevieve , O’Donnell Meaghan , McFarlane Alexander C , Studdert David M
Published: April 2018

Objectives

We sought to develop prognostic risk scores for compensation-related stress and long-term disability using markers collected within 3 months of a serious injury.

Design

Cohort study. Predictors were collected at baseline and at 3 months postinjury. Outcome data were collected at 72 months postinjury.

Setting

Hospitalised patients with serious injuries recruited from four major trauma hospitals in Australia.

Participants

332 participants who made claims for compensation for their injuries to a transport accident scheme or a workers’ compensation scheme.

Primary outcome measures

12-item WHO Disability Assessment Schedule and 6 items from the Claims Experience Survey.

Results

Our model for long-term disability had four predictors (unemployed at the time of injury, history of a psychiatric disorder at time of injury, post-traumatic stress disorder symptom severity at 3 months and disability at 3 months). This model had good discrimination (R2=0.37) and calibration. The disability risk score had a score range of 0–180, and at a threshold of 80 had sensitivity of 56% and specificity of 86%. Our model for compensation-related stress had five predictors (intensive care unit admission, discharged to home, number of traumatic events prior to injury, depression at 3 months and not working at 3 months). This model also had good discrimination (area under the curve=0.83) and calibration. The compensation-related stress risk score had score range of 0–220 and at a threshold of 100 had sensitivity of 74% and specificity of 75%. By combining these two scoring systems, we were able to identify the subgroup of claimants at highest risk of experiencing both outcomes.

Conclusions

The ability to identify at an early stage claimants at high risk of compensation-related stress and poor recovery is potentially valuable for claimants and the compensation agencies that serve them. The scoring systems we developed could be incorporated into the claims-handling processes to guide prevention-oriented interventions.
Sonic and ultrasonic oscillating devices for the management of pain and dental fear in children or adolescents that require caries removal: a systematic review
Authors: Cianetti Stefano , Abraha Iosief , Pagano Stefano , Lupatelli Eleonora , Lombardo Guido
Published: April 2018

Objectives

To evaluate the effectiveness and degree of acceptance by children and adolescents of the use of oscillating tips compared with rotating drills.

Design

Systematic review.

Data sources

PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Library and Web of Science (October 2017).

Eligibility criteria

Controlled randomised or non-randomised trials that evaluated sonic and ultrasonic oscillating devices versus rotating drill.

Data extraction

Eligible studies were selected and data extracted independently by two reviewers. Risk of bias was assessed using the Cochrane Method.

Results

Two controlled clinical trials comprising 123 children aged 2–12 years old were identified. Both trials were at high risk of selection bias and unclear risk of detection bias. In one trial, pain due to the use of oscillating drill resulted lower than employing rotating drill (Verbal Hochman Scale: RR 0.64 (95% CI 0.41 to 1.00); Visual Facial Expression Scale: RR 0.64 (95% CI 0.44 to 0.94)). In another study, compared with traditional drill ultrasonic tip was associated with a lower level of patient’s discomfort (RR 0.40 (95% CI 0.20 to 0.79)) but not with dental anxiety (RR 1.29 (95% CI 0.97 to 1.71)). The effectiveness of the removal of caries as well as fillings durability were only considered in one study, but no statistically significant differences were found between the two interventions.

Conclusions

The evidence based on two low-quality studies was insufficient to conclude that the use of oscillating tips for the management of pain and dental fear in children or adolescents compared with rotating drills was more effective.
Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales
Authors: Burn Edward , Liddle Alexander D , Hamilton Thomas W , Judge Andrew , Pandit Hemant G , Murray David W , Pinedo-Villanueva Rafael
Published: April 2018

Objectives

To assess the value for money of unicompartmental knee replacement (UKR) compared with total knee replacement (TKR).

Design

A lifetime Markov model provided the framework for the analysis.

Setting

Data from the National Joint Registry (NJR) for England and Wales primarily informed the analysis.

Participants

Propensity score matched patients in the NJR who received either a UKR or TKR.

Interventions

UKR is a less invasive alternative to TKR, where only the compartment affected by osteoarthritis is replaced.

Primary outcome measures

Incremental quality-adjusted life years (QALYs) and healthcare system costs.

Results

The provision of UKR is expected to lead to a gain in QALYs compared with TKR for all age and gender subgroups (male: <60 years: 0.12, 60–75 years: 0.20, 75+ years: 0.19; female: <60 years: 0.10, 60–75 years: 0.28, 75+ years: 0.44) and a reduction in costs (male: <60: £−1223, 60–75 years: £−1355, 75+ years: £−2005; female: <60 years: £−601, 60–75 years: £−935, 75+ years: £−1102 per patient over the lifetime). UKR is expected to lead to a reduction in QALYs compared with TKR when performed by surgeons with low UKR utilisation but an increase among those with high utilisation (<10%, median 6%: −0.04, ≥10%, median 27%: 0.26). Regardless of surgeon usage, costs associated with UKR are expected to be lower than those of TKR (<10%: £−127, ≥10%: £−758).

Conclusions

UKR can be expected to generate better health outcomes and lower lifetime costs than TKR. Surgeon usage of UKR does, however, have a significant impact on the cost-effectiveness of the procedure. To achieve the best results, surgeons need to perform a sufficient proportion of knee replacements as UKR. Low usage surgeons may therefore need to broaden their indications for UKR.
Educational differences in psychological distress? Results from a population-based sample of men and women in Sweden in 2012
Authors: Molarius Anu , Granström Fredrik
Published: April 2018

Background

Mental health problems are more frequent in socially disadvantaged groups, but the results vary between different studies, different populations and different measures of mental health. This paper investigated the association between educational level, economic difficulties and psychological distress in men and women in Sweden.

Methods

The study population included 24 510 respondents aged 25–74 years who responded to a survey questionnaire in Mid-Sweden in 2012 (response rate 53%). Psychological distress was measured with the 12-item version of the General Health Questionnaire, and multivariate logistic regression models were used in statistical analyses, adjusting for age, employment status and social support.

Results

The prevalence of psychological distress was higher in women (16.4%) than in men (11.3%; p<0.001). Persons with low and medium educational level had a lower risk of psychological distress than persons with high educational level after adjustment for confounders. Economic difficulties had a strong association with psychological distress (OR 2.80 (95% CI 2.39 to 3.27) and OR 2.40 (95% CI 2.12 to 3.71) in men and women, respectively) after adjustment for confounders.

Conclusion

We found a strong association between economic difficulties and psychological distress in this study, but no inverse association between educational level and psychological distress. On the contrary, persons with high education had more psychological distress than persons with low and medium education when age, employment status and social support were taken into account. The findings were similar in men and women.
Shared research priorities for pessary use in women with prolapse: results from a James Lind Alliance Priority Setting Partnership
Authors: Lough Kate , Hagen Suzanne , McClurg Doreen , Pollock Alex
Published: April 2018

Objectives

To identify the shared priorities for future research of women affected by and clinicians involved with pessary use for the management of prolapse.

Design

A priority setting project using a consensus method.

Setting

A James Lind Alliance Pessary use for prolapse Priority Setting Partnership (JLA Pessary PSP) conducted from May 2016 to September 2017 in the UK.

Participants

The PSP was run by a Steering Group of three women with experience of pessary use, three experienced clinicians involved with management of prolapse, two researchers with relevant experience, a JLA adviser and a PSP leader. Two surveys were conducted in 2016 and 2017. The first gathered questions about pessaries, and the second asked respondents to prioritise a list of questions. A final workshop was held on 8 September 2017 involving 10 women and 13 clinician representatives with prolapse and pessary experience.

Results

A top 10 list of priorities for future research in pessary use for prolapse was agreed by consensus.

Conclusions

Women with experience of pessary use and clinicians involved with prolapse management have worked together to determine shared priorities for future research. Aligning the top 10 results with existing research findings will highlight the gaps in current evidence and signpost future research to areas of priority. Effective dissemination of the results will enable research funding bodies to focus on gathering the evidence to answer the questions that matter most to those who will be affected.
Ongoing training of community health workers in low-income and middle-income countries: a systematic scoping review of the literature
Authors: O’Donovan James , O’Donovan Charles , Kuhn Isla , Sachs Sonia Ehrlich , Winters Niall
Published: April 2018

Objectives

Understanding the current landscape of ongoing training for community health workers (CHWs) in low-income and middle-income countries (LMICs) is important both for organisations responsible for their training, as well as researchers and policy makers. This scoping review explores this under-researched area by mapping the current delivery implementation and evaluation of ongoing training provision for CHWs in LMICs.

Design

Systematic scoping review.

Data sources

MEDLINE, Embase, AMED, Global Health, Web of Science, Scopus, ASSIA, LILACS, BEI and ERIC.

Study selection

Original studies focusing on the provision of ongoing training for CHWs working in a country defined as low income and middle income according to World Bank Group 2012 classification of economies.

Results

The scoping review found 35 original studies that met the inclusion criteria. Ongoing training activities for CHWs were described as supervision (n=19), inservice or refresher training (n=13) or a mixture of both (n=3). Although the majority of studies emphasised the importance of providing ongoing training, several studies reported no impact of ongoing training on performance indicators. The majority of ongoing training was delivered inperson; however, four studies reported the use of mobile technologies to support training delivery. The outcomes from ongoing training activities were measured and reported in different ways, including changes in behaviour, attitudes and practice measured in a quantitative manner (n=16), knowledge and skills (n=6), qualitative assessments (n=5) or a mixed methods approach combining one of the aforementioned modalities (n=8).

Conclusions

This scoping review highlights the diverse range of ongoing training for CHWs in LMICs. Given the expansion of CHW programmes globally, more attention should be given to the design, delivery, monitoring and sustainability of ongoing training from a health systems strengthening perspective.
Ward round template: enhancing patient safety on ward rounds
Authors: Gilliland Niall , Catherwood Natalie , Chen Shaouyn , Browne Peter , Wilson Jacob , Burden Helena
Published: April 2018

Introduction and aims

Concerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets.

Method

The quality improvement technique of plan–do–study–act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template.

Summary of results

Documentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%.

Conclusions

Following introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.
Reducing the rate of post-surgical urinary tract infections in orthopedic patients
Authors: Thakker Amit , Briggs Natasha , Maeda Azusa , Byrne Julie , Davey John Roderick , Jackson Timothy D
Published: April 2018

Urinary tract infection (UTI) is the fourth leading cause of healthcare-associated infections, with approximately 70%–80% being attributed to the inappropriate use of indwelling catheters. In many cases, indwelling catheters are used inappropriately without any valid indication, creating potentially avoidable and significant patient distress, discomfort, pain and activity restrictions, together with substantial care burden, cost and hospitalisation. In the Division of Orthopedic Surgery at Toronto Western Hospital (TWH), we identified UTI rate reduction as a quality improvement priority. Patients who underwent total hip and knee joint replacements and hip fracture repairs at TWH were monitored for the incidence of UTI and the usage of catheters. The data collected as part of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) revealed UTI rate of 2.1% among 666 patients who were treated between January and June 2016. Data collected through a custom field in the ACS NSQIP workstation further revealed that indwelling catheters were overused, with 55.2% of patients receiving indwelling catheters in the same time period. These data were presented to the orthopaedic leadership group and surgeons at TWH in July 2016 to set the quality improvement target and create the working group. Nursing staff was provided education to strictly follow the institutional catheter-associated UTI prevention guidelines and change ideas based on the guidelines were implemented in July 2016. As a result, the rate of UTI decreased to 1.1% and the use of indwelling catheter decreased to 19.8% among 883 patients who were treated between July 2016 and March 2017. The study indicated that a systematic approach, engaging all front-line staff including nurse educators and nurse practitioners, helps to facilitate implementation of practice changes. We expect that ongoing reminders and education ensure that the changes are sustainable.
Using an original triage and on call management tool aids identification and assessment of the acutely unwell surgical patient
Authors: Hodge Stacie , Helliar Sebastian , Macdonald Hamish Ian , Mackey Paul
Published: April 2018

Until now, there have been no published surgical triage tools. We have developed the first such tool with a tiered escalation policy, aiming to improve identification and management of critically unwell patients. The existing sheet which is used to track new referrals and admissions to the surgical assessment unit was reviewed. The sheet was updated and a traffic light triage tool generated using National Early Warning Scores (NEWS), sepsis criteria and user discretion. A tiered escalation policy to guide urgency of assessment was introduced and education sessions for all staff undertaken, to ensure understanding and compliance. Through multiple ‘plan-do-study-act’ cycles, the new system and its efficiency have been analysed. Prior to intervention, documentation of NEWS did not occur and only 13% of admission observations were communicated to the surgical team. Following multiple cycles and interventions, 93% of patients were fully triaged, and 80% of ‘red’ and ‘amber’ patients’ observations were communicated to the surgical team. The average time for a registrar to review a ‘red’ patient was 37 min and 79% of ‘green’ patients were reviewed within an hour of their presentation. Rapid identification of the unwell patient is crucial. Here we publish the first triage tool that enables early assessment of septic and otherwise potentially unwell surgical patients.
Comparison of the psychological and physiological effects on students of a video-assisted or text introduction to a simulated task
Authors: van Tetering Anne AC , Wijsman Jacqueline LP , Truijens Sophie EM , Fransen Annemarie F , van der Hout-van der Jagt M Beatrijs , Oei S Guid
Published: April 2018

Introduction

The use of different methods for introducing the scenario in simulation-based medical education has not been investigated before and may be a useful element to optimise the effectiveness of learning. The aim of this study was to compare an immersive video-assisted introduction to a minimal text-based one, with regard to emotional assessment of the situation.

Methods

In this pilot study, 39 students participated in a medical simulated scenario. The students were randomly assigned to an experimental group (video-assisted introduction) or a control group (minimal textual introduction) and both were followed by performing surgery on LapSim (Surgical Science, Gothenburg, Sweden). The emotional assessment of the situation, cognitive appraisal, was defined as the ratio of the demands placed by an individual’s environment (primary appraisal) to that person’s resources to meet the demands (secondary appraisal). Secondary outcomes were anxiety (State-Trait Anxiety Inventory), physiological parameters (heart rate, heart rate variability, skin conductance, salivary cortisol), engagement (Game Engagement Questionnaire), motivation (Intrinsic Motivation Inventory) and performance (mean score in percentage calculated by LapSim of predefined levels).

Results

Participants in the immersive video group (n=17) were overloaded in terms of their perceived demands (a ratio of 1.17, IQR 0.30) compared with those in the control group (a ratio of 1.00, IQR 0.42, n=22) (P=0.01). No significant differences were found between the groups in secondary outcomes. Both groups showed an increase of anxiety after the introduction method. In the experimental group, this score increased from 9.0 to 11.0, and in the textual group from 7.5 to 10.5, both P<0.01.

Discussion

This study shows that the method of introducing a simulated scenario may influence the emotional assessment of the situation. It may be possible to make your simulation introduction too immersive or stimulating, which may interfere with learning. Further research will be necessary to investigate the impact and usefulness of these findings on learning in simulation-based medical education.
Understanding the gut–kidney axis in nephrolithiasis: an analysis of the gut microbiota composition and functionality of stone formers
Authors: Ticinesi Andrea , Milani Christian , Guerra Angela , Allegri Franca , Lauretani Fulvio , Nouvenne Antonio , Mancabelli Leonardo , Lugli Gabriele Andrea , Turroni Francesca , Duranti Sabrina , Mangifesta Marta , Viappiani Alice , Ferrario Chiara , Dodi Rossella , Dall’Asta Margherita , Del Rio Daniele , Ventura Marco , Meschi Tiziana
Published: April 2018

Objectives

The involvement of the gut microbiota in the pathogenesis of calcium nephrolithiasis has been hypothesised since the discovery of the oxalate-degrading activity of Oxalobacter formigenes, but never comprehensively studied with metagenomics. The aim of this case–control study was to compare the faecal microbiota composition and functionality between recurrent idiopathic calcium stone formers (SFs) and controls.

Design

Faecal samples were collected from 52 SFs and 48 controls (mean age 48±11). The microbiota composition was analysed through 16S rRNA microbial profiling approach. Ten samples (five SFs, five controls) were also analysed with deep shotgun metagenomics sequencing, with focus on oxalate-degrading microbial metabolic pathways. Dietary habits, assessed through a food-frequency questionnaire, and 24-hour urinary excretion of prolithogenic and antilithogenic factors, including calcium and oxalate, were compared between SFs and controls, and considered as covariates in the comparison of microbiota profiles.

Results

SFs exhibited lower faecal microbial diversity than controls (Chao1 index 1460±363vs 1658±297, fully adjusted p=0.02 with stepwise backward regression analysis). At multivariate analyses, three taxa (Faecalibacterium, Enterobacter, Dorea) were significantly less represented in faecal samples of SFs. The Oxalobacter abundance was not different between groups. Faecal samples from SFs exhibited a significantly lower bacterial representation of genes involved in oxalate degradation, with inverse correlation with 24-hour oxalate excretion (r=−0.87, p=0.002). The oxalate-degrading genes were represented in several bacterial species, whose cumulative abundance was inversely correlated with oxaluria (r=−0.85, p=0.02).

Conclusions

Idiopathic calcium SFs exhibited altered gut microbiota composition and functionality that could contribute to nephrolithiasis physiopathology.
Hypermetabolism in ALS is associated with greater functional decline and shorter survival
Authors: Steyn Frederik J , Ioannides Zara A , van Eijk Ruben P A , Heggie Susan , Thorpe Kathryn A , Ceslis Amelia , Heshmat Saman , Henders Anjali K , Wray Naomi R , van den Berg Leonard H , Henderson Robert D , McCombe Pamela A , Ngo Shyuan T
Published: April 2018

Objective

To determine the prevalence of hypermetabolism, relative to body composition, in amyotrophic lateral sclerosis (ALS) and its relationship with clinical features of disease and survival.

Methods

Fifty-eight patients with clinically definite or probable ALS as defined by El Escorial criteria, and 58 age and sex-matched control participants underwent assessment of energy expenditure. Our primary outcome was the prevalence of hypermetabolism in cases and controls. Longitudinal changes in clinical parameters between hypermetabolic and normometabolic patients with ALS were determined for up to 12 months following metabolic assessment. Survival was monitored over a 30-month period following metabolic assessment.

Results

Hypermetabolism was more prevalent in patients with ALS than controls (41% vs 12%, adjusted OR=5.4; p<0.01). Change in body weight, body mass index and fat mass (%) was similar between normometabolic and hypermetabolic patients with ALS. Mean lower motor neuron score (SD) was greater in hypermetabolic patients when compared with normometabolic patients (4 (0.3) vs 3 (0.7); p=0.04). In the 12 months following metabolic assessment, there was a greater change in Revised ALS Functional Rating Scale score in hypermetabolic patients when compared with normometabolic patients (−0.68 points/month vs −0.39 points/month; p=0.01). Hypermetabolism was inversely associated with survival. Overall, hypermetabolism increased the risk of death during follow-up to 220% (HR 3.2, 95% CI 1.1 to 9.4, p=0.03).

Conclusions and relevance

Hypermetabolic patients with ALS have a greater level of lower motor neuron involvement, faster rate of functional decline and shorter survival. The metabolic index could be important for informing prognosis in ALS.
Angioplasty and stenting for symptomatic extracranial non-tandem internal carotid artery occlusion
Authors: Jadhav Ashutosh , Panczykowski David , Jumaa Mouhammad , Aghaebrahim Amin , Ranginani Manasa , Nguyen Felix , Desai Shashvat M , Grandhi Ramesh , Ducruet Andrew , Gross Bradley A , Jankowitz Brian Thomas , Jovin Tudor G
Published: April 2018

Introduction

Symptomatic internal carotid artery occlusion (ICAO) can lead to neurologic decline, recurrent stroke, and mortality.

Objective

We sought to evaluate the safety and feasibility of endovascular revascularization for ICAO without tandem intracranial large vessel occlusion (LVO).

Design, setting, and participants

This is a retrospective cohort analysis of all patients presenting to a single academic center with ischemic stroke and ipsilateral cervical ICAO from November 2003 through April 2016. Patients were excluded if pre-procedural angiography demonstrated tandem LVO or if patients were known to have chronic ICAO.

Main outcome(s) and measure(s)

Study endpoints included discharge neurologic examination, post-procedural infarct burden, 3-month functional outcomes, and treatment durability.

Results

A total of 107 patients with symptomatic angiographically-confirmed cervical ICAO without tandem LVO were identified. Median admission NIH Stroke Scale (NIHSS) score was 8 (IQR 11). Baseline radiographic stroke severity was assessed by ASPECT score (median 9; IQR 2), perfusion mismatch (present in 93%), and clinical imaging mismatch (42%). Median time from symptom onset to treatment was 25 hours (IQR 61). Successful revascularization was achieved in 92% of patients. At discharge, 83% had stable/improved NIHSS score, while at 3 months 65% achieved independence (modified Rankin Scale score ≤2). The most common complication was distal embolization (22%) of which 16% required intra-arterial treatment. Rate of significant restenosis (≥70%) was 15% at 1 year.

Conclusions

Stenting in selected patients at risk of neurologic deterioration due to symptomatic ICAO can be performed with high rates of technical success and good clinical outcomes. Because of significant peri-procedural risks and high rates of restenosis, randomized studies are necessary to understand the benefit of this approach.
Clinical use of organic near‐infrared fluorescent contrast agents in image‐guided oncologic procedures and its potential in veterinary oncology
Authors: Favril Sophie , Abma Eline , Blasi Francesco , Stock Emmelie , Devriendt Nausikaa , Vanderperren Katrien , de Rooster Hilde
Published: April 2018

One of the major challenges in surgical oncology is the intraoperative discrimination of tumoural versus healthy tissue. Until today, surgeons rely on visual inspection and palpation to define the tumoural margins during surgery and, unfortunately, for various cancer types, the local recurrence rate thus remains unacceptably high. Near‐infrared (NIR) fluorescence imaging is an optical imaging technique that can provide real‐time preoperative and intraoperative information after administration of a fluorescent probe that emits NIR light once exposed to a NIR light source. This technique is safe, cost‐effective and technically easy. Several NIR fluorescent probes are currently studied for their ability to highlight neoplastic cells. In addition, NIR fluorescence imaging holds great promise for sentinel lymph node mapping. The aim of this manuscript is to provide a literature review of the current organic NIR fluorescent probes tested in the light of human oncology and to introduce fluorescence imaging as a valuable asset in veterinary oncology.
Redox switchable 19π and 18π 5,10,20-triaryl-5,15-diazaporphyrinoid–nickel(II) complexes
Authors: Sudoh Keisuke , Hatakeyama Takuroh , Furukawa Ko , Nakano Haruyuki , Matano Yoshihiro
Published: April 2018

The synthesis and optical, electrochemical, and magnetic properties of nickel(II) complexes of 5,10,20-triaryl-5,15-diazaporphyrin (TriADAP) are reported. Metal-templated cyclization of unsymmetrically substituted nickel(II)–bis(1-amino-9-chloro-5-mesityldipyrrin; mesityl = 2,4,6-trimethylphenyl) complexes afforded the corresponding TriADAPs or 5-aryl-15-benzyl-10,20-dimesityl-5,15-diazaporphyrin, depending on the combination of base and solvent. The latter macrocycle was converted to TriADAP by deprotection of the [Formula: see text]-benzyl group through Pd/C-promoted hydrogenation. TriADAPs were isolated in both 18[Formula: see text] (cation) and 19[Formula: see text] (neutral) forms. The interconversion between these two oxidation states resulted in a distinct change in the optical properties of the DAP [Formula: see text]-system. NMR spectroscopy of the 18[Formula: see text] TriADAP cations showed that they had aromatic character, whereas EPR spectroscopy of the 19[Formula: see text] TriADAP showed a highly delocalized electron spin of the [Formula: see text]-radical. The para substituents of the [Formula: see text]-aryl groups of TriADAPs had a small but distinct impact on their HOMO and LUMO energies. The change in the net charge of one electron was directly reflected in the redox properties of the DAP ring; TriADAP was more easily reduced and less easily oxidized than DAP. The difference in the net charge was also reflected by the shielding of the pyrrolic [Formula: see text]-protons observed in the [Formula: see text]H NMR spectra. The present results confirm that TriADAP is a highly promising framework for constructing a new class of azaporphyrin-based materials with 18[Formula: see text]–19[Formula: see text] redox-switchable optical and magnetic properties.
(Zn2Al-LDH/ZnTPPS)n composite films with notable third-order optical nonlinearities
Authors: Ren Xiaoyu , Ren Haizhou , Zhou Yunshan , Zhang Lijuan , Shehzad Farooq K. , Li Chao
Published: April 2018

New inorganic-organic transparent composite films of the formula (Zn[Formula: see text]Al-LDH/ZnTPPS)[Formula: see text] were fabricated using exfoliated cationic Zn[Formula: see text]Al layered double hydroxide (Zn[Formula: see text]Al-LDH) nanosheets and anionic meso-tertra(4-sulfophenyl) zinc porphyrin (ZnTPPS) through an electrostatic layerbylayer self-assembly method. The resulting composite films were characterized by UV-vis spectroscopy (UV-vis) scanning electron microscopy (SEM) and atomic force microscopy (AFM). The results showed that the films have relatively smooth and orderly surfaces, with the large ring plane of the porphyrin molecules vertically aligned LDH nanosheets and can grow in a nearly linear fashion with increasing the deposition cycles. Z-scan measurements, which were conducted under laser irradiation at a wavelength of 532 nm pulse width of 6 ns, repetition rate of 10 Hz and light intensity at focus [Formula: see text] of 10 [Formula: see text]J, revealed that the composite films have notable saturation absorption (cf., ZnTPPS in solution shows reverse saturation) and optical nonlinear self-defocusing behavior with the nonlinear optical absorption coefficient [Formula: see text] refractive index [Formula: see text], and third-order NLO susceptibility [Formula: see text] of the films increasing with the increase in number of layers of films ([Formula: see text] value is up to 7.86 × 10[Formula: see text] esu when [Formula: see text] 40), implying the NLO responses could be modified by fine tuning the thickness of composite films.
Transmission Risk on a Neonatal Intensive Care Unit: Escherichia coli versus Klebsiella pneumoniae
Authors: Artelt Tanja , Kaase Martin , Bley Ivonne , Eiffert Helmut , Mellmann Alexander , Küster Helmut , Lange Martina , Scheithauer Simone
Published: April 2018

Isolation precautions required for neonatal intensive care units are part of a bundle with the aim to prevent transmission, colonization, and infection with multidrug-resistant gram-negative pathogens as neonates face an increased risk of mortality and morbidity in case of infection. The following short report describes a transmission of 3MDRGN Klebsiella pneumoniae on a neonatal intensive care unit in a university hospital in Germany. This transmission occurred even though intensified infection control measures were in place, which impressively shows the importance of surveillance, outbreak management, and awareness of contributing factors regarding outbreak situations.
Transcriptome Analysis Reveals Dynamic Gene Expression Profiles in Porcine Alveolar Macrophages in Response to the Chinese Highly Pathogenic Porcine Reproductive and Respiratory Syndrome Virus
Authors: Zeng Nanfang , Wang Cong , Liu Siyu , Miao Qi , Zhou Lei , Ge Xinna , Han Jun , Guo Xin , Yang Hanchun
Published: April 2018

Porcine reproductive and respiratory syndrome virus (PRRSV) is one of the most economically important swine pathogens and causes reproductive failure in sows and respiratory disease in growing pigs. PRRSV mainly infects porcine alveolar macrophages (PAMs), leading to the subversion of innate and adaptive immunity of pigs. The transcriptome analysis of gene expression profiles in PRRSV-infected PAMs is essential for understanding the pathogenesis of PRRSV. Here we performed next-generation RNA sequencing and a comprehensive bioinformatics analysis to characterize the dynamic transcriptome landscapes in PAMs following PRRSV infection. Totally 38222 annotated mRNAs, 12987 annotated long noncoding RNAs (lncRNAs), and 17624 novel lncRNAs in PRRSV-infected PAMs were identified through a transcripts computational identification pipeline. The differentially expressed mRNAs and lncRNAs during PRRSV infection were characterized. Several differentially expressed transcripts were validated using qRT-PCR. Analyses on dynamic overrepresented GO terms and KEGG pathways in PRRSV-infected PAMs at different time points were performed. Meanwhile the genes involved in IFN-related signaling pathways, proinflammatory cytokines and chemokines, phagocytosis, and antigen presentation and processing were significantly downregulated, indicating the aberrant function of PAMs during PRRSV infection. Moreover, the differentially and highly expressed lncRNA XR_297549.1 was predicted to both cis-regulate and trans-regulate its neighboring gene, prostaglandin-endoperoxide synthase 2 (PTGS2), indicating its role in inflammatory response. Our findings reveal the transcriptome profiles and differentially expressed mRNAs and lncRNAs in PRRSV-infected PAMsin vitro, providing valuable information for further exploration of PRRSV pathogenesis.
Prevalence of Anaemia among the Elderly in Malaysia and Its Associated Factors: Does Ethnicity Matter?
Authors: Yusof Muslimah , Awaluddin S. Maria , Omar Maisarah , Ahmad Noor Ani , Abdul Aziz Fazly Azry , Jamaluddin Rasidah , Aris Tahir , Tan Maw Pin
Published: April 2018

Introduction. Anaemia is common among the elderly, yet it remains an underresearched clinical condition. This study investigates ethnic differences in prevalence of anaemia and identifies potential factors associated with anaemia in the elderly. Methods. Data from the National Health & Morbidity Survey (NHMS) 2015 conducted by Ministry of Health was analyzed. Haemoglobin levels were measured using point-of-care testing, HemoCue® Hb 201+ System©, from consenting individuals. Demographic information and other clinical information were obtained through a structured questionnaire. Descriptive and multivariate analyses were conducted and significant results were presented as adjusted odds ratio. Results. A total of 3794 participants aged 60 years and older responded to the anaemia module with a response rate of 93.7%. 64.0% of respondents were of Malay ethnicity, 21.6% were Chinese, 6.1% were Indians, and 8.3% were of other ethnicities. The overall prevalence of anaemia among older people was 35.3%. The highest prevalence of anaemia was found among respondents of Indian ethnicity (45.5%). The Indian (aOR: 1.72; 95% CI 1.26–2.34) and Malay (aOR: 1.25; 95% CI 1.04–1.49) ethnic groups were more likely to be anaemic in comparison to those of Chinese ethnicity. Anaemia in older people was also associated with increasing age, history of hospital admission, and the presence of diabetes mellitus. Conclusion. Anaemia in the elderly is associated with Indian and Malay ethnicities, increasing age, hospitalization, and diabetes. Our study has identified important information on a common condition which will guide and assist future studies in reducing the burden of anaemia.
Capybara Oil Improves Hepatic Mitochondrial Dysfunction, Steatosis, and Inflammation in a Murine Model of Nonalcoholic Fatty Liver Disease
Authors: Marinho Polyana C. , Vieira Aline B. , Pereira Priscila G. , Rabelo Kíssila , Ciambarella Bianca T. , Nascimento Ana L. R. , Cortez Erika , Moura Aníbal S. , Guimarães Fernanda V. , Martins Marco A. , Barquero Gonzalo , Ferreira Rodrigo N. , de Carvalho Jorge J.
Published: April 2018

Nonalcoholic fatty liver disease (NAFLD) is recognized as the most common cause of liver dysfunction worldwide and is commonly associated with obesity. Evidences suggest that NAFLD might be a mitochondrial disease, which contributes to the hepatic steatosis, oxidative stress, cytokine release, and cell death. Capybara oil (CO) is a rich source of polyunsaturated fatty acids (PUFA), which is known to improve inflammation and oxidative stress. In order to determine the effects of CO on NAFLD, C57Bl/6 mice were divided into 3 groups and fed a high‐fat diet (HFD) (NAFLD group and NAFLD + CO group) or a control diet (CG group) during 16 weeks. The CO (1.5 g/kg/daily) was administered by gavage during the last 4 weeks of the diet protocol. We evaluated plasma liver enzymes, hepatic steatosis, and cytokine expression in liver as well as hepatocyte ultrastructural morphology and mitochondrial function. CO treatment suppressed hepatic steatosis, attenuated inflammatory response, and decreased plasma alanine aminotransferase (ALT) in mice with NAFLD. CO was also capable of restoring mitochondrial ultrastructure and function as well as balance superoxide dismutase and catalase levels. Our findings indicate that CO treatment has positive effects on NAFLD improving mitochondrial dysfunction, steatosis, acute inflammation, and oxidative stress.
Hemoadsorption in a Case of Severe Septic Shock and Necrotizing Fasciitis Caused by Nontraumatic Renal Rupture due to Pyelonephritis with Obstructive Uropathy
Authors: Kousoulas Lampros , Wittel Uwe , Fichtner-Feigl Stefan , Utzolino Stefan
Published: April 2018

Background. Nontraumatic renal rupture due to pyelonephritis with obstructive uropathy is an uncommon but life-threatening situation. Case Presentation. A 25-year-old female presented to the emergency department with acute worsening of abdominal pain that began four weeks earlier. She was found to have peritonitis, leukocytosis, severe lactic acidosis, and a pronounced anemia and imaging was consistent with nontraumatic renal rupture with retroperitoneal abscess, perforation of the colon, and severe necrotizing fasciitis of the right lower limb. She underwent a right nephrectomy, a right hemicolectomy, surgical debridement of the retroperitoneum, and an upper thigh amputation. Due to severe septic shock and rhabdomyolysis with acute renal failure we performed a combined treatment of hemoadsorption using a Cytosorb hemoadsorber and continuous venovenous hemodialysis (CVVHD). Subsequently the patient recovered and was discharged home with no signs of infections and with normal renal function. Conclusion. We present a case of pyelonephritis with nontraumatic renal rupture leading to necrotizing fasciitis with osteomyelitis of the lower limb. The early treatment of the patient with a Cytosorb hemoadsorber led to a rapid hemodynamic and metabolic stabilization and preservation of the renal function, suggesting that hemoadsorption might be a rescue therapy in patients with severe septic shock and traumatic rhabdomyolysis.
A Perceptive Approach to Digital Image Watermarking Using a Brightness Model and the Hermite Transform
Authors: Escalante-Ramírez Boris , Gomez-Coronel S. L.
Published: April 2018

This work presents a watermarking technique in digital images using a brightness model and the Hermite Transform (HT). The HT is an image representation model that incorporates important properties of the Human Vision System (HVS), such as the analysis of local orientation, and the model of Gaussian derivatives of early vision. The proposed watermarking scheme is based on a perceptive model that takes advantage of the masking characteristics of the HVS, thus allowing the generation of a watermark that cannot be detected by a human observer. The mask is constructed using a brightness model that exploits the limited sensibility of the human visual system for noise detection in areas of high or low brightness. Experimental results show the imperceptibility of the watermark and the fact that the proposed algorithm is robust to most common processing attacks. For the case of geometric distortions, an image normalization stage is carried out prior to the watermarking.
Learning on the Fly: The Interplay between Caspases and Cancer
Authors: Xu Derek Cui , Arthurton Lewis , Baena-Lopez Luis Alberto
Published: April 2018

The ease of genetic manipulation, as well as the evolutionary conservation of gene function, has placedDrosophila melanogasteras one of the leading model organisms used to understand the implication of many proteins with disease development, including caspases and their relation to cancer. The family of proteases referred to as caspases have been studied over the years as the major regulators of apoptosis: the most common cellular mechanism involved in eliminating unwanted or defective cells, such as cancerous cells. Indeed, the evasion of the apoptotic programme resulting from caspase downregulation is considered one of the hallmarks of cancer. Recent investigations have also shown an instrumental role for caspases in non-lethal biological processes, such as cell proliferation, cell differentiation, intercellular communication, and cell migration. Importantly, malfunction of these essential biological tasks can deeply impact the initiation and progression of cancer. Here, we provide an extensive review of the literature surrounding caspase biology and its interplay with many aspects of cancer, emphasising some of the key findings obtained fromDrosophilastudies. We also briefly describe the therapeutic potential of caspase modulation in relation to cancer, highlighting shortcomings and hopeful promises.
Coccydynia Treated with Dorsal Root Ganglion Stimulation
Authors: Giordano Nicholas L. , van Helmond Noud , Chapman Kenneth B.
Published: April 2018

Coccydynia can be difficult to resolve with conventional treatment options. Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for chronic pain, but its application has not been described in the context of coccydynia. We used DRG stimulation treatment in a patient suffering from intractable coccyx pain. At long-term follow-up, the patient experienced a decrease in pain intensity and improvement in function, without any complications. DRG stimulation may be a treatment modality for coccydynia refractory to other approaches.
Adaptive Fuzzy Sliding Mode Guidance Law considering Available Acceleration and Autopilot Dynamics
Authors: Wang Yulin , Tang Shengjing , Shang Wei , Guo Jie
Published: April 2018

Terminal guidance law for missiles intercepting high maneuvering targets considering the limited available acceleration and autopilot dynamics of interceptor is investigated. Conventional guidance laws based on adaptive sliding mode control theory were designed to intercept a maneuvering target. However, they demand a large acceleration for interceptor at the end of the terminal guidance, which may have acceleration saturation especially when the target acceleration is close to the available acceleration of interceptor. In this paper, a terminal guidance law considering the available acceleration and autopilot dynamics of interceptor is proposed. Then, a fuzzy system is utilized to approximate and replace the variable structure term, which can handle the unknown target acceleration. And an adaptive neural network system is adopted to compensate the effects caused by the designed overlarge acceleration of interceptor such that the interceptor with small available acceleration can intercept the high maneuvering target. Simulation results show that the guidance law with available acceleration and autopilot dynamics (AAADG) is highly effective for reducing the acceleration command and achieving a small final miss distance.
Brain Network Regional Synchrony Analysis in Deafness
Authors: Xu Lei , Wang Chang-Dong , Liang Mao-Jin , Cai Yue-Xin , Zheng Yi-Qing
Published: April 2018

Deafness, the most common auditory disease, has greatly affected people for a long time. The major treatment for deafness is cochlear implantation (CI). However, till today, there is still a lack of objective and precise indicator serving as evaluation of the effectiveness of the cochlear implantation. The goal of this EEG-based study is to effectively distinguish CI children from those prelingual deafened children without cochlear implantation. The proposed method is based on the functional connectivity analysis, which focuses on the brain network regional synchrony. Specifically, we compute the functional connectivity between each channel pair first. Then, we quantify the brain network synchrony among regions of interests (ROIs), where both intraregional synchrony and interregional synchrony are computed. And finally the synchrony values are concatenated to form the feature vector for the SVM classifier. What is more, we develop a new ROI partition method of 128-channel EEG recording system. That is, both the existing ROI partition method and the proposed ROI partition method are used in the experiments. Compared with the existing EEG signal classification methods, our proposed method has achieved significant improvements as large as 87.20% and 86.30% when the existing ROI partition method and the proposed ROI partition method are used, respectively. It further demonstrates that the new ROI partition method is comparable to the existing ROI partition method.
Bilateral Greater Trochanteric Avulsion Fractures after Bilateral Simultaneous Total Hip Arthroplasty
Authors: Tagomori Hiroaki , Kaku Nobuhiro , Tabata Tomonori , Tsumura Hiroshi
Published: April 2018

We report a case of bilateral spontaneous greater trochanteric fracture after bilateral simultaneous total hip arthroplasty (THA) performed via the posterolateral approach during the early postoperative phase. A 75-year-old woman underwent bilateral simultaneous THA (BS-THA) for severe osteoarthritis with developmental dysplasia of the hip; she also presented a limited range of adduction. BS-THA was successful without any intraoperative complications. Rehabilitation with full weight-bearing exercises was initiated the day after the surgery. On the 14th postoperative day, she experienced a spontaneous left greater trochanteric fracture during a walking exercise without any trauma. Osteosynthesis was performed for the fracture on the 18th postoperative day. On the 20th postoperative day, a right spontaneous greater trochanteric avulsion fracture occurred during a transfer exercise without any trauma; this was treated on the 27th postoperative day. In the 18th postoperative month, although the right fragment showed slight upper migration, the patient had no complaints of coxalgia and both hip joints showed an excellent range of motion.