bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring halide anion affinities to native cyclodextrins by mass spectrometry and molecular modelling
Authors: Xu Chongsheng , He Nan , Li Zhenhua , Chu Yanqiu , Ding Chuan-Fan
Published: December 2017

The binding affinities of cyclodextrins complexation with chlorine (Cl−), bromine (Br−) and iodine (I−), were measured by mass spectrometric titrimetry, and the fitting of the binding constants was based on the concentration measurement of the cyclodextrin equilibrium. The binding constants (lg Ka) for α-, β- or γ-cyclodextrin with Cl− were 3.99, 4.03 and 4.11, respectively. The gas-phase binding affinity of halide anions for native cyclodextrins was probed by collision-induced dissociation. In collision-induced dissociation, the centre-of-mass frame energy results revealed that in the gas phase, for the same type of cyclodextrin, the stability of the complexes decreased in order: Cl > Br > I, and for the same halide anion, the binding stability of the complex with α-, β- or γ-cyclodextrin decreased in the order: γ-cyclodextrin >β-cyclodextrin > α-cyclodextrin. The density functional theory calculations showed that halide anion binding on the primary face had a lower energy than the secondary face and hydrogen bonding was the main driving force for complex formation. The higher stability of the γ-cyclodextrin complex with the Cl anion can be attributed to the higher charge density of the Cl anion and better flexibility of γ-cyclodextrin.
Sleep disturbance in patients with an implantable cardioverter defibrillator: Prevalence, predictors and impact on health status
Authors: Habibović M , Mudde L , Pedersen SS , Schoormans D , Widdershoven J , Denollet J
Published: December 2017

Background:

Sleep disturbances are highly prevalent in patients with cardiac diseases and associated with poor health outcomes. However, little is known about sleep disturbance in patients with an implantable cardioverter defibrillator.

Aims:

We examined the prevalence and predictors of sleep disturbance and the impact on perceived health status in a Dutch cohort of implantable cardioverter defibrillator patients.

Methods:

Patients ( n=195) enrolled in the Web-based distress program for implantable cardioverter defibrillator patients (WEBCARE) trial completed questionnaires at the time of implantable cardioverter defibrillator implantation, three, six and 12 months afterwards. Sleep disturbance was assessed with the corresponding item #3 of the Patient Health Questionnaire 9.

Results:

At baseline, 67% ( n=130) reported sleep disturbance (cut off ≥1). One year later, the prevalence was 57% ( n=112). Younger age (odds ratio=0.96, 95% confidence interval 0.92–0.99; p=0.012) and high negative affectivity/low social inhibition (odds ratio=4.47, 95% confidence interval 1.52–13.17; p=0.007) were associated with sleep disturbance at 12 months in adjusted analyses. Sleep disturbance was not associated with health status at 12 months. Charlson Comorbidity Index, anxiety, Type D personality and high negative affectivity/low social inhibition were associated with impaired health status at follow-up.

Conclusions:

Sleep disturbance was highly prevalent in patients with an implantable cardioverter defibrillator. Younger age and high negative affectivity predicted sleep disturbance 12 months post-implantation independent of other demographic, clinical, intervention and psychological covariates. Sleep disturbance was not associated with impaired health status at the 12-month follow-up.
Damage identification using modal strains identified from operational fiber-optic Bragg grating data
Authors: Anastasopoulos Dimitrios , De Smedt Maure , Vandewalle Lucie , De Roeck Guido , Reynders Edwin P.B.
Published: December 2017

Vibration-based structural health monitoring of civil structures relies on the repeated identification of dynamic structural characteristics of the structure from output-only vibration data. Natural frequencies and displacement mode shapes are the most commonly employed dynamic characteristics; yet their sensitivity to local damage of moderate severity is rather low with respect to their sensitivity to other factors such as temperature, necessitating data normalization. Strain mode shapes offer a higher sensitivity to local damage, but their accurate identification in a dense grid is challenging given the very small dynamic strain levels that are encountered under ambient excitation. In this article, a method is presented for tackling this challenge. It consists of three stages. First, fiber-optic Bragg grating strain sensors are attached to the structure and interrogated with a tunable laser performing a wavelength sweep. In this way, the measured strain amplitudes have the required accuracy but synchronization errors are introduced between the different Bragg sensors. Second, a modal analysis is performed on the dynamic strain data using an accurate parametric system identification technique. This is followed by a synchronization step which compensates for the delays introduced by the wavelength sweep. Finally, the synchronized strain mode shapes are employed as damage-sensitive features, either directly or via a newly proposed quantity, the top-to-bottom strain ratio. The method is validated by progressive damage testing of a complex, prestressed concrete “roof” beam, reinforced with steel fibers. It is observed that the proposed method can identify both the presence and the location of the damage in a relatively early stage.
Thoracic Endovascular Aneurysm Sealing of a Complex Thoracoabdominal Aneurysm
Authors: Chisci Emiliano , Bellandi Guido , Michelagnoli Stefano
Published: December 2017

Purpose: To report bailout treatment of a thoracoabdominal aortic aneurysm using a single Nellix stent and parallel stents. Case Report: A 74-year-old man with multiple comorbidities and a previous fenestrated Anaconda stent-graft for a 60-mm juxtarenal aneurysm was diagnosed with a type IV thoracoabdominal aneurysm on the 2-year computed tomography angiography (CTA) scans. The imaging showed >10-mm downward migration of the proximal Anaconda stent with a massive type Ia endoleak and aneurysmal evolution of the distal descending thoracic aorta; the superior mesenteric artery (SMA) and renal artery covered stents were patent and intact. Open conversion or a second custom-made endograft was not feasible. A plan was devised to use off-the-shelf materials, including the deployment of a single Nellix stent extending from the descending thoracic aorta into the stented area of the fenestrated endograft, with parallel chimney stent-grafts into the SMA and right renal artery; the left renal artery was treated with a bare stent in a periscope configuration. Transient paraparesis was resolved with cerebrospinal fluid drainage. At 6-month CTA, ongoing aneurysm exclusion with patent SMA and renal arteries was confirmed. Conclusion: Thoracic endovascular aneurysm sealing with visceral and renal stenting seems to be a feasible bailout alternative treatment for urgent, complex cases without reconstruction options.
Endovascular Distal Plantar Vein Arterialization in Dialysis Patients With No-Option Critical Limb Ischemia and Posterior Tibial Artery Occlusion: A Technique for Limb Salvage in a Challenging Patient Subset
Authors: Gandini Roberto , Merolla Stefano , Scaggiante Jacopo , Meloni Marco , Giurato Laura , Uccioli Luigi , Konda Daniel
Published: December 2017

Purpose: To detail a percutaneous technique for distal plantar venous arterialization in diabetic, end-stage renal disease (ESRD) patients with no-option critical limb ischemia (CLI). Technique: After failure of standard intraluminal recanalization attempts, a subintimal approach through the posterior tibial artery (PTA) is begun using a 0.014-inch, 190- or 300-cm-long guidewire supported by a 2-×20-mm, low-profile balloon catheter positioned a short distance behind the narrow “U-shaped” loop in the guidewire. Typically, heavy calcification in the distal tortuous segment of the PTA prevents reentry to the arterial true lumen; however, an entry in the distal lateral or medial plantar vein from a subintimal channel in the plantar artery can be intentionally pursued as a bailout technique, pointing the tip of the guidewire opposite to the arterial wall calcifications. Venous access is confirmed by contrast injection through the balloon catheter. Once the guidewire is advanced in the distal lateral or medial plantar vein and a plantar arteriovenous fistula (AVF) has been created, the AV anastomosis and the occluded PTA segment are dilated with 0.014-inch balloon catheters. The technique has been attempted in 9 consecutive diabetic, ESRD patients (mean age 69 years; 5 men) with no-option CLI; an AVF was created between the PTA and plantar vein in 7 patients. The mean TcPO2 at 1 month was 30±17 mm Hg (vs 7.3±2.2 at baseline). Six ulcers healed over an average of 21±4 weeks. Three of the 9 patients had below-knee amputations. Conclusion: Although further investigations are required, distal plantar venous arterialization may represent a promising technique to improve recanalization rates and limb salvage in diabetic ESRD patients with extremely calcified PTA occlusions.
The Determinants and Consequences of Accurate Beliefs About Childhood Vaccinations
Authors: Joslyn Mark R. , Sylvester Steven M.
Published: December 2017

In this article, we examine the individual predictors that are responsible for accurate beliefs about the link between vaccinations and autism. We then show how these beliefs affect policy preferences about vaccines. We derive two hypotheses from motivated reasoning theory and test these on national survey data from Gallup and CBS News. Republicans were less likely to report accurate beliefs than Democrats. In addition, educational attainment modified the impact of party identification. The gap between Republicans and Democrats in likelihood of reporting accurate beliefs was largest among the most educated portion of the public. Finally, we show that accurate beliefs about vaccines, independent of statistical controls, are important predictors of policy attitudes about unvaccinated children attending public school and parental choice about the decision to vaccinate. We discuss the theoretical and practical significance of these findings.
Contrast-Enhanced Near-Infrared Optical Imaging Detects Exacerbation and Amelioration of Murine Muscular Dystrophy
Authors: Chrzanowski Stephen M. , Vohra Ravneet S. , Lee-McMullen Brittany A. , Batra Abhinandan , Spradlin Ray A. , Morales Jazmine , Forbes Sean , Vandenborne Krista , Barton Elisabeth R. , Walter Glenn A.
Published: December 2017

Assessment of muscle pathology is a key outcome measure to measure the success of clinical trials studying muscular dystrophies; however, few robust minimally invasive measures exist. Indocyanine green (ICG)-enhanced near-infrared (NIR) optical imaging offers an objective, minimally invasive, and longitudinal modality that can quantify pathology within muscle by imaging uptake of ICG into the damaged muscles. Dystrophic mice lacking dystrophin (mdx) or gamma-sarcoglycan (Sgcg−/−) were compared to control mice by NIR optical imaging and magnetic resonance imaging (MRI). We determined that optical imaging could be used to differentiate control and dystrophic mice, visualize eccentric muscle induced by downhill treadmill running, and restore the membrane integrity in Sgcg−/− mice following adeno-associated virus (AAV) delivery of recombinant human SGCG (desAAV8hSGCG). We conclude that NIR optical imaging is comparable to MRI and can be used to detect muscle damage in dystrophic muscle as compared to unaffected controls, monitor worsening of muscle pathology in muscular dystrophy, and assess regression of pathology following therapeutic intervention in muscular dystrophies.
Diamond Stress View Radiograph for Thumb Metacarpophalangeal Hyperextension
Authors: Marchessault Jeffrey A. , Knight Michael C. , Henkel Paul A.
Published: December 2017

Background: Successful surgical management of thumb carpometacarpal (CMC) arthritis requires treatment of coexisting metacarpophalangeal (MCP) hyperextension deformity when present. The surgeon’s decision to offer thumb CMC arthritis patients the option of no additional treatment, MCP capsulodesis, or MCP arthrodesis relies on the severity of the MCP deformity measured in clinic. The authors present a novel patient-performed radiographic stress view to measure MCP hyperextension. Methods: Fifty-seven thumbs in 30 consecutive patients offered thumb CMC arthroplasty were enrolled. Clinic goniometer measurements, patient-performed stress view radiographs, and intraoperative manual stress views of each MCP joint were documented for study. Paired samples t test was used to compare the differences between the preoperative measurements and intraoperative measurements of the right and left thumb groups. Results: The clinic goniometer measurements were significantly different ( P = .0001) than the MCP stress view obtained while the patient was under anesthesia. The difference in the new patient-derived x-ray stress view was not statistically significant compared with the stress view under anesthesia in the left ( P = .91) or right ( P = .53) groups. Conclusions: This new patient-performed stress view of the MCP joint allows accurate, objective measurement of hyperextension to aide in the decision making and patient education for the need of additional MCP joint surgery when addressing thumb CMC arthritis.
The Ethical Implications of Community-Based Research
Authors: Wood Lesley
Published: December 2017

Researchers need to provide evidence that they have met ethical requirements before entering the field—rightly so, since the power and privilege embedded in academic researchers is considerable. However, given the calls for universities to decolonize and democratize research, we need to question whether the ethical norms developed to cater for objective, researcher-driven enquiries are appropriate and sufficient to ensure ethical conduct for qualitative designs that are more subjective, participatory, and community-based. This conceptual article argues for the need to rethink the standards against which ethics boards evaluate community-based research projects and suggests some ways this could be done.
Oral Neuroimmune Network and Mast Cells
Authors: Karapanou V. , Kempuraj D. , Theoharides T.C.
Published: December 2017

Inflammation is a critical process in the oral cavity, especially in gingival inflammation and pulpitis, as seen in periodontitis and decayed tooth structure. Nevertheless, the cellular process involved in oral inflammation is not well delineated. Recent evidence from other organs as well as the mouth suggests that neurogenic inflammation involving mast cells (MCs) may be a critical factor. MCs, best known for their role in allergic reactions, are also involved in immunity and inflammation. They are located at strategic points close to small blood vessels and nerve fibers often containing substance P (SP). The pain models of reversible or irreversible pulpitis simply suggest the complexity of neural-inflammatory interactions within the dental pulp. In the pulp and periapical area, neuropeptides and cytokines modulate vascular responses, increase permeability and leukocyte migration. SP-immunoreactive nerve fibers and TNF-positive MCs were found localized around blood vessels in all samples of periapical granulomas. By generating a profound number of potent mediators, MCs may serve as a link between the immune, endocrine and nervous systems in pulp inflammation. This role has been strengthened by recent evidence of MCs involvement in inflammatory conditions.
Lipoxin A4 and Serum Amyloid a Differentially Modulate Phospholipase D in Human Fibroblast-Like Synoviocytes
Authors: Sodin-Semrl S. , Antico G. , Mikus R. , Lakota K. , Varga J. , Fiore S.
Published: December 2017

Lipoxin A4 (LXA4) and scrum amyloid A (SAA) are endogenous negative and positive modulators of inflammation, respectively. Both molecules bind the shared lipoxin A4 receptor (ALX) and elicit opposing effects on the production of inflammatory cytokines and matrix metalloproteinases. The aim of these studies is to examine the divergence of the intracellular signaling pathways triggered by lipid LXA4 (1 nM) and protein SAA (200 nM) ligands of ALX. Phospholipase D (PLD) is a phosphohydrolase enzyme that catalyzes the generation of phosphatidic acid (PA) from membrane phospholipids. Our results showed that in fibroblast-like synoviocytes, activation of PLD occurred only in response to LXA4, and not SAA. PA (30 μM) mimicked LXA4 and demonstrated inhibition of IL-8 production induced by SAA or interleukin-1β. In sharp contrast to LXA4, SAA confirmed the stimulation of IL-8 release as determined previously. Taken together, these findings suggest that two physiologic ligands sharing the common ALX receptor, LXA4 and SAA, differentially regulate the level of PLD activation and differentially modulate IL-8. These results may have important implications for understanding the regulation of inflammatory responses under physiologic and pathological conditions.
Dopamine Receptor Gene Expression Changes in Peripheral Blood Mononuclear Cells from Schizophrenic Patients Treated with Haloperidol and Olanzapine
Authors: Shariati G.H. , Ahangari G. , Asadi M.R. , Poyafard F. , Ahmadkhaniha H.R.
Published: December 2017

We investigated dopamine receptor gene expression in peripheral blood mononuclear cells of schizophrenic patients before and after treatment. Also dopamine receptor genes expression profile was compared in two treatment groups including haloperidol and olanzapine. The peripheral blood mononuclear cells were separated from whole blood by Ficoll-hypaque; the total cellular RNA was extracted and the cDNA was synthesized. This process was followed by real-time polymerase chain reaction using primer pairs specific for five dopamine receptor mRNAs and β-actin as internal control. The results show the presence of all types of dopamine receptor in lymphocytes. Dopamine receptor gene expression profile in dopamine receptor D2 gene and dopamine receptor D4 gene showed significant changes that were correlated with the type of treatment and Clinical Global Impressions score improvement. In conclusion, the present study shows that human lymphocytes express dopamine receptor D1–D5 genes. Moreover, investigated dopamine receptors gene expression in peripheral blood mononuclear cells of schizophrenic patients correlated with clinical symptom improvement.
No Evidence of Pathological Autoimmunity following Mycobacterium Leprae Heat-Shock Protein 65-Dna Vaccination in Mice
Authors: Lima D.S. , ZÁrate-Bladés C.R. , Souza P.R.M. , Trombone A.P. , Santos-Junior R.R. , Brandão Lt. , Masson A.P. , Bonato V.L. , Coelho-Castelo A.A.M. , Sartori A. , Vendramini M. , Soares E.G. , Benvenutti L.A. , Silva C.L. , Coelho V.
Published: December 2017

Heat-shock proteins (HSPs) are currently one of the most promising targets for the development of immunotherapy against tumours and autoimmune disorders. This protein family has the capacity to activate or modulate the function of different immune system cells. They induce the activation of monocytes, macrophages and dendritic cells, and contribute to cross-priming, an important mechanism of presentation of exogenous antigen in the context of MHC class I molecules. These various immunological properties of HSP have encouraged their use in several clinical trials. Nevertheless, an important issue regarding these proteins is whether the high homology among HSPs across different species may trigger the breakdown of immune tolerance and induce autoimmune diseases. We have developed a DNA vaccine codifying the Mycobacterium leprae Hsp65 (DNAhsp65), which showed to be highly immunogenic and protective against experimental tuberculosis. Here, we address the question of whether DNAhsp65 immunization could induce pathological autoimmunity in mice. Our results show that DNAhsp65 vaccination induced antibodies that can recognize the human Hsp60 but did not induce harmful effects in 16 different organs analysed by histopathology up to 210 days after vaccination. We also showed that anti-DNA antibodies were not elicited after DNA vaccination. The results are important for the development of both HSP and DNA-based immunomodulatory agents.
The Effects of Darbepoetin on Peritoneal Fibrosis Induced by Chemical Peritonitis and on Peritoneal Tissue Mmp-2 and Timp-2 Levels in Rats
Authors: Borazan A. , Camsari T. , Cavdar Z. , Sarioglu S. , Yilmaz O. , Oktay G. , Sifil A. , Celik A. , Cavdar C. , Aysal A. , Kolatan E.
Published: December 2017

The aim of this study is to assess the influence of darbepoetin on the development of peritoneal fibrosis in rats induced by Chlorhexidine gluconate (0.1%) and ethanol (15%) and to determine the effect on peritoneal tissue levels of MMP–2 and TIMP–2, possible important factors in progression of peritoneal fibrosis. Twenty-four female Wistar albino rats were divided into three groups. The first group (CH group) received 3 ml/200g daily intraperitoneal injections of Chlorhexidine gluconate (0.1%) and ethanol (15%) dissolved in saline to induce chemical peritonitis; group 2 (ESA group) received 3 ml/200g daily injections of Chlorhexidine gluconate (0.1%) and ethanol (15%) dissolved in saline and also darbepoetin 12.5 microgr/ per kilogram/ day subcutaneously on the first and seventh days; group 3 (Control group) received intraperitoneal 0.9% saline (3 ml/200g/d) through the right lower quadrant by 21 gauge needle. The study duration was fourteen days. On the fifteenth day rats were sacrificed, parietal peritoneum samples were obtained from the left anterior abdominal wall. Pathological samples were examined using Hematoxyline & Eosin (HE) stains. The thickness, vasculpathy, and inflammation were determined by light microscopy. MMP-2 and TIMP-2 were studied immunohistochemically by monoclonal antibody staining. The activity of MMP-2 on peritoneal tissue was studied by gelatin zymography and TIMP–2 protein level was analysed by ELISA, biochemically. The decrease in thickness of parietal peritoneum in group ESA was statistically significant when compared to CH group (p<0.05). Inflammation scores, and vascularization score surfaces were not statistically different between these groups (p>0.05). Immunohistochemically, darbepoetin was shown to decrease MMP-2 expression on parietal peritoneum in CH group (p<0.05), but had no effect on TIMP-2 (p>0.05). Biochemically the ratio of active MMP–2 to proMMP–2 was more significantly increased in the ESA group than in the CH group (p<0.001), however, TIMP- 2 levels in both groups were decreased compared to the control group (p<0.05). Darbepoetin histopathologically reduced peritoneal fibrosis induced by Chlorhexidine gluconate. We can suggest that Darbepoetin does not cause peritoneal fibrosis and may prevent peritoneal fibrosis in rats possibly related to an effect on MMP-2 expression. Further research regarding the utility and dosage should be considered.
Therapy of Oral Lichen Planus with Monochromatic Excimer Light
Authors: Germi L. , Lazzaro M. , Veller-Fornasa C.
Published: December 2017

Oral lichen planus can cause considerable inconvenience to the patient and is often resistant to the various therapeutic options used, tending to become chronic. The monochromatic excimer light 308 nm is UVB radiation generated and has already been used with good results in the treatment of psoriasis, vitiligo and, less frequently, lichen cutaneous. The purpose of this study is to assess the clinical efficacy of monochromatic excimer light in the treatment of symptomatic oral lichen planus. Twenty patients were treated weekly with single phototherapic sessions. The therapy was suspended on achieving a total score of gravity at least 35% or less than the score of departure. At the end of the study scoring on the size of lesions, intensity of white, intensity of erythema, grade of sick oral gingiva, for both gingival and non-gingival lichen was improved. The statistical processing found a highly significant reduction in post-therapy (p< 0002) of all subjective manifestations tested. Side effects were not observed. Our study shows that monochromatic excimer light 308 nm would appear to be an effective and well-tolerated treatment for oral lichen planus and could represent a new additional therapeutic strategy.
Mast Cells and Arachidonic Acid Cascade in Inflammation
Authors: Castellani M.L. , Felaco M. , Pandolfi F. , Salini V. , De Amicis D. , Orso C. , Vecchiet J. , Tetè S. , Ciampoli C. , Conti F. , Cerulli G. , Caraffa A. , Antinolfi P. , Cuccurullo C. , Felaco P. , Kempuraj D. , Boscolo P. , Sabatino G. , Shaik Y.B.
Published: December 2017

Prostaglandin D2 PGD2 is a major cyclooxygenase metabolite of arachidonic acid produced by mast cells and it is released following allergen challenge in diseases, such as allergic diseases. PGD2 may act as a neuromodulator and as an allergic and inflammatory mediator. In allergic diseases, activated mast cell synthesizes prostaglandin D2 (first cyclo-oxygenate mediator) which has bronchoconstrictive and vasodilating effects and attracts several leukocytes. It has been found that activated mast cells, challenged with physiological and non- physiological secretagogues, release elevated histamine and tryptase and chymase, leukotrienes B4, C4 and D4, 5-hydroxyeicosatetraenoic acid, PGD2, Platelet Activating Factor (PAF), heparin, and high-molecular-weight neutrophil chemotactic factor and cytokines/chemokines. PGD2 exerts its biological activity through the DP and CRTH2 receptors and their cDNA cloning which were characterized 15 years ago. In this report, we revisited the biological effects of arachidonic acid compounds released by activated mast cells in allergic and inflammatory states.
Seroepidemiology of Chlamydia Pneumoniae in Northern Greece
Authors: Chatzidimitriou D. , Exidari M. , Gioula G. , Papakonstantinou P. , Melidou A. , Gavriilaki E. , Diza E.
Published: December 2017

The prevalence of IgG and IgA antibodies to Chlamydia pneumoniae was evaluated in a group of an apparently healthy population in northern Greece. Serum samples were obtained over a period of one year (June 2006 to May 2007) from 530 individuals (300 males and 230 females, aged from 1 month to 90 years). The sera were tested for specific antibodies to C. pneumoniae by two commercial methods, an ELISA and a micro-IF assay based on the principles of MIF. The prevalence of IgG and IgA antibodies to C. pneumoniae was 53.2% and 45.9%, respectively, and was found to be unrelated to gender, even in the elderly >61 years old. The IgG antibody prevalence was low in children under 5 years old (7.7%), sharply increased by the age of 20 (40%) and continued to increase, gradually, to reach 80.1% in the elderly. IgA antibodies also increased with similar kinetics to IgG, although at a lower level (3.8–66.1%). Our results show that infection with C. pneumoniae is common in northern Greece. The high prevalence of IgA specific antibodies reported in the present study is due to primary infection at a young age, while in the elderly is probably due to infection or reinfection, although the option of persistence cannot be excluded.
Recombinant Human Deoxyribonuclease Treatment in Hospital Management of Infants with Moderate-Severe Bronchiolitis
Authors: Nenna R. , Tromba V. , Berardi R. , De Angelis D. , Papoff P. , Sabbatino G. , Moretti C. , Midulla F.
Published: December 2017

Bronchiolitis is the main cause of respiratory insufficiency in infants, characterized by acute inflammation, edema, necrosis of epithelial cells and increased mucus production. Mucus is mainly purulent and consequently rich in DNA, as derived from nuclei of degenerating neutrophils and epithelial debris. The treatment is mainly supportive; bronchodilators and systemic steroids are often used but do not reduce the length of hospital stay. The aim of our study is to evaluate the efficacy of recombinant human DNase (rhDNase), in infants affected by moderate-severe bronchiolitis. In a randomized double-blind placebo-controlled study, twenty-two infants (12 males) under 6 months of age (median age 1.6 months) were enrolled and randomly assigned to receive either nebulized rhDNase or placebo (saline) at a dose of 2.5 ml once a day for three days. All infants were evaluated, based on a clinical assessment score, on admission and four times daily during the hospitalization. Placebo and study groups were sex- and age-matched and were similar in terms of clinical severity on admission. No differences were observed between the two groups of patients with regard to the length of hospitalization and clinical score during the days observed. Two out of four infants, all in the study group, presenting atelectasis on chest radiographs, showed a rapid improvement on the first day. RhDNase is not an effective routine therapy in treating infants hospitalized for bronchiolitis and it is not useful in preventing severe forms of the disease. On the contrary, it may be an effective, safe and cost-benefit treatment only in infants with bronchiolitis and massive atelectasis.
Impact of IL-32 on Histamine Release by Human Derived Umbilical Cord Blood Mast Cells
Authors: Castellani M.L. , Toniato E. , Felaco P. , Ciampoli C. , De Amicis D. , Orso C. , Cucurullo C. , Vecchiet J. , Tetè S. , Salini V. , Caraffa A. , Pandolfi F. , Antinolfi P.L. , Cerulli G. , Conti F. , Fulcheri M. , Sabatino G. , Boscolo P. , Shaik Y.B.
Published: December 2017

IL-32 is onae of the last important cytokines discovered, produced mainly by T cells, natural killer cells, and epithelial cells. Probably many other different cells are a source of IL-32, which has been found to be a powerful pro-inflammatory mediator. Here we studied the effect of IL-32 on histamine release by human-derived cord-blood mast cells. In these studies we found that IL-32 significantly stimulates the release of histamine only at high concentrations (100 ng/ml) while at 10 or 50 ng/ml it had no effect. These results were found for the first time and demonstrate that IL-32 may play an important role in allergic and inflammatory diseases.
Ethical complexities in child co-research
Authors: Spriggs Merle , Gillam Lynn
Published: December 2017

Child co-research has become popular in social research involving children. This is attributed to the emphasis on children’s rights and is seen as a way to promote children’s agency and voice. It is a way of putting into practice the philosophy, common amongst childhood researchers, that children are experts on childhood. In this article, we discuss ethical complexities of involving children as co-researchers, beginning with an analysis of the literature, then drawing on data from interviews with researchers who conduct child co-research. We identify six ethical complexities, some of which are new findings which have not been mentioned before in this context. In light of these possible ethical complexities, a key finding is for researchers to be reflexive – to reflect on how the research may affect child co-researchers and participants before the research starts. A separate overriding message that came out in responses from the researchers we interviewed was the need for support and training for child co-researchers. We conclude by providing a list of questions for reflexive researchers to ask of themselves when they use child co-research methodology. We also provide important questions for human research ethics committees to ask when they review projects using child co-research.
Chronic limb-threatening ischemia could benefit from growth hormone therapy for wound healing and limb salvage
Authors: Caicedo Diego , Devesa Pablo , Arce Víctor M. , Requena Julia , Devesa Jesús
Published: December 2017

Revascularization for chronic limb-threatening ischemia (CLTI) is necessary to alleviate symptoms and wound healing. When it fails or is not possible, there are few alternatives to avoid limb amputation in these patients. Although experimental studies with stem cells and growth factors have shown promise, clinical trials have demonstrated inconsistent results because CLTI patients generally need arteriogenesis rather than angiogenesis. Moreover, in addition to the perfusion of the limb, there is the need to improve the neuropathic response for wound healing, especially in diabetic patients. Growth hormone (GH) is a pleiotropic hormone capable of boosting the aforementioned processes and adds special benefits for the redox balance. This hormone has the potential to mitigate symptoms in ischemic patients with no other options and improves the cardiovascular complications associated with the disease. Here, we discuss the pros and cons of using GH in such patients, focus on its effects on peripheral arteries, and analyze the possible benefits of treating CLTI with this hormone.
Perspective: interesterified triglycerides, the recent increase in deaths from heart disease, and elevated blood viscosity
Authors: Sloop Gregory D. , Weidman Joseph J. , St Cyr John A.
Published: December 2017

The authors hypothesize that consumption of interesterified fats may be the cause of the continuous increase in cardiovascular deaths in the United States which began in 2011. Interesterification is a method of producing solid fats from vegetable oil and began to supplant partial hydrogenation for this purpose upon recognition of the danger of trans fats to cardiovascular health. Long, straight carbon chains, as are present in saturated and trans fatty acids, decrease the fluidity of the erythrocyte cell membrane, which decreases erythrocyte deformability and increases blood viscosity. This decrease in cell membrane fluidity is caused by increased van der Waals interactions, which also solidify dietary fats. Elevated blood viscosity is favored as the pathogenic mechanism by which trans fats increase cardiovascular mortality because changes in lipoprotein levels do not account for all the mortality attributable to their consumption. The rapid changes in cardiovascular mortality noted with the introduction and withdrawal of trans fats from the food supply are reviewed. The evidence implicating elevated blood viscosity in cardiovascular disease is also reviewed. Data regarding the production and consumption of interesterified fats in the US should be released in order to determine if there is an association with the observed increase in cardiovascular deaths.
Retrospective review of the use of as-needed hydralazine and labetalol for the treatment of acute hypertension in hospitalized medicine patients
Authors: Gaynor Michelle F. , Wright Garth C. , Vondracek Sheryl
Published: December 2017

Background:

The aim of this study was to evaluate the use of as-needed (PRN) labetalol and hydralazine [intravenous (IV) or oral] in hospitalized medicine patients for the treatment of severe asymptomatic hypertension and to examine the potential negative outcomes associated with their use.

Methods:

The electronic health record of 250 medicine patients hospitalized at the University of Colorado Hospital between November 2014 and April 2016 who received at least one dose of PRN IV or oral hydralazine or labetalol were retrospectively reviewed. The primary outcome was to describe the use of PRN antihypertensive medications in this population.

Results:

A total of 573 PRN doses of antihypertensive medication were administered. Oral hydralazine was the most common (521 doses, 90.9%). A total of 36% of PRN administrations were given for a systolic blood pressure (SBP) <180 mmHg and diastolic blood pressure (DBP) <110 mmHg (cut-point for acute severe hypertension). No serious adverse events were related to PRN antihypertensive administration. Despite receiving at least one PRN antihypertensive medication during hospitalization, 40.8% of patients were not continued on their home antihypertensive medication(s) while hospitalized, and 62.4% of patients did not have their home regimens intensified at discharge.

Conclusion:

As-needed oral hydralazine is frequently prescribed for acute blood pressure lowering with administration thresholds often less than what are used to define acute severe hypertension. Many patients are prescribed PRN antihypertensive medication instead of being continued on their home regimens, and most patients do not have the intensity of their home regimens increased. Providers need to be educated about the use of PRN antihypertensive medication for the management of severe asymptomatic hypertension in the hospital setting.
Assessing the Responsibility to Protect’s motivational capacity: The role of humanity
Authors: Jarvis Samuel
Published: December 2017

While the concept of humanity is most often referred to as the moral source of the Responsibility to Protect’s motivational capacity, humanity’s normative status and value has continued to be left assumed and/or unexplored. Consequently, there remains a considerable lack of analysis into humanity’s role in supposedly helping to both locate moral harm and subsequently provide a motivational cause that can drive protection practices in support of the Responsibility to Protect principle. In response to this lacuna, this article puts forward three hypotheses regarding the motivational role of humanity in this process: (a) humanity functioning as a rhetorical tool with no motivational qualities, (b) humanity as a concept that works to redefine sovereignty in support of the Responsibility to Protect and (c) humanity as a motivating principle that ultimately diminishes in influence as the Responsibility to Protect principle is diffused into action. Through this analysis, the article offers a more rigorous and systematic evaluation of humanity’s limitations as a moral motivator for generating collective response to mass atrocity crimes, highlighting the need to further develop understanding of the complex interaction between morality and politics in international decision-making.
A quality assurance investigation of CLABSI events: are there exceptions to never?
Authors: Strickler Samantha , Gupta Rohit R , Doucette John T , Kohli-Seth Roopa
Published: December 2017

Background:

In the USA, central line associated blood stream infections (CLABSIs) have been designated as ‘never events’, prompting initiatives towards a ‘zero CLABSIs’ standard. We propose that there are cascading risk factors predisposing certain patient cohorts to higher CLABSIs rates.

Methods:

A retrospective review of all CLABSI infections over a 12-month period was undertaken. Risk factors examined included catheter type, insertion site and parenteral nutrition (PN) status. Additional factors analysed included acute kidney injury (AKI), chronic kidney disease (CKD) and hospital-acquired infections (HAIs).

Results:

Thirty-four CLABSIs were identified in 33 adult patients (median age = 57 years). Temporary central venous catheters accounted for 12 (35%), peripherally inserted central catheters for five (14.7%), and permanent catheters for 17 CLABSIs (50%); the median duration from insertion was 15 days (interquartile range = 9–26). Among patient factors, immunosuppression and hyperglycaemia were the most common (n = 19, 55%), followed by PN and CKD (n = 17, 50.0%), AKI (n = 16, 47.1%) and HAIs (n = 13, 38.2%). A majority of patients with CLABSIs (n = 20 58.8%) had at least three risk factors.

Discussion:

These findings reflect the complexity of CLABSIs with multiple patient and hospital factors influencing incidence. It suggests the need for further studies to re-calibrate the zero CLABSI model towards one with greater relevance.
Prevalence and risk factors for bloodstream infection present on hospital admission
Authors: Aliyu Sainfer , Cohen Bevin , Liu Jianfang , Larson Elaine
Published: December 2017

Background:

Bloodstream infection present on hospital admission (BSI-POA) is a major cause of morbidity and mortality. The purpose of this study was to measure prevalence and describe the risk factors of patients with BSI-POA and to determine the prevalence of resistance in isolates by admission source.

Methods:

We conducted a retrospective cohort study of patients discharged from three hospitals in New York City between 2006 and 2014. BSI-POA was defined as BSI diagnosed within 48 h of hospitalisation.

Results:

The prevalence for BSI-POA was 5307/315,010 discharges (1.7%). The odds of being admitted with BSI-POA were greatest among patients admitted with renal failure, chronic dermatitis, malignancies and prior hospitalisation. Odds ratios and 95% confidence intervals (CI) were 2.72 (95% CI = 2.56–2.88), 2.15 (95% CI = 1.97–2.34), 1.76 (95% CI = 1.64–1.88) and 1.59 (95% CI = 1.50–1.69), respectively. The largest proportion of BSI-POA presented with Staphylococcus aureus (48.4%), followed by Enterococcus faecalis/faecium (20.3%), Klebsiella pneumoniae (16.2%), Streptococcus pneumoniae (8.7%), Pseudomonas aeruginosa (4.2%) and Acinetobacter baumannii (2.2%). Overall, 44% of those admitted from nursing homes presented with antibiotic resistant strains versus 34% from other hospitals and 31% from private homes ( P = 0.002).

Conclusion:

Understanding the risk factors of patients who present to the hospital with BSI could enable timely interventions and better patient outcomes.
Impact of choice of skin preparation solution in cardiac surgery on rate of surgical site infection: a propensity score matched analysis
Authors: Raja Shahzad G , Rochon Melissa , Mullins Clair , Morais Carlos , Kourliouros Antonios , Wishart Ellie , De Souza Anthony , Bhudia Sunil
Published: December 2017

Background:

Antiseptic skin preparations containing chlorhexidine gluconate and povidone iodine are routinely used to reduce the risk of surgical site infection (SSI). This study assesses the efficacy of two alcohol-based solutions, 2% chlorhexidine-alcohol and 10% povidone iodine-alcohol, on the incidence of cardiac SSI.

Methods:

A total of 738 consecutive patients undergoing cardiac surgery had skin preparation with 2% chlorhexidine gluconate in 70% isopropanol (ChloraPrep, BD Ltd, UK) were propensity matched to 738 patients with skin prepared with 10% povidone–iodine in 30% industrial methylated spirit (Videne Alcoholic Tincture, Ecolab Ltd, UK). Continuous, prospective SSI surveillance data were collected for all these patients. A retrospective analysis of prospectively collected perioperative data was performed.

Results:

The overall rate of SSI was similar in the chlorhexidine–alcohol and povidone–iodine–alcohol groups (3.3% versus 3.8%; P = 0.14; relative risk [RR] = 0.98; 95% confidence interval [CI] = 0.52–1.78). Superficial (1.2% versus 1.8%; P = 0.18; RR = 0.97; 95% CI = 0.48–1.80) and deep incisional (1.2% versus 1.6%; P = 0.24) SSI rates were also similar with 10% povidone–iodine–alcohol being marginally more effective against organ-space infections (0.8% versus 0.4%; P = 0.05; RR = 0.38; 95% CI = 0.20–1.01).

Conclusion:

Our analysis confirms that alcohol-based skin preparation in cardiac surgery with povidone–iodine reduces the incidence of organ-space infections with no significant superiority in preventing incisional SSI compared with chlorhexidine-alcohol.
Clostridium difficile multidisciplinary team root cause analysis: impact on clinical care and circumvention of financial penalties posed by clinical commissioning groups, but at what cost?
Authors: Saeed Kordo , Petridou Christina , Gray Hazel , Dryden Matthew , Davis-Blues Karen , Lucero Sheryl , Parker Natalie , Keyser Taryn , Matthews Tanya , Cortes Nick , Kidd Stephen , Thomas Claire , Peacock Heather , Hornzee Joanna , Wake Bruce
Published: December 2017

Background:

In Hampshire Hospitals NHS Foundation Trust, in addition to an on-the-spot investigation into hospital-onset Clostridium difficile infection (CDI) by the infection prevention team, a multidisciplinary team root cause analysis (MDT-RCA) forum has been developed. The MDT-RCA aims to deliver a more thorough investigation into individual cases and the recommendation of cases to the clinical commissioning groups (CCG) appeals panel against potential financial penalties (£10,000 per breached case). We mainly aimed to investigate the financial impact of MDT-RCAs to the Trust.

Methodology:

Over two years, 84 cases of hospital-onset CDI cases were reviewed by the MDT-RCA forum.

Results:

Among this cohort, no additional learning outcomes were identified by the MDT-RCAs over those that were found by on-the-spot investigations. In total, 543 staff members attended the MDT-RCAs at a potential cost to the Trust of £23,795.74–£51,670.10. The Trust appealed against financial penalties for 27 cases and 14 were successful, i.e. £140,000 would have been avoided had targets been breached by 14 cases. However, targets were only breached by two cases, meaning only £20,000 in fines was avoided. Deducting this from the total costs of the MDT-RCA meant the Trust lost £3,795.74–£31,670.10.

Conclusion:

Over the two years reviewed, the MDT-RCA proved to be costly to the Trust, with no additional learning or quality improvement measures identified.
An evaluation of infection control in private and public sector intensive care units in South Africa
Authors: Mahomed Saajida , Sturm A Willem , Knight Stephen , Moodley Prashini
Published: December 2017

Background:

Appropriate infection control policies and practices are key to reducing the risk of healthcare-associated infections in patients in intensive care units (ICUs).

Objective:

To evaluate infection control in ICUs using the Infection Control Assessment Tool (ICAT).

Methods:

Six public and five private adult ICUs were included. Seven modules from the ICAT were administered including ICU, hand hygiene, and isolation and standard precautions. Modules were scored on a quantitative scale as per the tool guidelines and trained independent nurses observed practices.

Results:

All ICUs reported to have a 1:1 nurse-to-patient ratio. One public ICU did not have the required 1:2 hand wash basin-to-bed ratio. We observed 100% adherence to handwashing or alcohol rub at each of the five moments of hand hygiene; however, the correct amount of alcohol rub was used in only 2% (n = 2) of the 117 observations. The median score for isolation and standard precautions was 79%.

Discussion:

There was good infection control practice in ICUs. However, ICUs did not have isolation policies for all the infections listed in the ICAT and did not screen visitors to the ICU. We identified shortcomings in the ICAT and a more suitable tool is required for our healthcare setting.
Point prevalence survey of indwelling urinary catheter use and appropriateness in patients living at home and receiving a community nursing service in Ireland
Authors: Forde Liz , Barry Fiona
Published: December 2017

Background:

Indwelling urinary catheters (IUC) are reported as the most common indwelling device in hospitals and residential/care home settings.

Aim:

The aim of this study was to assess the prevalence and appropriateness of IUCs in people living at home and receiving a community nursing service.

Methods:

An IUC self-report questionnaire was sent to 66 community nurses in one community care area. A second questionnaire was completed by the researcher on each patient (n = 80) identified by the community nurses. Data were analysed using descriptive statistics and the chi-square test was used to test associations between patient demographics, catheter changes and nurses documentation.

Results:

The self-report questionnaire was completed by 46 of the 52 areas (88% response rate). The overall prevalence of IUCs was 1.9% with a higher prevalence among men (70%) and in the over-85-years age group (31%). The mean age was 76 years (age range = 34–98 years) and duration of use was approximately four years. Routine IUC changes were carried out by community nurses (52%), in the acute hospital (25%) or by general practitioners (20%) and the type of catheter influenced person/location of catheter changes ( P = 0.001).

Discussion:

This study adds to the understanding of IUCs in patients at home and is the first to investigate if the IUC is appropriate in this setting. It prompted a review of current guidance and development of standard documentation for IUC management locally to ensure that the IUC in use is appropriate. It also suggests that there is a need for internationally accepted, appropriate indications for long-term IUC use to facilitate consistency and allow comparison across studies in future.