bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic resection of large colorectal adenomas – clinical experience of a tertiary referral centre
Authors: Mlynarsky L. , Zelber‐Sagi S. , Miller E. , Kariv R.
Published: November 2017

Aim

Colorectal cancer is a leading cause of cancer‐related mortality. Adenomatous polyps are typically resected endoscopically to prevent cancer while giant and complex polyps are managed surgically. No criteria clearly define the indications for surgical vs endoscopic resection. Our aim was to evaluate factors associated with the short‐term efficacy and safety of endoscopic resection of large (≥ 20 mm) and giant (≥ 40 mm) adenomas.

Method

Consecutive cases with colonic adenomas larger than 20 mm resected endoscopically were included. Endoscopic, clinical and histological details of polyps were recorded as well as the need for surgical resection.

Result

A total of 351 resections were included. The average adenoma diameter was 30.34 ± 10.66 mm. Surgery was recommended in 21 (5.98%) cases. In a multivariate analysis for efficacy, two variables were independent risk factors for surgery: adenoma size [OR 1.08 (95% CI: 1.04–1.12)] and caecal location [5.97(1.60–22.33)]. Postpolypectomy complications were documented in 85 (24.2%) cases: bleeding 69 (19.7%), perforations 8(2.3%) and significant discomfort 15(4.3%). Twenty‐one patients (6.0%) developed serious complications requiring further hospitalization. In multivariate analysis for safety, independent risk factors for postpolypectomy complications included adenoma size [1.04 (1.06–1.01)], polyp morphology [sessile 2.55 (1.45–4.51), flat 2.40 (1.04–5.52)] and submucosal adrenaline injection [1.87 (1.11–3.20)]. Increments of 1 mm in adenoma diameter beyond 20 mm increased the need for surgery by 8% and the risk of complications by 4%.

Conclusion

Resection of large or giant adenomas is generally a safe procedure. Although adenoma size and morphology are significant predictors of efficacy and safety, each case should be individually evaluated in a specialist unit for feasibility of endoscopic resection.
Evaluation of nasal mucociliary clearance using saccharin test in smokers: A prospective study
Authors: Dülger Seyhan , Akdeniz Önder , Solmaz Fevzi , Şengören Dikiş Özlem , Yildiz Tekin
Published: November 2017

Background and aim

Nasal mucociliary clearance time (NMCT) can be measured with the saccharine clearance test which is an inexpensive and easy method. The aim of the present study was to compare and evaluate NMCT using the saccharine clearance test in smokers and non‐smokers.

Materials and methods

Eighty‐five patients whose ages ranged from 18 to 65 years were included in the study. Fifty of the patients were smokers (Group 1) while 35 were healthy, non‐smoking volunteers (Group 2). Saccharin clearance test was used to evaluate NMCT in both groups. The results obtained were compared and the statistical analyses were performed using the Statistical Package for Social Sciences (SPSS).

Results

NMCT was statistically significantly higher in Group 1 as compared to Group 2 (P < .001, Mann‐Whitney U test). However, in cumulative smoking duration (pack‐year), Fagerström test values and gender categories, there was no statistically significant difference in the average NMCT values of the two groups (P = .943 vs P = .812 respectively), P = .45).

Conclusion

Mucociliary activity, the primary defence mechanism of the respiratory epithelium, is significantly depressed in smokers. Our findings showed that the said depression is not associated with the number of cigarettes smoked, duration of smoking or nicotine dependence.
The safety and efficacy of different methods for obtaining transbronchial lung cryobiopsy in diffuse lung diseases
Authors: Dhooria Sahajal , Mehta Ravindra M. , Srinivasan Arjun , Madan Karan , Sehgal Inderpaul Singh , Pattabhiraman Vallandramam , Yadav Pavan , Sivaramakrishnan Mahadevan , Mohan Anant , Bal Amanjit , Garg Mandeep , Agarwal Ritesh
Published: November 2017

Introduction

Most data on transbronchial lung cryobiopsy (TBLC) are from single centers, with little evidence on the outcome of different methods for performing TBLC.

Objective

To report the diagnostic yield and safety of TBLC with different procedural techniques.

Materials and Methods

Retrospective multicenter study of subjects who underwent TBLC for the diagnosis of diffuse parenchymal lung diseases (DPLDs). The procedure was performed using various methods: flexible or rigid bronchoscopy, with or without the use of fluoroscopy or occlusion balloon.

Results

In total, 128 subjects (59% women) with a mean age of 48.9 years were included. The overall diagnostic yield of TBLC was 78.1%, with a definite diagnosis on multidisciplinary discussion made in 57 (44.5%) subjects. On a multivariate analysis, the diagnostic yield was associated with the number of biopsies taken {ajdusted odds ratio [AOR] [95% confidence interval (CI)], 2.17 [1.29‐3.67]}. The incidence of pneumothorax was lower in subjects who underwent TBLC with fluoroscopic guidance (5.9% vs 20.9%), [AOR (95% CI), 0.26 (0.07‐0.94)]. Moderate‐to‐severe bleeding occurred less frequently when an occlusion balloon was used [1.8% vs 35.7%; AOR (95% CI), 0.02 (0.001‐0.18)], after adjusting for age, use of fluoroscopy, number of biopsies obtained and number of lobes sampled. Four deaths occurred; 2 because of acute exacerbation of idiopathic pulmonary fibrosis.

Conclusions

Transbronchial lung cryobiopsy was found to offer a reasonable yield in the diagnosis of DPLDs. The incidence of pneumothorax and moderate‐to‐severe bleeding was lower with the use of fluoroscopy and an occlusion balloon, respectively.
Early and delayed post‐pneumonectomy empyemas: Microbiology, management and prognosis
Authors: Stern Jean‐Baptiste , Fournel Ludovic , Wyplosz Benjamin , Girard Philippe , Al Nakib Malik , Gossot Dominique , Seguin‐Givelet Agathe
Published: November 2017

Introduction

Post‐pneumonectomy empyema (PPE) is the most severe complication of pneumonectomy. Microbiology and its impact on management and prognosis have rarely been reported

Methods

We retrospectively reviewed the files of a series of 37 consecutive patients with PPE over a 10‐year period with a special focus on microbiology, means used to treat empyema and prognosis.

Results

PPE occurred within 14 days of pneumonectomy in 17 cases (early PPE) and after postoperative day 16 in 20 patients (delayed PPE). PPE was monomicrobial in 57% of cases. The most frequent pathogens were Staphylococcus sp. and Streptococcus sp. Polymicrobial empyema was more frequent in patients with early PPE than delayed PPE (65% vs 25%; P = .02). Video‐assisted thoracoscopic approach for cavity lavage was performed in 22 patients without broncho‐pleural fistulae (BPF), associated with antimicrobial therapy and drainage, and was successful in 13 cases (59%). Seventeen patients (46%) underwent an open window thoracostomy. Overall 90‐day post empyema mortality was 19%, with 6 deaths because of empyema in the early PPE group (35%), versus one (5%) in the delayed PPE group (P = .02).

Conclusion

We distinguished 2 different PPE presentations: an early occurrence, mostly with polymicrobial cultures, including Gram‐negative bacteria, and associated with a high mortality rate. By contrast, delayed PPEs were mostly monomicrobial with Gram‐positive bacteria and associated with a better prognosis. VATS approach was successful in the majority of cases without BPF, even if some patients required secondary thoracostomy. PPE was associated with an excess of mortality especially when occurring in the early course after pneumonectomy.
Association of early left ventricular dysfunction with advanced magnetic resonance white matter and gray matter brain measures: The CARDIA study
Authors: Armstrong Anderson C. , Muller Majon , Ambale‐Ventakesh Bharath , Halstead Michael , Kishi Satoru , Bryan Nick , Sidney Stephen , Correia Luís C. L. , Gidding Samuel S. , Launer Lenore J. , Lima João A. C.
Published: November 2017

Introduction

Relations between heart failure and clinically manifested stroke are well known, but the associations between heart and brain early abnormalities are not totally clear.

Aims

We explore relations of subclinical brain abnormalities with early cardiac dysfunction in a large healthy middle‐aged biracial cohort.

Methods

The CARDIA study enrolled 5115 young adults aged 18–30 years at baseline (1985–1986). We assessed 719 Caucasian and African American participants of the CARDIA study, with echocardiograms and brain MRI at follow‐up year 25 (2010–2011). Echocardiography assessed aortic root diameter; LVEF; circumferential, longitudinal, and radial deformation. Cerebral MRI DTI, and, on a subset, ASL perfusion sequences were used to assess white matter fractional anisotropy and gray matter cerebral blood flow (CBF). Linear regression explored relations between cardiac parameters and cerebral measures, adjusting for anthropometrics, risk factors, and brain constitutional variation.

Results

Mean age 50 ± 4 years, SBP 118 ± 15 mm Hg; 60% white, and 48% men. Mean CBF was 46 ± 9 mL/100 g/min, and white matter fractional anisotropy was 0.31 ± 0.02. Worse circumferential deformation and larger aortic root were related to worse white matter fractional anisotropy. Worse radial systolic deformation was related to worse CBF in multivariable models. LVEF did not relate to early brain abnormalities.

Conclusions

In spite of no apparent effect of LV ejection fraction, early subclinical cardiac dysfunction and brain abnormalities are present and associated in middle‐aged generally healthy individuals.
Quantitative assessment of aortic regurgitation by Doppler echocardiography: Usefulness of the comparison of aortic and pulmonary flows
Authors: Gallais Katell , Maréchaux Sylvestre , Czitrom Daniel , Saunier Carole , Guerbaai Raphaëlle‐Ashley , Castel Anne‐Laure , Delelis François , Tribouilloy Christophe , Ennezat Pierre‐Vladimir
Published: November 2017

Aims

Patients with significant (3+/4+) aortic regurgitation (AR) require careful monitoring or valve surgery. We sought to evaluate the diagnostic performance of aortic and pulmonary flow comparison in identifying patients with significant AR, by echocardiography.

Method

Two hundred forty‐six patients with more than trivial AR were prospectively enrolled from three centers. Aortic regurgitation (AR) severity was assessed by an expert using the currently recommended integrative approach. Aortic and pulmonary flows were independently assessed by another investigator to calculate the regurgitant fraction (RF), the aortic to pulmonary flow ratio (Qao/Qp) and the aortic to pulmonary velocity‐time integral (VTIao/VTIp) ratio. The control group consisted of 195 patients without AR.

Results

A significant correlation was observed between AR grading and RF (r = .82, P < .0001) and Qao/Qp (r = .81, P < .0001), but the correlation was modest for VTIao/VTIp ratio (r = .63; P < .0001). The accuracy of RF and Qao/Qp ratio to identify patients with significant AR was excellent (0.96 and 0.95, respectively), but was significantly lower for VTIao/VTIp ratio at 0.82. A RF > 40% indicated grade 3 or 4 AR with a sensitivity of 83% and a specificity of 93%. A Qao/Qp ratio > 1.6 indicated grade 3 or 4 AR with a sensitivity of 88% and a specificity of 89%. The VTIao/VTIp ratio was not helpful in identifying patients with significant AR, as a wide overlap was found between 1+/2+ and 3+/4+ patients.

Conclusion

Regurgitant fraction (RF) and Qao/Qp are helpful in identifying significant AR. The assessment of Doppler aortic/pulmonary flow should be incorporated in the comprehensive evaluation of AR.
Seizure‐susceptible brain regions in glioblastoma: identification of patients at risk
Authors: Cayuela N. , Simó M. , Majós C. , Rifà‐Ros X. , Gállego Pérez‐Larraya J. , Ripollés P. , Vidal N. , Miró J. , Gil F. , Gil‐Gil M. , Plans G. , Graus F. , Bruna J.
Published: November 2017

Background and purpose

The main aim of this study was to identify which patients with glioblastoma multiforme (GBM) have a higher risk of presenting seizures during follow‐up.

Methods

Patients with newly diagnosed GBM were reviewed (n = 306) and classified as patients with (Group 1) and without (Group 2) seizures at onset. Group 2 was split into patients with seizures during follow‐up (Group 2A) and patients who never had seizures (Group 2B). The anatomical location of GBM was identified and compared by voxel‐based lesion symptom mapping (discovery set). Seizure‐susceptible brain regions obtained were assessed visually and automatically in external GBM validation series (n = 85).

Results

In patients with GBM who had no seizures at onset, an increased risk of presenting seizures during follow‐up was identified in the superior frontal and inferior occipital lobe, as well as in inferoposterior regions of the temporal lobe. Conversely, those patients with GBM located in medial and inferoanterior temporal areas had a significantly lower risk of suffering from seizures during follow‐up. Additionally, the seizure‐susceptible brain region maps obtained classified patients in the validation set with high positive and negative predictive values.

Conclusions

Tumor location is a useful marker to identify patients with GBM who are at risk of suffering from seizures during follow‐up. These results may help to support the use of antiepileptic prophylaxis in a selected GBM population and to improve stratification in antiepileptic clinical trials.
A somewhat unexpected result from the deconvolution of DSC curves for human hair: There is no apparent relation between cortical cell fractions and hair curliness
Authors: Wortmann Franz J. , Wortmann Gabriele
Published: November 2017

A deconvolution process has been developed for curves obtained by differential scanning calorimetry in water for Merino wool and the main ethnic hair types. This enables estimation of the fractions of ortho‐ and para‐type cell groups. The results also indicate that hair may contain a further, low‐sulphur subgroup of ortho‐type cells. The sizes of the major cell fractions are in line with expectations from microscopical investigations. The fractions are comparable for hair types, and no consistent association between cell‐type fractions and hair curvature is observed.
Impaired p53/CEP‐1 is associated with lifespan extension through an age‐related imbalance in the energy metabolism of C. elegans
Authors: Yanase Sumino , Suda Hitoshi , Yasuda Kayo , Ishii Naoaki
Published: November 2017

In the nematode Caenorhabditis elegans, the mammalian tumor suppressor p53 ortholog CEP‐1 mediates the stress response, activates germ line apoptosis and regulates meiotic chromosome segregation. A reduction in its expression, which frequently occurs in mammalian cancer cells, extends lifespan and induces an adaptive response in C. elegans. However, these effects do not involve an increase in oxidative stress resistance. Here, we showed that intermittent exposure to hyperoxia, which induces oxidative stress resistance and lowers the production of ROS derived from mitochondrial respiration in C. elegans, slightly improved the lifespan extension of cep‐1 mutant. Interestingly, ATP levels were increased without an increase in oxygen consumption in cep‐1 mutant during aging. In the wild‐type, lactate levels and consequentially the lactate/pyruvate ratio decreased during aging in adults. Furthermore, the expression levels of mitochondrial respiration‐related sco‐1, which is a target of p53/CEP‐1, as well as those of gluconeogenesis regulation and mammalian sirtuin ortholog genes, were also increased in the aged and adaptive conditioned wild‐type animals. In contrast, the lactate/pyruvate ratio increased in cells of the cep‐1 mutant and was amplified by intermittent hyperoxia. These results suggest that impaired p53/CEP‐1 leads to an imbalance in the age‐related energy metabolic alteration between mitochondrial oxidative phosphorylation and aerobic glycolysis and plays an important role in the extension of both intact and adaptive lifespans.
The unbelieved and historians, part III: Responses and elaborations
Authors: Clark Roland , Clossey Luke , Ditchfield Simon , Gordon David M. , Wiesenthal Arlen , Zaman Taymiya R.
Published: November 2017

The first two parts of "The Unbelieved" argued for the possibility of the existence of supernatural beings and for their agency in historical writing. This instalment is a roundtable assessing the problems and potential in the category of the Unbelieved and in its knowability. Space limitations prevented our following the rich avenues of further inquiry our extraordinary peer reviewers suggested, but we remain grateful, especially for their reminders of the complexity of motivations of historians who avoid the Unbelieved and their emphasis on the importance of humility as a historian's tool.
Cognitive‐affective drivers of employees' daily compliance with information security policies: A multilevel, longitudinal study
Authors: D'Arcy John , Lowry Paul Benjamin
Published: November 2017

We present a model of employee compliance with information security policy (ISP) that (1) explicates stable, cognitive beliefs regarding the consequences of compliance and noncompliance as well as state‐based affective constructs, namely, positive and negative mood states and episodic, security‐related work‐impediment events, and (2) provides an expanded conceptualisation of moral considerations and normative influences regarding employees' ISP compliance. Because affect is central to this theorisation, we ensure that the model captures and explains differences in day‐to‐day affective constructs to account for the often fleeting nature of affective states. We test our multilevel model using an experience‐sampling methodology design, in which employees completed daily surveys over a 2‐week period, followed by a hierarchal linear modelling statistical assessment. Our contribution to theory is a unique account of ISP compliance that integrates affective factors with constructs from rational choice theory and theory of planned behaviour and that diverges from prior conceptualisations of ISP compliance as a purely stable and reason‐based phenomenon. For practitioners, our results suggest that a combination of cognitive and affective influences may produce discrete episodes of ISP compliance that do not coincide with prior behavioural trends.
Marine species distribution modelling and the effects of genetic isolation under climate change
Authors: Cacciapaglia C. , van Woesik R.
Published: November 2017

Aim

Coral reefs are experiencing both an increasing frequency and intensity of anomalously warm ocean temperatures because of climate change. Studies show that the majority of coral populations will likely decline as temperatures continue to increase, although some previous species‐distribution models predict that ubiquitous species, such as the primary reef‐building coral species Porites lobata, will increase their distribution under projected climate change. These predictive models, however, assume that all individuals of a population are able to tolerate the entire range of environmental conditions within the species’ geographic range. The effects of genetic isolation and local adaptation are not considered in species‐distribution models that assume genetically contiguous populations. We aim to determine the effects of genetic isolation and local adaptation in species‐distribution modelling of the ubiquitous species P. lobata under three climate change scenarios by comparing contiguous and isolated subpopulations.

Location

Indian and Pacific Oceans.

Methods

We ran a novel species‐distribution model for P. lobata, segregated as five geographically isolated regions across the Indian and Pacific Oceans, and examined the species response to three climate‐change scenarios (i.e., A2, A1B and B1, most recently considered as Representative Concentration Pathways 8.5, 6.0, and 4.5 Wm−2) by the year 2100.

Results

In contrast with previous homogeneous species‐distribution models that predict a global expansion of P. lobata, (˜5 ± 1%), we predict major losses of suitable habitat for P. lobata in four of the five regions examined, particularly in the central Pacific Ocean (>99% ± <0.1% for all climate scenarios). Indeed, when geographic and genetic isolation were considered, our predictions suggested that P. lobata would lose between 50–52 ± 4% of its habitat, depending on the climate‐change scenario, mainly in the Pacific Ocean.

Main conclusions

Genetic isolation will likely play a major role in the persistence of coral species under climate change, and small isolated populations may be more vulnerable to climate change than populations in large, highly connected regions.
A longitudinal functional magnetic resonance imaging study of task control circuits and bulimic symptoms over adolescence
Authors: Cyr Marilyn , Fontaine Martine , Stefan Mihaela , Terranova Kate , Kopala‐Sibley Daniel C. , Attia Evelyn , Marsh Rachel
Published: November 2017

Background

Previous cross‐sectional findings from adolescents and adults with Bulimia Nervosa (BN) suggest disturbances in fronto‐striatal and cingulo‐opercular task control circuits that support self‐regulatory processes, including the resolution of cognitive conflict. Herein, we used longitudinal data to examine the developmental trajectories of such disturbances and how the functioning of these circuits relates to changes in BN symptoms over adolescence.

Methods

Thirty‐two adolescent females with BN symptoms and 28 healthy control (HC) adolescents participated in the study. Functional magnetic resonance images (fMRI) during performance of a Simon task were acquired at three time points within 2‐year intervals over adolescence. From the initial sample, 70% and 30% of the participants completed the second and third time points, respectively. Participants who completed all study time points did not differ from those lost to attrition on baseline demographic characteristics or any outcome measures. Using a region‐of‐interest approach, growth curve models tested group differences in the trajectory of conflict‐related activation in task control circuits over time. Cross‐lagged panel models examined transactional relationships between conflict‐related activation in the same regions and BN symptoms over time.

Results

Growth curve models revealed different trajectories of conflict‐related activation in right task control regions across BN and HC adolescents, such that HC but not BN adolescents showed activation decreases over time. These group differences were greatest when including only the BN adolescents whose symptoms remitted over time. Cross‐lagged panel models revealed that less frequent bulimic episodes at first follow‐up predicted later increases in conflict‐related activation in bilateral task control regions.

Conclusions

These longitudinal findings suggest overengagement of task control circuits in BN adolescents, especially those most resilient to persistent illness. Such overengagement may compensate for regulatory disturbances, allowing them to regulate eating behaviors over development. Thus, task control circuits may constitute targets for early interventions that enhance self‐regulatory control.
Effect of the gluten‐free diet on cardiovascular risk factors in patients with coeliac disease: A systematic review
Authors: Potter Michael D E , Brienesse Stephen C , Walker Marjorie M , Boyle Andrew , Talley Nicholas J
Published: November 2017

Background and Aims

A gluten‐free diet (GFD), the mainstay of treatment for celiac disease, is being increasingly adopted by people without this condition. The long‐term health effects of this diet, apart from its beneficial effect on enteropathy in celiac disease, are unclear. Concerns exist that the GFD may result in micronutrient deficiencies, increased exposure to toxins such as arsenic, and an increased cardiovascular risk. This systematic review addresses the effect of the GFD on several modifiable cardiovascular risk factors.

Methods

A systematic search of the literature addressing the GFD and blood pressure, glycaemia, body mass index, waist circumference, and serum lipids in patients before and after adoption of a GFD was conducted using the MEDLINE, EMBASE, PSYCInfo, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases. Two authors performed abstract and full text screening, and quality assessment.

Results

A total of 5372 articles were identified, from which 27 were included. Lack of control groups in all but one study prevented meta‐analysis of results. Overall study quality was low and restricted to patients with celiac disease. Consistent findings across studies included an increase in total cholesterol, high density lipoprotein, fasting glycaemia, and body mass index (while remaining within the healthy weight range). Significant changes in low density lipoprotein, triglycerides, and blood pressure were not consistently reported.

Conclusions

A GFD alters certain cardiovascular risk factors in patients with celiac disease, but the overall effect on cardiovascular risk is unclear. Further studies are warranted.
3‐O‐Glyceryl‐2‐O‐hexyl ascorbate suppresses melanogenesis by interfering with intracellular melanosome transport and suppressing tyrosinase protein synthesis
Authors: Taira Norihisa , Katsuyama Yushi , Yoshioka Masato , Okano Yuri , Masaki Hitoshi
Published: November 2017

Background

Ascorbic acid (AsA) has multifunctional benefits on skin beauty, such as the reduction in oxidative stress and the induction of collagen production. Among them, the prevention and improvement of skin pigmentation by AsA is a most important benefit for people. However, it is well known that AsA not only is quite unstable in formulations but it also has a low capability of skin penetration due to its hydrophilic property. In addition, existing water‐soluble AsA derivatives that were developed to improve its stability also have low skin penetration.

Aim

To investigate the potential of a newly synthesized amphiphilic derivative of AsA, 3‐O‐Glyceryl‐2‐O‐hexyl ascorbate (VC‐HG), which has an added glyceryl group and a hexyl group, on skin beauty focusing on its skin lightening/whitening effects.

Methods

DNA microarray analysis and real‐time PCR were used to clarify the effects of VC‐HG on melanogenesis using B16 mouse melanoma cells. The effects of VC‐HG on melanin synthesis, tyrosinase protein levels, and the inhibition of tyrosinase activity were evaluated.

Results

DNA microarray analysis revealed that treatment with VC‐HG downregulated the expression of genes encoding tyrosinase and MyosinVa. Further, real‐time PCR analysis showed the downregulation of tyrosinase, MyosinVa, Rab27a, and Kinesin mRNAs following VC‐HG treatment. In addition, VC‐HG caused decreases in tyrosinase protein levels and melanin synthesis.

Conclusion

We conclude that VC‐HG has an impact on skin lightening/whitening by inhibiting tyrosinase protein synthesis and interfering with intracellular melanosome transport.
Dental provider practices and perceptions regarding adolescent vaccination
Authors: Naleway Allison L. , Henninger Michelle L. , Waiwaiole Lisa A. , Mosen David M. , Leo Michael C. , Pihlstrom Daniel J.
Published: November 2017

Objective

To assess dental providers' clinical practices and perceptions regarding adolescent vaccinations.

Methods

We surveyed 234 dental providers in an integrated health care setting in Portland, Oregon, in March‐April 2015. We assessed participants' knowledge of adolescent vaccines, barriers to recommending vaccines, and their perceived role in the promotion of vaccination and preventive medical care.

Results

Over 80 percent of respondents correctly identified influenza, tetanus‐diphtheria‐acellular pertussis, and human papillomavirus as vaccinations recommended for adolescents; 60 percent correctly identified meningococcal conjugate. Forty‐four percent of providers reported previously discussing vaccination with their adolescent patients. Lack of knowledge (66 percent), uncertainty about whether patients would accept recommendations (62 percent), and lack of time (61 percent) were commonly reported barriers. While few providers expressed personal concerns about the safety (13 percent) and effectiveness (10 percent) of adolescent vaccines, most believed parents had concerns about safety (70 percent) and effectiveness (60 percent). Although 80 percent endorsed the premise that providers should discuss preventive medical care with their patients, only 54 percent said they should discuss vaccinations specifically.

Conclusions

Dental providers reported several barriers to recommending vaccines. While comfortable with discussing preventive medical care in general, providers are less comfortable making vaccine recommendations to their patients. Vaccine recommendations are not a traditional practice among dental providers and may require additional education and communication tools.
The impact of the affordable care act's Medicaid expansion on dental care use through 2016
Authors: Nasseh Kamyar , Vujicic Marko
Published: November 2017

Objective

To examine the impact of the Affordable Care Act on dental care use among low‐income adults ages 21‐64.

Methods

Our analysis uses national survey data from the 2010‐2016 Gallup Wellbeing‐Index. We use a differences‐in‐differences analysis to assess changes since the end of 2013 in dental care use among low‐income adults. We compare changes in states that expanded Medicaid and offer adult Medicaid dental benefits versus changes in other states.

Results

Relative to the pre‐reform period and other states, in Medicaid expansion states with adult dental benefits, dental care use increased 3‐6 percentage points in 2016.

Conclusions

In Medicaid expansion states with adult dental benefits, evidence suggests that low‐income adults have greater access to dental care.
The room for ethical considerations in patent law applied to biotechnology
Authors: Tvedt Morten Walløe , Forsberg Ellen‐Marie
Published: November 2017

Since the advent of the so‐called “patents on life” debate there have been frequent calls for patent policy to take into account ethical concerns over and above the ethically relevant justifications for issuing patents generally. The degree to which the patent system is respondent to including these ethical concerns varies. Ethical arguments frequently encounter attitudes within the patent system that ethics has little to do with patenting and that ethical issues concerning biotechnology must be regulated in other areas of society than in IPR law and practice. In this article, we explore the room for ethical considerations in patent law‐making, and show that there is limited ability or will to use this room in practice. We explore global, European and Norwegian institutions and illustrate our point by looking at law‐making, administrative, and judicial practices (courts/boards of appeal). We particularly assess the success of the “countermeasures” to undesired ethical effects of accepting the EU Biotech Directive implemented by the Norwegian government in 2003/4. We end the article by pointing to some key tensions between the law‐making and executive level in the patent system when it comes to ethical considerations.
Impact of hepatitis C virus (HCV) antiviral treatment on the need for liver transplantation (LT)
Authors: Sáez‐González Esteban , Vinaixa Carmen , San Juan Fernando , Hontangas Vanesa , Benlloch Salvador , Aguilera Victoria , Rubín Angel , García María , Prieto Martín , López‐Andujar Rafa , Berenguer Marina
Published: November 2017

Background

Therapies for hepatitis C virus (HCV) infection have revolutionized the treatment of patients with chronic HCV infection. The effect of these therapies on the epidemiology of liver transplantation (LT) has yet to be elucidated.

Aim

To establish whether the indications for LT have changed as a result of the introduction of new therapies for HCV.

Materials and methods

We conducted a retrospective study based on a prospectively maintained registry of patients who undergo LT at La Fe Hospital in Valencia from 1997 to 2016. An analysis of outcome measures over time stratified by LT indications was performed.

Results

From January 1997 to December 2016, 2379 patients were listed for LT. Of these, 1113 (47%) were listed for HCV cirrhosis±hepatocellular carcinoma (HCC). This percentage varied significantly over time declining from 48.8% in the 1997‐2009 initial period (IFN‐based regimens) to 33% in the 2014‐2016 final period (DAAs regimens) (P = .03). However, during that period, the proportion of those included in the waiting list (WL) due to HCV‐HCC increased significantly (P = .001). In addition, among HCV‐positive waitlisted patients with decompensated cirrhosis without HCC, the proportion of those with an HCV‐alcohol mixed etiology also increased significantly over time (P = .001). Of all HCV‐positive waitlisted patients, 203 were eventually removed from the WL due to either clinical improvement (n = 77) or more frequently worsening/death (n = 126).

Conclusions

The proportion of patients wait‐listed for LT for decompensated HCV cirrhosis has significantly decreased over time. These changes are possibly related to the large‐scale use of direct‐acting antivirals.
Hepatic iron overload in the portal tract predicts poor survival in hepatocellular carcinoma after curative resection
Authors: Chung Jung Wha , Shin Eun , Kim Haeryoung , Han Ho‐Seong , Cho Jai Young , Choi Young Rok , Hong Sukho , Jang Eun Sun , Kim Jin‐Wook , Jeong Sook‐Hyang
Published: November 2017

Background & Aims

Hepatic iron overload is associated with liver injury and hepatocarcinogenesis; however, it has not been evaluated in patients with hepatocellular carcinoma (HCC) in Asia. The aim of this study was to clarify the degree and distribution of intrahepatic iron deposition, and their effects on the survival of HCC patients.

Methods

Intrahepatic iron deposition was examined using non‐tumorous liver tissues from 204 HCC patients after curative resection, and they were scored by 2 semi‐quantitative methods: simplified Scheuer's and modified Deugnier's methods. For the Scheuer's method, iron deposition in hepatocytes and Kupffer cells was separately evaluated, while for the modified Deugnier's method, hepatocyte iron score (HIS), sinusoidal iron score (SIS) and portal iron score (PIS) were systematically evaluated, and the corrected total iron score (cTIS) was calculated by multiplying the sum (TIS) of the HIS, SIS, and PIS by the coefficient.

Results

The overall prevalence of hepatic iron was 40.7% with the simplified Scheuer's method and 45.1% with the modified Deugnier's method with a mean cTIS score of 2.46. During a median follow‐up of 67 months, the cTIS was not associated with overall survival. However, a positive PIS was significantly associated with a lower 5‐year overall survival rate (50.0%) compared with a negative PIS (73.7%, P = .006). In the multivariate analysis, a positive PIS was an independent factor for overall mortality (hazard ratio, 2.310; 95% confidence interval, 1.181‐4.517).

Conclusions

Intrahepatic iron deposition was common, and iron overload in the portal tract indicated poor survival in curatively resected HCC patients.
Reproductive isolation and environmental adaptation shape the phylogeography of mountain pine beetle (Dendroctonus ponderosae)
Authors: Dowle Eddy J. , Bracewell Ryan R. , Pfrender Michael E. , Mock Karen E. , Bentz Barbara J. , Ragland Gregory J.
Published: November 2017

Chromosomal rearrangement can be an important mechanism driving population differentiation and incipient speciation. In the mountain pine beetle (MPB, Dendroctonus ponderosae), deletions on the Y chromosome that are polymorphic among populations are associated with reproductive incompatibility. Here, we used RAD sequencing across the entire MPB range in western North America to reveal the extent of the phylogeographic differences between Y haplotypes compared to autosomal and X‐linked loci. Clustering and geneflow analyses revealed three distinct Y haplogroups geographically positioned within and on either side of the Great Basin Desert. Despite close geographic proximity between populations on the boundaries of each Y haplogroup, there was extremely low Y haplogroup mixing among populations, and gene flow on the autosomes was reduced across Y haplogroup boundaries. These results are consistent with a previous study suggesting that independent degradation of a recently evolved neo‐Y chromosome in previously isolated populations causes male sterility or inviability among Y haplotype lineages. Phylogeographic results supported historic contraction of MPB into three separate Pleistocene glacial refugia followed by postglacial range expansion and secondary contact. Distinct sets of SNPs were statistically associated with environmental data among the most genetically distinct sets of geographic populations. This finding suggests that the process of adaptation to local climatic conditions is influenced by population genetic structure, with evidence for largely independent evolution in the most genetically isolated Y haplogroup.
Metabarcoding of freshwater invertebrates to detect the effects of a pesticide spill
Authors: Andújar Carmelo , Arribas Paula , Gray Clare , Bruce Catherine , Woodward Guy , Yu Douglas W. , Vogler Alfried P.
Published: November 2017

Biomonitoring underpins the environmental assessment of freshwater ecosystems and guides management and conservation. Current methodology for surveys of (macro)invertebrates uses coarse taxonomic identification where species‐level resolution is difficult to obtain. Next‐generation sequencing of entire assemblages (metabarcoding) provides a new approach for species detection, but requires further validation. We used metabarcoding of invertebrate assemblages with two fragments of the cox1 “barcode” and partial nuclear ribosomal (SSU) genes, to assess the effects of a pesticide spill in the River Kennet (southern England). Operational taxonomic unit (OTU) recovery was tested under 72 parameters (read denoising, filtering, pair merging and clustering). Similar taxonomic profiles were obtained under a broad range of parameters. The SSU marker recovered Platyhelminthes and Nematoda, missed by cox1, while Rotifera were only amplified with cox1. A reference set was created from all available barcode entries for Arthropoda in the BOLD database and clustered into OTUs. The River Kennet metabarcoding produced matches to 207 of these reference OTUs, five times the number of species recognized with morphological monitoring. The increase was due to the following: greater taxonomic resolution (e.g., splitting a single morphotaxon “Chironomidae” into 55 named OTUs); splitting of Linnaean binomials into multiple molecular OTUs; and the use of a filtration‐flotation protocol for extraction of minute specimens (meiofauna). Community analyses revealed strong differences between “impacted” vs. “control” samples, detectable with each gene marker, for each major taxonomic group, and for meio‐ and macrofaunal samples separately. Thus, highly resolved taxonomic data can be extracted at a fraction of the time and cost of traditional nonmolecular methods, opening new avenues for freshwater invertebrate biodiversity monitoring and molecular ecology.
Environmental filtering bypHand soil nutrients drives community assembly in fungi at fine spatial scales
Authors: Glassman Sydney I. , Wang Ian J. , Bruns Thomas D.
Published: November 2017

Whether niche processes, like environmental filtering, or neutral processes, like dispersal limitation, are the primary forces driving community assembly is a central question in ecology. Here, we use a natural experimental system of isolated tree “islands” to test whether environment or geography primarily structures fungal community composition at fine spatial scales. This system consists of isolated pairs of two distantly related, congeneric pine trees established at varying distances from each other and the forest edge, allowing us to disentangle the effects of geographic distance vs. host and edaphic environment on associated fungal communities. We identified fungal community composition with Illumina sequencing ofITSamplicons, measured all relevant environmental parameters for each tree—including tree age, size and soil chemistry—and calculated geographic distances from each tree to all others and to the nearest forest edge. We applied generalized dissimilarity modelling to test whether total and ectomycorrhizal fungal (EMF) communities were primarily structured by geographic or environmental filtering. Our results provide strong evidence that as in many other organisms, niche and neutral processes both contribute significantly to turnover in community composition in fungi, but environmental filtering plays the dominant role in structuring both free‐living and symbiotic fungal communities at fine spatial scales. In our study system, we foundpHand organic matter primarily drive environmental filtering in total soil fungal communities and thatpHand cation exchange capacity—and, surprisingly, not host species—were the largest factors affectingEMFcommunity composition. These findings support an emerging paradigm thatpHmay play a central role in the assembly of all soil‐mediated systems.
Spatial variability of marine bacterial and archaeal communities along the particulate matter continuum
Authors: Mestre Mireia , Ferrera Isabel , Borrull Encarna , Ortega‐Retuerta Eva , Mbedi Susan , Grossart Hans‐Peter , Gasol Josep M. , Sala M. Montserrat
Published: November 2017

Biotic and abiotic particles shape the microspatial architecture that defines the microbial aquatic habitat, being particles highly variable in size and quality along oceanic horizontal and vertical gradients. We analysed the prokaryotic (bacterial and archaeal) diversity and community composition present in six distinct particle size classes ranging from the pico‐ to the microscale (0.2 to 200 μm). Further, we studied their variations along oceanographic horizontal (from the coast to open oceanic waters) and vertical (from the ocean surface into the meso‐ and bathypelagic ocean) gradients. In general, prokaryotic community composition was more variable with depth than in the transition from the coast to the open ocean. Comparing the six size‐fractions, distinct prokaryotic communities were detected in each size‐fraction, and whereas bacteria were more diverse in the larger size‐fractions, archaea were more diverse in the smaller size‐fractions. Comparison of prokaryotic community composition among particle size‐fractions showed that most, but not all, taxonomic groups have a preference for a certain size‐fraction sustained with depth. Species sorting, or the presence of diverse ecotypes with distinct size‐fraction preferences, may explain why this trend is not conserved in all taxa.
Cultivation of Peptidiphaga gingivicola from subgingival plaque: The first representative of a novel genus of Actinomycetaceae
Authors: Beall C.J. , Mokrzan E.M. , Griffen A.L. , Leys E.J.
Published: November 2017

A novel bacterium was isolated from the subgingival plaque of a patient with periodontal disease. Bacterial strain BA112T is a facultative Gram‐positive coccus. It metabolizes alanine, arginine, glycine, histidine, leucine, proline, serine and tyrosine, but does not appear to use carbohydrates. Urease, esculin, indole, catalase and nitrate reduction tests were all negative. Major cellular fatty acids were C18:0, C12:0, C16:0, C18:1 w9c and C20:0. The genome was sequenced and is 2.4 Mbp in length and has 64% GC content. Based on phylogenetics of the 16S rRNA sequence and concatenated alignments of 37 conserved proteins, BA112T belongs to the family Actinomycetaceae but is located on a branch of the tree without currently named members. Based on our phenotypic and phylogenetic studies, we propose that BA112T is the first known representative of a new genus, for which the name Peptidiphaga gingivicola gen. nov., sp. nov. is proposed. The type strain is BA112T.
Liver abnormalities and post‐transplant survival in pediatric Fontan patients
Authors: Hofferberth Sophie C. , Singh Tajinder P. , Bastardi Heather , Blume Elizabeth D. , Fynn‐Thompson Francis
Published: November 2017

The impact of liver parenchymal abnormalities on survival post‐heart transplant remains unknown in pediatric Fontan patients. We assessed pediatric Fontan patients who underwent heart transplant and had documented pretransplant hepatic ultrasound (U/S) studies. Liver U/S findings were classified as normal (Group 1), mildly abnormal (Group 2, hepatomegaly/vascular congestion), or severely abnormal (Group 3, heterogeneous echotexture/nodularity). Among 30 study patients, 8 were classified as Group 1, 14 as Group 2, while 8 met Group 3 criteria. Pretransplant liver biochemistry and synthetic function were similar in all groups. Six Group 3 patients underwent liver biopsy; 4 demonstrated perisinusoidal or centrilobular fibrosis, and 2 had cirrhosis. Overall mortality was 30% (n = 9). Median follow‐up was 5 years (range, 0.25‐13 years). One‐year survival was similar among all 3 groups (P = .37), with a trend toward higher cumulative 5‐year survival in Group 1 (100%). The majority of pediatric Fontan patients who underwent heart transplant demonstrated abnormal preoperative liver ultrasound findings. Heterogeneous echotexture or nodularity detected on U/S frequently indicates underlying liver parenchymal abnormalities. The presence of severe liver abnormalities was not associated with higher early mortality post‐heart transplant in pediatric Fontan patients; however, late outcomes must be further elucidated.
Mapping field photographs to textured surface meshes directly on mobile devices
Authors: Kehl Christian , Buckley Simon J. , Viseur Sophie , Gawthorpe Robert L. , Mullins James R. , Howell John A.
Published: November 2017

The mapping of photographs to surface geometry is an important procedure for many applications within the geosciences. This paper proposes an interactive framework for feature‐based image‐to‐geometry mapping that works directly on mobile devices, under challenging imaging conditions and with limited available hardware performance. The framework makes use of openly available digital elevation models (DEMs) together with mobile position‐and‐orientation sensor data. It integrates calculation heuristics for result evaluation and feedback, synthesising available knowledge in current registration literature. The approach is assessed on two image datasets captured on separate occasions. Their interpretations are mapped to one textured lidar surface model and the projection accuracy is qualitatively assessed. The experiments show a significant accuracy improvement in photograph registration results, as well as the faithful mapping of image interpretations on the underlying surface geometry. This semi‐automatic, user‐guided, interactive approach is superior to comparable fully automatic registration methods.
The Logic of Opacity
Authors: Bacon Andrew , Russell Jeffrey Sanford
Published: November 2017

We explore the view that Frege's puzzle is a source of straightforward counterexamples to Leibniz's law. Taking this seriously requires us to revise the classical logic of quantifiers and identity; we work out the options, in the context of higher‐order logic. The logics we arrive at provide the resources for a straightforward semantics of attitude reports that is consistent with the Millian thesis that the meaning of a name is just the thing it stands for. We provide models to show that some of these logics are non‐degenerate.
Unravelling the roles of innate lymphoid cells in cerebral malaria pathogenesis
Authors: Palomo J. , Quesniaux V. F. J. , Togbe D. , Reverchon F. , Ryffel B.
Published: November 2017

Cerebral malaria (CM) is one complication of Plasmodium parasite infection that can lead to strong inflammatory immune responses in the central nervous system (CNS), accompanied by lung inflammation and anaemia. Here, we focus on the role of the innate immune response in experimental cerebral malaria (ECM) caused by blood‐stage murine Plasmodium berghei ANKA infection. While T cells are important for ECM pathogenesis, the role of innate lymphoid cells (ILCs) is only emerging. The role of ILCs and non‐lymphoid cells, such as neutrophils and platelets, contributing to the host immune response and leading to ECM and human cerebral malaria (HCM) is reviewed.