bluuebunny/crossref_metadata_2025 huggingface dataset:
High incidence of biliary stricture after associating liver partition and portal vein ligation for staged hepatectomy
Authors: Sanjeevi Srinivas , Sparrelid Ernesto , Gilg Stefan , Jonas Eduard , Isaksson Bengt
Published: December 2017

Background

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a two‐stage procedure most frequently applied in the setting of an extended right‐sided hemi‐hepatectomy. Initial reports of high mortality have sparked debate regarding the safety and efficacy of the procedure. We describe a higher incidence of early post‐operative bile duct strictures after ALPPS, a complication rarely seen after conventional liver resection.

Methods

An institutional review was conducted to assess the incidence of post‐operative biliary strictures following conventional right‐sided or extended right‐sided hemi‐hepatectomy and ALPPS. Patient demographics and operative data were obtained from the patient database of Karolinska University Hospital.

Results

Between 2010 and 2015, 528 hemi‐hepatectomies or extended hemi‐hepatectomies were performed, of which 500 were conventional liver resections and 28 were ALPPS. The incidence of post‐operative biliary stricture was 10.7% (n = 3) following ALPPS, 1.4% (n = 2) following extended right‐sided hepatectomy (P = 0.023; OR = 8.46; 95% CI 1.35–53.2) and 1.1% following formal right‐sided hepatectomy (P = 0.004; OR = 11.0; 95% CI 2.11–57.6). All biliary strictures were at the level of the hilum affecting the left hepatic duct. Pre‐operative comorbidity was less in the ALPPS group and post‐operative complications were more severe following ALPPS.

Conclusion

Iatrogenic biliary strictures following conventional liver resection is an uncommon complication. It does, however, occur more frequently following ALPPS and is associated with an increased morbidity. Caution should therefore be exercised when dividing the right hilar pedicle at stage 2 of ALPPS.
Diabetic macular edema, innovative technologies and economic impact: New opportunities for the Lombardy Region healthcare system?
Authors: Foglia Emanuela , Ferrario Lucrezia , Bandello Francesco , Ferri Camilla , Figini Innocente , Franzin Michela , Gambaro Gianpiera , Introini Ugo , Medaglia Massimo , Staurenghi Giovanni , Tadini Patrizia , Fomiatti Andrea , Croce Davide
Published: December 2017

Purpose

Diabetic macular edema (DME) is a leading cause of vision loss and blindness. The aim of this study was to evaluate the economic benefits of introducing additional alternative technologies (Dexamethasone intravitreal implant – DEX – and Aflibercept injections), compared with the historical scenario of Ranibizumab intravitreal injections.

Methods

A 3‐year budget impact model was developed, taking into consideration the perspective of the Lombardy Region Healthcare Service (LRHS). Total administration costs (real‐life data retrieved from clinical practice at three Departments of Ophthalmology) as well as costs related to the management of potential adverse events (information collected from the literature) were analysed.

Results

Over a 36‐month horizon, the results showed that a higher consumption of DEX could lead to significant economic savings for the Regional Healthcare Service, ranging from a minimum of −4.35% (if DEX were used only in the second‐line of treatment) to a maximum of −12.97% (if DEX were used in both the first‐line and second‐line), including the potential impact of adverse events. Therapy costs with Aflibercept and Ranibizumab were similar.

Conclusions

This study demonstrates that concentrating all eligible patients within the Ranibizumab regimen is unlikely to represent a cost‐effective strategy. Indeed, significant economic advantages would be achieved by introducing the other licensed alternatives, Dexamethasone implant and Aflibercept, thus optimising DME Italian healthcare expenditure. The results demonstrate DEX as an advantageous technological alternative for the target population affected by DME, both as a first‐ and second‐line treatment option, reducing the economic burden of the pathology for the Regional/National Health Service.
The effect of haemopoietic stem cell transplantation on the ocular phenotype in mucopolysaccharidosis type I (Hurler)
Authors: Javed Ahmed , Aslam Tariq , Jones Simon A. , Mercer Jean , Tyler Karen , Church Heather , Ghosh Arunabha , Wynn Robert , Sornalingam Krishanthy , Ashworth Jane
Published: December 2017

Purpose

To determine whether the ocular phenotype in patients with mucopolysaccharidosis type I (MPSI) Hurler is affected by the efficacy of previous haemopoietic stem cell transplantation (HSCT).

Design

A retrospective cohort study of patients with MPSI who had undergone treatment with HSCT.

Methods

Ocular phenotype was documented for each patient and compared to levels of biomarkers representing efficacy of previous transplantation. Main outcome measures: Assessment of visual acuity (VA), severity of corneal clouding and the presence of optic neuropathy or retinopathy. Biomarker assessment included dermatan sulphate/chondroitin sulphate (DS/CS) ratio and iduronidase enzyme level.

Results

Severe corneal clouding was significantly greater in patients with lower iduronidase levels (p = 0.023) and raised DS/CS ratio (R2 = 0.28 p = 0.043). Better VA was related to a higher iduronidase levels (R2 = 0.15, p = 0.004) and lower DS/CS ratio (R2 = 0.38, p = 0.001).

Conclusion

Improved ocular phenotypes in MPSI are associated with markers signifying efficacy of prior transplant. Early and effective HSCT may result in a better visual prognosis and reduction in ocular complications for patients with MPSI.
Diabetic macular oedema treated with intravitreal anti‐vascular endothelial growth factor – 2–4 years follow‐up of visual acuity and retinal thickness in 566 patients following Danish national guidelines
Authors: Hodzic‐Hadzibegovic Delila , Sander Birgit Agnes , Monberg Tine Juul , Larsen Michael , Lund‐Andersen Henrik
Published: December 2017

Purpose

To investigate long‐term functional and anatomical outcomes, discontinuation patterns, drug switching and rates of nonimprovement in patients treated with ranibizumab pro re nata (PRN) regimen for diabetic macular oedema (DME) according to the Danish national guidelines.

Methods

Retrospective cohort study of 566 eyes in 566 patients with centre‐involved DME who started intravitreal treatment with ranibizumab between January 2011 and December 2013 in the Greater Copenhagen region. Data were retrieved from a database and patient records between January 2011 and March 2016 and analysed using mixed‐model statistics.

Results

At the conclusion of follow‐up, 24.6% were in active ranibizumab follow‐up, 25.4% had switched to other intravitreal pharmacotherapy, 31.6% had been discontinued because of disease stability, 13.8% had been lost to follow‐up, 1.4% had been discontinued because of low visual acuity (VA), and 3.2% had died. At baseline, mean best‐corrected visual acuity (BCVA) and mean central subfield thickness (CST) were 64.9 (±15.0) letters and 400.2 (±120.3) μm. Mean change in BCVA and mean change in CST from baseline to 3, 12, 24, 36 and 48 months of follow‐up were +3.9, +3.5, +2.7, +1.8, +2.3 letters and −97.4, −102.6, −106.9, −105.9, −131.6 μm, respectively. Mean number of injections was 6.1 in year 1 and 1.8 in year 4. In 93 patients, drug switching to aflibercept showed no difference between the two drugs on BCVA or CST. In 79 patients, CST decreased <10% compared to baseline during the first year.

Conclusion

In a single‐centre clinical setting, 566 patients treated for DME with ranibizumab according to the Danish national guidelines were followed for up to 4 years. Best‐corrected visual acuity (BCVA) outcomes are in the low end of clinical studies, but studied on a wider population and achieved with fewer injections.
Wealth inequality: Theory, measurement and decomposition
Authors: Davies James B. , Fortin Nicole M. , Lemieux Thomas
Published: December 2017

This paper reviews the basic principles of inequality measurement, underlining the advantages and shortcomings of alternative measures from a theoretical standpoint and in the context of the study of the distribution of wealth. Adopting the two most popular measures, the Gini index and the P‐shares, the paper documents wealth inequality in Canada using the 1999, 2005 and 2012 Survey of Financial Security (SFS). It carries out several decompositions with covariates, featuring DFL‐type reweighting methods and Gini and P‐shares RIF regressions. The latter parallel decompositions deepen our understanding of how changes in socio‐demographic characteristics, including the compensating role of family formation and human capital, impact wealth inequality.
Discovery of novel negletein derivatives as potent anticancer agents for acute myeloid leukemia
Authors: Wu Jianlei , Chen Yingyu , Liu Xuanping , Gao Yu , Hu Jianda , Chen Haijun
Published: December 2017

Baicalin and its aglycone baicalein derived from Scutellaria baicalensis exhibited potent anticancer effects in various types of cancer cell lines. However, the unfavorable pharmaceutical properties became the main obstacle for their potential clinical development. With the aim of development of novel anticancer agents based on the skeleton of baicalin, a series of novel negletein derivatives were designed and synthesized. Among them, compound 8 (FZU‐02,006) with an N,N‐dimethylamino ethoxyl moiety at the C‐6 position exhibited significant enhanced antiproliferative effect against HL‐60 cells in vitro through regulating multisignaling pathways. These results revealed that compound 8 with the improved aqueous solubility (as HCl salt, >1 mg/ml) and enhanced antileukemia potency might serve as a promising lead for further development.
Developing educators of European undergraduate dental students: Towards an agreed curriculum
Authors: Chuenjitwongsa S. , Oliver R. G. , Bullock A. D.
Published: December 2017

Introduction

Recent developments in European dental education are student‐focused, concerned with competency‐based and problem‐based learning. The development of dental educators has so far received little consideration. This study aimed to agree curriculum content for developing dental educators so that they are better able to support changing undergraduate dental education.

Methods

Adopting consensus methodology, a 2‐round Delphi was conducted in 2012. Fifty‐three dental educators and 39 dental students across Europe volunteered to take part. The Delphi questionnaire was developed based on literature, piloted and sent to participants to gather opinions and seek consensus on educational content using rating scales and open‐ended questions. Numeric data were analysed using descriptive statistics, and qualitative data were analysed thematically.

Results and Discussion

This study revealed 7 domains of curriculum content for dental educators. Four of these domains were considered essential: educational principles; educational practice in dentistry; curriculum, quality and improvement; and educational professionalism. Three domains were viewed as optional and could be tailored to local needs: educational principles in relation to specific contexts, educational research, and educational and healthcare management. When developing training for dental educators, factors which need consideration were identified as the academic position and teaching experience of educators, and the nature of clinical dental education.

Conclusion

The results are beneficial for individual educators to inform professional development plans; institutions to devise faculty developments; ADEE to inform policies on developing European dental educators; and other disciplines to inform training for their educators.
DNA and RNA binding by the Wilms' tumour gene 1 (WT1) protein +KTS and −KTS isoforms—From initial observations to recent global genomic analyses
Authors: Ullmark Tove , Montano Giorgia , Gullberg Urban
Published: December 2017

The Wilms' tumour gene 1 protein (WT1) is a zinc finger transcription factor found indispensable for foetal development. WT1 has also been implicated in the development of tumours in several organ systems, including acute myeloid leukaemia (AML). Four main WT1 isoforms come from 2 alternative splice events. One alternative splice results in the inclusion or exclusion of 3 amino acids, KTS, between zinc fingers 3 and 4 in the WT1 protein. The KTS insert has been extensively investigated due to the functional implications for DNA and RNA binding. In this review, we provide an overview of the research into the isoforms containing or lacking the KTS insert in leukaemic cells, as well as the research into the binding patterns of the WT1 −KTS and +KTS isoforms to DNA and RNA. Finally, we connect the results of the DNA binding research to the ChIP‐CHIP and ChIP‐Seq investigations into the global genomic binding of the WT1 protein that have recently been performed.
Assessment of procoagulant potential in patients with reactive thrombocytosis and its association with platelet count
Authors: Rottenstreich Amihai , Shai Ela , Kleinstern Geffen , Spectre Galia , Varon David , Kalish Yosef
Published: December 2017

Objective

We aimed to determine hemostatic changes and characterize the procoagulant potential among patients with reactive thrombocytosis (RT).

Methods

Sixty patients with RT (median platelet count 718 × 109/L) and 20 healthy persons were tested for complete blood count, C‐reactive protein, von Willebrand factor (VWF), factor VIII and fibrinogen, and thrombin generation. Platelet studies, including light transmission aggregometry and Cone and Plate(let) Analyzer, were also conducted. Reticulated platelets and platelet P‐selectin expression were measured using flow cytometry.

Results

Compared to patients with mild thrombocytosis (platelet count 500‐700 × 109/L; n = 27), those with moderate‐to‐severe thrombocytosis (platelet count >700 × 109/L; n = 33) had significantly higher fibrinogen, factor VIII, and VWF antigen and activity levels; higher endogenous thrombin potential, peak thrombin generation and velocity index levels, and shorter time‐to‐peak thrombin level. VWF antigen and activity, fibrinogen, and factor VIII were positively associated with platelet count, whereas VWF activity/antigen ratio was inversely correlated. In a multivariate analysis of RT and control participants, only platelet count predicted endogenous thrombin potential with a positive‐linear correlation. No patients developed acquired von Willebrand syndrome.

Conclusions

As determined by thrombin generation, RT was associated with in vitro prothrombotic tendency, which correlated with platelet count. This may explain the increased thromboembolic risk previously reported in patients with RT.
Outcome following second allogeneic hematopoietic cell transplantation: A single‐center experience
Authors: Aljasem Hassan A. , Messner Hans A. , Lipton Jeffrey H. , Kim Dennis Dong Hwan , Viswabandya Auro , Thyagu Santhosh , Deotare Uday , Michelis Fotios V.
Published: December 2017

Objective

Second allogeneic hematopoietic cell transplantation (HCT) may be indicated following relapse or graft failure following first HCT. Our retrospective single‐center study sought to investigate parameters that influence post‐second allogeneic HCT survival.

Method

We investigated 92 patients who underwent second allogeneic HCT between 1980 and 2016 for relapse or graft failure following first HCT. Median age at second HCT was 41 years (range 16‐68), performed for relapse in 59 patients (64%) and for graft failure in 33 patients (36%).

Results

On univariate analysis, 3‐year OS of the entire cohort was 35% (95% CI=25‐45). Eastern Cooperative Oncology Group (ECOG) score (3‐year OS 48% for ECOG 0‐1, 18% for ECOG 2‐3, P=.0006), second HCT indication (3‐year OS 43% for relapse, 20% for graft failure, P=.02), time from first HCT to relapse/graft failure (3‐year OS for <12months 21%, for ≥12months 46%, P=.009), and conditioning intensity (3‐year OS for MA 42% vs other regimens 23%, P=.08) significantly influenced OS. Multivariable analysis confirmed ECOG score (HR=2.15 for ECOG 2‐3, 95% CI=1.32‐3.51, P=.002) and second HCT indication (HR=1.67 for graft failure, 95% CI=1.02‐2.75, P=.04) to independently influence survival.

Conclusion

Second HCT may offer long‐term survival particularly to patients with good performance status who relapse post‐first HCT.
Maintenance of equine anaesthesia over the last 50 years: Controlled inhalation of volatile anaesthetics and pulmonary ventilation
Authors: Mosing M. , Senior J. M.
Published: December 2017

In the first edition of this journal, Barbara Weaver wrote a review titled ‘Equine Anaesthesia’, stating that, at that time, it was quickly becoming accepted practice that many horses were being anaesthetised ‘by essentially similar procedures, i.e. premedication, induction and then maintenance by controlled inhalation’. To celebrate the 50th anniversary of the first edition of this journal, this review covers the development of understanding and practice of inhalational anaesthesia and controlled ventilation in horses over the last 50 years. We review how the perceived benefits of halothane led to its widespread use, but subsequently better understanding of halothane's effects led to changes in equine anaesthetic practice and the utilisation of different inhalation agents (e.g. isoflurane and sevoflurane). We discuss how more recently, better understanding of the effects of the ‘newer’ inhalation agents’ effects has led to yet more changes in equine anaesthetic practice, and while, further new inhalation agents are unlikely to appear in the near future, further enhancements to anaesthetic practice may still lead to improved outcomes. We review advances in our understanding of the anatomy and pathophysiology of the equine lung as well of the effects of anaesthesia on lung function and how these predispose to some of the common problems of gas exchange and ventilation during anaesthesia. We identify the aims of optimal mechanical ventilation for anaesthetic management and whether the various methods of ventilatory support during equine anaesthesia achieve them. We also highlight that further developments in equipment and optimal ventilator modes are likely in the near future.
Multiaxial low‐cycle fatigue life evaluation under different non‐proportional loading paths
Authors: Qu W. L. , Zhao E. N. , Zhou Q. , Pi Y.‐L.
Published: December 2017

This paper presents analytical and experimental investigations for fatigue lives of structures under uniaxial, torsional, multiaxial proportional, and non‐proportional loading conditions. It is known that the rotation of principal stress/strain axes and material additional hardening due to non‐proportionality of cycle loading are the 2 main causes resulting in shorter fatigue lives compared with those under proportional loading. This paper treats these 2 causes as independent factors influencing multiaxial fatigue damage and proposes a new non‐proportional influencing parameter to consider their combined effects on the fatigue lives of structures. A critical plane model for multiaxial fatigue lives prediction is also proposed by using the proposed non‐proportional influencing factor to modify the Fatemi‐Socie model. The comparison between experiment results and theoretical evaluation shows that the proposed model can effectively predict the fatigue life due to multiaxial non‐proportional loading.
Flourishing: positive emotion regulation strategies of pharmacy students
Authors: Basson Mariëtta J , Rothmann Sebastiaan
Published: December 2017

Objectives

The aim of this study was to investigate whether flourishing students use different emotion regulation strategies from moderately mentally healthy and languishing students.

Methods

Registered pharmacy students (779) at the North-West University in South Africa completed the emotion regulation profile and Mental Health Continuum – Short Form. The data were analysed using a latent class analysis in Mplus 7.31.

Key findings

Three latent classes were revealed comprising languishing (14.2%), moderately mentally healthy (47.5%) and flourishing students (38.3%). Students who flourished were more likely to use adaptive positive emotion regulation strategies (savouring the moment, behavioural display, capitalising). Students who languished were inclined to use maladaptive emotion regulation strategies (inattention, fault finding, external attribution).

Conclusion

Flourishing students increase or maintain their positive emotions and refrain from decreasing their positive emotions.
Transvenous pacemaker implantation after the bidirectional Glenn operation for patients with complex congenital disease
Authors: Harake Danielle E. , Shannon Kevin M. , Aboulhosn Jamil A. , Moore Jeremy P.
Published: December 2017

Introduction

The bidirectional Glenn operation for congenital heart disease produces anatomical constraints to conventional transvenous pacemaker implantation. An iliac approach, although not previously described in this population, is potentially a preferable alternative to a thoracotomy for epicardial pacing.

Methods and results

A single‐center retrospective review was performed for all patients that underwent transvenous pacemaker implantation following the bidirectional Glenn operation with partial biventricular repair. Follow‐up data, implant indications, and techniques were recorded. Five patients underwent a transvenous iliac approach (median age 26.9 years, interquartile range [IQR] 25.8–27.6). Pacing indications included AV block in 3 patients (2 requiring cardiac resychronization therapy) and sinus node dysfunction in 2. Implanted leads were atrial in 4 and ventricular in 3 (1 of the latter was placed in the coronary sinus). In two cases, transvenous leads were tunneled to a preexisting epicardial abdominal generator. Median follow‐up was 4.1 years (range 1.0–16.7 years). One patient underwent device revision for lead position‐related groin discomfort; a second patient developed atrial lead failure following a Maze operation and underwent lead replacement by the iliac approach. Patients were not routinely anticoagulated postprocedure given lead position in the subpulmonary circulation. At last follow‐up, all patients were alive. One patient underwent heart transplantation 6 months after implant with only partial resolution of pacing‐induced cardiomyopathy.

Conclusions

Trans‐iliac pacemaker placement may be an effective alternative to surgery for patients requiring permanent pacing after the Glenn operation.
Clinical judgement in the era of big data and predictive analytics
Authors: Chin‐Yee Benjamin , Upshur Ross
Published: December 2017

Clinical judgement is a central and longstanding issue in the philosophy of medicine which has generated significant interest over the past few decades. In this article, we explore different approaches to clinical judgement articulated in the literature, focusing in particular on data‐driven, mathematical approaches which we contrast with narrative, virtue‐based approaches to clinical reasoning. We discuss the tension between these different clinical epistemologies and further explore the implications of big data and machine learning for a philosophy of clinical judgement. We argue for a pluralistic, integrative approach, and demonstrate how narrative, virtue‐based clinical reasoning will remain indispensable in an era of big data and predictive analytics.
Three‐dimensional digital reconstruction of skin epidermis and dermis
Authors: LIU P. , ZHU J.‐Y. , TANG B. , HU Z.‐C.
Published: December 2017

This study describes how three‐dimensional (3D) human skin tissue is reconstructed, and provides digital anatomical data for the physiological structure of human skin tissue based on large‐scale thin serial sections. Human skin samples embedded in paraffin were cut serially into thin sections and then stained with hematoxylin‐eosin. Images of serial sections obtained from lighting microscopy were scanned and aligned by the scale‐invariant feature transform algorithm. 3D reconstruction of the skin tissue was generated using Mimics software. Fibre content, porosity, average pore diameter and specific surface area of dermis were analysed using the ImageJ analysis system. The root mean square error and mutual information based on the scale‐invariant feature transform algorithm registration were significantly greater than those based on the manual registration. Fibre distribution gradually decreased from top to bottom; while porosity showed an opposite trend with irregular average pore diameter distribution. A specific surface area of the dermis showed a ‘V’ shape trend. Our data suggested that 3D reconstruction of human skin tissue based on large‐scale serial sections could be a valuable tool for providing a highly accurate histological structure for analysis of skin tissue. Moreover, this technology could be utilized to produce tissue‐engineered skin via a 3D bioprinter in the future.
Wnt signaling loss accelerates the appearance of neuropathological hallmarks of Alzheimer's disease in J20‐APP transgenic and wild‐type mice
Authors: Tapia‐Rojas Cheril , Inestrosa Nibaldo C.
Published: December 2017

Alzheimer's disease (AD) is a neurodegenerative pathology characterized by aggregates of amyloid‐β (Aβ) and phosphorylated tau protein, synaptic dysfunction, and spatial memory impairment. The Wnt signaling pathway has several key functions in the adult brain and has been associated with AD, mainly as a neuroprotective factor against Aβ toxicity and tau phosphorylation. However, dysfunction of Wnt/β‐catenin signaling might also play a role in the onset and development of the disease. J20 APPswInd transgenic (Tg) mouse model of AD was treated i.p. with various Wnt signaling inhibitors for 10 weeks during pre‐symptomatic stages. Then, cognitive, biochemical and histochemical analyses were performed. Wnt signaling inhibitors induced severe changes in the hippocampus, including alterations in Wnt pathway components and loss of Wnt signaling function, severe cognitive deficits, increased tau phosphorylation and Aβ1–42 peptide levels, decreased Aβ42/Aβ40 ratio and Aβ1–42 concentration in the cerebral spinal fluid, and high levels of soluble Aβ species and synaptotoxic oligomers in the hippocampus, together with changes in the amount and size of senile plaques. More important, we also observed severe alterations in treated wild‐type (WT) mice, including behavioral impairment, tau phosphorylation, increased Aβ1–42 in the hippocampus, decreased Aβ1–42 in the cerebral spinal fluid, and hippocampal dysfunction. Wnt inhibition accelerated the development of the pathology in a Tg AD mouse model and contributed to the development of Alzheimer's‐like changes in WT mice. These results indicate that Wnt signaling plays important roles in the structure and function of the adult hippocampus and suggest that inhibition of the Wnt signaling pathway is an important factor in the pathogenesis of AD.

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Read the Editorial Highlight for this article on page 356.
How perceived feelings of “wellness” influence the decision‐making of people with predialysis chronic kidney disease
Authors: Campbell‐Crofts Sandra , Stewart Glenn
Published: December 2017

Aims and objectives

To identify the subjective meanings attached to decisions made by people living with chronic kidney disease as they consider their transition to renal replacement therapy.

Background

Within the challenging world of chronic illness, people draw upon their temporal life experiences to help them make the best or most balanced primary healthcare decisions. Understanding the risks and benefits associated with these decisions has been an area of intense interest in health research.

Design

An exploratory qualitative descriptive design.

Method

A convenience sample of twelve people, at stages 3B to 5 of chronic kidney disease, attending two predialysis renal clinics in Sydney, Australia, consented to be interviewed. The semi‐structured interviews centred on their decision‐making experiences as they considered their transition to renal replacement therapy.

Results

Three themes emerged from participant narratives which have been framed into the following questions: (i) Do I need renal replacement therapy? (ii) What is the “right” renal replacement therapy for me? and (iii) When should I start renal replacement therapy? Decisions about the transition to renal replacement therapy were impacted upon by the participants’ perceived feelings of wellness and the belief that renal replacement therapy would not be needed at any time in the foreseeable future.

Conclusion

This study highlights the importance of optimising person‐centred care and raises important issues for the education and management of people with chronic kidney disease in the predialysis stages of the illness.

Relevance to clinical practice

In order to facilitate the transition to renal replacement therapy, renal clinicians have a responsibility to more fully understand the patient journey during the predialysis stages of chronic kidney disease. A clearer understanding of patients’ perceptions and decision‐making experiences creates a space for mutual understanding. This is essential for the future development and implementation of collaborative, person‐centred educational strategies and long‐term renal healthcare outcomes.
Redox imbalance correlates with high Nugent score in bacterial vaginosis
Authors: Waqqar Shakeel , Aziz Salman , Shakeel Rabia , Waheed Anum , Ahmed Syed S. , Ali Asad , Khan Ayyaz A. , Shoaib Muhammad
Published: December 2017

Aim

The main goal of this work was to highlight the significance of redox imbalance in the pathophysiology of bacterial vaginosis (BV). We studied the pro‐oxidant (malondialdehyde) and antioxidants (glutathione, total antioxidant capacity) in the vaginal fluids of women and compared them on the basis of their Nugent score (NS).

Methods

Women were clinically screened using Amsel criteria (≥2 were regarded as positive) and were further screened for NS on the basis of microscopic examination. Subjects were classified into one of three groups – healthy controls, intermediate, and BV – on the basis of NS (0–3, 4–6, and 7–10, respectively). High vaginal swabs were collected from the study participants in order to estimate the levels of pro and antioxidants in the vaginal fluids.

Results

Our results indicated that levels of both pro‐ and antioxidants were elevated in high vaginal swabs of women in the intermediate (NS: 4–6) and BV (NS: 7–10) groups as compared to those of healthy control women. The difference in mean values for total antioxidant capacity and glutathione was found to be statistically significant. Furthermore, in the BV group (NS: ≥7) both antioxidants (glutathione and total antioxidant capacity) and the pro‐oxidant, malondialdehyde, were found to be negatively correlated to NS. Interestingly, the correlation between NS and malondialdehyde was statistically significant.

Conclusion

Our results suggest a significant correlation between redox imbalance and NS, which signifies changes in vaginal ecology from normal flora (Lactobacillus spp.) towards a more mixed bacterial population representing BV.
Performance measures for a dialysis setting
Authors: Gu Xiuzhu , Itoh Kenji
Published: December 2017

Objectives

This study from Japan extracted performance measures for dialysis unit management and investigated their characteristics from professional views.

Methods

Two surveys were conducted using self‐administered questionnaires, in which dialysis managers/staff were asked to rate the usefulness of 44 performance indicators. A total of 255 managers and 2,097 staff responded.

Results

Eight performance measures were elicited from dialysis manager and staff responses: these were safety, operational efficiency, quality of working life, financial effectiveness, employee development, mortality, patient/employee satisfaction and patient‐centred health care. These performance measures were almost compatible with those extracted in overall healthcare settings in a previous study. Internal reliability, content and construct validity of the performance measures for the dialysis setting were ensured to some extent. As a general trend, both dialysis managers and staff perceived performance measures as highly useful, especially for safety, mortality, operational efficiency and patient/employee satisfaction, but showed relatively low concerns for patient‐centred health care and employee development. However, dialysis managers’ usefulness perceptions were significantly higher than staff.

Conclusions

Important guidelines for designing a holistic hospital/clinic management system were yielded. Performance measures must be balanced for outcomes and performance shaping factors (PSF); a common set of performance measures could be applied to all the healthcare settings, although performance indicators of each measure should be composed based on the application field and setting; in addition, sound causal relationships between PSF and outcome measures/indicators should be explored for further improvement.
Differing disintegration and dissolution rates, pharmacokinetic profiles and gastrointestinal tolerability of over the counter ibuprofen formulations
Authors: Bjarnason Ingvar , Sancak Ozgur , Crossley Anne , Penrose Andrew , Lanas Angel
Published: December 2017

Objectives

Formulations of over the counter (OTC) NSAIDs differ substantially, but information is lacking on whether this alters their gastrointestinal profiles. To assess disintegration and dissolution rates and pharmacokinetics of four preparations of OTC ibuprofen and relate these with spontaneously reported gastrointestinal adverse events.

Methods

Disintegration and dissolution rates of ibuprofen tablets as (a) acid, (b) sodium salt, (c) lysine salt, and (d) as a liquid gelatine capsule were assessed. Pharmacokinetic data gastrointestinal and spontaneously reported adverse events arising from global sales were obtained from files from Reckitt Benckiser.

Key findings

Disintegration at low pH was progressively shorter for the preparations from a-to-d with formation of correspondingly smaller ibuprofen crystals, while dissolution was consistently poor. Dissolution at a neutral pH was least rapid for the liquid gelatine capsule. Pharmacokinetic data showed a shorter tmax and a higher Cmax for preparations b–d as compared with ibuprofen acid. Spontaneously reported abdominal symptoms were rare with the liquid gelatine preparation.

Conclusions

The formulations of OTC ibuprofen differ in their disintegration and dissolution properties, pharmacokinetic profiles and apparent gastrointestinal tolerability. Spontaneously reported abdominal symptoms were five times lower with the liquid gelatine capsule as compared with ibuprofen acid despite a 30% increase in Cmax.
Materialism and Fashion Consciousness: The Moderating Role of Status Consumption Tendencies and Religiosity
Authors: Yeniaras Volkan , Akkemik K. Ali
Published: December 2017

Understanding whether materialistic values translate directly into fashion consciousness or whether it is the status consumption and religiosity that intensifies this relationship within the specifics of explicitly religious consumers is important as fashion consumption appears to occupy a focal position both socially and economically in the lives of many. The Islamic fashion clothing market has begun to attract recent attention and is becoming an area of interest in consumer research. The Turkish Islamic fashion clothing consumptionscape that reached a yearly sales volume of $39 billion in 2013 within a $266 billion global market shows that the explicitly Muslim Turkish consumer gains excitement and pleasure from keeping up‐to‐date with fashion. Utilizing a unique data set from a survey in Istanbul this article examines the relationships between materialism, status consumption tendencies, intrinsic religiosity, and fashion‐novelty consciousness. Strong evidence is found for the positive relationship of materialism to fashion‐novelty consciousness. In addition, intrinsic religiosity has been identified to have a negative moderating effect on the materialism‐fashion‐novelty consciousness association.
Land‐use legacies in forests at Jefferson's Monticello plantation
Authors: Druckenbrod Daniel L. , Neiman Fraser D. , Richardson David L. , Wheeler Derek
Published: December 2017

Questions

We evaluate the role of past land use on long‐term forest succession and ask fundamental questions: (i) are successional patterns along a chronosequence consistent through time; (ii) is past land use or physiography a greater driver of forest composition; and (iii) does forest composition converge with age?

Location

Thomas Jefferson's Monticello plantation, Virginia Piedmont, USA.

Methods

Combining dendroecology, historical documents and a repeated vegetation survey from 1934, we reconstruct forest histories along a chronosequence that retains a temporal dimension. Tree‐ring data indicate initial canopy status and canopy release events using time series analysis with intervention detection.

Results

Forest extent was lowest during Jefferson's tenure; however, tree ring and documentary evidence revealed the location of Jefferson's timber zone. Jefferson‐era trees in this zone are largely on the west slope with scattered Pinus recruitment starting in the late 18th century, followed by Quercus species. Pinus cohorts also recruited into former agricultural fields on south and east slopes in two chronosequence stages from the 20th century. Synchronized release events were observed during the early 1800s, 1850s–1860s and 1960s, indicating periods of intense forest use. Ordination of repeated vegetation surveys showed a progression in forest age that explained more variation in forest composition than elevation and slope. The forest age gradient is also evident independently from tree‐ring data, but the ordination does not show convergence in composition with forest age.

Conclusion

Past land use is a greater driver of forest composition than an inferred soil moisture gradient. The composition of the most recent chronosequence stage suggests that future forest dynamics may be novel compared to the prior two centuries because of differences in land use and species availability. These land‐use legacies demonstrate how colonial‐era agricultural decisions at Monticello continue to impact forest growth and composition more than two centuries later.
Danaparoid reduces transplant‐related mortality in stem cell transplantation for children
Authors: Kato Koji , Sakaguchi Hirotoshi , Muramatsu Hideki , Sekiya Yuko , Kawashima Nozomu , Narita Atsushi , Doisaki Sayoko , Watanabe Nobuhiro , Yoshida Nao , Matsumoto Kimikazu
Published: December 2017

In SCT, death from transplant‐related complications is the major obstacle hindering improvement of transplant outcomes, and proper supportive care is essential to reduce TRM. The transplant outcomes of 210 pediatric patients with malignant and non‐malignant disorders who consecutively underwent SCT in our institution from 2000 to 2013 were analyzed. The transplant years were divided into three periods: A (2000‐2004), B (2005‐2008), and C (2009‐2013), and an improvement in 5‐year OS and a decrease in 5‐year TRM were observed over these time periods; that is, OS was 61.5%, 60.3%, and 79.5% (P = .062), and TRM was 19.9%, 7.9%, and 0.0% (P < .001) in periods A, B, and C, respectively. On multivariate analysis, the prognostic factor for TRM for all patients was administration of danaparoid (HR = 0.109, 95% CI = 0.033‐0.363, P < .001), and for patients with hematological malignancies in allogeneic SCT, the prognostic factors were danaparoid (HR = 0.046, 95% CI = 0.006‐0.326, P = .002) and advanced disease at SCT (HR = 4.802, 95% CI = 1.734‐13.30, P = .003). A reduction in TRM after SCT was observed over the time periods, and supportive care with danaparoid was found to be significantly effective in reducing TRM in SCT for children.
Intact rock bridge breakage and rock mass fragmentation upon failure: quantification using remote sensing techniques
Authors: Spreafico Margherita C. , Franci Francesca , Bitelli Gabriele , Borgatti Lisa , Ghirotti Monica
Published: December 2017

In this work, two processes related to the onset and the evolution of large‐scale rockfalls have been analysed by means of remote sensing techniques. First, the number of rock bridges as a proportion of pre‐existing fractures has been estimated in a newly formed landslide scarp by analysing the spectral information of the rock mass in terrestrial laser scanner (TLS) and unmanned aerial vehicle (UAV) photogrammetric point clouds. Second, the fragmentation of the rock mass after failure has been assessed by comparing the percentage of newly formed fractures in the scarp and in the deposit. For this purpose, an orthophoto of the landslide deposit was classified using an object‐based method. The presented workflow gained new data on the intact rock breakage during and after failure, and consequently deepened knowledge about rock failure and fragmentation mechanisms.
Does the amount of lower extremity movement variability differ between injured and uninjured populations? A systematic review
Authors: Baida S. R. , Gore S. J. , Franklyn‐Miller A. D. , Moran K. A.
Published: December 2017

Movement variability during repetitive performance of a dynamic activity (eg, running, jumping, kicking) is considered an integral characteristic of optimal movement execution; however, its relationship with musculo‐skeletal injury is not known. The primary aim of this study was to review published comparison trials to determine whether movement variability differs between uninjured controls and subjects with a lower limb musculo‐skeletal injury. A systematic search of online databases; MEDLINE, Sports Discus, Scopus, and Web of Science was conducted from July to November 2016. Studies were selected if they (a) included participants with a lower limb injury, (b) compared injured participants to uninjured controls, (c) examined movement variability for at least one dependent variable, and (d) provided a statistical between‐group comparison when comparing measures of movement variability. Studies were excluded if they (a) investigated neurological disorders, (b) examined musculo‐skeletal injury in the upper extremity or spine, and (c) used nonlinear measures to examine variability (ie, complexity). A significant difference between injured and uninjured populations was reported in 73% of the included studies, and of these, 64% reported greater movement variability in the injured group. This is the first systematic review with a best‐evidence synthesis investigating the association between movement variability and musculo‐skeletal injury. Findings suggest that movement variability in those with a musculo‐skeletal injury differs from uninjured individuals. Interestingly, there was an overall trend toward greater movement variability being associated with the injured groups, although it should be noted that this trend was not consistent across all subcategories (eg, injury type). For a clearer insight into the clinical application of variability, greater methodological homogeneity is required and prospective research is recommended.
Extracellular matrix/stromal vascular fraction gel conditioned medium accelerates wound healing in a murine model
Authors: Deng Chengliang , He Yunfan , Feng Jingwei , Dong Ziqing , Yao Yao , Mok Hsiaopei , Lin Maohui , Feng Lu
Published: December 2017

Conditioned medium (CM) is a new treatment modality in regenerative medicine and has shown a successful outcome in wound healing. We recently introduced extracellular matrix/stromal vascular fraction gel (ECM/SVF‐gel), an adipose‐derived stem cell and adipose native extracellular matrix‐enriched product for cytotherapy. This study aimed to evaluate the effect of CM from ECM/SVF‐gel (Gel‐CM) on wound healing compared with the conventional CM from adipose tissue (Adi‐CM) and stem cell (SVF‐CM). In vitro wound healing effect of three CMs on keratinocytes and fibroblasts was evaluated in terms of proliferation property, migratory property, and extracellular matrix production. In vivo, two full‐thickness wounds were created on the back of each mice. The wounds were randomly divided to receive Gel‐CM, Adi‐CM, SVF‐CM, and PBS injection. Histologic observations and collagen content of wound skin were made. Growth factors concentration in three CMs was further quantified. In vitro, Gel‐CM promoted the proliferation and migration of keratinocytes and fibroblasts and enhanced collagen I synthesis in fibroblasts compared to Adi‐CM and SVF‐CM. In vivo, wound closure was faster, and dermal and epidermal regeneration was improved in the Gel‐CM‐treated mice compared to that in Adi‐CM and SVF‐CM‐treated mice. Moreover, The growth factors concentration (i.e., vascular endothelial growth factor, basic fibroblast growth factor, hepatocyte growth factor, and transforming growth factor‐β) in Gel‐CM were significantly higher than those in Adi‐CM and SVF‐CM. Gel‐CM generated under serum free conditions significantly enhanced wound healing effect compared to Adi‐CM and SVF‐CM by accelerating cell proliferation, migration, and production of ECM. This improved trophic effect may be attributed to the higher growth factors concentration in Gel‐CM. Gel‐CM shows potential as a novel and promising alternative to skin wound healing treatment. But limitations include the safety and immunogenicity studies of Gel‐CM still remain to be clearly clarified and more data on mechanism study are needed.
IMPROVING STABILITY OF CHLOROPHYLL AS NATURAL DYE FOR DYE-SENSITIZED SOLAR CELLS
Authors: Arifin Zainal , Soeparman Sudjito , Widhiyanuriyawan Denny , Suyitno Suyitno , Setyaji Argatya Tara
Published: December 2017

Natural dyes have attracted much researcher’s attention due to their low-cost production, simple synthesis processes and high natural abundance. However the dye-sensitized solar cells (DSSCs) based natural dyes have higher tendency to degradation. This article reports on the enhancement of performance and stability of dye-sensitized solar cells (DSSCs) using natural dyes. The natural dyes were extracted from papaya leaves by ethanol solvent at a temperature of 50 °C. Then the extracted dyes were isolated and modified into Mg-chlorophyll using column chromatography. Mg-chlorophyll was then synthesized into Fe-chlorophyll to improve stability. The natural dyes were characterized using ultraviolet-visible spectrometry, Fourier transform infrared spectroscopy, and cyclic voltammetry. The performance of DSSCs was tested using a solar simulator. The results showed the open-circuit voltage, the short-circuit current density, and the efficiency of the extracted papaya leaves-based DSSCs to be 325 mV, 0.36 mA/cm2, and 0.07%, respectively. Furthermore, the DSSCs with purified chlorophyll provide high open-circuit voltage of 425 mV and short-circuit current density of 0.45 mA/cm2. The use of Fe-chlorophyll for sensitizing the DSSCs increases the efficiency up to 2.5 times and the stability up to two times. The DSSCs with Fe-chlorophyll dyes provide open-circuit voltage, short-circuit current density, and efficiency of 500 mV, 0.62 mA/cm2, and 0.16%, respectively. Further studies to improve the current density and stability of natural dye-based DSSCs along with an improvement in the anchor between dyes and semiconducting layers are required.