bluuebunny/crossref_metadata_2025 huggingface dataset:
A review article on gastric varices with focus on the emerging role of endoscopic ultrasound-guided angiotherapy
Authors: Khoury Tawfik , Nadella Divya , Wiles Alex , Marshall Caitlin , Kumar Manoj , Shapira Gilad , Ludvik Nicholas , Schumann Alan , Mahamid Mahmud , Mizrahi Meir
Published: July 2018

Background

Gastric varices (GV) manifest in almost one-fifth of the patients with portal hypertension. Although primary pharmacological prevention of esophageal varices has been identified, there are limited therapeutic options that are optimal for GV bleeding. Recently, the use of endoscopic ultrasound (EUS)-guided angiotherapy [cyanoacrylate (CA) and coils] was introduced for the treatment of GV. Although CA injection is the recommended first-line therapeutic modality, it is associated with systemic, life-threatening embolization as well as technical instrumental challenges. Recently, EUS-guided coiling for GV was used with high safety profile.

Methods

This is a review of the current literature on the treatment of GV, focusing on the role of EUS-guided angiotherapy in the treatment of GV. We performed a Medline/PubMed search, and 37 relevant studies were extracted and examined.

Results

EUS-guided angiotherapy has shown a consistent favorable result among the several reports throughout the literature, with better safety and efficacy profile toward EUS-guided coiling; however, a combination treatment with EUS-guided coiling followed by glue injection has shown as well to reduce the embolization adverse events associated with glue injection.

Conclusion

EUS-guided angiotherapy and specifically EUS-guided coiling is an emerging promising technique and should be considered as a first-line therapeutic option for bleeding GV.
The Significant Value of Preoperative Prognostic Nutritional Index for Survival in Pancreatic Cancers
Authors: Liu Jiandong , Jiang Shanshan , Yang Xinghua , Li Xiaoqiang , Wang Ning
Published: July 2018

Nutritional status plays a significant value in the incidence of postoperative complications and survival rate after resection of cancers. The preoperative prognostic nutritional index (PNI) has recently been reported to be a simple, sensitive, and effective prognostic parameter in various cancers. We conducted a meta-analysis to explore the significant value of PNI in pancreatic cancers. We systematically searched electronic databases of PubMed, Embase, Cochrane Library, Web of Science, Wanfang Data, and Chinese National Knowledge Infrastructure. Then, relevant studies were selected to perform this meta-analysis. Eleven studies with a total of 2123 patients met the inclusion criteria of this meta-analysis. The pooled results revealed that a lower PNI was significantly correlated with poorer overall survival (hazard ratio, 1.57; 95% confidence interval, 1.40–1.77; P < 0.001). Preoperative PNI might be an efficient predictor of survival with pancreatic cancers.
Association of Admission Functional Status and Assistive Device Provision for Veterans Poststroke
Authors: Winkler Sandra L. , Kairalla John A. , Feng Hua
Published: July 2018

Objectives

The aims of the study were (a) to provide knowledge about the provision of assistive devices in practice and (b) to describe the challenges of standardizing device provision.

Design

This is a retrospective study using Department of Veteran Affairs National Prosthetic Patient Database and other administrative databases. The cohort included all veterans treated by the Veterans Health Administration for stroke during fiscal years 2007–2008. Descriptive methods were used to analyze data with emphasis on inspecting relationships between device provision and motor and cognitive function using Functional Independence Measure scores.

Results

A total of 8374 veterans treated for stroke and receiving at least one assistive device are included. Individuals who received standard or caregiver controlled wheelchairs tended to be older, and those who received ultralight or caregiver controlled wheelchairs had a higher proportion of Hispanics than the overall cohort. Veterans who received any type of wheelchair had lower motor, cognitive, and total functioning scores than the cohort as a whole. Veterans who received canes had the highest functioning. Veteran patients who received patient lifts and beds had lower cognitive scores compared with the overall cohort.

Conclusions

Functional status can provide some objectivity to the largely subjective assistive device provision decision-making process; however, many other factors must be considered simultaneously, complicating efforts to standardize provision.
Changes in Patient Safety Culture in Palestinian Public Hospitals: Impact of Quality and Patient Safety Initiatives and Programs
Authors: Hamdan Motasem , Saleem Abed Alra'oof
Published: July 2018

Objectives

To assess the changes in the patient safety culture between 2011 and 2016 after the implementation of patient safety initiative in Palestinian public hospitals.

Methods

A cross-sectional quantitative design employed using the Hospital Survey on Patient Safety Culture to collect data. Participants were 1,229 clinical and nonclinical employees from all public hospitals in the West Bank.

Results

Significant improvements were observed in patient safety culture with positive responses to 10 (83.3%) composite categories and 36 (86.0%) items of the Hospital Survey on Patient Safety Culture since the baseline survey in 2011 (P < 0.05). The increase in the percent of positive responses to the survey composites ranged from 9.1% (P < 0.001) to “Frequency of events reported” to 3.8% for “Teamwork across hospital units” (P < 0.001). Significant decrease in positive responses to “Staffing” (11.4%) was observed (P < 0.05); no significant change was observed in “Organizational learning—continuous improvement” (P > 0.05). Most participants (70.5%) rated patient safety level in their units/hospital as ‘Excellent/Very good’, with an increase of 6.3% from the baseline (P < 0.001); no significant increase in the number of reported events in the past 12 months was observed (P < 0.05).

Conclusions

Compared with the baseline survey results, patients’ safety initiatives and quality improvement programs had positive effect on the safety culture in public Palestinian hospitals.
Multimodal Imaging Study of Gadolinium Presence in Rat Cerebellum
Authors: Rasschaert Marlène , Schroeder Josef A. , Wu Ting-Di , Marco Sergio , Emerit Andréa , Siegmund Heiko , Fischer Claudia , Fretellier Nathalie , Idée Jean-Marc , Corot Claire , Brochhausen Christoph , Guerquin-Kern Jean-Luc
Published: July 2018

Purpose

The aim of this study was to investigate, based on in-depth multimodal imaging, the presence of Gd deposits, their ultrastructure, location, and co-location with endogenous elements, in the cerebellum, after repeated administrations of gadolinium-based contrast agents (GBCAs).

Methods

Rats sensitized by subtotal nephrectomy received 20 daily intravenous injections of 0.6 mmol Gd/kg for 5 weeks of commercial forms of either gadoterate, gadobenate or gadodiamide, or saline (n = 2/group). The study was randomized and blinded. Magnetic resonance imaging examination was performed weekly. One month after the last injection, electron microscopy analysis of the deep cerebellar nuclei, the granular layer of cerebellar cortex, and the choroid plexus was performed. Elemental analysis of deposits was carried out by electron energy loss spectroscopy. Secondary ion mass spectroscopy was used for complementary chemical mapping.

Results

A T1 hypersignal was evidenced in the deep cerebellar nuclei of rats treated with linear GBCAs, and Gd deposits were identified in all the studied cerebellar structures with gadobenate and gadodiamide (except in the granular layer in gadobenate-treated rats). No such effect was found with the macrocyclic GBCA gadoterate. Most of the Gd deposits revealed a characteristic spheroid “sea urchin-like” morphology, rich in phosphorus, and were localized in the basal lamina of microvessels, in the perivascular Virchow-Robin space, and in the interstitium. Gd was also identified in the glial cells, associated with lipofuscin pigments, for these same groups.

Conclusions

Transmission electron microscopy analysis of cerebellums of renally impaired rats repeatedly injected with gadobenate and gadodiamide revealed the presence of Gd. Spheroid Gd depositions consisting of a filamentous meshwork were observed in the wall of microvessels, in perivascular Virchow-Robin space, and in the interstitium. Gd was also found in choroid plexus and was associated with pigments (likely lipofuscin) in glial cells. This is consistent with the involvement of the glymphatic distribution pathway for GBCAs. No insoluble Gd deposits were detected in rats injected with the macrocyclic GBCA gadoterate and controls.
Cognitive Impairment Level and Elderly Hip Fracture: Implications in Rehabilitation Nursing
Authors: Jiménez Mola Sonia , Calvo-Lobo César , Idoate Gil Javier , Seco Calvo Jesús
Published: July 2018

Purpose

The aim of the study was to determine the cognitive impairment level influence in descriptive characteristics, comorbidities, complications, and pharmacological features of older adults with hip fracture.

Design

Cross-sectional study.

Method

Five hundred fifty-seven older adults with hip fracture were recruited and divided into cognitive impairment levels (severe/moderate, mild, no impairment). Descriptive characteristics, comorbidities, complications, and pharmacological data were collected.

Findings

Significant differences (p < .05, R
2 = .012–.475) between cognitive impairment levels were shown. Shorter presurgery hospital length of stay and lower depression and Parkinson comorbidities; delirium complication; and antidepressants, antiparkinsonians, and neuroleptics use were shown for the no-impairment group. With regard to the cognitive impairment groups, lower presence of cardiopathy and hypertension; higher presence of dementia; antihypertensives, antiplatelets, and antidementia medication; infection/respiratory insufficiency complications; and lower constipation complications were shown.

Conclusion

Cognitive impairment levels may determine the characteristics, comorbidities, pharmacology, and complications of older adults with hip fracture.

Clinical Relevance

Cognitive impairment level may impact rehabilitation nursing practice, education, and care coordination.
Facing the facts on prophylactic antibiotics for facial fractures: 1 day or less
Authors: Zosa Brenda M. , Elliott Charles W. , Kurlander David E. , Johnson Freedom , Ho Vanessa Phillis , Claridge Jeffrey A.
Published: July 2018

BACKGROUND

To evaluate the role of initial prophylactic antibiotics on facial fractures, outcomes were compared between a short course (≤24 hours) of antibiotics to those who received an extended course (>24 hours).

METHODS

Adults admitted (2010–2015) to a Level I trauma center intensive care unit with at least one facial bone fracture and major injuries isolated to the head and neck were included. Our primary analysis compared infectious complications of the head or neck (H/N infection) between patients given short or extended courses of antibiotic prophylaxis. Multivariate logistic regression and analysis of propensity score matched pairs were performed.

RESULTS

A total of 403 patients were included, 85.6% had blunt injuries and 72.7% had their facial fracture managed nonoperatively. The H/N infection rate was 11.2%. Two hundred eighty patients received a short course of antibiotics and 123 patients received an extended course. Median Injury Severity Score was 14 in both groups (p= 0.78). Patients receiving an extended course of antibiotics had higher rates of H/N infection (20.3% vs. 7.1%,p< 0.001). Factors associated with development of H/N infection included younger age, penetrating injury, open fracture, upper face or mandible fracture, fractures in multiple facial thirds, vascular injury, hypertension, and extended antibiotic course. Multivariate logistic regression identified younger age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96–1.00;p= 0.02), multiple facial third fractures (OR, 4.9; 95% CI, 2.4–10.2;p< 0.001), and penetrating mechanism (OR, 3.1; 95% CI, 1.5–6.4;p= 0.003) as independent predictors of H/N infection, but not antibiotic duration. Propensity score-matched analysis found no differences in H/N infection between short and extended antibiotic courses (11.4% vs. 12.5%;p= 1.0). Subgroup analyses demonstrated no differences in H/N infection between short or extended antibiotic courses by injury pattern, mechanism, or treatment (operative or nonoperative).

CONCLUSION

These results lead us to believe that we should limit antibiotics to 24 hours or less upon admission for facial fractures.

LEVEL OF EVIDENCE

Therapeutic/care management, level IV.
Abdominal Aortic and Junctional Tourniquet release after 240 minutes is survivable and associated with small intestine and liver ischemia after porcine class II hemorrhage
Authors: Brännström Andreas , Rocksén David , Hartman Johan , Nyman Niklas , Gustavsson Jenny , Arborelius Ulf P. , Günther Mattias
Published: July 2018

BACKGROUND

Uncontrolled hemorrhage is a leading cause of tactical trauma-related deaths. Hemorrhage from the pelvis and junctional regions are particularly difficult to control due to the inability of focal compression. The Abdominal Aortic and Junctional Tourniquet (AAJT) occludes aortic blood flow by compression of the abdomen. The survivability of tourniquet release beyond 120 minutes is unknown and fluid requirements to maintain sufficient blood pressure during prolonged application are undetermined. We therefore compared 60-minute and 240-minute applications and release of the AAJT for 30 minutes, with crystalloid fluid therapy, after a Class II hemorrhage.

METHODS

Sixty-kilogram anesthetized pigs were subjected to 900-mL hemorrhage and AAJT application for 60 minutes (n = 5), 240 minutes (n = 5), and fluid therapy only for 240 minutes (n = 5) and reperfusion for 30 minutes.

RESULTS

The AAJT application was hemodynamically and respiratory tolerable for 60 minutes and 240 minutes. Cumulative fluid requirements decreased by 64%, comparable to 3000 mL of crystalloids. Mechanical ventilation was impaired. AAJT increased the core temperature by 0.9°C compared with fluid therapy. Reperfusion consequences were reversible after 60 minutes but not after 240 minutes. A 240-minute application resulted in small intestine and liver ischemia, persisting hyperkalemia, metabolic acidosis, and myoglobinemia, suggesting rhabdomyolysis.

CONCLUSION

The AAJT application for 240 minutes with reperfusion was survivable in an intensive care setting and associated with abdominal organ damage. Long time consequences and spinal cord effects was not assessed. We propose an application time limit within 60 minutes to 240 minutes, though further studies are needed to increase the temporal resolution. The AAJT application may be considered as a rescue option to maintain central blood pressure and core temperature in cases of hemorrhagic shock from extremity bleedings, if fluid therapy is unavailable or if the supply is limited.

LEVEL OF EVIDENCE

Therapeutic study, level II.
A comparison of resuscitation intensity and critical administration threshold in predicting early mortality among bleeding patients: A multicenter validation in 680 major transfusion patients
Authors: Meyer David E. , Cotton Bryan A. , Fox Erin E. , Stein Deborah , Holcomb John B. , Cohen Mitchell , Inaba Kenji , Rahbar Elaheh
Published: July 2018

BACKGROUND

To address deficiencies associated with the classic definition of massive transfusion (MT), critical administration threshold (CAT) and resuscitation intensity (RI) were developed to better quantify the overall severity of illness and predict the need for transfusions and early mortality. We sought to evaluate these as more appropriate replacements for MT in defining mortality risk in patients undergoing major transfusions.

METHODS

Patients predicted to receive MT at 12 Level I trauma centers were randomized in the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial. MT of 10 U or greater red blood cell (RBC) in 24 hours; CAT+, 3 U or greater RBC in the first hour; and RI, total products in the first 30 minutes (1 U RBC, 1 U plasma, 1000 mL crystalloid, 500 mL colloid each valued at 1 U). Resuscitation intensity was evaluated as a continuous variable and dichotomized as RI4+, where RI is 4 U or greater. Each metric was evaluated for its ability to predict mortality at 3 hours, 6 hours, and 24 hours, and at 30 days.

RESULTS

Of the 680 patients, 301 patients met MT definition, 521 were CAT+, and 445 were RI4+. Of those that died, 23% never reached MT threshold, but all were captured by CAT+ and RI4+. The 3-hour (9% vs. 9%), 6-hour (14% vs. 14%), 24-hour (17% vs. 18%), and 30-day mortality rates (28% vs. 29%) were similar between CAT+ and RI4+ patients. When RI was evaluated as a continuous variable, each unit increase was associated with a 20% increase in hemorrhage-related mortality (odds ratio, 1.20; 95% confidence interval, 1.15–1.29; p < 0.05).

CONCLUSION

Both RI and CAT are valid surrogates for early mortality in patients undergoing major transfusion, capturing patients omitted by the MT definition. The CAT+ showed the best sensitivity; RI4+ demonstrated better specificity and good positive predictive values and negative predictive values. While CAT+ may be suited for patients receiving an RBC-dominant resuscitation, RI4+ is more comprehensive. RI can also be used as a continuous variable to provide quantitative as well as qualitative risk of death.

LEVEL OF EVIDENCE

Prognostic, level III.
Severely injured trauma patients with admission hyperfibrinolysis: Is there a role of tranexamic acid? Findings from the PROPPR trial
Authors: Khan Muhammad , Jehan Faisal , Bulger Eileen M. , O'Keeffe Terence , Holcomb John B. , Wade Charles E. , Schreiber Martin A. , Joseph Bellal
Published: July 2018

INTRODUCTION

Administration of tranexamic acid (TXA) in coagulopathy of trauma gained popularity after the CRASH-2 trial. The aim of our analysis was to analyze the role of TXA in severely injured trauma patients with admission hyperfibrinolysis.

METHODS

We reviewed the prospectively collected Pragmatic, Randomized Optimal Platelet and Plasma Ratios database. We included patients with admission hyperfibrinolysis (Ly30 >3%) on thromboelastography. Patients were stratified into two groups (TXA and No-TXA) and were matched in 1:2 ratio using propensity score matching for demographics, admission vitals, and injury severity. Primary outcome measures were 6-, 12-, and 24-hour and 30-day mortality; 24-hour transfusion requirements; time to achieve hemostasis; and rebleeding after hemostasis requiring intervention. Secondary outcome measures were thrombotic complications.

RESULTS

We analyzed 680 patients. Of those, 118 had admission hyperfibrinolysis, and 93 patients (TXA: 31 patients; No-TXA: 62 patients) were matched. Matched groups were similar in age (p = 0.33), gender (p = 0.84), race (p = 0.81), emergency department (ED) Glasgow Coma Scale (p = 0.34), ED systolic blood pressure (p = 0.28), ED heart rate (p = 0.43), mechanism of injury (p = 0.45), head Abbreviated Injury Scale score (p = 0.68), injury severity score (p = 0.56), and blood products ratio (p = 0.44). Patients who received TXA had a lower 6-hour mortality rate (34% vs. 13%, p = 0.04) and higher 24-hour transfusion of plasma (15 vs. 10 units, p = 0.03) compared with the No-TXA group. However, there was no difference in 12-hour (p = 0.24), 24-hour (p = 0.25), and 30-day mortality (p = 0.82). Similarly, there was no difference in 24-hour transfusion of RBC (p = 0.11) or platelets (p = 0.13), time to achieve hemostasis (p = 0.65), rebleeding requiring intervention (p = 0.13), and thrombotic complications (p = 0.98).

CONCLUSION

Tranexamic acid was associated with increased 6-hour survival but does not improve long-term outcomes in severely injured trauma patients with hemorrhage who develop hyperfibrinolysis. Moreover, TXA administration was not associated with thrombotic complications. Further randomized clinical trials will identify the subset of trauma patients who may benefit from TXA.

LEVEL OF EVIDENCE

Therapeutic study, level III.
Waiting List Mortality and Transplant Rates for NASH Cirrhosis When Compared With Cryptogenic, Alcoholic, or AIH Cirrhosis
Authors: Thuluvath Paul J. , Hanish Steven , Savva Yulia
Published: July 2018

Background

Patients with nonalcoholic steatohepatitis (NASH) cirrhosis have excellent postliver transplant survival despite having many comorbidities. We hypothesized that this could be due to a selection bias.

Methods

We analyzed the United Network for Organ Sharing data from 2002 to 2016 and compared postliver transplant survival of NASH (n = 7935) patients with cryptogenic cirrhosis (CC) (n = 6087), alcoholic cirrhosis (AC) (n = 16 810), and autoimmune hepatitis cirrhosis (AIH) (n = 2734).

Results

By 3 years of listing, the cumulative incidence (CI) of death or deterioration was 29% for NASH, 28% for CC and AC, and 24% for AIH, but when adjusted for risk factors, the CI was similar for NASH and AIH. The factors that increased the risk of waiting list removal due to death/deterioration were poor performance status, encephalopathy, diabetes, high Model for End-stage Liver Disease, Hispanic race, older age and a low serum albumin. Most patients were transplanted within the first year (median, 2 months; interquartile range, 1-7 months) of listing and by 5 years, the unadjusted CI of transplantation was 54% for NASH, 52% for CC, 51% for AIH, and 48% for AC. The adjusted CI of transplantation within 2 months of listing was higher for AC (subhazard ratio [SHR], 1.17), AIH (SHR, 1.17), and CC (SHR, 1.13) when compared with NASH, but after 2 months, adjusted transplantation rates decreased in AC (SHR, 0.6), AIH (SHR, 0.78), and CC (SHR, 0.95). The negative predictors of receiving a transplant were dialysis, female sex, nonwhite race, high albumin, and creatinine.

Conclusions

Patients with NASH cirrhosis are not disadvantaged by higher waitlist removal or lower transplantation rates.
The Spectral Footprints of Periodic and Rhythmic Patterns
Authors: Johnson Emily L. , Kaplan Peter W. , Ritzl Eva K.
Published: July 2018

Visual displays of quantitative EEG, consisting of mathematical processing of EEG signals for graphical display, are powerful tools to enhance review of raw EEG. Quantitative EEG is widely used for seizure detection and for delayed cerebral ischemia detection, and it improves efficiency of long-term monitoring review. Here, we review the signature “footprints” of periodic and rhythmic patterns on quantitative EEG. While changes in the frequency and rhythmicity shown on quantitative EEG can highlight these patterns, review of raw EEG to evaluate and confirm the pattern is vital.
Ictal–Interictal Continuum
Authors: Kalamangalam Giridhar P. , Pohlmann-Eden Bernhard
Published: July 2018

The term “ictal–interictal” continuum has seen wide adoption in the critical care EEG domain, referring to the presence of abnormal periodic activity on the scalp EEG variably associated with seizures. The historical origin of the ictal–interictal continuum concept is discussed with a review of known and surmised physiological mechanisms for their origin and relationship to seizures. Therapeutic approaches to patients exhibiting ictal–interictal continuum EEG patterns are reviewed, and some open scientific questions highlighted. Further understanding of the ictal–interictal continuum is likely to significantly improve the care of the critically ill neurological patient.
Approach to Managing Periodic Discharges
Authors: Bauerschmidt Andrew , Rubinos Clio , Claassen Jan
Published: July 2018

Use of continuous EEG monitoring in the intensive care unit setting has increased detection of not only subclinical seizures, but also patterns of discharges that have epileptiform features and periodicity yet do not meet the criteria for seizures. These periodic discharges present a clinical challenge: some patterns may reflect brain injury that has already occurred, although there is evidence that some periodic discharges represent an ongoing process causing additional brain injury and necessitate treatment. Herein, we review the available data regarding the clinical significance of different categories of periodic discharges, specifically those that have features physiologically similar to seizures. We propose a stepwise approach to assessment and management of periodic discharges and lay out the general paradigm of (1) clinical assessment including benzodiazepine trial, (2) EEG assessment, with a focus on discharge frequency, and (3) integration of adjunctive data such as neuroimaging and metabolic data when available. A flowchart is provided to simplify and summarize this approach. The goal of this approach is to treat patterns associated with increased risk of seizures and/or additional brain injury, while avoiding unnecessary interventions.
Neuroimaging Correlates of Periodic Discharges
Authors: Herlopian Aline , Struck Aaron F. , Rosenthal Eric , Westover Brandon M.
Published: July 2018

Despite being first described over 50 years ago, periodic discharges continue to generate controversy as to whether they are always, sometimes, or never “ictal.” Investigators and clinicians have proposed adjunctive markers to help clarify this distinction—in particular measures of perfusion and metabolism. Here, we review the growing number of neuroimaging studies using Fluorodeoxyglucose-PET, MRI diffusion, Magnetic resonance perfusion, Single Photon Emission Computed Tomography, and Magnetoencepgalography to gain further insight into the physiology and clinical significance of periodic discharges. To date, however, no definitive consensus exists regarding the features of periodic discharges that warrant treatment intensification. However, an emerging consilience among neuroimaging modalities suggests that periodic discharges can induce a hyperexcitatory state with associated hypermetabolism and hyperperfusion, which may result in local metabolic failure.
Functional exploration of natural networks and ecological communities
Authors: Ankenbrand Markus J. , Hohlfeld Sonja C. Y. , Weber Lorenz , Förster Frank , Keller Alexander
Published: July 2018

Species composition assessment of ecological communities and networks is an important aspect of biodiversity research. Yet often ecological traits of organisms in a community are more informative than scientific names only. Furthermore, other properties like threat status, invasiveness, or human usage are relevant to many studies, but cannot be evaluated from taxonomy alone. Despite public databases collecting such information, it is still a tedious manual task to enrich community analyses with such, especially for large‐scaled data.

Thus we aimed to develop a public and free tool that eases bulk trait mapping of community data in a web browser, implemented with current standard web and database technologies.

Here, we present the Fennec (Functional Exploration of Natural Networks and Ecological Communities), a workbench that eases the process of mapping publicly available trait data to the user's communities in an automated process. Usage is either by a local self‐hosted or a public instance (https://fennec.molecular.eco) covering exemplary traits. Alongside the software, we also provide usage and hosting documentation as well as online tutorials.

The Fennec aims to motivate public trait data submission and its reuse in meta‐analyses. Further, it is an open‐source development project with the code freely available to use and open for community contributions (https://github.com/molbiodiv/fennec).
Egg masses of some stream‐dwelling caddisflies (Trichoptera: Hydrobiosidae) from Victoria, Australia
Authors: Lancaster Jill , Glaister Alena
Published: July 2018

Eggs are a largely neglected life stage in most ecological studies of aquatic insects, despite the importance of oviposition behaviour and fecundity estimates for many research questions. Incorporating egg stages into ecological research requires that ecologists can identify and quantify eggs, but descriptions of eggs and egg masses are scarce for many groups and particularly for Australian taxa. This paper focusses on stream‐dwelling caddisflies in the family Hydrobiosidae and provides species‐level identifications, morphological descriptions and images of egg masses of some species that commonly occur in south‐eastern Australia. All the species we identified laid plaque‐shaped egg masses attached to the underside of river rocks that protrude above the water surface. These egg masses can be identified in the field with the naked eye or the aid of a low‐magnification hand lens. Interspecific variations in egg mass morphology were primarily thickness and firmness of the spumaline layer, egg mass size and arrangement of eggs within the mass. We also provide some ecological information on clutch sizes and the physical characteristics of oviposition sites, and we discuss various ways in which these taxa could be exploited as model systems for ecological research.
Neurodevelopmental subtypes of bipolar disorder are related to cortical folding patterns: An international multicenter study
Authors: Sarrazin Samuel , Cachia Arnaud , Hozer Franz , McDonald Colm , Emsell Louise , Cannon Dara M , Wessa Michele , Linke Julia , Versace Amelia , Hamdani Nora , D'Albis Marc‐Antoine , Delavest Marine , Phillips Mary L. , Brambilla Paolo , Bellani Marcella , Polosan Mircea , Favre Pauline , Leboyer Marion , Mangin Jean‐François , Houenou Josselin
Published: July 2018

Objectives

Brain sulcation is an indirect marker of neurodevelopmental processes. Studies of the cortical sulcation in bipolar disorder have yielded mixed results, probably due to high variability in clinical phenotype. We investigated whole‐brain cortical sulcation in a large sample of selected patients with high neurodevelopmental load.

Methods

A total of 263 patients with bipolar disorder I and 320 controls were included in a multicentric magnetic resonance imaging (MRI) study. All subjects underwent high‐resolution T1‐weighted brain MRI. Images were processed with an automatized pipeline to extract the global sulcal index (g‐SI) and the local sulcal indices (l‐SIs) from 12 a priori determined brain regions covering the whole brain. We compared l‐SI and g‐SI between patients with and without early‐onset bipolar disorder and between patients with and without a positive history of psychosis, adjusting for age, gender and handedness.

Results

Patients with early‐onset bipolar disorder had a higher l‐SI in the right prefrontal dorsolateral region. Patients with psychotic bipolar disorder had a decreased l‐SI in the left superior parietal cortex. No group differences in g‐SI or l‐SI were found between healthy subjects and the whole patient cohort. We could replicate the early‐onset finding in an independent cohort.

Conclusions

Our work suggests that bipolar disorder is not associated with generalized abnormalities of sulcation, but rather with localized changes of cortical folding restricted to patients with a heavy neurodevelopmental loading. These findings support the hypothesis that bipolar disorder is heterogeneous but may be disentangled using MRI, and suggest the need for investigations into neurodevelopmental deviations in the disorder.
How self‐generated labelling shapes transfer of learning during early childhood: The role of individual differences
Authors: Moser Alecia , Olsen Sarah , Rusnak Sylvia N. , Barr Rachel , Gerhardstein Peter
Published: July 2018

Multiple factors influence imitation during toddlerhood, including task complexity, social contingency, and individual differences. We conducted a secondary data analysis of individual differences in self‐generated labelling using data collected from a complex puzzle imitation task with 355 2‐ to 3‐year‐olds. This analysis indicated that toddlers’ ability to label the completed puzzle (fish or boat) was associated with better imitation performance. Labelling occurs during social interactions; therefore, our second analysis tested how labelling differed as a function of the level of social scaffolding in each condition. This analysis revealed that self‐generated labelling was lower when the social demonstrator was removed and the task was presented on a touchscreen. This study is one of the first to examine self‐generated labelling during a complex imitation task in toddlers and increases our understanding of the complexity of memory processing needed for imitation learning.

Statement of contribution

What is already known on this subject?

Toddlers exhibit a transfer of learning deficit from 2D media, including books, TV, and tablets.

Self‐generated labelling enhances children's learning, through attentional and cognitive mechanisms.

Children are sensitive to reduced social cues in screen media contributing to the transfer deficit.

What does this study add?

Self‐generated labelling is associated with better goal imitation performance.

Self‐generated labelling occurs more frequently under social conditions.
Targeting toll‐like receptor 4 signalling pathways: can therapeutics pay the toll for hypertension?
Authors: Nunes Kenia Pedrosa , de Oliveira Amanda Almeida , Mowry Francesca Elisabeth , Biancardi Vinicia Campana
Published: July 2018

The immune system plays a prominent role in the initiation and maintenance of hypertension. The innate immune system, via toll‐like receptors (TLRs), identifies distinct signatures of invading microbes and damage‐associated molecular patterns and triggers a chain of downstream signalling cascades, leading to secretion of pro‐inflammatory cytokines and shaping the adaptive immune response. Over the past decade, a dysfunctional TLR‐mediated response, particularly via TLR4, has been suggested to support a chronic inflammatory state in hypertension, inducing deleterious local and systemic effects in host cells and tissues and contributing to disease progression. While the underlying mechanisms triggering TLR4 need further research, evidence suggests that sustained elevations in BP disrupt homeostasis, releasing endogenous TLR4 ligands in hypertension. In this review, we discuss the emerging role of TLR4 in the pathogenesis of hypertension and whether targeting this receptor and its signalling pathways could offer a therapeutic strategy for management of this multifaceted disease.

Linked Articles

This article is part of a themed section on Immune Targets in Hypertension. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.12/issuetoc
Novel chemical compound SINCRO with dual function in STING‐type I interferon and tumor cell death pathways
Authors: Kimura Yoshitaka , Negishi Hideo , Matsuda Atsushi , Endo Nobuyasu , Hangai Sho , Inoue Asuka , Nishio Junko , Taniguchi Tadatsugu , Yanai Hideyuki
Published: July 2018

Recent years have seen a number of regulatory approvals for immune oncology or immunotherapies based on their ability to enhance antitumor immune responses. Nevertheless, the majority of patients remain refractory to these treatments; hence, new therapies that augment current immunotherapies are required. Innate immune receptors that recognize nucleic acids are potent activators of subsequent T‐cell responses and, as a result, can evoke potent antitumor immune responses. Herein, we present a novel compound N‐{3‐[(1,4′‐bipiperidin)‐1′‐yl]propyl}‐6‐[4‐(4‐methylpiperazin‐1‐yl)phenyl]picolinamide (SINCRO; STING‐mediated interferon‐inducing and cytotoxic reagent, original) as an anticancer drug that activates the cytosolic DNA‐sensing STING (stimulator of interferon genes) signaling pathway leading to the induction of type I interferon (IFN) genes. Indeed, IFN‐β gene induction by SINCRO is abolished in STING‐deficient cells. In addition to its IFN‐inducing activity, SINCRO shows STING‐independent cytotoxic activity against cancer cells. SINCRO does not evoke DNA double‐strand break or caspase‐3 cleavage. Thus, SINCRO induces cell death in a method different from conventional apoptosis‐inducing pathways. Finally, we provide evidence that giving SINCRO significantly attenuates in vivo tumor growth by both type I IFN‐dependent and independent mechanisms. Thus, SINCRO is an attractive anticancer compound with dual function in that it evokes type I IFN response to promote antitumor immunity as well as inducing tumor cell death. SINCRO may provide a new platform for the development of drugs for effective cancer therapy.
Updated long‐term outcomes after carbon‐ion radiotherapy for primary renal cell carcinoma
Authors: Kasuya Goro , Tsuji Hiroshi , Nomiya Takuma , Makishima Hirokazu , Haruyama Yasuo , Kobashi Gen , Ebner Daniel K. , Hayashi Kazuhiko , Omatsu Tokuhiko , Kishimoto Riwa , Yasuda Shigeo , Igarashi Tatsuo , Oya Mototsugu , Akakura Koichiro , Suzuki Hiroyoshi , Ichikawa Tomohiko , Shimazaki Jun , Kamada Tadashi ,   the Working Group for Genitourinary Tumors
Published: July 2018

Long‐term oncological outcomes for primary renal cell carcinoma (RCC) treated with carbon‐ion radiotherapy (CIRT) are poorly understood. Patients with primary RCC were treated with 12 or 16‐fraction CIRT at The Hospital of the National Institute of Radiological Sciences outside of clinical trials. Outcome data were pooled and retrospectively analyzed for toxicity, local control, and disease‐free, cancer‐specific, and overall survival. From 1997 to 2014, 19 RCC patients (11 with T1aN0M0, 4 with T1bN0M0, and 4 with inoperable advanced stage [T4N0M0, T3aN1M0, and T1aN0M1]) were treated with CIRT and followed up for a median of 6.6 (range, 0.7‐16.5) years; 9 of these patients were inoperable because of comorbidities or advanced‐stage disease. Diagnoses were confirmed by imaging in 11 patients and by biopsy in the remaining 8. In 4 of 5 patients with definitive renal comorbidities, including diabetic nephropathy, sclerotic kidney or solitary kidney pre‐CIRT progressed to grade 4 chronic kidney disease (CKD). In contrast, the remaining 14 patients without definitive renal comorbidities did not progress to grade 3 or higher CKD. Furthermore, although 1 case of grade 4 dermatitis was observed, there were no other grade 3 or higher non‐renal adverse events. Local control rate, and disease‐free, cancer‐specific, and overall survival rates at 5 years of all 19 patients were 94.1%, 68.9%, 100%, and 89.2%, respectively. This updated retrospective analysis based on long‐term follow‐up data suggests that CIRT is a safe treatment for primary RCC patients without definitive renal comorbidities pre‐CIRT, and yield favorable treatment outcomes, even in inoperable cases.
High expression of CD44v9 and xCT in chemoresistant hepatocellular carcinoma: Potential targets by sulfasalazine
Authors: Wada Fumitaka , Koga Hironori , Akiba Jun , Niizeki Takashi , Iwamoto Hideki , Ikezono Yu , Nakamura Toru , Abe Mitsuhiko , Masuda Atsutaka , Sakaue Takahiko , Tanaka Toshimitsu , Kakuma Tatsuyuki , Yano Hirohisa , Torimura Takuji
Published: July 2018

CD44v9 is expressed in cancer stem cells (CSC) and stabilizes the glutamate‐cystine transporter xCT on the cytoplasmic membrane, thereby decreasing intracellular levels of reactive oxygen species (ROS). This mechanism confers ROS resistance to CSC and CD44v9‐expressing cancer cells. The aims of the present study were to assess: (i) expression status of CD44v9 and xCT in hepatocellular carcinoma (HCC) tissues, including those derived from patients treated with hepatic arterial infusion chemoembolization (HAIC) therapy with cisplatin (CDDP); and (ii) whether combination of CDDP with sulfasalazine (SASP), an inhibitor of xCT, was more effective on tumor cells than CDDP alone by inducing ROS‐mediated apoptosis. Twenty non‐pretreated HCC tissues and 7 HCC tissues administered HAIC therapy with CDDP before surgical resection were subjected to immunohistochemistry analysis of CD44v9 and xCT expression. Human HCC cell lines HAK‐1A and HAK‐1B were used in this study; the latter was also used for xenograft experiments in nude mice to assess in vivo efficacy of combination treatment. CD44v9 positivity was significantly higher in HAIC‐treated tissues (5/7) than in non‐pretreated tissues (2/30), suggesting the involvement of CD44v9 in the resistance to HAIC. xCT was significantly expressed in poorly differentiated HCC tissues. Combination treatment effectively killed the CD44v9‐harboring HAK‐1B cells through ROS‐mediated apoptosis and significantly decreased xenografted tumor growth. In conclusion, the xCT inhibitor SASP augmented ROS‐mediated apoptosis in CDDP‐treated HCC cells, in which the CD44v9‐xCT system functioned. As CD44v9 is typically expressed in HAIC‐resistant HCC cells, combination treatment with SASP with CDDP may overcome such drug resistance.
A retrospective comparative study of venous vs nonringed expanded polytetrafluoroethylene extension grafts for anterior sector outflow reconstruction in right lobe living donor liver transplantation
Authors: Goja Sanjay , Yadav Sanjay K. , Roy Rahul , Soin Arvinder S.
Published: July 2018

Background

Prosthetic vessel grafts are increasingly being used for anterior sector (AS) outflow reconstruction in right lobe living donor liver transplantation (RL‐LDLT) in view of easy availability and proper fit. The aim of the study was to analyze technique and outcomes of AS reconstruction using nonringed expanded polytetrafluoroethylene (ePTFE) grafts and compare outcomes with venous extension grafts.

Methods

This is a retrospective study of 437 consecutive RL‐LDLTs from January 2014 to August 2015. Vein (V) and ePTFE (alone or composite) were used alternatively or best fit for particular right lobe graft.

Result

V graft was used in 200 recipients and ePTFE in 237 recipients with comparable preoperative donor and recipient characteristics. Cold ischemia time was significantly high in the ePTFE group. Postoperative recipient outcomes were comparable between the groups. The graft patency rate was comparable between the groups at different time intervals of follow‐up. However, 12‐month patency was low in those with multiple venous tributaries than with single outflow reconstruction ([V 90%, ePTFE 86.7%] vs [V 97.4%, ePTFE 95.2%]). No patient was re‐explored for graft blockage. There was no significant difference in 30‐day (V 92%, ePTFE 94.5%, P = 0.34), 90‐day (V 90%, ePTFE 90.7%, P = 0.87) and one‐year (V 87.5%, ePTFE 89%, P = 0.66) patient survival between the groups.

Conclusion

Expanded polytetrafluoroethylene gives equivalent patency and recipient outcomes with the added advantage of proper size match fit, allowing more complex AS reconstruction with ease without increased infection rate or associated complications.
Cranial ultrasound and neurophysiological testing to predict neurological outcome in infants born very preterm
Authors: Franckx Helen , Hasaerts Daniele , Huysentruyt Koen , Cools Filip
Published: July 2018

Aim

Infants born preterm are at risk of cerebral palsy (CP) and motor or cognitive developmental delay. For clinicians, it is essential to know the relative predictive accuracy of the most commonly used neuroimaging and neurophysiological tests for the early prediction of adverse neurodevelopmental outcome. The aim of this study was to compare the accuracy of these tests in survivors of a population of infants born very preterm.

Method

A retrospective cohort study was performed in 163 children born before 32 weeks gestational age. We compared the accuracy in predicting adverse neurodevelopmental outcome at the age of 2 years 6 months of early and late cranial ultrasound (CUS), magnetic resonance imaging, somatosensory evoked potentials after stimulation of the posterior tibial nerve, and electroencephalography by calculating positive and negative likelihood ratios.

Results

An abnormal early CUS is the best predictor of the presence of CP (positive likelihood ratio 6.09), motor developmental delay (positive likelihood ratio 3.11), and cognitive developmental delay (positive likelihood ratio 5.66). Overall, negative likelihood ratios were poor, ranging between 0.49 and 0.98, meaning that a normal test result had only minimal influence on the probability of adverse neurological outcome.

Interpretation

None of the diagnostic tests had a good performance in predicting future neurodevelopmental problems in infants born preterm. A normal test result provided very little clinically useful information.

What this paper adds

An abnormal early cranial ultrasound (positive test result) is the best predictor of adverse neurodevelopmental outcome.

All negative results have poor predictive value of future neurodevelopmental problems.
Echocardiography in transcatheter aortic (Core)Valve implantation: Part 2—Transesophageal echocardiography
Authors: Naqvi Tasneem Z.
Published: July 2018

Transesophageal echocardiography (TEE) plays a significant role during transcatheter aortic valve implantation (TAVR). 2DTEE allows assessment of anatomy of the aortic valve, aortic root, left ventricular (LV) outflow tract, severity of the aortic valve stenosis (AS), and the presence and severity of other valve stenosis and regurgitation. Left and right ventricular size and global function as well as cardiac hemodynamics pre and post TAVR and LV regional wall motion can be assessed. Three‐dimensional (3D) imaging adds significantly via accurate measurement of aortic annulus that helps select the appropriate valve size. Biplane imaging allows simultaneous assessment of target cardiac structure in two orthogonal views and provides a rapid assessment during and immediately post valve deployment by evaluating stent height, leaflet motion, and the presence and severity of paravalvular leak (PVL). 2DTEE and 3DTEE allow evaluation of mechanism of PVL that helps guide the decision regarding need for balloon post dilation of the implanted valve or valve in valve implantation.
Clinical and echocardiographic predictors of new‐onset atrial fibrillation in patients admitted with blunt trauma
Authors: Morsy Mohamed , Slomka Teresa , Shukla Anuj , Uppal Dipan , Bomb Ritin , Akinseye Oluwaseun A. , Koshy Santhosh K. G. , Garg Nadish
Published: July 2018

Background

Atrial fibrillation (AF) is a common arrhythmia after trauma or burn injury; however, its predisposing factors are not well known. Moreover, little is known about its effect on mortality and other short‐term clinical outcomes.

Objectives

This study is aimed at identifying risk factors for new‐onset AF in patients admitted with blunt trauma or burn injuries at a Level 1 academic trauma center, and to determine its effects on the short‐term clinical outcomes.

Methods

This case–control study compared patients with new‐onset AF with a cohort of patients without AF during the hospital stay after trauma or burn injury. Patients with prior AF or lack of transthoracic echocardiogram were excluded. Demographic, clinical factors including injury severity score and echocardiographic parameters were compared in both cohorts. Risks of short‐term clinical outcomes, namely persistent AF, new stroke, myocardial infarction, or death, were compared.

Results

Older age, sepsis, CHADS2‐VASC score >1, larger left atrium (LA) size, left ventricular hypertrophy (LVH), and left ventricular diastolic dysfunction imposed a significant risk for new‐onset AF on univariate analysis. On multivariate, independent predictors of new‐onset AF were LA dilation and LVH. LA enlargement increased odds of new‐onset AF by 23‐fold (OR 23; CI: 5.7–92, P < 0.0001) and the presence of LVH increased the odds of new‐onset AF more than 20‐fold (OR 20.8; CI: 5–87, P < 0.0001).

Conclusions

Dilated LA and LVH are independent predictors of new‐onset AF in the patients with blunt trauma or burn. New‐onset AF did not confer increased risk for in‐hospital mortality.