bluuebunny/crossref_metadata_2025 huggingface dataset:
Berberine Ameliorates Periodontal Bone Loss by Regulating Gut Microbiota
Authors: Jia X. , Jia L. , Mo L. , Yuan S. , Zheng X. , He J. , Chen V. , Guo Q. , Zheng L. , Yuan Q. , Xu X. , Zhou X.
Published: September 2018

Postmenopausal osteoporosis (PMO) is a risk factor for periodontitis, and current therapeutics against PMO prevent the aggravated alveolar bone loss of periodontitis in estrogen-deficient women. Gut microbiota is recognized as a promising therapeutic target for PMO. Berberine extracted from Chinese medicinal plants has shown its effectiveness in the treatment of metabolic diseases such as obesity and diabetes via regulating gut microbiota. Here, we hypothesize that berberine ameliorates periodontal bone loss by improving the intestinal barriers by regulating gut microbiota under an estrogen-deficient condition. Experimental periodontitis was established in ovariectomized (OVX) rats, and the OVX-periodontitis rats were treated with berberine for 7 wk before sacrifice for analyses. Micro–computed tomography and histologic analyses showed that berberine treatment significantly reduced alveolar bone loss and improved bone metabolism of OVX-periodontitis rats as compared with the vehicle-treated OVX-periodontitis rats. In parallel, berberine-treated OVX-periodontitis rats harbored a higher abundance of butyrate-producing gut microbiota with elevated butyrate generation, as demonstrated by 16S rRNA sequencing and high-performance liquid chromatography analysis. Berberine-treated OVX-periodontitis rats consistently showed improved intestinal barrier integrity and decreased intestinal paracellular permeability with a lower level of serum endotoxin. In parallel, IL-17A-related immune responses were attenuated in berberine-treated OVX-periodontitis rats with a lower serum level of proinflammatory cytokines and reduced IL-17A+ cells in alveolar bone as compared with vehicle-treated OVX-periodontitis rats. Our data indicate that gut microbiota is a potential target for the treatment of estrogen deficiency–aggravated periodontal bone loss, and berberine represents a promising adjuvant therapeutic by modulating gut microbiota.
Book Review: Krupa Shandilya, Intimate Relations: Social Reform and the Late Nineteenth-Century South Asian Novel
Authors: Paiker Ufaque
Published: September 2018

Krupa Shandilya, Intimate Relations: Social Reform and the Late Nineteenth-Century South Asian Novel. Hyderabad: Orient BlackSwan, 2017, 157 pp., ₹525, ISBN: 978 93 86392 53 4 (Paperback).
Book Review: Lakshmidhar Mishra, Discovery of Truth and Nothing but Truth: Memoirs of a Civil Servant
Authors: Saxena K. B.
Published: September 2018

Lakshmidhar Mishra, Discovery of Truth and Nothing but Truth: Memoirs of a Civil Servant. New Delhi: Aakar Books, 2017, 318 pp., ₹2,572, ISBN: 9789350024911 (Hardcover).
Linking News Value Theory With Online Deliberation: How News Factors and Illustration Factors in News Articles Affect the Deliberative Quality of User Discussions in SNS’ Comment Sections
Authors: Ziegele Marc , Quiring Oliver , Esau Katharina , Friess Dennis
Published: September 2018

Previous research suggests that distinct characteristics of news articles, such as their news factors, account for the different participation rates in comment sections as well as the degree of interactivity among the discussants. In this study, this assumption is tested in the Facebook environment and extended to the analysis of how news factors (i.e., event characteristics) and illustration factors (i.e., characteristics resulting from a specific journalistic editing) of news articles predict the inclusiveness of discussions, as well as the occurrence of civility, rationality, and deliberative interactivity in user comments. A content analysis of 619 news articles and 11,218 related user comments on nine nation-wide Facebook news pages reveals that the news factors controversy, latent conflict, contravention, obtrusiveness, and impact particularly account for specific discussion qualities. The results also show that the illustration factors emotional language/ visualizations, slant, and conversational prompts affect the deliberative quality of the discussions.
Diffusion-based swelling in elastomers under low- and high-salinity brine
Authors: Akhtar Maaz , Qamar Sayyad Zahid , Mehdi Syed Murtuza , Hussain Ahmad
Published: September 2018

Swelling elastomers are designed to swell when immersed into fluids like water, oil, or acid. The mechanism of swelling can be either diffusion or osmosis, initiating the imbibition of fluid inside the elastomer and progressively swelling it. Work presented here investigates diffusion as the swelling mechanism. Swelling experiments are conducted at two temperatures (room and 50°C) using water of different salinities (0.6% and 12%) as the swelling medium. Changes in volume, thickness, mass, and hardness are recorded. Measurements are taken before swelling and after 1, 2, 4, 7, 10, 16, 23, and 30 days of swelling. As expected, volume, thickness, and mass of the elastomer increase with increase in the number of swelling days, while hardness shows a decreasing trend. More variation is observed for all quantities in low-salinity brine as compared to high salinity, at both temperatures. However, density values are larger for high-salinity brine at both temperatures. Stokes–Einstein formula is used to determine the diffusion coefficients. Viscosity is measured using a Cannon–Fenske apparatus of size 50. Larger values of diffusion coefficient are found in low-salinity water at both temperatures, consistent with the higher amount of swelling and the faster swelling rate. These results and the diffusion-based approach will help in understanding the mechanics of swelling phenomenon. This work can aid in the development of new analytical and semi-analytical models that can predict seal pressure and other performance factors more accurately for applications in oil and gas wells.
STS, Meet Data Science, Once Again
Authors: Ribes David
Published: September 2018

Science and technology studies (STS) and the emerging field of data science share surprising elective affinities. At the growing intersections of these fields, there will be many opportunities and not a few thorny difficulties for STS scholars. First, I discuss how both fields frame the rollout of data science as a simultaneously social and technical endeavor, even if in distinct ways and for diverging purposes. Second, I discuss the logic of domains in contemporary computer, information, and data science circles. While STS is often agnostic about the borders between the sciences or with industry and state—occasionally taking those boundaries as an object of study—data science takes those boundaries as its target to overcome. These two elective affinities present analytic and practical challenges for STS but also opportunities for engagement. Overall, in addition to these typifications, I urge STS scholars to strategically position themselves to investigate and contribute to the breadth of transformations that seek to touch virtually every science and newly bind spheres of academy, industry, and state.
Factors associated with misdiagnosis of frozen section of mucinous borderline ovarian tumor
Authors: Zhang Wen , Jia Shuangzheng , Xiang Yang , Yang Junjun , Jia Congwei , Leng Jinhua
Published: September 2018

Objective

This study was performed to investigate the diagnostic accuracy of frozen section (FS) of mucinous borderline ovarian tumors (mBOTs) and the diagnostic value of various risk factors for misdiagnosis.

Methods

Patients with either an FS or permanent pathologic diagnosis of mBOT were included. Optimum cut-off values for serum tumor markers and maximal tumor diameter were determined, and risk factors for underdiagnosis of mucinous malignant ovarian tumors (mMOTs) were evaluated. The sensitivity, specificity, Youden’s index, and diagnostic odds ratio of the risk factors were assessed to determine their diagnostic value for mMOTs.

Results

Of 121 included patients, 97 were diagnosed with mBOTs by FS. Relatively abnormal cancer antigen 125 (CA125), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) levels; bilateral tumors; and specific pathological features showed significant associations with underdiagnosis of mMOTs in the univariate analysis. The presence of specific pathological features was the only significant risk factor in the multivariate analysis. The CA125, CA19-9, and CEA levels and specific pathological features demonstrated certain diagnostic value in detecting malignant cases among FS-diagnosed mBOTs.

Conclusions

In patients with FS-diagnosed mBOT, significant predictors of malignancy were relatively higher CA125, CA19-9, and CEA levels; bilateral tumors; and tumors with specific pathological features.
Effects of propofol and isoflurane on excitatory amino acid carrier 1 mRNA and glutathione protein levels in rat hippocampus
Authors: Park Jin Hyoung , Kim Doyeon , Shin Byung Seop
Published: September 2018

Objective

We compared the effects of two anesthetics, isoflurane and propofol, on the nuclear or cytosolic localization of nuclear factor erythroid 2-related factor 2 (Nrf2), mRNA expression levels of excitatory amino acid carrier 1 (EAAC1), and glutathione (GSH) protein levels in the rat hippocampus.

Methods

Fifty-two adult male Sprague–Dawley rats were randomly divided into three groups: a control group, a group that received propofol for 240 minutes (P240), and a group that received isoflurane for 240 minutes (I240). We compared GSH protein and EAAC1 mRNA expression levels in the rat hippocampus and evaluated Nrf2 content in cytosolic and nuclear fractions in the three groups.

Results

GSH protein and EAAC1 mRNA expression levels were significantly higher in the I240 and P240 groups compared with the control group. The I240 and P240 groups showed lower Nrf2 protein levels in the cytosolic fractions, but higher levels in the nuclear fractions compared with the control group.

Conclusion

Treatment with isoflurane or propofol may enhance GSH production by facilitating translocation of Nrf2 into the nucleus and increasing EAAC1mRNA expression in the rat hippocampus. Isoflurane and propofol show similar profiles in EAAC1 expression-associated GSH production.
Rails-Next-to-Trails: A Methodology for Selecting Appropriate Safety Treatments at Complex Multimodal Intersections
Authors: Alligood Anna Bovbjerg , Sheth Manali , Goodchild Anne , McCormack Edward , Butrina Polina
Published: September 2018

There are more than 212,000 at-grade railroad crossings in the United States. Several feature paths running adjacent to the railroad tracks, and crossing a highway; they serve urban areas, recreational activities, light rail station access, and a variety of other purposes. Some of these crossings see a disproportionate number of violations and conflicts between rail, vehicles, and pedestrians and bikes. This research focuses on developing a methodology for appropriately addressing the question of treatments in these complex, multimodal intersections. The methodology is designed to be able to balance a predetermined, prescriptive approach with the professional judgment of the agency carrying out the investigation. Using knowledge and data from the literature, field studies, and video observations, a framework for selecting treatments based on primary issues at a given location is developed. Using such a framework allows the agency to streamline their crossing improvement efforts; to easily communicate and inform the public of the decisions made and their reasons for doing so; to secure stakeholder buy-in prior to starting a project or investigation; to make sure that approach and selected treatments are more standardized; and to ensure transparency in the organization to make at-grade crossings safer for pedestrians and bicyclists, without negatively impacting trains or vehicles.
Modeling Free-flow Speeds on Undivided Roads in Mixed Traffic with Weak Lane Discipline
Authors: Chathoth Vipin , Asaithambi Gowri
Published: September 2018

In developing countries like India, transportation systems are characterized by limited roadway infrastructure and lack of operation and management experience. Hence, there exists a need to evaluate a performance indicator that reflects the current level of service (LOS) of a road facility. Free-flow speed (FFS) is a key parameter used to express LOS assessment. The objective of this study is to develop FFS prediction models for undivided roads with mixed traffic conditions in both urban and rural settings in India. Traffic data were collected from two-way two-lane undivided roads in southern India during free-flow traffic conditions using videographic method. Various class-specific and site-specific characteristics, such as vehicle class, subclass, carriageway width, link length, number of side roads, lateral clearance, land use type, and area type, were investigated and their influence on FFS evaluated. Statistical tests assessed the variations of obtained FFS with different vehicle-specific and site-specific factors. Free-flow prediction models were developed using linear regression method. The developed models show that FFS increases with greater carriageway width, lateral clearance, and link length, and decreases with increase in number of side roads. In general, FFS is higher in rural areas than urban areas. Similarly, open areas have higher FFS than residential, institutional, and commercial areas. The model can be used to predict FFS of undivided roads if site-specific and vehicle-specific data are known. This study finds interesting applications in capacity and LOS analysis, accident analysis, and before-and-after studies of road improvement schemes.
Evaluating the Performance of Coordinated Signal Timing: Comparison of Common Data Types with Automated Vehicle Location Data
Authors: Remias Stephen M. , Day Christopher M. , Waddell Jonathan M. , Kirsch Jenna N. , Trepanier Ted
Published: September 2018

Performance measures are essential for managing transportation systems, including signalized corridors. Coordination is an essential element of signal timing, enabling reliable progression of traffic along corridors. Improved progression leads to less user delay, which leads to user cost savings and lower vehicle emissions. This paper presents a comparative study of signal coordination assessment using four different technologies. These technologies include detector-based high-resolution controller data, Bluetooth/Wi-Fi sensors, segment-based probe vehicle data, and automated vehicle location data consisting of GPS-based vehicle trajectories, representing the data anticipated from emerging connected vehicle technologies. The data were compiled for a 4.2-mi corridor in Holland, Michigan. The results show that all of the data sources were able to identify, at some level, where coordination issues existed. Detector-based controller data and GPS-based vehicle trajectory data were capable of showing greater detail, and could be used to make offset adjustments. The paper concludes by demonstrating the identification of signal coordination issues with the use of visual performance metrics incorporating automated vehicle location (AVL) trajectory data.
Characteristics and Profiles of Moped Crashes in Urban Areas: An In-Depth Study
Authors: Ceunynck Tim De , Slootmans Freya , Daniels Stijn
Published: September 2018

In this in-depth study, 167 severe injury crashes involving a moped in urban areas in Belgium in 2013 are analyzed. The study provides an overview of the general crash characteristics of and contributing factors to these moped crashes, and identifies typical crash profiles and their characteristics. The representation of class A mopeds (maximum speed 25 km/h [16 mph]; no driving license needed) and class B mopeds (maximum speed 45 km/h [28 mph]; driving license required) in these crashes is approximately fifty-fifty, which seems to imply an over-representation of mopeds class A. The involved moped riders have an average age of 33 and three-quarters are men. Human factors are by far the largest category of contributing factors in moped crashes, factors related to infrastructure and environment play a moderate role, and vehicle-related factors play only a minor role. The most important human factors are psychological factors and risk assessment errors, the main non-human contributing factors are sight obstructions owing to infrastructure or other vehicles. The following crash profiles, grouping similar types of crashes, were identified: crashes between a vehicle turning off and a moped going straight through (18%); crashes caused by the moped rider’s risky behavior (17%); crashes between a moped and another vulnerable road user (13%); crashes resulting from entering or exiting destinations alongside the road (12%); crashes at intersections (other than vehicles turning off) (11%); single-vehicle crashes with loss of control (9%); crashes caused by an error during overtaking (8%); rear-end crashes (3%); and other (9%).
Developing and Implementing a Port Fluidity Performance Measurement Methodology using Automatic Identification System Data
Authors: Kruse C. James , Mitchell Kenneth N. , DiJoseph Patricia K. , Kang Dong Hun , Schrank David L. , Eisele William L.
Published: September 2018

The U.S. Army Corps of Engineers (USACE) is responsible for the maintenance of federally authorized navigation channels and associated infrastructure. As such, USACE requires objective performance measures for determining the level of service being provided by the hundreds of maintained navigation projects nationwide. To this end, the U.S. Army Engineer Research and Development Center partnered with Texas A&M Transportation Institute to develop a freight fluidity assessment framework for coastal ports. The goal was to use archival automatic identification system (AIS) data to develop and demonstrate how ports can be objectively compared in relation to fluidity, or the turnaround time reliability of oceangoing vessels. The framework allows USACE to evaluate maintained navigation project conditions alongside port system performance indices, thereby providing insight into questions of required maintained channel dimensions. The freight fluidity concept focuses on supply chain performance measures such as travel time reliability and end-to-end shipping costs. Although there are numerous research efforts underway to implement freight fluidity, this is the first known application to U.S. ports. This paper covers AIS data inputs, quality control, and performance measures development, and also provides a demonstration application of the methodology at the Port of Mobile, Alabama, highlighting travel time and travel time reliability operating statistics for the overall port area. This work provides foundational knowledge to practitioners and port stakeholders looking to improve supply chain performance and is also valuable for researchers interested in the development and application of multimodal freight fluidity performance measures.
Waste reduction through Kaizen approach: A case study of a company in India
Authors: Goyal Ankur , Agrawal Rajat , Chokhani Rakesh Kumar , Saha Chiraranjan
Published: September 2018

The growth in manufacturing activities for economic development is putting a lot of pressure on the environment. One such impact is due to generation of waste from hazardous material. The best way for hazardous waste management is either elimination or substitution with non-hazardous material. The case study in the present paper is focused on the problem of hazardous waste reduction in absence of non-hazardous substitution. In absence of any non-hazardous substitute of hazardous material, waste generation can be reduced using improvement techniques such as Kaizen to improve the manufacturing process. An Indian company improved the manufacturing procedure with very low cost to reduce waste generation of hazardous material. The outcome of this Kaizen project is the reduction of waste by 13.8% at very low cost. Along with waste reduction, cost saving, and other resource savings are another benefits. This case study provides insight about the use of Kaizen for environmentally sustainable manufacturing.
Two Faces of Today's Learners: Multiple Identity Formation
Authors: Ryu Dongwan , Jeong Jiwon
Published: September 2018

With the help of digital media and networking technologies, today's learners are increasingly participating in the consuming, producing, and disseminating of new meanings in various modes such as text, image, sound, video, or all together—particularly in online communities—forming new identities as knowledge producers. By using online ethnography coupled with qualitative data collection instruments including participant observation and e-mail interview, the study explored (a) how game players participated in learning how to make mods a fan-programmed game feature and (b) why they created and shared mods with others. Findings revealed that game players participated in learning through collaboration, appreciation and validation, and mentoring. Moreover, affiliation, offline interests, and increased enjoyment motivated them to participate in making and sharing mods with their peers. The findings also unveiled that gaming culture has been overlooked or neglected as a form of possible applications for informal online learning, which can provide many rewarding benefits—especially to teachers, researchers, and school reformers—with a new understanding toward today's learners' multiple identity formation.
Full-court press: How segregationist newspapers covered the championship season of an integrated Virginia high school basketball team
Authors: Atwood Elizabeth , Pietrzak Sara
Published: September 2018

This qualitative study examines how two small Virginia newspapers that had opposed school integration covered an integrated high school boys basketball team that won a state championship three years after the school admitted African American students. While previous studies of sports journalism have found evidence of racial bias in the depiction of black athletes, this study finds values governing community journalism, including local boosterism, trumped racial bias.
Improvement of late life depression after therapeutic enoxaparin: two case reports
Authors: Graham David , Wu Qi Xuan , Gilligan Ian , Ismail Raiz , Walker Mark
Published: September 2018

Objective:

Late life depression (LLD) may have a significant vascular component. While this organic basis remains controversial it would explain the refractory nature of LLD. Moreover, depression is a risk factor for venous thrombus embolism (VTE). This paper aims to describe two elderly patients with LLD who developed and were treated for pulmonary embolism (PE).

Methods:

Two cases of elderly patients who developed PE while they were undergoing inpatient treatment for depression are presented. This is discussed using the vascular and the cytokine hypotheses of depression as an explanatory framework.

Results:

Both patients showed significant clinical improvement in their mental state following therapeutic enoxaparin despite no other changes to their management of depression. This observed benefit of enoxaparin can be explained by the vascular hypothesis of LLD, and possibly the cytokine hypothesis of major depression.

Conclusion:

Enoxaparin may be a novel adjunct to the treatment of depression in elderly patients. The possible benefit of enoxaparin would require further study to exclude a coincidence in these clinical cases.
Digesting Data: Tracing the Chromosomal Imprint of Scientific Evidence Through the Development and Use of Canadian Dietary Guidelines
Authors: Rachul Christen
Published: September 2018

The Eating Well With Canada’s Food Guide (CFG), which represents Canada’s official dietary guidelines, is designed to address high rates of obesity and diet-related chronic disease in Canada. This article presents a qualitative study of the social and ideological actions that the CFG performs. The study draws on the concepts of antecedent genres and uptake from rhetorical genre studies, applying them in a multimodal analysis of the CFG and interviews with the CFG’s producers and registered dietitians (RDs) who work with vulnerable populations. Findings reveal that scientific representations play a profound role in the social and ideological actions that the CFG performs. The author demonstrates how representations of scientific evidence from nutrition science, as exemplified in the concept of the Food Guide Serving, are taken up by the CFG and, in turn, how these scientific representations influence RDs’ use of the CFG and dominate, rather than facilitate, discussions about healthy eating. The study suggests that the CFG, instead of being an enabling resource, is a limiting document: It limits who can make healthier food choices and how such choices can be made.
Innovative Implementation Studies Conducted in US Safety Net Health Care Settings: A Systematic Review
Authors: Lyles Courtney R. , Handley Margaret A. , Ackerman Sara L. , Schillinger Dean , Williams Pamela , Westbrook Marisa , Gourley Gato , Sarkar Urmimala
Published: September 2018

Little is known about dissemination and implementation in safety net settings. The authors conducted a literature review of innovation/implementation studies in US safety net health care settings between 2008 and 2017. Each article was coded for (1) intervention characteristics, (2) implementation stage, (3) internal versus external ownership, and (4) prespecified implementation outcomes (eg, acceptability and fidelity). Twenty studies were identified; the majority were implemented within community clinics or integrated safety net systems (15 articles), most involved care process improvements (13 articles), and most were internally developed (13 articles). The internally developed innovations reported fewer barriers to acceptability among staff/providers, higher leadership involvement and organizational alignment, greater amounts of customization to the local setting, and better sustainment. Future work should harness the high levels of alignment and acceptability in implementation research within safety net settings, with an eye toward maintaining fidelity to facilitate dissemination across sites.
Risk Assessment in Chinese Hospitalized Patients Comparing the Padua and Caprini Scoring Algorithms
Authors: Chen Xiaolan , Pan Lei , Deng Hui , Zhang Jingyuan , Tong Xinjie , Huang He , Zhang Min , He Jianlin , Caprini Joseph A. , Wang Yong
Published: September 2018

The current venous thromboembolism (VTE) guidelines recommend all patients to be assessed for the risk of VTE using risk assessment models (RAMs). The study was to evaluate the performance of the Caprini and Padua RAMs among Chinese hospitalized patients. We reviewed data from 189 patients with deep venous thrombosis (DVT) and 201 non-DVT patients. Deep venous thrombosis risk factors were obtained from all patients. The sensitivity and specificity of the Caprini and Padua scores for all patients were calculated. The receiver operating curve (ROC) and the area under the ROC curve (AUC) were used to evaluate the performance of each score. We documented that age, acute infection, prothrombin time (PT), D-dimer, erythrocyte sedimentation rate, blood platelets, and anticoagulation were significantly associated with the occurrence of DVT ( P < .05). These results were true for all medical and surgical patients group (G1), as well as the analysis of medical versus surgical patients (G2). Finally, analysis of the scores in patients with and without cancer was also done (G3). The Caprini has a higher sensitivity but a lower specificity than the Padua ( P < .05). Caprini has a better predictive ability for the first 2 groups ( P < .05). We found Caprini and Padua scores have a similar predictive value for patients with cancer ( P > .05), while Caprini has a higher predictive ability for no cancer patients in G3 than Padua ( P < .05). For Chinese hospitalized patients, Caprini has a higher sensitivity but a lower specificity than Padua. Overall, Caprini RAM has a better predictive ability than Padua RAM.
Music participation for older people: Five choirs in Victoria, Australia
Authors: Joseph Dawn , Southcott Jane
Published: September 2018

In Australia and across the globe music participation by older people active in the community has the potential to enhance quality of life. A recent review of the literature found clear evidence of numerous benefits from participation in active music making that encompass the social, physical and psychological. This article reports on five phenomenological case studies of community singing groups comprised of older people active in the community in Melbourne, Victoria. These studies are part of a research project, Well-being and Ageing: Community, Diversity and the Arts in Victoria that began in 2008. Interview data were analysed using interpretative phenomenological analysis and are reported under three overarching themes: Social connection, A sense of well-being, and Musical engagement. For older people in these studies singing in community choirs offered opportunities for social cohesion, positive ageing, and music learning that provided a sense of personal and group fulfilment, community engagement and resilience.
Relating Anticipatory Postural Adjustments to Step Outcomes During Loss of Balance in People With Parkinson’s Disease
Authors: Peterson Daniel S. , Lohse Keith R. , Mancini Martina
Published: September 2018

Background. Effective protective steps are critical for fall prevention, and anticipatory postural adjustments (APAs) after a perturbation but prior to protective steps affect step performance. Although APAs prior to protective steps are altered in people with Parkinson’s disease (PD), whether these changes affect subsequent step performance is poorly understood. Objective. Characterize the relationship between mediolateral APA size and protective step outcomes in response to anteroposterior balance perturbations in people with PD. Methods. Twenty-eight individuals with PD completed 25 forward and 25 backward protective steps in response to support surface translations. Multilevel linear models related mediolateral APA size to protective step outcomes. Results. During forward protective stepping, larger mediolateral APAs were associated with delayed ( P < .001) and larger ( P = .004) steps. Larger APAs were also associated with smaller mediolateral ( P < .001) but larger anterior-posterior center of mass movement at foot off ( P < .001). During backward stepping, larger APAs were associated with later steps ( P < .001) and smaller anterior-posterior margin of stability at first foot contact ( P < .001). During backward stepping, larger APAs were also associated with worse clinical (ie, UPDRS [Unified Parkinson’s Disease Rating Scale]; P = .005) and balance (ie, MiniBEST [Mini-Balance Evaluation Systems Test]; P = .021) outcomes. Conclusions. During forward protective stepping, larger APAs were associated with larger and later steps, suggesting APA size may have mixed effects on the subsequent step. During backward stepping, larger APAs were associated with worse stepping outcomes (ie, later steps, smaller anterior-posterior margin of stability, worse clinical outcomes). Interventions aimed at improving APAs in PD should monitor spatial and temporal protective step outcomes to ensure treatment does not negatively affect protective steps, particularly for forward stepping.
Stapled Transperineal Fistula Repair of Rectovaginal Fistula: A Preliminary Experience
Authors: Lin Hong-Cheng , Huang Liang , Chen Hua-Xian , Zhou Qian , Ren Dong-Lin
Published: September 2018

Purpose. This study is designed to assess the safety, efficacy, and postoperative outcomes of stapled transperineal repair in management of rectovaginal fistula (RVF). Methods. A prospective database of patients with RVF undergoing stapled transperineal repair between May 2015 and December 2017 was established and studied retrospectively. Results. Seven consecutive RVF patients underwent stapled transperineal repair. The mean operative time was 119 ± 42 minutes. The estimated blood loss during operation was 24 ± 14 mL. Concomitant levatorplasty was performed with 4 patients and sphincteroplasty with 2 patients. Over a median follow-up of 6 months (range 3-33 months), no case was encountered with recurrence. The mean postoperative Wexner score was significantly improved when compared with the preoperative scores (mean preoperative vs postoperative Wexner scores 3 [range 3-4] vs 1 [range 1-2], respectively; P = .01). Conclusions. Stapled transperineal repair of RVF appears safe and effective. The initial results are encouraging, suggesting the need for a more formal prospective assessment of this technique as part of a randomized trial for the management of low- and mid-vaginal fistulas.
Eugène Louis Doyen (1859-1916): The Reformer of French Surgery
Authors: Laios Konstantinos , Charalampakis Antonis , Manes Konstantinos , Lagiou Efstathia , Mavrommatis Evangelos , Karamanou Marianna
Published: September 2018

Eugène Louis Doyen (1859-1916) is considered as the reformer of French surgery at the end of 19th and early 20th century. Although he had a short life, dying at the age of 57, he left his mark in the history of French medicine and especially surgery, not only because he introduced many new medical instruments but also for his innovative idea to introduce cinematography in surgical education, which is crucial until today in the education of every surgeon in the world.
Elevated C-reactive protein increases diagnostic accuracy of algorithm-defined stroke-associated pneumonia in afebrile patients
Authors: Kalra Lalit , Smith Craig J , Hodsoll John , Vail Andy , Irshad Saddif , Manawadu Dulka
Published: September 2018

Background and aim

Pyrexia-dependent clinical algorithms may under or overdiagnose stroke-associated pneumonia. This study investigates whether inclusion of elevated C-reactive protein as a criterion improves diagnosis.

Methods

The contribution of C-reactive protein  ≥30 mg/l as an additional criterion to a Centers for Disease Control and Prevention-based algorithm incorporating pyrexia with chest signs and leukocytosis and/or chest infiltrates to diagnose stroke-associated pneumonia was assessed in 1088 acute stroke patients from 37 UK stroke units. The sensitivity, specificity, and positive predictive value of different approaches were assessed using adjudicated stroke-associated pneumonia as the reference standard.

Results

Adding elevated C-reactive protein to all algorithm criteria did not increase diagnostic accuracy compared with the algorithm alone against adjudicated stroke-associated pneumonia (sensitivity 0.74 (95% CI 0.65–0.81) versus 0.72 (95% CI 0.64–0.80), specificity 0.97 (95% CI 0.96–0.98) for both; kappa 0.70 (95% CI 0.63–0.77) for both). In afebrile patients (n = 965), elevated C-reactive protein with chest and laboratory findings had sensitivity of 0.84 (95% CI 0.67–0.93), specificity of 0.99 (95% CI 0.98–1.00), and kappa 0.80 (95% CI 0.70–0.90). The modified algorithm of pyrexia or elevated C-reactive protein and chest signs with infiltrates or leukocytosis had sensitivity of 0.94 (95% CI 0.87–0.97), specificity of 0.96 (95% CI 0.94–0.97), and kappa of 0.88 (95% CI 0.84–0.93) against adjudicated stroke-associated pneumonia.

Conclusions

An algorithm consisting of pyrexia or C-reactive protein ≥30 mg/l, positive chest signs, leukocytosis, and/or chest infiltrates has high accuracy and can be used to standardize stroke-associated pneumonia diagnosis in clinical or research settings.

Trial Registration

http://www.isrctn.com/ISRCTN37118456
A protocol for precise comparisons of small vessel disease lesions between ex vivo magnetic resonance imaging and histopathology
Authors: Humphreys Catherine A , Jansen Maurits A , Muñoz Maniega Susana , González-Castro Víctor , Pernet Cyril , Deary Ian J , Al-Shahi Salman Rustam , Wardlaw Joanna M , Smith Colin
Published: September 2018

Rationale

Neuroimaging and clinical studies have defined human sporadic cerebral small vessel disease but the pathophysiology remains relatively poorly understood. To develop effective therapies and preventative strategies, we must better understand the heterogeneity and development of small vessel disease at a cellular level.

Hypothesis

Small vessel disease lesions as seen on neuroimaging have specific neuropathological correlates.

Methods and design

Standard histological samples are taken from strategic areas of the brain typically affected by small vessel disease, in cases with a range of disease from mild to severe and controls. Tissue is formalin fixed, scanned using 7-tesla magnetic resonance imaging and processed for histology. Histological slides are digitalized then registered with the corresponding magnetic resonance image. Small vessel disease burden is assessed and lesions are precisely identified on the ex vivo imaging and microscopy independently then compared. The tissue can be interrogated using multiple magnetic resonance sequences and histological methods targeting the gliovascular unit.

Study outcomes

The primary outcome is identifying and defining the cellular characteristics of small vessel disease lesions compared to imaging. Secondary outcomes are related to obtaining information about abnormalities of protein expression in the gliovascular unit, defining groups of small vessel disease severity in our cohorts for future analysis and developing a reliable, reproducible protocol for accurate radiological–histological lesion comparison, which can be applied to other neurological diseases in the future.

Discussion

Comprehensive, precise pathological–radiological–clinical correlations in small vessel disease will provide greater insight into associations and pathophysiology underlying magnetic resonance imaging findings in normal- and abnormal-appearing tissue, ex vivo and in vivo.
Cultural Capital as a Hidden Asset: Culture, Egalitarianism and Inter-Class Social Encounters in Stavanger, Norway
Authors: Vassenden Anders , Jonvik Merete
Published: September 2018

In this article, we engage with the theory of cultural capital, which was originally outlined in Pierre Bourdieu’s magnum opus Distinction. We start from a study of lifestyles in Stavanger, Norway, and qualitative interviews with 39 people dispersed in the social space. We find that interviewees with less education are largely indifferent to cultural capital, and secure about their own lifestyles. This diverges from Bourdieu’s depiction of the working-class ‘sense of place’. Yet cultural capital has social consequences. To university graduates, taste and education often matter for self-definition and social networks. Cultural capital thus contributes to social closure. Importantly, though, the highly educated are careful to de-emphasize their cultural capital when appropriate, especially in inter-class social encounters. They keep cultural distinctions hidden. In accounting for why our findings diverge from Bourdieu’s, possible explanations pertain to national cultural repertoires (Nordic egalitarianism) as well as broader (even transnational) changes in morality. Crucially, though, we engage with social interaction, which has been more neglected in previous research. For that purpose, we build on Erving Goffman’s theories. For cultural capital studies, we propose the concept of a ‘discursive gap’, and suggest more emphasis on social encounters.
Diastolic left ventricular function in relation to circulating metabolic biomarkers in a population study
Authors: Zhang Zhen-Yu , Marrachelli Vannina G , Yang Wen-Yi , Trenson Sander , Huang Qi-Fang , Wei Fang-Fei , Thijs Lutgarde , Van Keer Jan , Monleon Daniel , Verhamme Peter , Voigt Jens-Uwe , Kuznetsova Tatiana , Redón Josep , Staessen Jan A
Published: September 2018

Aims

We studied the association of circulating metabolic biomarkers with asymptomatic left ventricular diastolic dysfunction, a risk-carrying condition that affects 25% of the population.

Methods and results

In 570 randomly recruited people, we assessed in 2005–2010 and in 2009–2013 the multivariable-adjusted correlations of e’ (early left ventricular relaxation) and E/e’ (left ventricular filling pressure) measured by Doppler echocardiography with 43 serum metabolites, quantified by magnetic resonance spectroscopy. In 2009–2013, e’ cross-sectionally increased (Bonferroni corrected p ≤ 0.016) with the branched-chain amino acid valine (per one standard deviation increment, +0.274 cm/s (95% confidence interval, 0.057–0.491)) and glucose+the amino acid (AA) taurine (+0.258 cm/s (0.067–0.481)), while E/e’ decreased ( p ≤ 0.017) with valine (–0.264 (–0.496– –0.031)). The risk of developing left ventricular diastolic dysfunction over follow-up (9.4%) was inversely associated ( p ≤ 0.0059) with baseline glucose+amino acid taurine (odds ratio, 0.64 (0.44–0.94). In partial least squares analyses of all the baseline and follow-up data, markers consistently associated with better diastolic left ventricular function included the amino acids 2-aminobutyrate and 4-hydroxybutyrate and the branched-chain amino acids leucine and valine, and those consistently associated with worse diastolic left ventricular function glucose+amino acid glutamine and fatty acid pentanoate. Branched-chain amino acid metabolism (–log10p = 12.6) and aminoacyl-tRNA biosynthesis (9.9) were among the top metabolic pathways associated with left ventricular diastolic dysfunction.

Conclusion

The associations of left ventricular diastolic dysfunction with circulating amino acids and branched-chain amino acids were consistent over a five-year interval and suggested a key role of branched-chain amino acid metabolism and aminoacyl-tRNA biosynthesis in maintaining diastolic left ventricular function.
Kaposi’s sarcoma in an HIV-negative chronic lymphocytic leukemia patient without immunosuppressive therapy: A case report
Authors: Vučinić Damir , Dekanić Andrea , Zamolo Gordana , Belušić-Gobić Margita , Belac-Lovasić Ingrid , Batinac Tanja
Published: September 2018

Kaposi’s sarcoma is a neoplasm of endothelial cells. That vascular tumor is usually limited to the skin, but it may involve mucous membranes, visceral organs, and lymph nodes. Serological evidence has shown that human herpesvirus 8 infection is required for the development of Kaposi’s sarcoma. Chronic lymphocytic leukemia is the most common leukemia all over the world. Increased skin cancer risk has been reported for patients with chronic lymphocytic leukemia. The relation between these two pathologies has not yet been clarified. We report a case of Kaposi’s sarcoma along with chronic lymphocytic leukemia in a patient who did not receive therapy for chronic lymphocytic leukemia.
Gender Bias in Medical Images Affects Students’ Implicit but not Explicit Gender Attitudes
Authors: Parker Rhiannon B. , Larkin Theresa , Cockburn Jon
Published: September 2018

Medical education curricula have the potential to impact the gender attitudes of future healthcare providers. This study investigated whether gender-biased imagery from anatomy textbooks had an effect on the implicit and explicit gender attitudes of students. We used an online experimental design in which students (N = 456; 55% female) studying anatomy were randomly assigned to a visual priming task using either gender-neutral or gender-biased images. The impact of this priming task on implicit attitudes was assessed using the Implicit Association Test (IAT) and the impact on explicit attitudes was measured using the Gender Bias in Medical Education Scale. Viewing biased images was significantly positively associated with implicit gender bias as indicated by higher IAT scores in the treatment compared to the control condition (mean IAT difference = 43 milliseconds; Cohen’s d = .33). In contrast, there was no significant effect of gender-biased images on explicit gender attitudes.
Physiotherapy provision to hospitalised stroke patients: Analysis from the UK Sentinel Stroke National Audit Programme
Authors: McGlinchey Mark P , Paley Lizz , Hoffman Alex , Douiri Abdel , Rudd Anthony G
Published: September 2018

Introduction

The purpose of this study is to investigate which factors are associated with physiotherapy provision to hospitalised stroke patients.

Methods

Data were analysed for stroke patients admitted to hospital in England and Wales between April 2013 and March 2017 recorded on the Sentinel Stroke National Audit Programme (SSNAP) national stroke register. Associations between different patient factors, and applicability for and intensity of physiotherapy were measured using multi-level logistic and regression models. Findings: Data from 306,078 patients were included on the SSNAP register. Median age was 77 years (IQR 67–85) and 84.7% of patients with completed stroke severity data had a mild-moderate stroke. In all, 85.2% of patients recorded on SSNAP were deemed applicable for physiotherapy. Applicability for physiotherapy was 47% higher among thrombolysed patients (aOR 1.47, 95% CI 1.40–1.54), 36% lower in those with severe pre-morbid disability (aOR 0.64, 95% CI 0.58–0.71) and more than 2.5-fold higher among patients admitted to hospitals with greater availability of early supported discharge (aOR 2.62, 95% CI 1.28–5.37). Patients who were younger, male, had less pre-morbid disability, lower stroke severity, sustained an infarction, received thrombolysis, and had fewer medical complications were more likely to receive more intensive physiotherapy post-stroke.

Conclusion

Several patient and service organisational factors are associated with physiotherapy provision to stroke patients, some of which may not be justifiable. Physiotherapists should be aware of these factors when planning and delivering physiotherapy as well as any possible biases associated with physiotherapy provision to patients post-stroke.
Association of Foveal Avascular Zone Enlargement and Diabetic Retinopathy Progression Using Optical Coherence Tomography Angiography
Authors: Suzuki Katsuya , Nozaki Miho , Takase Noriaki , Kato Aki , Morita Hiroshi , Ozeki Hironori , Yoshida Munenori , Ogura Yuichiro
Published: September 2018

Purpose:

The purpose of this article is to evaluate long-term change of the foveal avascular zone (FAZ) area in diabetic eyes using optical coherence tomography angiography (OCTA) (AngioVue, Avanti OCT, Optovue).

Methods:

A retrospective chart review was conducted of patients who had undergone OCTA fundus examinations with at least 12 months of follow-up. Eyes with previous laser photocoagulation and antivascular endothelial growth factor treatments were excluded. ImageJ software was used to evaluate the FAZ area in the superficial capillary plexus (SCP) and deep capillary plexus (DCP).

Results:

Forty eyes were analyzed in this study and divided into 3 groups: healthy controls (13 eyes), diabetic patients without diabetic retinopathy (DR) (14 eyes), and diabetic patients with DR (13 eyes). During the 22 months of follow-up, the FAZ area of eyes with DR in the DCP enlarged from 0.64 ± 0.20 mm2 to 0.70 ± 0.20 mm2 ( P = .021), which was a 10.1% increase from baseline (5.1% per year). No significant changes were observed during the study period for FAZ areas in the DCP of controls and diabetic patients without DR. Enlargement of FAZ in the DCP was significantly greater in eyes with DR progression vs those without progression (19.2% and 1.2%, respectively, P = .013).

Conclusions:

Our data suggest FAZ enlargement in the DCP is associated with DR progression. Assessment of the FAZ by OCTA might be useful for the evaluation of microcirculation abnormalities in DR and the onset of DR progression.