bluuebunny/crossref_metadata_2025 huggingface dataset:
A complication of meningitis and infective endocarditis due toStreptococcus pyogenes
Authors: Inoue Kosuke , Hagiwara Akiyoshi , Kimura Akio , Ohmagari Norio
Published: September 2017

We described a rare case of meningitis and infective endocarditis (IE) due toStreptococcus pyogenes.An 80-year-old woman was admitted to our hospital with unconsciousness. Glasgow Coma Scale was E1V3M5. We diagnosed her with acute meningitis due toS. pyogenesand started treatment using ceftriaxone. In spite of the improvement of her unconscious state, she developed a new-onset systolic murmur on day 13, and echocardiography revealed severe mitral valve regurgitation with vegetation. Therefore, we also diagnosed her with IE and continued the antibiotics for 6 weeks after we confirmed the negative blood cultures. The patient was finally transferred to another hospital for rehabilitation 57 days after admission. Considering that the number ofS. pyogenesinfections has been reported to increase in Japan and worldwide, we need to be more careful about the rare complication of meningitis and IE due toS. pyogenes.
Posterior meningeal artery DMSO injection resulting in reproducible asystole prior to Onyx therapy of a dural arteriovenous fistula: a previously undescribed variant of the trigeminocardiac reflex or a new phenomenon?
Authors: Crockett Matthew Thomas , Robinson Anthony Ernest , Aneja Harmeet , Phillips Timothy John
Published: September 2017

We describe a case of reproducible asystole during endovascular treatment of a posterior fossa dural arteriovenous fistula. Catheterisation of the posterior meningeal artery, a branch of the vertebral artery in this patient, followed by dimethyl sulfoxide injection prior to Onyx administration resulted in two episodes of asystole.

To the best of our knowledge, this is the first reported case of asystole occurring during endovascular intervention in the posterior meningeal artery. This may represent a previously undescribed variant of the trigemino-cardiac reflex (TGCR) caused by chemical stimulation of small areas of trigeminally innervated posterior fossa dura. Alternatively, this may represent a newly identified phenomenon with chemical stimulation of regions of posterior fossa dura innervated by branches of the vagus nerve leading to increased parasympathetic activity and resultant asystole.

In either case, it is important to recognise the potential for such episodes in this vascular territory to allow case planning and management.
Wearable technology in an international telementoring setting during surgery: a feasibility study
Authors: Meijer Henriëtte A W , Sánchez Margallo Juan A , Sánchez Margallo Francisco M , Goslings J Carel , Schijven Marlies P
Published: September 2017

Background

Telemedicine holds promise for improving access to care. Telementoring—defined as mentoring by means of telecommunication and computer networks—can be used for remote education of healthcare professionals. Furthermore, it is rapidly establishing itself as a valuable asset in medicine and education. This paper aims to establish a financially and practically feasible, stable telementoring network using wearables for sterile and hands-free remote control, to be used during surgical procedures.

Methods

Two stand-alone computer systems, located at an academic hospital in the Netherlands and at a surgical research facility in Spain, were connected using TeamViewer software allowing for remote, hands-free controlling of radiological images using Myo gesture control armband. The operating surgeon consulted the remote surgeon through an audio, video and desktop sharing system during a live surgical procedure on a single porcine model. The system was analysed for feasibility and connection quality.

Results

The sensors used were commercially available and relatively cheap, with the integrating computer system being responsible for the majority of costs. A successful connection was established without any downtime and with only a minor time lag, not interfering with the telementoring procedures. The operating surgeon effectively consulted with and was mentored by the remote surgeon, through video, audio and the desktop sharing system, using the wearable sensors.

Conclusions

This proof of principle shows the feasibility of using an internet-based remote desktop sharing system in combination with wearable sensors and TedCube technology for telementoring purposes during surgical procedures.
New technical solution to minimise noise exposure for surgical staff: the ‘silent operating theatre optimisation system’
Authors: Friedrich Martin G , Boos Margarete , Pagel Manuela , Thormann Tobias , Berakdar Adel , Russo Sebastian , Tirilomis Theodor
Published: September 2017

The increasing number of technical equipment in the operating room (OR) is resulting in significantly higher noise levels. The more complex and sophisticated the surgical procedure is, the more essential it is for all team members of the OR to work together in a harmonious fashion to process and manage their demanding team tasks. With increasing noise in OR, the risk of more frequent errors also increases. The reduction of noise production in the OR is possible but limited. The aim of this study was to develop a device that reduces ambient noise for the operating team without hindering their ability to communicate.

We developed a new communication technology set-up for the OR to meet all needed requirements. All members of the operating team are issued headsets with microphones. The headsets filter out background noises (active and passive noise cancelling) and the microphones enable interactive communication among and between OR subgroups through targeted information selection (signal selection). Any remaining background noise is overshadowed by music, which is quiesced by direct speech into the microphone (ducking). Information flow is programmed on a digital workstation, providing each team member a selection of acoustic signals from the OR on their bidirectional headset. A complex matrix of connections in this audio technology allows a predefined communication structure. These procedures were assembled in the Silent Operating Theatre Optimisation System (SOTOS). The technical specifications and user interface are described. A pilot study in 2015 using the SOTOS in cardiac surgery showed very positive feedback from the participating operating team members. Further studies focusing on communicational psychology perspective and physiological reaction are recommended.
A priori consent within pragmatic randomised controlled trials: a web-based survey of statin use in primary care
Authors: Semprini Alex , Hills Thomas , Braithwaite Irene , Weatherall Mark , Beasley Richard
Published: September 2017

Background

Clinical research methodology is evolving with the advent of pragmatic randomised controlled trials (PRCTs). Novel approaches for informed consent in PRCTs are needed.

Objective

To explore public opinion about different ways of giving informed consent for PRCTs.

Design

Web-based survey assessing acceptability of three PRCT consent scenarios for statin use.

Setting

Community-based study.

Participants

678 (12%) adults responded to an open-access web-based survey.

Measurements

Participant-rated acceptability of three different options for giving informed consent for a PRCT testing two commonly prescribed, effective treatments: statins for hyperlipidaemia. Option A was written informed consent given a priori for a specific study, with verbal confirmation of consent at time of randomisation. Option B was written informed, general consent a priori for multiple comparative effectiveness studies, with verbal confirmation for a specific study at time of randomisation. Option C was written informed consent for a specific study at time of randomisation.

Results

Acceptability was higher for option A (475/529 (89.9%)) and B (441/487 (90.6%)) compared with C (339/481 (70.5%)). The estimates of differences in paired proportions were A versus C, 19.4% (95% CI 14.4 to 24.5), p<0.001; B versus C, 20.1% (95% CI 15.2 to 25.0), p<0.001.

Limitations

The study design may have been subject to cognitive biases such as framing and anchoring effects. The anonymised web-based survey allowed no follow-up or verification for missing data. The sampling frame used an institutional database and social media and selection bias and halo effects may have been present. The 12.3% response rate may represent poor generalisability.

Conclusion

The concept of giving a priori consent, with subsequent confirmation at time of randomisation in a PRCT, was more favourable than the traditional model of consent in a general-practice-based study of statin use.
Clinical trial transparency: a reassessment of industry compliance with clinical trial registration and reporting requirements in the United States
Authors: Lassman Scott M , Shopshear Olivia M , Jazic Ina , Ulrich Jocelyn , Francer Jeffrey
Published: September 2017

Objective

To evaluate the accuracy of a 2015 cross-sectional analysis published in theBMJ Openwhich reported that pharmaceutical industry compliance with clinical trial registration and results reporting requirements under US law was suboptimal and varied widely among companies.

Design

We performed a reassessment of the data reported in Milleret alto evaluate whether statutory compliance analyses and conclusions were valid.

Data sources

Information from the Dryad Digital Repository, ClinicalTrials.gov, Drugs@FDA and direct communications with sponsors.

Main outcome measures

Compliance with the clinical trial registration and results reporting requirements under the Food and Drug Administration Amendments Act (FDAAA).

Results

Industry compliance with FDAAA disclosure requirements was notably higher than reported by Milleret al.Among trials subject to FDAAA, Milleret alreported that, per drug, a median of 67% (middle 50% range: 0%–100%) of trials fully complied with registration and results reporting requirements. On reanalysis of the data, we found that a median of 100% (middle 50% range: 93%–100%) of clinical trials for a particular drug fully complied with the law. When looking at overall compliance at the trial level, our reassessment yields 94% timely registration and 90% timely results reporting among the 49 eligible trials, and an overall FDAAA compliance rate of 86%.

Conclusions

The claim by Milleret althat industry compliance is below legal standards is based on an analysis that relies on an incomplete dataset and an interpretation of FDAAA that requires disclosure of study results for drugs that have not yet been approved for any indication. On reanalysis using a different interpretation of FDAAA that focuses on whether results were disclosed within 30 days of drug approval, we found that industry compliance with US statutory disclosure requirements for the 15 reviewed drugs was consistently high.
Paradigm shift: should the elderly undergo propofol sedation for DBE? A prospective cohort study
Authors: Ching Hey-Long , Branchi Federica , Sanders David S , Turnbull David , Sidhu Reena
Published: September 2017

Objective

Evaluate the safety of propofol-assisted double balloon enteroscopy (DBE) in elderly patients against a younger cohort.

Design

Prospective cohort study

Setting

All patients undergoing DBE over a 30-month period were recruited at our tertiary centre.

Patients

215 procedures in 161 patients were performed. An age cut-off of 65 years and above was used to define those who were elderly.

Interventions

Patients were subcategorised into four groups: elderly or young undergoing DBE with propofol or conventional sedation (with midazolam±fentanyl).

Main outcome measures

Patient demographics, comorbidities, procedural data, complications, diagnostic and therapeutic yield were compared.

Results

Cardiovascular disease and a higher American Society of Anaethesiologists (ASA) status were more prevalent in elderly patients undergoing DBE with propofol (p<0.05). Common indications for DBE were occult and overt obscure gastrointestinal bleeding and suspected Crohn’s disease (elderly vs young: 50.7% vs 42.3%, 17.8% vs 12% and 19.2% vs 26.1%, respectively). Diagnostic yield was higher in elderly compared with young patients (75.3% vs 58.5%, p=0.016). The most common findings in elderly and young patients were angioectasia (30.1% and. 18.3%, respectively) and ulcers (17.8% and 9.2%, respectively), while therapeutic intervention rates were comparable (42.5% vs 32.4%, p=0.18). ASA status did not affect propofol dose (p=0.55) or procedure duration (p=0.31). Tolerance scores were favourable in those receiving propofol compared with conventional sedation (p<0.05). There was no difference in complications between the four groups (p=0.17).

Conclusion

Compared with young patients, propofol-assisted DBE in the elderly is safe and has a high diagnostic yield.
Trends in UK endoscopy training in the BSG trainees’ national survey and strategic planning for the future
Authors: Biswas Sujata , Alrubaiy Laith , China Louise , Lockett Melanie , Ellis Antony , Hawkes Neil
Published: September 2017

Background

Improvements in the structure of endoscopy training programmes resulting in certification from the Joint Advisory Group in Gastrointestinal Endoscopy have been acknowledged to improve training experience and contribute to enhanced colonoscopy performance.

Objectives

The 2016 British Society of Gastroenterology trainees’ survey of endoscopy training explored the delivery of endoscopy training - access to lists; level of supervision and trainee’s progression through diagnostic, core therapy and subspecialty training. In addition, the barriers to endoscopy training progress and utility of training tools were examined.

Methods

A web-based survey (Survey Monkey) was sent to all higher specialty gastroenterology trainees.

Results

There were some improvements in relation to earlier surveys; 85% of trainees were satisfied with the level of supervision of their training. But there were ongoing problems; 12.5% of trainees had no access to a regular training list, and 53% of final year trainees had yet to achieve full certification in colonoscopy. 9% of final year trainees did not feel confident in endoscopic management of upper GI bleeds.

Conclusions

The survey findings provide a challenge to those agencies tasked with supporting endoscopy training in the UK. Acknowledging the findings of the survey, the paper provides a strategic response with reference to increased service pressures, reduced overall training time in specialty training programmes and the requirement to support general medical and surgical on-call commitments. It describes the steps required to improve training on the ground: delivering additional training tools and learning resources, and introducing certification standards for therapeutic modalities in parallel with goals for improving the quality of endoscopy in the UK.
Impact and cost-effectiveness of formal gastroenterology outpatient referral Clinical Assessment Service
Authors: Pelitari Stavroula , Hathaway Charlotte , Gritton Dean , Smith Andrea , Bush David , Menon Shyam , McKaig Brian
Published: September 2017

Objective

The aim was to assess the financial and operational impact of our new gastroenterology referral pathway model on our services.

Design

An electronic ‘Clinical Assessment Service’ (CAS) proforma and an information platform were developed, and all data were analysed retrospectively.

Setting

Royal Wolverhampton NHS Trust.

Patients

14 245 general practitioner (GP) referrals were received during January 2014–December 2016 with 9773 of them being triaged via our CAS.

Main outcome measures

We looked into patients’ clinical outcome along with departmental performance and finances.

Results

A new outpatient appointment was offered to 60.1% (n=5873) of the CAS referred patients. Endoscopic or radiological investigations were requested for 29.2% (n=2854) of patients prior to deciding on further management plan. Out of those, 27% (n=765) went on to receive another gastroenterology (GI) clinic appointment. The remaining 21.3% (n=2089) of the CAS patients were discharged back to their GP following initial investigations. 5.5% (n=538) were discharged back to primary care with a letter of advice, whereas 5.2% (n=509) were deemed inappropriate for GI clinic and were redirected to other specialists. Overall, 32% (n=3127) of patients were managed without a face to face consultation in the GI clinic. This corresponds to 3136 less outpatient appointments with estimated reduced expenditure by the Clinical Commissioning Group (CCG) of £481K. The 18-week performance and waiting times remained stable despite the increasing referral population. The DNA rate dropped from 14% pre to 8.5%.

Conclusions

Our clinical assessment model has, in addition to the clinical benefits, a considerable positive financial impact to the health economy.
How are we managing fistulating perianal Crohn’s disease? Results of a national survey of consultant gastroenterologists
Authors: Lee Matthew James , Brown Steven R , Fearnhead Nicola S , Hart Ailsa , Lobo Alan J
Published: September 2017

Objective

Fistulating perianal Crohn’s disease represents a significant challenge to both clinicians and patients. This survey set out to describe current practice and variation in the medical management of this condition.

Design

A survey was designed by an expert group of gastroenterologists and surgeons with an inflammatory bowel disease (IBD) interest. The questionnaire aimed to capture opinions from consultant gastroenterologists with a UK practice on the management of acutely symptomatic fistula, assessment of a new fistula presentation, medical management strategies and surgical intervention. The survey was piloted at the British Society of Gastroenterology Clinical Research Group meeting, and distributed at UK gastroenterology meetings.

Results

There were 111 completed responses (response rate 55%). Following clearance of sepsis, 22.1% of respondents would wait 6 weeks or more before commencing medical therapy. Antibiotics were used by 89.2%, with a variable duration. First-line medical therapy was thiopurine for 48% and antitumour necrosis factor (TNF) for 50% of respondents. These were used in combination by 44.4%. Interval to escalation of therapy (if required) varied from 1 month to a year. Anti-TNF therapies were favoured in deteriorating patients. An IBD multidisciplinary team was accessible to 98%, although only 23.6% routinely discussed these patients. Optimisation strategies for anti-TNF and thiopurines were used by 70% of respondents. Recurrent sepsis, refractory disease and patient choice are indications for surgical referral.

Conclusion

These results illustrate the huge variation in practice and lack of consensus among physicians for the optimal medical management of perianal Crohn’s disease. There are gaps in knowledge that require targeted research.
The clinical management of hereditary haemochromatosis
Authors: Pericleous Marinos , Kelly Claire
Published: September 2017

Hereditary haemochromatosis is an autosomal recessive disorder with variable penetrance. Most patients are C282Y homozygotes while heterozygotes or patients who are homozygous with other mutations are uncommonly affected. The true genotype to phenotype expression remains unclear. Treatment with phlebotomy is highly effective and cost-efficient while liver transplantation confers a curative option.
Prognostic value of galectin-3 in adults with congenital heart disease
Authors: Baggen Vivan J M , van den Bosch Annemien E , Eindhoven Jannet A , Menting Myrthe E , Witsenburg Maarten , Cuypers Judith A A E , Boersma Eric , Roos-Hesselink Jolien W
Published: September 2017

Objective

Galectin-3 is an emerging biomarker for risk stratification in patients with heart failure. This study aims to investigate the release of galectin-3 and its association with cardiovascular events in patients with adult congenital heart disease (ACHD).

Methods

In this prospective cohort study, 602 consecutive patients with ACHD who routinely visited the outpatient clinic were enrolled between 2011 and 2013. Galectin-3 was measured in thaw serum by batch analysis. The association between galectin-3 and a primary endpoint of all-cause mortality, heart failure, hospitalisation, arrhythmia, thromboembolic events and cardiac interventions was investigated using multivariable Cox models. Reference values and reproducibility were established by duplicate galectin-3 measurements in 143 healthy controls.

Results

Galectin-3 was measured in 591 (98%) patients (median age 33 (25–41) years, 58% male, 90% New York Heart Association (NYHA) class I). Median galectin-3 was 12.7 (range 4.2–45.7) ng/mL and was elevated in 7% of patients. Galectin-3 positively correlated with age, cardiac medication use, NYHA class, loss of sinus rhythm, cardiac dysfunction and N-terminal pro-B-type natriuretic peptide (NT-proBNP). During a median follow-up of 4.4 (IQR 3.9–4.8) years, the primary endpoint occurred in 195 patients (33%). Galectin-3 was significantly associated with the primary endpoint in the univariable analysis (HR per twofold higher value 2.05; 95% CI 1.44 to 2.93, p<0.001). This association was negated after adjustment for NT-proBNP (HR 1.04; 95% CI 0.72 to 1.49, p=0.848).

Conclusions

Galectin-3 is significantly associated with functional capacity, cardiac function and adverse cardiovascular events in patients with ACHD. Nevertheless, the additive value of galectin-3 to a more conventional risk marker such as NT-proBNP seems to be limited.
Increased incidence of BK virus viraemia among patients undergoing chronic haemodialysis: a case–control study
Authors: Swedan Samer Fuad
Published: September 2017

Aims

Incidence of BK virus (BKV) viraemia, a major risk factor for nephropathy, among patients undergoing chronic haemodialysis remains poorly investigated. This case–control study evaluated the risk of infection by BKV, in addition to hepatitis C virus (HCV) among haemodialysis subjects (n=100), compared with age-matched controls (n=100).

Methods

Subjects’ blood plasma samples were subjected to nucleic acid extraction, followed by real-time PCR to evaluate viraemia by BKV and HCV, while sera samples were subjected to ELISA, to identify IgG seropositivity for HCV.

Results

Mean age±SD was 47.8±20.4 and 48.9±17.6 years for the haemodialysis and control groups, respectively. BKV and HCV viraemia was observed among 19% versus 8% (OR 2.38, 95% CI 1.09 to 5.18; p=0.023) and 3% versus 0% (p=0.081) of the haemodialysis and control groups, respectively. Mean BK viral load±SD did not vary significantly among the two groups; 914.8±2868 versus 44.30±74.04 copies/mL for the haemodialysis and control groups, respectively (p=0.4041). HCV seropositivity rates were 6% versus 2% (p=0.149), among the haemodialysis and control groups, respectively.

Conclusions

Subjects on haemodialysis may be at increased risk of nephropathy due to increased incidence of BK virus reactivations and may require optimisation of immunosuppressive therapy.
Cancer stem cells in colorectal cancer: a review
Authors: Munro Matthew J , Wickremesekera Susrutha K , Peng Lifeng , Tan Swee T , Itinteang Tinte
Published: September 2017

Colorectal cancer (CRC) is the second most common cancer in women and the third most common in men. Adenocarcinoma accounts for 90% of CRC cases. There has been accumulating evidence in support of the cancer stem cell (CSC) concept of cancer which proposes that CSCs are central in the initiation of cancer. CSCs have been the focus of study in a range of cancers, including CRC. This has led to the identification and understanding of genes involved in the induction and maintenance of pluripotency of stem cells, and markers for CSCs, including those investigated specifically in CRC. Knowledge of the expression pattern of CSCs in CRC has been increasing in recent years, revealing a heterogeneous population of cells within CRC ranging from pluripotent to differentiated cells, with overlapping and sometimes unique combinations of markers. This review summarises current literature on the understanding of CSCs in CRC, including evidence of the presence of CSC subpopulations, and the stem cell markers currently used to identify and localise these CSC subpopulations. Future research into this field may lead to improved methods for early detection of CRC, novel therapy and monitoring of treatment for CRC and other cancer types.
Radiation dose reduction during neuroendovascular procedures
Authors: Morris Pearse P , Geer Carol P , Singh Jasmeet , Brinjikji Waleed , Carter Rickey E
Published: September 2017

Aim

To describe the impact of steps towards reduction of procedural doses of radiation during neuroendovascular procedures.

Methods

Phantom exposures under controlled circumstances were performed using a Rando-Alderson adult-sized head phantom. Customized imaging protocols were devised for pediatric and adult imaging and implemented in clinical use. Outcome data for estimated skin doses (ESD) and dose–area product (DAP) following pediatric and adult diagnostic and interventional procedures over 4.5 years were analyzed retrospectively.

Results

Dose estimates were reduced by 50% or more after introduction of customized imaging protocols in association with modification of personnel behavior compared with doses recorded with previously used vendor-recommended protocols.

Discussion

Substantial reductions in radiation use during neuroendovascular procedures can be achieved through a combination of equipment modification and operator behavior.
Efficacy and safety of non-vitamin K antagonist oral anticoagulants compared with warfarin in patients with atrial fibrillation
Authors: Friberg Leif , Oldgren Jonas
Published: September 2017

Aims

Non-vitamin K antagonist oral anticoagulants (NOACs) were in pivotal randomised controlled trials at least non-inferior to warfarin for stroke prevention in atrial fibrillation, but time in therapeutic range (TTR) for warfarin was lower (mean 55%–65%) than in Swedish general care where TTR is >70%. We compared efficacy and safety of NOACs and warfarin treatment for stroke prevention in Sweden.

Methods

Retrospective cohort study of all non-selected oral anticoagulation naïve atrial fibrillation patients with first prescription for NOACs or warfarin between December 2011 and December 2014, excluding patients with mitral stenosis or mechanical valvular prosthesis. Data were obtained from cross-linked national registers, propensity scores were used as continuous covariates, and associations between treatment and outcomes were evaluated by multivariable Cox regressions.

Results

The study comprised 18 638 patients on NOAC and 49 418 on warfarin treatment, with 90 204 patient-years follow-up. Age (mean) was 73.4 vs 73.7 years, p<0.001, and CHA2DS2-VASc points (mean) 3.38 vs 3.24, p<0.001, in NOAC and warfarin groups, respectively. HRs (95% CI) for NOACs versus warfarin were 1.04 (0.91–1.19) for all-cause stroke or systemic embolism, 1.16 (1.00–1.35) for ischaemic stroke, 0.85 (0.76–0.96) for major bleeding, 1.22 (1.01–1.46) for gastrointestinal bleeding, 0.60 (0.47–0.76) for intracranial haemorrhage and 0.89 (0.81–0.96) for all-cause mortality.

Conclusion

In this large non-selected anticoagulation naïve Swedish atrial fibrillation cohort, the risks for all-cause stroke or systemic embolism were similar with NOACs and warfarin, but NOACs were associated with significantly lower risks of all-cause mortality, major bleeding and intracranial haemorrhage but higher risk of gastrointestinal bleeding. Better safety suggests NOACs as preferred treatment for patients with atrial fibrillation starting oral anticoagulation.
Uveitis: a sight-threatening disease which can impact all systems
Authors: Krishna Unnat , Ajanaku Deji , Denniston Alastair K , Gkika Theodora
Published: September 2017

Uveitis describes a group of conditions characterised by intraocular inflammation. The term uveitis technically describes inflammation of the uvea which comprises the iris, ciliary body and choroid, however now encompasses inflammation of adjacent intraocular structures such as the retina, vitreous and optic nerve. Uveitis is a significant cause of blindness worldwide, but its impact is generally underappreciated due to a lack of awareness and understanding of the condition among the public and most non-ophthalmic healthcare professionals. In this review, we provide an introduction to uveitis for the non-specialist, outlining the clinical presentations that should raise the suspicion of the disease, the signs that should be looked for and a framework in which to understand the condition. We show how a logical approach to classifying uveitis by aetiology and anatomical focus of disease provides the basis for treatment strategies (drug and route of administration) and clinical presentation and prognosis. We also show why understanding uveitis is helpful to clinicians working in almost every speciality due to the wide-ranging associations with systemic disease.
Interventions for smoking cessation in patients admitted with Acute Coronary Syndrome: a review
Authors: Chehab Omar M , Dakik Habib A
Published: September 2017

Tobacco smoking contributes to about six million deaths per year and is predicted to increase in the future. Several pharmacological interventions are used for smoking cessation. Trials using nicotine replacement therapy (NRT) in acute coronary syndrome (ACS) showed inconclusive results. Furthermore, three trials using bupropion in patients admitted with ACS failed to show improvement in smoking cessation compared with placebo. Interestingly, only one trial using varenicline was successful in achieving smoking abstinence in the acute setting. With regard to behavioural interventions, a meta-analysis found that telephone counselling was successful in both the acute and stable settings, with greater effect in the acute setting. The best results for smoking cessation were found in trials that used a combination of pharmacological and behavioural interventions. The objective of this report is to review the results of studies on interventions used for smoking cessation after an ACS.
The application and mechanism of PD pathway blockade for cancer therapy
Authors: Wang Xing , Huang Shan , Zhang Ya , Zhu Lin , Wu Xiaoliang
Published: September 2017

Research in cancer therapeutics has achieved major progress in the understanding of the tumour-immunity cycle, which controls the delicate balance between the immune system and tumour. Identification of cancer cell T-cell inhibitory signals, including PD-L1, has generated novel insight into how to reinvigorate the patients’ immune cells to respond to a variety of tumour types. PD-1 and PD-L1 (PD) inhibitory pathway blockade appears to a highly promising therapy and could accomplish durable anti-tumour responses with a reasonable toxicity profile. Some of the FDA-approved mAbs can reverse the negative regulators from tumour cells and antigen presenting cells of T-cell function to treat some cancer types by blocking the PD signalling pathway,especially advanced solid tumours. Emerging clinical data suggest that cancer immunotherapy will become a significant part of the clinical treatment of cancer.
Unique manifestations and risk factors of Jarisch–Herxheimer reaction during treatment of child congenital syphilis
Authors: Wang Caiying , He Shuxin , Yang Hongling , Liu Yuhuan , Zhao Yang , Pang Lin
Published: September 2017

Objectives

The objective of this retrospective study was to summarise the clinical manifestations of, and to analyse the incidence and risk factors of, Jarisch–Herxheimer reaction (JHR) during the treatment of children with symptomatic congenital syphilis.

Methods

Clinical data of 60 children with clinically and laboratory diagnosed congenital syphilis, hospitalised in Beijing Ditan Hospital between January 2010 and November 2015, were collected and analysed.

Results

A total of 11 patients with congenital syphilis (11/60, 18.3%) developed JHR. JHR occurred in 1–6 hour after the first dose of penicillin. Common clinical manifestations included fever (11/11, 100%), irritability (11/11, 100%), rapid pulse and breathing (11/11, 100%), exacerbation of existing rash (5/11, 45.6%) and chills (3/11, 27.3%). Of the 11 patients who developed JHR, 9 patients (9/11, 81.8%) had bone syphilis, 10 (10/11, 90.9%) had more than three organs affected by syphilis and 10 (10/11, 90.9%) had a high plasma concentration of rapid plasma reagin (RPR) (≥1:256); these percentages were significantly higher than in patients who had not developed JHR (p<0.05), suggesting that the occurrence of JHR was related to bone syphilis, having more than three organs affected by syphilis and a high plasma concentration of RPR.

Conclusions

Clinicians should be familiar with the risk factors for this reaction and its common clinical manifestations.
Impact of point-of-care management on the transmission of anogenital gonococcal infections among men who have sex with men in Amsterdam: a mathematical modelling and cost-effectiveness study
Authors: Bartelsman Menne , Vaughan Kelsey , van Rooijen Martijn S , de Vries Henry J C , Xiridou Maria
Published: September 2017

Objective

Point-of-care (POC) management may avert ongoing transmissions occurring between testing and treatment or due to loss to follow-up. We modelled the impact of POC management of anogenital gonorrhoea (with light microscopic evaluation of Gram stained smears) among men who have sex with men (MSM) on gonorrhoea prevalence and testing and treatment costs.

Methods

Data concerning costs and sexual behaviour were collected from the STI clinic of Amsterdam. With a deterministic model for gonorrhoea transmission, we calculated the prevalence of gonorrhoea in MSM in Amsterdam and the numbers of consultations at our clinic over 5 years, in three testing scenarios: POC for symptomatic MSM only (currently routine), POC for all MSM and no POC for MSM.

Results

Among MSM, 34.7% (109/314) had sexual contacts in the period between testing and treatment, of whom 22.9% (25/109) had unprotected anal intercourse. Expanding POC testing from symptomatic MSM to all MSM could result in an 11% decrease (IQR, 8%–15%) in gonorrhoea prevalence after 5 years and a cost increase of 8.6% (€2.40) per consultation and €86 118 overall (+8.3%). Switching from POC testing of symptomatic MSM to no POC testing could save €1.83 per consultation (6.5%) and €54 044 (−5.2%) after 5 years with a 60% (IQR, 26%–127%) gonorrhoea prevalence increase. Overtreatment was 2.1% (30/1411) with POC for symptomatic MSM only and 4.1% (68/1675) with POC for all MSM.

Conclusions

In the Amsterdam setting, possible abandonment of POC testing of symptomatic MSM because of budget cuts could result in a considerable increase in gonorrhoea prevalence against a reduction in costs per consultation. Expanding POC testing to all MSM could result in a modest reduction in prevalence and a cost increase. While the costs and outcomes depend on specific local characteristics, the developed framework of this study is useful to evaluate POC management in other settings.
Assessment of Weight Management Practices among Adults in the United Arab Emirates
Authors: Attlee Amita , Atmani Nour , Stromtsov Viktor , Ali Fatima , Tikarly Rim , Ryad Sarah , Salah Ghada , Hasan Hayder , Obaid Reyad
Published: September 2017

With a rise in global incidence of overweight and obesity, the number of patients seeking weight management (WM) advice is likely to increase. Our aim was to explore the prevalence of WM practices and investigate association of WM goals with sociodemographic variables and practices among United Arab Emirates (UAE) adults. An exploratory, cross-sectional research was conducted on 1275 adult males and females, residing in UAE. A structured questionnaire was administered. WM goals to lose/maintain/gain weight were reported in 88.3% participants. WM goals were significantly associated with age, sex, marital status, education, current body weight perception, and medical condition. Out of 21 selected WM practices, popular strategies included increasing physical activity (52.9%), eating less fat (51.1%), consuming fewer calories (43.3%), joining gym (27.5%), skipping meals (26.1%), and consuming natural herbs and teas (20.7%). Visiting dietitian (12.3%) ranked ninth in the order of preference. Males focused on physical activity, gyms, and wellness centers and females on calories counting, dietitian visits, meals replacement, skipping meals, and natural herbs/teas. Married adults reported eating less fat (54.3% versus 47.3%, p=0.020); singles opted calories counting, gyms, and meals replacement. Frequent referral sources were friends (37.8%) and Internet (32.1%). Most UAE adults had WM goals that were associated with sociodemographic variables and WM practices. Awareness about the ill-effects of unhealthy WM practices and importance of dietitian’s consultation are imperative.
Antimicrobial Resistance Profiles of Bacteria Isolated from the Nasal Cavity of Camels in Samburu, Nakuru, and Isiolo Counties of Kenya
Authors: Mutua J. M. , Gitao C. G. , Bebora L. C. , Mutua F. K.
Published: September 2017

This study was designed to determine antimicrobial resistance profiles of bacteria isolated from the nasal cavity of healthy camels. A total of 255 nasal samples (swabs) were collected in Isiolo, Samburu, and Nakuru counties, Kenya, from which 404 bacterial isolates belonging to various genera and species were recovered. The bacterial isolates included Bacillus (39.60%), coagulase-negative Staphylococcus (29.95%), Streptococcus species other than Streptococcus agalactiae (25.74%), coagulase-positive Staphylococcus (3.96%), and Streptococcus agalactiae (0.74%). Isolates were most susceptible to Gentamicin (95.8%), followed by Tetracycline (90.5%), Kanamycin and Chloramphenicol (each at 85.3%), Sulphamethoxazole (84.2%), Co-trimoxazole (82.1%), Ampicillin (78.9%), and finally Streptomycin (76.8%). This translated to low resistance levels. Multidrug resistance was also reported in 30.5% of the isolates tested. Even though the antibiotic resistance demonstrated in this study is low, the observation is significant, since the few resistant normal flora could be harboring resistance genes which can be transferred to pathogenic bacteria within the animal, to other animals’ bacteria and, most seriously, to human pathogens.
Molecular Age-Related Changes in the Anterior Segment of the Eye
Authors: Hernandez-Zimbron Luis Fernando , Gulias-Cañizo Rosario , Golzarri María F. , Martínez-Báez Blanca Elizabeth , Quiroz-Mercado Hugo , Gonzalez-Salinas Roberto
Published: September 2017

Purpose. To examine the current knowledge about the age-related processes in the anterior segment of the eye at a biological, clinical, and molecular level. Methods. We reviewed the available published literature that addresses the aging process of the anterior segment of the eye and its associated molecular and physiological events. We performed a search on PubMed, CINAHL, and Embase using the MeSH terms “eye,” “anterior segment,” and “age.” We generated searches to account for synonyms of these keywords and MESH headings as follows: (1) “Eye” AND “ageing process” OR “anterior segment ageing” and (2) “Anterior segment” AND “ageing process” OR “anterior segment” AND “molecular changes” AND “age.” Results. Among the principal causes of age-dependent alterations in the anterior segment of the eye, we found the mutation of the TGF-β gene and loss of autophagy in addition to oxidative stress, which contributes to the pathogenesis of degenerative diseases. Conclusions. In this review, we summarize the current knowledge regarding some of the molecular mechanisms related to aging in the anterior segment of the eye. We also introduce and propose potential roles of autophagy, an important mechanism responsible for maintaining homeostasis and proteostasis under stress conditions in the anterior segment during aging.
Complexity Dynamic Character Analysis of Retailers Based on the Share of Stochastic Demand and Service
Authors: Ma Junhai , Di Weiya , Ren Hao
Published: September 2017

Apart from the price fluctuation, the retailers’ service level becomes another key factor that affects the market demand. This paper depicts a modified price and demand game model based on the stochastic demand and the retailer’s service level which influences the market demand decided by customers’ preference, while the market demand is stochastic in this model. We explore how the price adjustment speed affects the stability of the supply chain system with respect to service level and stochastic demand. The dynamic behavior of the system is researched by simulation and the stability domain and the bifurcation phenomenon are shown clearly. The largest Lyapunov exponent and the chaotic attractor are also given to confirm the chaotic characteristic of the system. The simulation results indicate that relatively small price adjustment speed may maintain the system at stable state. With the price adjustment speed gradually increasing, the price system gets unstable and finally becomes chaotic. This chaotic phenomenon will perturb the product market and this phenomenon should be controlled to keep the system stay in the stable region. So the chaos control is done and the chaos can be controlled completely. The conclusion makes significant contribution to the system referring to the price fluctuation based on the service level and stochastic demand.
The Efficacy and Safety of Shen Guo Lao Nian Granule for Common Cold of Qi‐Deficiency Syndrome: Study Protocol for a Randomized, Double‐Blind, Placebo‐Controlled, Multicenter, Phase II Clinical Trial
Authors: Liu Xuemei , Fu Juanjuan , Fan Tao , Liu Wei , Jiang Hongli , Zhang Ruiming , Ding Hong , Yang Haimiao , Hu Siyuan , Huang Yuhong , Li Guanhong , Lan Ying , She Bin , Mao Bing
Published: September 2017

Background. Common cold is one of the most frequently occurring illnesses in primary healthcare services and represents considerable disease burden. Common cold of Qi‐deficiency syndrome (CCQDS) is an important but less addressed traditional Chinese medicine (TCM) pattern. We designed a protocol to explore the efficacy, safety, and optimal dose of Shen Guo Lao Nian Granule (SGLNG) for treating CCQDS. Methods/Design. This is a multicenter, randomized, double‐blind, placebo‐controlled, phase II clinical trial. A total of 240 eligible patients will be recruited from five centers. Patients are randomly assigned to high‐dose group, middle‐dose group, low‐dose group, or control group in a 1 : 1 : 1 : 1 ratio. All drugs are required to be taken 3 times daily for 5 days with a 5‐day follow‐up period. Primary outcomes are duration of all symptoms, total score reduction on Jackson’s scale, and TCM symptoms scale. Secondary outcomes include every single TCM symptom duration and score reduction, TCM main symptoms disappearance rate, curative effects, and comparison between Jackson’s scale and TCM symptom scale. Ethics and Trial Registration. This study protocol was approved by the Ethics Committee of Clinical Trials and Biomedicine of West China Hospital of Sichuan University (number IRB‐2014‐12) and registered with the Chinese Clinical Trial Registry (ChiCTR-IPR-15006349).
Review of and Updates on Hypertension in Obstructive Sleep Apnea
Authors: Ahmad Masood , Makati Devan , Akbar Sana
Published: September 2017

Obstructive sleep apnea (OSA) is a prevalent sleep disorder as is hypertension (HTN) in the 21st century with the rising incidence of obesity. Numerous studies have shown a strong association of OSA with cardiovascular morbidity and mortality. There is overwhelming evidence supporting the relationship between OSA and hypertension (HTN). The pathophysiology of HTN in OSA is complex and dependent on various factors such as sympathetic tone, renin-angiotensin-aldosterone system, endothelial dysfunction, and altered baroreceptor reflexes. The treatment of OSA is multifactorial ranging from CPAP to oral appliances to lifestyle modifications to antihypertensive drugs. OSA and HTN both need prompt diagnosis and treatment to help address the growing cardiovascular morbidity and mortality due to these two entities.
Outage Probability Analysis in Power-Beacon Assisted Energy Harvesting Cognitive Relay Wireless Networks
Authors: Le Ngoc Phuc
Published: September 2017

We study the performance of the secondary relay system in a power-beacon (PB) assisted energy harvesting cognitive relay wireless network. In our system model, a secondary source node and a relay node first harvest energy from distributed PBs. Then, the source node transmits its data to the destination node with the help of the relay node. Also, fading coefficients of the links from the PBs to the source node and relay node are assumed independent but not necessarily identically distributed (i.n.i.d) Nakagami-m random variables. We derive exact expressions for the power outage probability and the channel outage probability. Based on that, we analyze the total outage probability of the secondary relay system. Asymptotic analysis is also performed, which provides insights into the system behavior. Moreover, we evaluate impacts of the primary network on the performance of the secondary network with respect to the tolerant interference threshold at the primary receiver as well as the interference introduced by the primary transmitter at the secondary source and relay nodes. Simulation results are provided to validate the analysis.
A Comparison of Different Shipment Policies in an Integrated Inventory System for Imperfect Quality Items with Inspection Errors
Authors: Zhou Yongwu , Zhang Xiong , Lin Zhaozhan
Published: September 2017

Considering a production‐ordering system where items are not perfect and quality screening is conducted with inspection errors, we develop integrated inventory models under different shipment policies and make a comprehensive comparison among them to select an optimal one, so as to improve the supply chain’s performance. It is assumed that all items classified as defective during the screening process are sold as a single batch at a discounted price at the end of this screening process; items returned from the market are accumulating; and all of them are stored and sold as a single batch at a discounted price at the end of the next screening process. All the numerical results show that the proportional size shipment policy is always optimal, except for one situation where the difference between the vendor’s and the buyer’s unit inventory holding costs is considerably large. Therefore, we mainly recommend the proportional size shipment policy.
Effects of Aminoglycoside Antibiotics on Human Embryonic Stem Cell Viability during Differentiation In Vitro
Authors: Varghese Divya S. , Parween Shama , Ardah Mustafa T. , Emerald Bright Starling , Ansari Suraiya A.
Published: September 2017

Human embryonic stem cells (hESCs) are being used extensively in array of studies to understand different mechanisms such as early human embryogenesis, drug toxicity testing, disease modeling, and cell replacement therapy. The protocols for the directed differentiation of hESCs towards specific cell types often require long-term cell cultures. To avoid bacterial contamination, these protocols include addition of antibiotics such as pen-strep and gentamicin. Although aminoglycosides, streptomycin, and gentamicin have been shown to cause cytotoxicity in various animal models, the effect of these antibiotics on hESCs is not clear. In this study, we found that antibiotics, pen-strep, and gentamicin did not affect hESC cell viability or expression of pluripotency markers. However, during directed differentiation towards neural and hepatic fate, significant cell death was noted through the activation of caspase cascade. Also, the expression of neural progenitor markers Pax6, Emx2, Otx2, and Pou3f2 was significantly reduced suggesting that gentamicin may adversely affect early embryonic neurogenesis whereas no effect was seen on the expression of endoderm or hepatic markers during differentiation. Our results suggest that the use of antibiotics in cell culture media for the maintenance and differentiation of hESCs needs thorough investigation before use to avoid erroneous results.