bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant otitis externa in Australian Aboriginal patients: A 9‐year retrospective analysis from the Northern Territory
Authors: Loh Tze Ling , Renger Laura , Latis Sergios , Patel Hemi
Published: January 2019

Objective

In the Australian Aboriginal population, type 2 diabetes occurs at a much higher prevalence, with a much younger age of onset of the disease and its complications. Despite the clear association with malignant otitis externa, no previous studies have examined malignant otitis externa in this population. This study explores the pattern of malignant otitis externa amongst Australian Aboriginal patients in the Northern Territory.

Design

Retrospective case series.

Setting

Otolaryngology unit in a tertiary referral hospital in Northern Territory, Australia.

Participants

Patients admitted with malignant otitis externa between January 2007 and October 2016 were identified by reviewing case notes. Patients diagnosed with malignant otitis externa based on results from clinical, microbiological and radiological criteria were included.

Main outcome measures

Complications rates, duration of hospital stay and parenteral antibiotics, age of onset and causative organisms.

Results

Nine patients were included. Six were Australian Aboriginal – all from regional centres. The most common causative organism was Pseudomonas aeruginosa. There was a higher‐than‐expected occurrence of fungal malignant otitis externa (33% of Australian Aboriginal patients), who tended to be younger at diagnosis, had longer hospital stays and had a higher disease‐specific mortality. Over half of the patients did not receive follow‐up gallium bone scans to monitor disease resolution, reflecting the limitations of rural health care.

Conclusion

Malignant otitis externa in the Australian Aboriginal population is a challenging disease with high complication and mortality rates. Their rural and remote distribution is a significant barrier to specialist investigation and care. Providing effective care for this disease requires improved access to high‐quality primary health care and tertiary specialist services.
Renal trauma: a 3‐year audit from a Gold Coast trauma centre
Authors: Mansbridge Margaret M. , Ryan James , Hill David C. , Wullschleger Martin
Published: January 2019

Background

Limited data Exists ? on the Australian epidemiology of renal trauma, with very few studies published in the literature. The authors aim to detail the trends of renal trauma in the coastal city of the Gold Coast.

Methods

Retrospective data collection yielded 81 patients who sustained renal trauma from our 3‐year period. Data included information on demographics, mechanism, American Association for the Surgery of Trauma (AAST) grade, presence of haematuria, associated injuries, management, and complications.

Results

Male patients accounted for 83% (n = 67) of cases, and the average age of all injuries was 36 years. Low‐grade AAST Grade I–III injuries comprised of 76% (n = 62) of injuries, AAST Grade IV contributed to 20% (n = 16) and 4% (n = 3) of injuries were AAST Grade V. The most common mechanism of injury was road accidents accounting for 35% (n = 28) followed by fall‐related injuries (26%, n = 21). Other mechanisms included sport‐related (13.5%, n = 11), non‐motorized bicycle injuries (8.5%, n = 7), alleged assault (8.5%, n = 7), pedestrian injuries (5%, n = 4) and horse‐related injuries (2%, n = 2). Ninety‐six percent (n = 78) of kidney injuries were managed conservatively. Of the patients requiring intervention, all were AAST Grade V kidney injuries.

Conclusion

Males accounted for the majority of renal trauma cases, similar to the 3:1 ratio of male‐to‐female injuries found in other studies. In line with other studies, renal trauma reviewed on the Gold Coast also revealed road trauma as the leading cause, closely followed by falls. The majority of high‐grade renal trauma was managed conservatively.
Increasing rate of para‐oesophageal hiatus hernia surgical repair within Australia
Authors: Wood Brielle E. , Mayne Darren J. , Punch Gratian , Craig Steven J.
Published: January 2019

Background

Symptomatic para‐oesophageal hiatus (PEH) hernias are treated by surgical intervention, and are associated with older age (>50 years) and higher body mass index (>25 kg/m2). Both risk factors are increasing within the Australian population. Given these trends, this study aimed to determine if the rate of PEH repair is increasing within Australia.

Methods

The study used publically available Medicare Benefits Scheme service data for operations claimed under the item number 31468 (PEH hernia, repair of, with complete reduction of hernia, resection of sac and repair of hiatus, with or without fundoplication) between 1 January 2001 and 31 December 2016. Directly age‐standardized rates per 100 000 population were calculated using the 2001 Australian standard population and compared using Poisson regression models.

Results

Repair of PEH significantly increased (P < 0.0001) in Australia during this period, with the average number of services increasing by 14.6% per annum. Average rates of repair increased significantly (P < 0.001) with increasing age up to 75 years after which they significantly reduced (P < 0.001) in each successive age group. Western Australia had the greatest increase in annual claims and Northern Territory had the least, but the state‐specific average claim rate over the whole period was highest in Queensland and lowest in Northern Territory.

Conclusion

Operations claimed under Medicare Benefits Scheme item number 31468 have significantly increased in Australia since January 2001. Reasons for this rise are likely multifactorial, and may indicate increasing PEH incidence, increased diagnosis and investigation or increased surgical capability to manage the issue laparoscopically with reduced peri‐operative morbidity.
Development of xenogeneic decellularized biotubes for off‐the‐shelf applications
Authors: Yamanami Masashi , Kanda Keiichi , Kawasaki Takanori , Kami Daisuke , Watanabe Taiji , Gojo Satoshi , Yaku Hitoshi
Published: January 2019

In earlier studies, we developed in vivo tissue‐engineered, autologous, small‐caliber vascular grafts, called “biotubes,” which withstand systemic blood pressure and exhibit excellent performance as small‐caliber vascular prostheses in animal models. However, biotube preparation takes 4 weeks; therefore, biotubes cannot be applied in emergency situations. Moreover, for responses to various types of surgery, grafts should ideally be readily available in advance. The aim of this study was to develop novel, off‐the‐shelf, small‐caliber vascular grafts by decellularizing in vivo tissue‐engineered xenogeneic tubular materials. Silicone rod molds (diameter: 2 mm, length: 70 mm) placed in subcutaneous pouches of a beagle dog for 4 weeks were harvested with their surrounding connective tissues. Tubular connective tissues were obtained after pulling out the impregnated molds. Subsequently, they were decellularized by perfusion with sodium dodecyl sulfate and Triton X‐100. They were stored as off‐the‐shelf grafts at −20°C for 1 week. The decellularized grafts derived from the beagle dog were xenogeneically transplanted to the abdominal aortas of rats (n = 3). No signs of abnormal inflammation or immunological problems due to the xenogeneic material were observed. Echocardiography confirmed the patency of the grafts at 1 month after implantation. Histological evaluation revealed that the grafts formed neointima on the luminal surface, and that the graft walls had cell infiltration. Little accumulation of CD68‐positive macrophages in the graft wall was observed. Xenogeneic decellularized tubular tissues functioned as small‐caliber vascular grafts, as well as autologous biotubes. This technology enables the easy fabrication of grafts from xenogeneic animals in advance and their storage for at least a week, satisfying the conditions for off‐the‐shelf grafts.
Homologous role of CovRS two‐component regulatory system in NAD+‐glycohydrolase activity in Streptococcus dysgalactiae subsp. equisimilis as in Streptococcus pyogenes
Authors: Hasegawa Tadao , Matsumoto Masakado , Hata Nanako , Yano Hisako , Isaka Masanori , Tatsuno Ichiro
Published: January 2019

Streptococcal toxic shock syndrome (STSS) is primarily caused by Streptococcus pyogenes, but it may also be caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE). The analyses of S. pyogenes have revealed the important roles of NAD+‐glycohydrolase (Nga) and CovR/CovS, a two‐component regulatory system. We examined these factors in SDSE by analyzing mainly two isogenic SDSE strains (12‐10‐1 and 12‐10‐3) from the blood of a patient with STSS. The Nga activities were measured and the nucleotide sequences of covR and covS genes were determined. We detected one nucleotide difference between the covR gene of 12‐10‐1 and that of 12‐10‐3, and the Nga activity of 12‐10‐1 was approximately 6.8‐fold more than that of 12‐10‐3. The introduction of covR of 12‐10‐3 into 12‐10‐1 significantly reduced the Nga activity, but the introduction of 12‐10‐1 covR into itself had only a little effect. In addition, the knockout of covR or covS of 12‐10‐3 remarkably increased the Nga activity. We are the first to report that strains with wild‐type and mutated covR were isolated simultaneously from an SDSE STSS patient and that the CovR/CovS two‐component regulatory system is involved in the Nga activity in SDSE as well as in S. pyogenes.
Carbamoyl phosphate synthetase 1 (CPS1) as a prognostic marker in chronic hepatitis C infection
Authors: El‐Sheikh Ranya M. , Mansy Soheir S. , Nessim Iris G. , Hosni Hala N. , El Hindawi Ali , Hassanein Moataz H. , AbdelFattah Ahmed S.
Published: January 2019

This study aims to assess the value of carbamoyl phosphate synthetase 1 (CPS1), as a non‐invasive serum marker, for the evolution of chronic HCV infection and hepatic fibrosis. Seventy‐two patients with HCV positive serum RNA and 15 health volunteers were enrolled in this study. Out of 72 patients, 10 patients had decompensated liver with ascites. Quantitative analysis of CPS1 was performed in the harvested sera and corresponding liver biopsies using ELISA and immunohistochemistry techniques respectively. Also, mitochondrial count using electron microscopy, urea analysis and conventional liver tests were done. Patients were grouped into (F1 + F2) and (F3 + F4) representing stages of moderate and severe fibrosis respectively. Tissue and serum CPS1 (s.CPS1) correlated significantly in moderate and severe fibrosis. Patients with severe fibrosis showed significantly higher levels of s.CPS1 (p‐value ≤ 0.05) and significantly lower mitochondrial counts (p‐value = 0.0065) than those with moderate fibrosis. S.urea positively correlated with s.CPS1 only in the decompensated group, at which s.urea reached maximal levels. In conclusion, s.CPS1 is a potential non‐invasive marker for the assessment of severity and progression of HCV in relation to mitochondrial dysfunction. Also, increased s.urea with the progression of the disease is mainly due to a concurrent renal malfunction, which needs further investigation.
Systematic review with meta‐analysis: the critical role of dermatological events in patients with hepatocellular carcinoma treated with sorafenib
Authors: Díaz‐González Álvaro , Sanduzzi‐Zamparelli Marco , Sapena Víctor , Torres Ferran , LLarch Neus , Iserte Gemma , Forner Alejandro , da Fonseca Leonardo , Ríos José , Bruix Jordi , Reig María
Published: January 2019

Background

The positive results of the REFLECT trial in terms of survival (sorafenib vs lenvatinib) offer a new first‐line option for hepatocellular carcinoma. Additionally, the expected results of immunotherapy could change the first‐line treatment in hepatocellular carcinoma or the clinical trial design in first and second‐line.

Aims

To evaluate the impact of dermatologic adverse events under sorafenib in hepatocellular carcinoma patients as a clinical marker to predict prognosis and critically evaluate outcomes within trials.

Methods

A systematic search of original articles published until October 2018 was performed using PubMed/MEDLINE and a meta‐analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement.

Results

A total of 393 studies were identified and 13 articles with 2035 patients (79.5% Child‐Pugh‐A, 73.2% BCLC‐C) were selected for qualitative and quantitative analysis. The main type of dermatologic adverse events was hand‐foot skin reaction (47.7%) but other dermatologic adverse events were reported in 31.7% of the cases. Presence of dermatologic adverse events was associated with a lower mortality when compared with those patients without them (pooled Hazard Ratio for the univariate analysis 0.45 (95% CI: 0.38‐0.53) and there was no heterogeneity for the analysis (P = 0.511; I2 = 0.0%). Refuting this association would require the future report of 1370 negative studies.

Conclusions

This meta‐analysis shows a clinically meaningful association between dermatologic adverse events and a higher probability of longer survival. These data support the use of dermatologic adverse events in the clinical decision‐making when informing the prognosis and when systemic treatment is decided.
The Effects of an Assistance Dog on the Therapeutic Dyad: The Intersubjective Experience
Authors: Goldblatt Mark J.
Published: January 2019

Assistance dogs have long been used to help with physical disabilities and are now increasingly being used by patients suffering from a host of psychological ailments. As assistance dogs enter the physical space of the psychotherapist's office, we should consider their effect on the psychological space. Psychoanalytic theory and technique have evolved to address the ways that the participants’ subjectivity may influence each other. The presence of an assistance dog in the consulting room inevitably contributes to the treatment process, especially affecting the subjective experience of both patient and therapist. In this paper, a clinical example is used to describe the intersubjective experience of the therapist, the patient and the assistance dog.
Arid Mental Landscapes and Avid Cravings for Human Contact: Beckettian and Analytic Narratives
Authors: Schellekes Alina
Published: January 2019

This paper focuses on states of mind in which a psychic void predominates, characterized by a deep sense of meaninglessness and formlessness, and on the various survival strategies and protective shells employed in the attempt to ‘a‐void’ this experience/state. At one pole, through a clinical case, I will illustrate the use of excitation envelopes and rebirth phantasies, as main pacifiers of the psychic void; at the other pole, through a discussion of Beckett's short play ‘Rockaby’, I will elaborate on overly rhythmic, controlled manoeuvres that are devoid of aliveness, but protect against the awareness of such depleted states of mind. In both cases, one can notice the oscillation between the defence employed and the ever‐pulsating need for human contact, however faint it may be. The seemingly paradoxical contradiction between the psychic void and the overly structured literary text that embodies this void is frequently encountered in texts that express and give form to otherwise formless experiences through the structuring and ordering aspects of the text. These structures simultaneously express both something of the defence against the experience of fragmentation and dissolution, and something of the experience that is being defended against by the protagonist.
The Footprints of the Past Walk Through the Novel: A Conversation with Deborah Levy
Authors: Lewis Katie
Published: January 2019

I enjoyed the privilege of being in conversation with Deborah Levy and this paper is a brief account of our dialogue. Deborah read from two of her novels, Swimming Home (2012) and Hot Milk (2016), and we discussed the points of contact between her writing and compositional process, reading her work and listening as a psychotherapist. She spoke of the importance of a back story and we thought about the way that history lies behind actions in the present, about the enduring impact of trauma and the transgenerational transmission of trauma.
Epstein‐Barr virus strain variation and cancer
Authors: Kanda Teru , Yajima Misako , Ikuta Kazufumi
Published: January 2019

Epstein‐Barr virus (EBV) is a human tumor virus and is etiologically linked to various malignancies. Certain EBV‐associated diseases, such as Burkitt lymphomas and nasopharyngeal carcinomas, are endemic and exhibit biased geographic distribution worldwide. Recent advances in deep sequencing technology enabled high‐throughput sequencing of the EBV genome from clinical samples. Rapid cloning and sequencing of cancer‐derived EBV genomes, followed by reconstitution of infectious virus, have also become possible. These developments have revealed that various EBV strains are differentially distributed throughout the world, and that the behavior of cancer‐derived EBV strains is different from that of the prototype EBV strain of non‐cancerous origin. In this review, we summarize recent progress and future perspectives regarding the association between EBV strain variation and cancer.
Vocabulary Development and Trajectories of Behavioral and Emotional Difficulties Via Academic Ability and Peer Problems
Authors: Westrupp Elizabeth M. , Reilly Sheena , McKean Cristina , Law James , Mensah Fiona , Nicholson Jan M.
Published: January 2019

This study investigates associations between trajectories of children's vocabulary development and subsequent behavioral and emotional difficulties via two potential mediating mechanisms; literacy and peer problems. Nationally representative data from 4,983 Australian children were used to examine trajectories of receptive vocabulary (4–5, 6–7, and 8–9 years) and hyperactivity‐inattention, conduct problems and emotional symptoms (8–9, 10–11, 12–13, 14–15 years), and literacy and peer problems (8–9 years). Lower growth in vocabulary was related to trajectories of hyperactivity‐inattention, conduct problems, and emotional symptoms. Literacy was a key mediator explaining these associations. Results were consistent for children below the 50th percentile for vocabulary at 4–5 years compared to the full sample. These findings suggest that early literacy‐based interventions may alleviate declining academic, emotional and behavioral functioning in adolescence.
The Capricious Nature of Theory of Mind: Does Mental State Understanding Depend on the Characteristics of the Target?
Authors: Gönültaş Seçil , Selçuk Bilge , Slaughter Virginia , Hunter John A. , Ruffman Ted
Published: January 2019

Using a between‐groups design and random assignment, this study examined 214 Turkish children's (M = 11.66 years) mindreading and general reasoning about in‐group members (Turks), similar out‐group members (Syrians within Turkey) and dissimilar out‐group members (Northern Europeans). Children heard four mindreading and four general reasoning stories with in‐group or out‐group members as targets. Whereas children's general reasoning about three groups was equivalent, accuracy of mental state inferences differed by target with more accurate mindreading of in‐group targets compared to both sets of out‐group targets. In this Turkish sample, mindreading of Syrian targets was the least accurate. Prejudice and perceived realistic threat predicted lower mindreading. These findings have important implications for understanding how similarity and intergroup processes play a role in children's mindreading.
Genome‐wide association study of inhaled corticosteroid response in admixed children with asthma
Authors: Hernandez‐Pacheco Natalia , Farzan Niloufar , Francis Ben , Karimi Leila , Repnik Katja , Vijverberg Susanne J. , Soares Patricia , Schieck Maximilian , Gorenjak Mario , Forno Erick , Eng Celeste , Oh Sam S. , Pérez‐Méndez Lina , Berce Vojko , Tavendale Roger , Samedy Lesly‐Anne , Hunstman Scott , Hu Donglei , Meade Kelley , Farber Harold J. , Avila Pedro C. , Serebrisky Denise , Thyne Shannon M. , Brigino‐Buenaventura Emerita , Rodriguez‐Cintron William , Sen Saunak , Kumar Rajesh , Lenoir Michael , Rodriguez‐Santana Jose R. , Celedón Juan C. , Mukhopadhyay Somnath , Potočnik Uroš , Pirmohamed Munir , Verhamme Katia M. , Kabesch Michael , Palmer Colin N. A. , Hawcutt Daniel B. , Flores Carlos , Maitland‐van der Zee Anke H. , Burchard Esteban G. , Pino‐Yanes Maria
Published: January 2019

Background

Inhaled corticosteroids (ICS) are the most widely prescribed and effective medication to control asthma symptoms and exacerbations. However, many children still have asthma exacerbations despite treatment, particularly in admixed populations, such as Puerto Ricans and African Americans. A few genome‐wide association studies (GWAS) have been performed in European and Asian populations, and they have demonstrated the importance of the genetic component in ICS response.

Objective

We aimed to identify genetic variants associated with asthma exacerbations in admixed children treated with ICS and to validate previous GWAS findings.

Methods

A meta‐analysis of two GWAS of asthma exacerbations was performed in 1347 admixed children treated with ICS (Hispanics/Latinos and African Americans), analysing 8.7 million genetic variants. Those with P ≤ 5 × 10−6 were followed up for replication in 1697 asthmatic patients from six European studies. Associations of ICS response described in published GWAS were followed up for replication in the admixed populations.

Results

A total of 15 independent variants were suggestively associated with asthma exacerbations in admixed populations (P ≤ 5 × 10−6). One of them, located in the intergenic region of APOBEC3B and APOBEC3C, showed evidence of replication in Europeans (rs5995653, P = 7.52 × 10−3) and was also associated with change in lung function after treatment with ICS (P = 4.91 × 10−3). Additionally, the reported association of the L3MBTL4‐ARHGAP28 genomic region was confirmed in admixed populations, although a different variant was identified.

Conclusions and clinical relevance

This study revealed the novel association of APOBEC3B and APOBEC3C with asthma exacerbations in children treated with ICS and replicated previously identified genomic regions. This contributes to the current knowledge about the multiple genetic markers determining responsiveness to ICS which could lead in the future the clinical identification of those asthma patients who are not able to respond to such treatment.
Morbidity related to diverting ileostomy after restorative proctocolectomy in patients with ulcerative colitis
Authors: Karjalainen E. K. , Renkonen‐Sinisalo L. , Mustonen H. K. , Lepistö A. H.
Published: January 2019

Aim

Restorative proctocolectomy with ileal pouch–anal anastomosis is considered by many surgeons to be the standard procedure for surgical management of ulcerative colitis. There is controversy about whether or not a covering ileostomy should be constructed. The aim of this study was to evaluate the outcomes and morbidity for patients with ulcerative colitis who underwent restorative proctocolectomy with or without a diverting ileostomy.

Method

This is a retrospective study of a consecutive series of 510 patients with ulcerative colitis who were operated on in Helsinki University Hospital between January 2005 and June 2016. A diverting ileostomy was performed in 119 patients (the stoma group) compared with 391 patients with no stoma.

Results

Dehydration and intestinal obstruction occurred more often in the stoma group (P < 0.0001). Clinical anastomotic leakage was more common among patients without an ileostomy (6.6% vs 1.7%, P = 0.04). However, the need for re‐laparotomy because of any early complication did not differ between the groups (P = 0.58). Within 3 months, 50 patients with ileostomy (42.0%) and 51 patients without (13.0%) were readmitted (P < 0.0001). In total, 35 patients (29.3%) had a complication relating to ileostomy closure and four of them required surgery. There was no difference in the rate of fistulas, pouchitis or pouch failure between the groups.

Conclusion

Our study shows that a diverting ileostomy is associated with considerable morbidity but it does not seem to prevent later failure of the pouch. We suggest that a diverting ileostomy should only be constructed for high‐risk patients.
The evolving risk of sudden cardiac death after heart transplant. An analysis of the ISHLT Thoracic Transplant Registry
Authors: Alba Ana C. , Fan Chun‐Po S. , Manlhiot Cedric , Dipchand Anne I. , Stehlik Josef , Ross Heather J.
Published: January 2019

Sudden cardiac death (SCD) is responsible for ~10% of post‐heart transplant deaths. We conducted a retrospective analysis of the ISHLT registry evaluating the risk of post‐transplant SCD. Adult heart transplant recipients (2004‐2014) surviving the first year were included. We used multivariable multistate competing risk survival analysis to evaluate the impact of history of treated rejection and cardiac allograft vasculopathy (CAV) on SCD risk. We used a probabilistic analytical model and Monte Carlo simulation to estimate the impact of CAV severity and graft dysfunction on SCD. We included 25 242 recipients. During a median follow‐up of 4.7 (2.3‐7.0) years, 582 patients died suddenly. Treated rejection (HR 1.76, 95% CI 1.36‐2.31) and CAV (HR 3.32, 95% CI 2.73‐4.03) were important risk factors for SCD. The estimated SCD risk in patients with severe CAV without and with graft dysfunction was 3.2% (95% CI 2.0‐4.6) and 5.4% (95% CI 3.8‐7.0), respectively, at 2 years from the CAV diagnosis, and 4.9% (95% CI 3.4‐6.5) and 8.0% (95% CI 6.1‐10.0), respectively, in those who also had treated rejection. These results provide evidence that recipients with severe CAV and graft dysfunction or treated rejection are at clinically significant increased SCD risk. The benefit of ICD post‐transplant remains uncertain.
Spatially explicit species distribution models: A missed opportunity in conservation planning?
Authors: Domisch Sami , Friedrichs Martin , Hein Thomas , Borgwardt Florian , Wetzig Annett , Jähnig Sonja C. , Langhans Simone D.
Published: January 2019

Aim

Systematic conservation planning is vital for allocating protected areas given the spatial distribution of conservation features, such as species. Due to incomplete species inventories, species distribution models (SDMs) are often used for predicting species’ habitat suitability and species’ probability of occurrence. Currently, SDMs mostly ignore spatial dependencies in species and predictor data. Here, we provide a comparative evaluation of how accounting for spatial dependencies, that is, autocorrelation, affects the delineation of optimized protected areas.

Location

Southeast Australia, Southeast U.S. Continental Shelf, Danube River Basin.

Methods

We employ Bayesian spatially explicit and non‐spatial SDMs for terrestrial, marine and freshwater species, using realm‐specific planning unit shapes (grid, hexagon and subcatchment, respectively). We then apply the softwaregurobito optimize conservation plans based on species targets derived from spatial and non‐spatial SDMs (10%–50% each to analyse sensitivity), and compare the delineation of the plans.

Results

Across realms and irrespective of the planning unit shape, spatially explicit SDMs (a) produce on average more accurate predictions in terms of AUC, TSS, sensitivity and specificity, along with a higher species detection probability. All spatial optimizations meet the species conservation targets. Spatial conservation plans that use predictions from spatially explicit SDMs (b) are spatially substantially different compared to those that use non‐spatial SDM predictions, but (c) encompass a similar amount of planning units. The overlap in the selection of planning units is smallest for conservation plans based on the lowest targets and vice versa.

Main conclusions

Species distribution models are core tools in conservation planning. Not surprisingly, accounting for the spatial characteristics in SDMs has drastic impacts on the delineation of optimized conservation plans. We therefore encourage practitioners to consider spatial dependencies in conservation features to improve the spatial representation of future protected areas.
Higher rates of large‐for‐gestational‐age newborns mediated by excess maternal weight gain in pregnancies with Type 1 diabetes and use of continuous subcutaneous insulin infusion vs multiple dose insulin injection
Authors: Hauffe F. , Schaefer‐Graf U. M. , Fauzan R. , Schohe A. L. , Scholle D. , Sedlacek L. , Scherer K. A. , Klapp C. , Ramsauer B. , Henrich W. , Schlembach D. , Abou‐Dakn M.
Published: January 2019

Aims

To compare glycaemic control, maternal and neonatal outcomes in pregnancies with Type 1 diabetes, managed either by continuous subcutaneous insulin infusion, multiple daily insulin injection or switch from multiple daily insulin injection (MDI) to continuous subcutaneous insulin infusion (CSII) in early pregnancy.

Research design and methods

Data from 339 singleton pregnancies were retrospectively reviewed. HbA1c values were measured preconception and in each trimester. In a secondary analysis, use of CSII pre‐pregnancy was compared with initiation of CSII during pregnancy.

Results

MDI was used in 140 pregnancies (41.3%) and CSII was used in 199 (58.7%), including 34 pregnancies (10.0%) during which the women switched to CSII. In pregnancies during which CSII was used duration of diabetes [median (interquartile range) 16.0 (8.0–23.0) years vs 11.0 (5.5–17.5) years; P<0.001] was longer, and the Institute of Medicine recommendations for appropriate weight gain were exceeded more often (64.8% vs. 50.8%; P=0.01). CSII use and pre‐pregnancy BMI were independent predictors of excess weight gain. There was no difference in glucose control, but CSII was associated with higher birth weight [median (interquartile range) 3720 (3365–4100) g vs 3360 (3365–4100) g; P<0.001] and higher large‐for‐gestational‐age (LGA) rate (44.7% vs. 33.6%; P=0.04) than MDI. HbA1c concentration in the third trimester and excess weight gain were predictive of LGA infants [odds ratio 2.33 (95% CI 1.54–3.51); P<0.001 and 1.89 (95% CI 1.02–3.51); P=0.04]. In pregnancies where CSII therapy was initiated in the first trimester and in those with pre‐pregnancy use, similar glucose control and outcome was achieved.

Conclusions

There was no advantage of CSII with respect to glycaemic control and neonatal outcomes. The rate of LGA neonates was higher in the CSII group, possibly mediated by excess maternal weight gain, which was more frequent than in women treated with MDI.
How tightly controlled do fluctuations in blood glucose levels need to be to reduce the risk of developing complications in people with Type 1 diabetes?
Authors: Livingstone R. , Boyle J. G. , Petrie J. R.
Published: January 2019

In 2011, the James Lind Alliance published a ‘top 10’ list of priorities for Type 1 diabetes research based on a structured consultation process. Whether reducing fluctuations in blood glucose can prevent long‐term microvascular and macrovascular complications was one of these. In this narrative review, 8 years on, we have assessed the updated evidence for the assertion that increased glucose variability plays an independent and clinically important role in the complications of Type 1 diabetes, over and above mean blood glucose and the effects of hypoglycaemia: the ‘glucose variability hypothesis’. Although studies in cultured cells and ex vivo vessels have been suggestive, most studies in Type 1 diabetes have been small and/or cross‐sectional, and based on ‘finger‐prick’ glucose measurements that capture glucose variability only in waking hours and are affected by missing data. A recent analysis of the Diabetes Control and Complications Trial that formally imputed missing data found no independent effect of short‐term glucose variability on long‐term complications. Few other high‐quality longitudinal studies have directly addressed the glucose variability hypothesis in Type 1 diabetes. We conclude that there is little substantial evidence to date to support this hypothesis in Type 1 diabetes, although increasing use of continuous glucose monitoring provides an opportunity to test it more definitively. In the meantime, we recommend that control of glycaemia in Type 1 diabetes should continue to focus on the sustained achievement of target HbA1c and avoidance of hypoglycaemia.
Sodium‐glucose co‐transporter‐2 inhibitor use and risk of lower‐extremity amputation: Evolving questions, evolving answers
Authors: Yang Jeff Y. , Wang Tiansheng , Pate Virginia , Gower Emily W. , Crowley Matthew J. , Buse John B. , Stürmer Til
Published: January 2019

Aim

To examine whether sodium‐glucose co‐transporter‐2 (SGLT2) inhibitors are associated with a higher risk of lower‐extremity amputation than dipeptidyl‐peptidase‐4 (DPP‐4) inhibitors and sulphonylureas.

Methods

We conducted a retrospective cohort study, using the MarketScan Commercial Claims and Encounters Database (2013‐2015), to compare the incidence of lower‐extremity amputation (LEA) between initiators of SGLT2 inhibitors and initiators of two second‐line drugs, DPP‐4 inhibitors and sulphonylureas (SUs). We estimated crude incidence rates (IRs) and adjusted hazard ratios (aHR), with 95% confidence intervals (CIs), before and after propensity‐score weighting. We additionally conducted sensitivity analyses using a comparator group of all non‐metformin, non‐SGLT2 inhibitor glucose‐lowering drugs, as previous studies used this approach.

Results

In a cohort of 328 150 individuals aged 18 to 64 years, the IR of LEA ranged from 1.5 to 2.4 per 1000 person‐years. In as‐treated analysis, the estimated hazard of LEA was increased among SGLT2 inhibitor initiators compared to DPP‐4 inhibitor initiators (aHR 1.69, 95% CI 1.20‐2.38), but not compared to SU initiators (aHR 1.02, 95% CI 0.67‐1.55) or non‐metformin, non‐SGLT2 inhibitor initiators (aHR 1.02, 95% CI 0.54‐1.93). Results were consistent in intention‐to‐treat analysis and across a number of sensitivity analyses.

Conclusions

Among commercially insured patients in the United States, our results suggest that initiation of SGLT2 inhibitors may increase the risk of LEA compared to initiation of DPP‐4 inhibitors. Contrasting results when comparing SGLT2 inhibitor initiators to DPP‐4 inhibitor and SU initiators highlight the importance of choosing appropriate comparator drugs when addressing comparative effectiveness and safety questions that can inform clinical decision‐making.
Linking sanitation policy to service delivery in Rwanda and Uganda: From words to action
Authors: Ekane Nelson , Kjellén Marianne , Westlund Hans , Ntakarutimana Amans , Mwesige Daniel
Published: January 2019

Motivation

The gap between policy, implementation and outcome is neither new nor specific to the sphere of sanitation. This article attempts to apply policy implementation literature in the context of developing countries, when much of the scholarly work on implementation and policy process and empirical research has been in the context of developed countries.

Purpose

This article explores the gap between sanitation policy intentions and outcomes in a comparative study in Rwanda and Uganda with “good” and “limited or no” reported progress respectively towards the former Millennium Development Goals (MDGs).

Approach and methods

From a multi‐level governance perspective, the gap between strong political will and insufficient resources, implementation and outcome, is examined by drawing on policy and implementation theories and empirical research. The selection of variables for comparison is based on a range of factors theorized as affecting outcome in contemporary governance.

Findings

Whereas the policy climate and prioritization of sanitation has been favourable in much of sub‐Saharan Africa (SSA), resources and capacity constraints, especially at the local level, negatively affect sector performance in an increasingly decentralized governance landscape. Progress in Rwanda is explained by stronger political leadership and support for sanitation, stringent performance monitoring and oversight, an institutionalized community‐based approach, and investment in rural sanitation.

Policy implications

This article shows that the management of sanitation depends on a changing governance landscape; leadership is important for overall sector improvement; networks present co‐ordination challenges; approaching sanitation as a public concern requires strong government intervention; the move towards markets necessitates government oversight; approaches that foster inclusion and legitimacy at the local level need to be considered.
Modelling horse management in the Australian Alps
Authors: Beeton Nicholas J. , Johnson Christopher N.
Published: January 2019

Management of the feral Horse (Equus caballus) in the Australian Alps bioregion is a difficult and emotive issue, with interested parties working from vastly differing perspectives. Compounding this, information regarding ecology and distribution of horses, and the cost and effectiveness of management strategies is often unknown or uncertain. Resolving these issues requires an objective approach with the flexibility to incorporate different potential scenarios. We used a spatially explicit population model to compare the potential effects of two different management strategies on populations of horses in the Australian Alps bioregion: culling from helicopters versus trapping and mustering. We populated the model using the results of population surveys conducted in 2014, vegetation data and cost estimates. We then provided an estimate of the effect of each strategy on population size across the Alps, and their corresponding costs, compared to no management. To account for uncertainties, we simulated different scenarios for horse population densities, dispersal rates and population growth rates. Management using aerial culling was more effective than mustering in every scenario modelled, and three to six times cheaper. Aerial culling was only slightly more effective within its control region. However, because mustering is necessarily restricted by road access, this translated to a substantial improvement in population control – up to 2000 horses where growth and dispersal rates were high. Our results unequivocally suggest aerial culling as the only strategy that could effectively control horses within the modelled range of scenarios; this result stands in addition to its other potential benefits of lower cost, animal stress and landscape disturbance. A major advantage of this modelling approach is that we can easily update it with new data, test different measures of effectiveness and add new scenarios to adapt to the rapidly changing situation on the ground, both in terms of the ecology and the political climate.
The occurrence of the Broad‐toothed Rat Mastacomys fuscus in relation to feral Horse impacts
Authors: Schulz Martin , Schroder Mellesa , Green Ken
Published: January 2019

Feral Horse (Equus caballus) impacts in northern Kosciuszko National Park, New South Wales, Australia are directly occurring in habitat of the nationally threatened Broad‐toothed Rat (Mastacomys fuscus). This species is endemic primarily to the mountain regions of south‐eastern mainland Australia and Tasmania, with a disjunct population at Barrington Tops. The Broad‐toothed Rat's preferred habitat is being increasingly impacted by browsing and trampling associated with the expansion of feral horse populations. This study surveyed 180 sites supporting preferred habitat for this species to determine Broad‐toothed Rat presence and relative abundance in relation to the level of feral horse impacts within the reserve. There was a significant negative relationship between feral horse impacts and both Broad‐toothed Rat presence and abundance. No scats were identified at localities where feral horse impacts were severe, and at moderate horse impact sites, there was a proportion (34%) without scats found. Locations with low horse impacts had little impact on Broad‐toothed Rat occurrence. As feral horse populations increase, Broad‐toothed Rat populations may be further impacted. Such impacts will be due to the loss of vegetation cover from feral horse trampling and grazing, making animals more vulnerable to predation by predators or impacting on their ability to disperse to more suitable habitat. Habitat remnants and vegetation corridors along drainage lines require protection from feral horses to prevent localized extinctions of Broad‐toothed Rat.
Rehabilitation and revegetation of the Kosciuszko summit area, following the removal of grazing – An historic review
Authors: Good Roger , Johnston Stuart
Published: January 2019

The removal of grazing from the high country in NSW and almost 20 years of rehabilitation and revegetation works at a cost of almost $10 million has restored the alpine zone in Kosciuszko National Park to a near natural landscape. Few visitors today would realise that the summer alpine floral display which they now enjoy each summer, hides a once degraded and severely eroded landscape, devoid of many of the natural catchment values so important to the discharge of water to the rivers and to the Snowy Mountains Hydro‐electric Scheme. The rehabilitation of the alpine zone has contributed to and seen the recovery of many native species and communities, some nearing extinction during the grazing years, such that their conservation will be forever ensured. The rehabilitation and revegetation programme is one that the Soil Conservation Service officers and more recently National Parks staff can be justly proud. It was arguably the first and certainly at the time, the largest landscape restoration programme undertaken in NSW. Much was learnt from the programme through observation of long‐term natural processes, providing for recognition of the limitations within which the work had to be carried out. Working with nature and utilising sound ecological principles was essential to the success of this landscape restoration programme and to the long‐term conservation of the alpine zone.
Effects and interactions of increased environmental temperature and UV radiation on photoageing and photocarcinogenesis of the skin
Authors: Lan Cheng‐Che E.
Published: January 2019

Solar radiation is one of fundamental elements sustaining and maintaining life on earth. Previous studies on health effects from the sun exposure mostly focused on ultraviolet (UV) radiation. Although exposure to the solar radiation likely occurs in an environment with elevated temperature, the effects and interactions of elevated environmental temperature with UV radiation on the skin, especially in the context of ageing and carcinogenesis, have not been carefully examined. It is known that UVA radiation results in reduced production and increased degradation of dermal collagen, contributing to photoageing of the skin. Previous studies showed conflicting results regarding the effects of increased environmental temperature on dermal collagen. Additionally, we demonstrated that solar‐simulated radiation and increased environmental temperature have similar impacts on dermal fibroblasts through activation of distinct pathways. UVB radiation is well known for its carcinogenic capacity. Previously, it was reported that exposure to heat treatment before UVB radiation reduces epidermal keratinocyte cell death. We demonstrated that exposure to elevated environmental temperature prior to UVB radiation reduces UVB‐induced skin tumor formation. We proposed that alterations in molecular dynamics and quantum mechanics were involved for the observed increased environmental temperature‐induced protective effect against UVB damage. This review emphasizes that both environmental temperature and solar radiation are important elements in nature that have significant impacts on the human health, and future studies should focus on the biological effects and interactions of environmental temperature and solar radiation since this scenario is most relevant to the real‐world setting.
Novel nanocapsule of α‐lipoic acid reveals pigmentation improvement: α‐Lipoic acid stimulates the proliferation and differentiation of keratinocyte in murine skin by topical application
Authors: Kubota Yoshiki , Musashi Mina , Nagasawa Teruaki , Shimura Nanako , Igarashi Rie , Yamaguchi Yoko
Published: January 2019

α‐Lipoic acid is amphipathic with low molecular sulphur‐containing fatty acid and has strong antioxidant effects. It has been used at the purposes of anti‐ageing, treatment of diabetic neuropathy, and supplement as antioxidant. Though α‐lipoic acid is normally administered in oral or injection, it has not been used in a topical use via skin because of its bad penetration. We developed the novel nanocapsule of α‐lipoic acid, named α‐lipoactive (nLA), to improve skin permeability. The nLA is constructed as micelles of α‐lipoic acid mixed with the non‐ionic surfactant, and its surface of the micelles was coated with inorganic metal salts. It is water soluble and has a diameter of approximately 8‐15 nm. After nLA was applied to the murine skin, epidermal thickening was observed. It was confirmed that this effect is caused by α‐lipoic acid molecule, but not by the raw material used for encapsulation. In in vivo experiments, it was found that nLA is very effective for improving UV‐induced pigmentation and epidermal thickening. Our findings suggest that nanoencapsulation of α‐lipoic acid is considerably effective for topical application.
Lipid phosphatases SKIP and SHIP2 regulate fibronectin‐dependent cell migration in glioblastoma
Authors: Ramos Ana Raquel , Ghosh Somadri , Dedobbeleer Matthias , Robe Pierre A. , Rogister Bernard , Erneux Christophe
Published: January 2019

Cell migration is an important process that occurs during development and has also been linked to the motility of cancer cells. Cytoskeleton reorganization takes place in the migration process leading to lamellipodia formation. Understanding the molecular underpinnings of cell migration is particularly important in studies of glioblastoma, a highly invasive and aggressive cancer type. Two members of the phosphoinositide 5‐phosphatase family, SKIP and SHIP2, have been associated with cell migration in glioblastoma; however, the precise role these enzymes play in the process—and whether they work in concert—remains unclear. Here, we compared phosphoinositide 5‐phosphatases expression in glioblastoma primary cells and cell lines and showed that SHIP2 and SKIP expression greatly varies between different cell types, while OCRL, another phosphoinositide 5‐phosphatase, is constitutively expressed. Upon adhesion of U‐251 MG cells to fibronectin, SHIP2, SKIP, and PI(4,5)P2 colocalized in membrane ruffles. Upregulation of PI(4,5)P2 was observed in SKIP‐depleted U‐251 MG cells compared to control cells, but only when cells were adhered to fibronectin. Both PTEN‐deficient (U‐251) and PTEN‐containing (LN229) glioblastoma cells showed a decrease in cell migration velocity in response to SKIP downregulation. Moreover, a SHIP2 catalytic inhibitor lowered cell migration velocity in the U‐251 MG cell line. We conclude that integrin activation in U‐251 cells leads to colocalization of both SKIP and SHIP2 in ruffles, where they act as potential drivers of cell migration. Depending on their expression levels in glioblastoma, phosphoinositide 5‐phosphatases could cooperate and synergize in the regulation of cell migration and adhesion.