bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementing Innovative Drainage Management Practices in the Mississippi River Basin to Enhance Nutrient Reductions
Authors: Kröger R. , Prince Czarnecki J.M. , Tank J.L. , Christopher S.F. , Witter J.D.
Published: July 2015

In the Mississippi River Basin (MRB), practices that enhance drainage (e.g., channelization, tile drainage) are necessary management tools in order to maintain optimal agricultural production in modern farming systems. However, these practices facilitate, and may speed the delivery of excess nutrients and sediments to downstream water bodies via agricultural streams and ditches. These nonpoint sources contribute to elevated nutrient loading in the Gulf of Mexico, which has been linked to widespread hypoxia and associated ecological and economic problems. Research suggests agricultural drainage ditches are important links between farm fields and downstream ecosystems, and application of new management practices may play an important role in the mitigation of water quality impairments from agricultural watersheds. In this article, we describe how researchers and producers in the MRB are implementing and validating novel best management practices (BMPs) that if used in tandem could provide producers with continued cropping success combined with improved environmental protection. We discuss three BMPs — low‐grade weirs, slotted inlet pipes, and the two‐stage ditch. While these new BMPs have improved the quality of water leaving agricultural landscapes, they have been validated solely in isolation, at opposite ends of the MRB. These BMPs have similar function and would greatly benefit from stacked incorporation across the MRB to the benefit of the basin as a whole.
Computed tomography overexposure as a consequence of extended scan length
Authors: Badawy Mohamed Khaldoun , Galea Michael , Mong Kam Shan , U Paul
Published: July 2015

Introduction

This study aimed to raise awareness around the increased effective dose as scan length chosen is increased from standard protocol

Methods

The Monte Carlo‐based software CT‐Expo (G. Stamm (Medizinische Hochschule Hannover, Hannover, Germany) and H.D. Nagel (SASCRAD, Buchholz, Germany)) was used to simulate the effective dose increase as the scanned region of the standard protocol increased.

Results

The results of this study show that for scans with a high computed tomography dose index (CTDI)vol the patient could be exposed to an extra 1 mSv within 6 cm of overscan. Protocols that investigated large scan areas may not see a significant relative dose reduction because of the use of a lower CTDIvol; however, radiation exposure should be kept as low as reasonably achievable.

Conclusion

There is significant dose optimisation potential when strictly adhering to appropriate scan lengths within each imaging protocol wherever possible.
Comparison of patients with ankylosing spondylitis (AS) and non‐radiographic axial spondyloarthritis (nr‐axSpA) from a single rheumatology clinic in New Delhi
Authors: Malaviya Anand N. , Kalyani Alok , Rawat Roopa , Gogia Shashi Bhushan
Published: July 2015

Aim

Comparison of ankylosing spondylitis (AS) with non‐radiographic axial spondyloarthritis (nr‐axSpA) classified with the recent ASsessment of spondyloArthritis International Society (ASAS) criteria.

Patients & Methods

This study included 288 patients clinically diagnosed as having spondyloarthritis (SpA) where a satisfactory radiograph of sacroiliac (S‐I) joints was available. The AS and the nr‐axSpA groups were compared for the various SpA‐related variables.

Results

Of 288 axSpA patients, there were 187 with AS. Of the remaining 101 patients without radiographic sacroiliitis, S‐I joint magnetic resonance imaging (MRI) was available in 72; 54 of them showed active sacroiliitis thus classified as nr‐axSpA according to the ASAS criteria. The remaining 18 patients with normal MRI and the other 29 patients without MRI of the S‐I joints (total 47 patients), were classified as nr‐axSpA using the ‘clinical arm’ of the ASAS criteria. On comparing the 187 AS with 101 patients in the nr‐axSpA group, the AS group showed significantly more males, longer disease duration, more axial symptoms at disease onset, higher Bath Ankylosing Spondylitis Metrology Index and more syndesmophytes. Biologicals were offered significantly more often to the AS group but methotrexate as monotherapy or in combination with other disease‐modifying anti‐rheumatic drugs was offered more often in nr‐axSpA group. There was no statistically significant difference between AS and nr‐axSpA in other SpA parameters.

Conclusion

The differences brought out between AS and nr‐axSpA groups show that they may not be the same disease. A prospective long‐term follow‐up of large cohorts may help in clarifying if nr‐axSpA is simply an early stage in the spectrum of SpA evolving into AS over time or is there inherent difference between them.
Glomerulomegaly in lupus nephritis: a prognostic marker for renal outcomes
Authors: Hanaoka Hironari , Kuwana Masataka , Takeuchi Tsutomu
Published: July 2015

Aim

Glomerulomegaly refers to the abnormal enlargement of glomeruli and is associated with an increased risk of progressive chronic kidney disease (CKD). However, it has rarely been investigated in lupus nephritis (LN). We therefore assessed glomerulomegaly as a prognostic factor for renal pathology.

Method

Patients with class III or IV LN were retrospectively recruited and divided into two groups according to complete renal response (CR) at 3 years after the initiation of induction therapy. Baseline clinical and renal pathological findings were compared to identify prognostic factors, and patients were followed for up to 10 years to assess long‐term renal outcomes.

Results

Nineteen patients with and 19 without CR on 3‐year follow‐up were analyzed. Long‐term disease duration and high levels of proteinuria were frequently observed in patients without CR (P = 0.03 and P = 0.01, respectively) at baseline compared to those with CR. On renal pathological analysis, a significantly higher proportion of patients without CR had enlarged glomeruli than those with CR (P = 0.03) in analysis of segmentally or minimally affected glomeruli. On 10‐year follow‐up, a higher proportion of patients without enlarged glomeruli maintained CR compared to those with enlarged glomeruli (P = 0.004). Further, glomerular area and disease duration were significantly correlated (P = 0.04).

Conclusions

Enlarged segmentally or minimally affected glomeruli at diagnosis of LN might predict a worse renal prognosis at 3 years after induction therapy. Mechanical glomerular injury might influence clinical outcomes.
Kawasaki disease in a 9‐year old girl presenting with febrile cholestasis: case report and review of literature
Authors: Koca Tugba , Aslan Nagehan , Akaslan Kara Aybuke , Pektas Ayhan , Ozen Metehan , Akcam Mustafa
Published: July 2015

Kawasaki disease is a systemic vasculitis that develops during childhood, especially in those younger than 5 years. Gastrointestinal involvement does not belong to the classic diagnostic criteria. We reported here, a 9‐year old girl who presented with febrile cholestasis, and developed a medium right coronary artery aneurysm despite intravenous immunoglobulin administration on the 9th day of fever. Hepatobiliary ultrasonographic evaluation revealed normal findings. Seroimmunologic markers of cholestasis were negative. Her clinical feature was ameliorated shortly after a second dose of intravenous immunoglobulin administration. We consider that a high index of suspicion of Kawasaki disease could prevent delayed diagnosis and complications.
A prospective, randomized, double‐blind, multicentre, parallel‐group, active controlled study to compare efficacy and safety of biosimilar adalimumab (Exemptia; ZRC‐3197) and adalimumab (Humira) in patients with rheumatoid arthritis
Authors: Jani Rajendrakumar H. , Gupta Rajiv , Bhatia Girish , Rathi Gaurav , Ashok Kumar Patnala , Sharma Reena , Kumar Uma , Gauri Liyakat A. , Jadhav Praveen , Bartakke Girishchandra , Haridas Vikram , Jain Dinesh , Mendiratta Sanjeev K.
Published: July 2015

Aim

In this study, efficacy, tolerability and safety of biosimilar adalimumab (Exemptia; Zydus Cadila) was compared with reference adalimumab (Humira; AbbVie) in patients with moderate to severe rheumatoid arthritis (RA).

Method

In this multicentre, prospective, randomized, double‐blind, active controlled parallel arm study, 120 patients with moderate to severe RA were given 40 mg of either test adalimumab (Exemptia) or reference adalimumab (Humira) by subcutaneous route every other week for 12 weeks. The primary endpoint was proportion of responders in two tretament groups by American College of Rheumatology 20 (ACR20) at week 12. The secondary endpoints were change in Disease Activity Score of 28 joints – C‐reactive protein (DAS28‐CRP) and proportion of patients with an ACR50 and ACR70 response in two treatment groups at week 12. Safety outcomes were also assessed.

Results

After 12 weeks, patients treated every other week with test adalimumab (Zydus Cadila) had statistically similar response rates as compared to reference adalimumab (AbbVie): ACR20 (82% vs. 79.2%; P > 0.7); ACR50 (46%, vs. 43.4%; P > 0.7); ACR70 (14% vs. 15.1%; P > 0.8). The change in DAS28‐CRP score was −2.1 ± 1.09 and −2.1 ± 1.21, in test and reference products, respectively. It was statistically significant compared to baseline, but not significantly different between the two products. Three serious adverse events and no death was reported during the study. Both adalimumab preparations were safe and well tolerated in this study.

Conclusion

The results demonstrated biosimilarity with respect to efficacy, tolerability and safety of test adalimumab (Exemptia) and reference adalimumab (Humira) in patients with moderate to severe RA.
Circulating microRNA signature of genotype‐by‐age interactions in the long‐lived Ames dwarf mouse
Authors: Victoria Berta , Dhahbi Joseph M. , Nunez Lopez Yury O. , Spinel Lina , Atamna Hani , Spindler Stephen R. , Masternak Michal M.
Published: July 2015

Recent evidence demonstrates that serum levels of specific miRNAs significantly change with age. The ability of circulating sncRNAs to act as signaling molecules and regulate a broad spectrum of cellular functions implicates them as key players in the aging process. To discover circulating sncRNAs that impact aging in the long‐lived Ames dwarf mice, we conducted deep sequencing of small RNAs extracted from serum of young and old mice. Our analysis showed genotype‐specific changes in the circulating levels of 21 miRNAs during aging [genotype‐by‐age interaction (GbA)]. Genotype‐by‐age miRNAs showed four distinct expression patterns and significant overtargeting of transcripts involved in age‐related processes. Functional enrichment analysis of putative and validated miRNA targets highlighted cellular processes such as tumor suppression, anti‐inflammatory response, and modulation of Wnt, insulin, mTOR, and MAPK signaling pathways, among others. The comparative analysis of circulating GbA miRNAs in Ames mice with circulating miRNAs modulated by calorie restriction (CR) in another long‐lived mouse suggests CR‐like and CR‐independent mechanisms contributing to longevity in the Ames mouse. In conclusion, we showed for the first time a signature of circulating miRNAs modulated by age in the long‐lived Ames mouse.
Internet‐based brief intervention for young men with unhealthy alcohol use: a randomized controlled trial in a general population sample
Authors: Bertholet Nicolas , Cunningham John A. , Faouzi Mohamed , Gaume Jacques , Gmel Gerhard , Burnand Bernard , Daeppen Jean‐Bernard
Published: July 2015

Aim

To test the efficacy of an internet‐based brief intervention (IBI) in decreasing alcohol use among young Swiss men aged 21 years on average.

Design

Two parallel‐group randomized controlled trial with a 1 : 1 allocation ratio containing follow‐up assessments at 1 and 6 months post‐randomization

Setting

Internet‐based study in a general population sample.

Participants

Twenty‐one‐year‐old men from Switzerland with unhealthy alcohol use (> 14 drinks/week or ≥ 6 drinks/occasion at least monthly or Alcohol Use Disorders Identification Test (AUDIT) scores ≥ 8)

Intervention

IBI consisting of (1) normative feedback, (2) feedback on consequences of alcohol use, (3) calorific value of reported consumption, (4) computed blood alcohol concentration for reported consumption, (5) indication of risk, (6) information on alcohol and health and (7) recommendations indicating low‐risk drinking limits. Control condition: no intervention (assessment only).

Measurements

At 1 and 6 months: quantity/frequency questions on alcohol use (primary outcome: number of drinks/week) and binge drinking prevalence; at 6 months: AUDIT score, consequences of drinking (range = 0–12).

Findings

Follow‐up rates were 92% at 1 month and 91% at 6 months. At 6 months, participants in the intervention group (n = 367) reported greater reductions in the number of drinks/week than participants in the control group (n = 370) [treatment × time interaction, incidence rate ratio (RR) = 0.86, 95% confidence interval (CI) = 0.78; 0.96], but no significant differences were observed on binge drinking prevalence. There was a favourable intervention effect on AUDIT scores (IRR = 0.93, 95% CI = 0.88; 0.98), but not on the number of consequences (IRR = 0.93, 95% CI = 0.84; 1.03).

Conclusions

An internet‐based brief intervention directed at harmful alcohol use among young men led to a reduction in self‐reported alcohol consumption and AUDIT scores compared with a no‐intervention control condition (assessment only).
Environmental drivers of anuran calling phenology in a seasonal Neotropical ecosystem
Authors: Schalk Christopher M. , Saenz Daniel
Published: July 2015

Temporal variation represents an important component in understanding the structure of ecological communities and species coexistence. We examined calling phenology of an assemblage of anurans in the Gran Chaco ecoregion of Bolivia by deploying automated recording devices to document nocturnally vocalizing amphibians nightly at seven ponds from 20 January 2011 until 31 October 2011. Using logistic regression, we modelled the relationships between temperature, rainfall and photoperiod with calling activity. There was a distinct seasonal effect with calling activity concentrated in the rainy season with no species detected during the dry season from June until the end of October. Calling activity was positively and significantly correlated with photoperiod in 9 of the 10 species analyzed, but there were distinct species‐specific relationships associated with rainfall and temperature. All of these species utilize ephemeral ponds as breeding sites, which can account for their reliance on rainfall as an important driver in calling activity. Two prolonged breeders exhibited similar seasonal breeding patterns across the rainy season, but differed in their response to daily abiotic factors, which might be attributed to the constraints imposed by their reproductive mode. Explosive breeders needed several days of rain to elicit calling. Two pairs of congeners had distinct species‐specific relationships between their calling activity and abiotic factors, even though the congeners shared the same reproductive mode, suggesting that the reproductive modes vary in the constraints imposed on calling activity. The patterns observed suggest that calling phenology of tropical anurans is determined by the interaction of exogenous factors (i.e. climatic variables) and endogenous factors (i.e. reproductive modes).
Methicillin‐resistant Staphylococcus aureus in children with atopic dermatitis from 1999 to 2014: A longitudinal study
Authors: Chaptini Cassandra , Quinn Steve , Marshman Gillian
Published: July 2015

Background/Objectives

With the increase in rates of methicillin‐resistant Staphylococcus aureus (MRSA) skin infections in the general population, there may be a similar increase of such infections in patients with atopic dermatitis (AD). There are few studies on MRSA prevalence in the AD population, and no previous studies in Australia. This study investigated the prevalence of MRSA and other organisms in the paediatric AD population over the previous 15 years.

Methods

Skin swab results and other significant data, including patients' characteristics and comorbidities, were collected on patients with AD aged 0–18 years, admitted to a large teaching hospital in South Australia from 1999 to 2014 (N = 298). This longitudinal, retrospective study investigated, using logistic regression, the change of prevalence of MRSA, methicillin‐sensitive S. aureus (MSSA) and Streptococcus spp. in AD over the past 15 years.

Results

Compared with 1999–2002, in 2003–2006 patients were approximately threefold more likely (P = 0.350), in 2007–2010 they were approximately 13‐fold more likely (P = 0.030) and in 2011–2014 they were approximately 24‐fold more likely to test positive for MRSA (P = 0.008), despite low absolute MRSA numbers. There was a positive association between the number of previous hospital admissions per patient and MRSA (OR = 1.16 [1.08–1.25], P = 0.000). In contrast, there was no change in the prevalence of MSSA or Streptococcus spp. over time.

Conclusion

The prevalence of MRSA in children with AD is clearly on the rise. This has negative consequences for individuals with AD and is also a major public health problem.
Supervisor perspectives on the summative in‐training assessment
Authors: Scarff Catherine E , Bearman Margaret , Corderoy Robert M
Published: July 2015

Background

Assessment is a fundamental component of medical education and exists in many formats. In‐training assessments are one such example and they serve to provide feedback to learners about their performance during a period of clinical attachment. However, in addition to trainee knowledge and performance, many factors influence the assessment given to a trainee.

Method

This study used an anonymous survey to investigate the perceptions of supervisors of the influences on their assessments of Australian dermatology trainees, focusing on the summative in‐training assessment (SITA) format.

Results

A response rate of 41% was achieved. The importance of reporting underperformance and providing feedback to trainees was agreed on, but current limitations in the ability of the tool to do this were noted. Implications for practice are discussed including the education and support of supervisors, consideration of logistical issues, the process of SITA completion and supervisor appointment. Further research into the impact of supervisor concerns about potential challenges to a judgement and hesitations about making negative comments about a trainee are required. Examination of the trainee perspective is also required.

Conclusion

Quality feedback is essential for learners to guide and improve their performance. Supervisors face many potential influences on their assessments and if these are too great, they may jeopardise the quality of the assessment given. Attention to highlighted areas may serve to improve the process, so allowing trainees to develop into the best clinicians they can be.
Cost‐effectiveness of term induction of labour using inpatient prostaglandin gel versus outpatient Foley catheter
Authors: Austin Kathryn , Chambers Georgina M. , de Abreu Lourenco Richard , Madan Arushi , Susic Daniella , Henry Amanda
Published: July 2015

Objective

Evaluating cost‐effectiveness of induction of labour (IOL) using outpatient mechanical cervical ripening using a Foley catheter (OFC) compared to inpatient chemical ripening using prostin gel (IPG).

Study Design

Cost‐effectiveness analysis from a hospital perspective alongside a RCT. Women in a metropolitan Australian maternity hospital with an unfavourable cervix requiring IOL at term were randomised to IPG (n = 51) or OFC (n = 50). Primary economic measures were mean patient costs, incremental cost per predelivery inpatient hour prevented, and incremental cost per vaginal delivery within 12 h of admission to the birthing unit. Bootstrapping estimates were used to construct 95% confidence intervals. Estimates of net monetary benefit were calculated to aid interpretation of the results.

Results

Mean hospital costs per woman were nonsignificantly higher ($6524 OFC vs $5876 IPG) and mean difference $643; 95% CI −$366 to $1652. OFC group experienced fewer predelivery inpatient hours, resulting in an incremental cost per inpatient hour prevented of $57 (95% CI −$79.44 to $190.65). However, OFC patients were less likely to deliver vaginally within 12 h of admission to birthing unit. Other cost influencing clinical outcomes, including caesarean section rates and total inpatient hours, were not statistically different. Results were not sensitive to changes in costs or the cost‐effectiveness thresholds.

Conclusion

OFC had fewer inpatient hours and costs prior to birth. However, OFC did not reduce overall inpatient hours and failed to achieve comparable rates of vaginal delivery within 12 h of birthing unit admission. Therefore, OFC is unlikely to be considered cost‐effective compared to IPG in current hospital settings.
Introducing a laparoscopic simulation training and credentialing program in gynaecology: an observational study
Authors: Janssens Sarah , Beckmann Michael , Bonney Donna
Published: July 2015

Background

Simulation training in laparoscopic surgery has been shown to improve surgical performance.

Aims

To describe the implementation of a laparoscopic simulation training and credentialing program for gynaecology registrars.

Materials and Methods

A pilot program consisting of protected, supervised laparoscopic simulation time, a tailored curriculum and a credentialing process, was developed and implemented. Quantitative measures assessing simulated surgical performance were measured over the simulation training period. Laparoscopic procedures requiring credentialing were assessed for both the frequency of a registrar being the primary operator and the duration of surgery and compared to a presimulation cohort. Qualitative measures regarding quality of surgical training were assessed pre‐ and postsimulation.

Results

Improvements were seen in simulated surgical performance in efficiency domains. Operative time for procedures requiring credentialing was reduced by 12%. Primary operator status in the operating theatre for registrars was unchanged. Registrar assessment of training quality improved.

Conclusions

The introduction of a laparoscopic simulation training and credentialing program resulted in improvements in simulated performance, reduced operative time and improved registrar assessment of the quality of training.
The success rate of IVF has significantly improved over the last decade
Authors: Wade Jessica J. , MacLachlan Vivien , Kovacs Gab
Published: July 2015

Aim

To demonstrate that success rates with in vitro fertilisation (IVF) have been improving despite decreasing the number of embryos transferred.

Materials and Methods

This was a retrospective cohort study comparing live birth outcomes for women who started IVF between 2001 and 2005 with women who started between 2006 and 2010, using life table analysis to allow for the fact that women had differing number of cycles of treatment. The data were obtained from a single IVF centre, Monash IVF Geelong, Victoria. The 2001–2005 cohort consisted of 233 women, and the 2006–2010 cohort consisted of 453 women who started IVF between the specified dates. The main outcome measure was a live birth. Life table analysis was used to estimate the cumulative probability of a live birth after each cycle.

Results

The estimate of cumulative live birth probability demonstrated that the chance of a live birth by cycle five was 75.8% in the 2001–2005 cohort, which significantly increased to 80.1% by cycle five in the 2006–2010 cohort (P = <0.05). There was a mean of 1.8 embryos transferred per embryo transfer in the 2001–2005 cohort, which decreased to a mean of 1.3 embryos transferred per embryo transfer in the 2006–2010 cohort. This was associated with a significant decrease in the multiple birth rate from 24.7% in the 2001–2005 cohort to 7.5% in the 2006–2010 cohort.

Conclusion

The IVF success rate has significantly improved despite the number of embryos transferred being reduced. This study provides further support for elective single embryo transfers.
Incidence of transmissible diseases in a network of assisted reproduction clinics throughout Queensland
Authors: Harrison Keith , Darling Nicky , Vargas Karen , Irving Jacquelyn , Osborn Jeremy , Yazdani Anusch , Molloy David
Published: July 2015

In assisted reproduction, knowledge of the presence of transmissible disease assists diagnosis and permits appropriate risk minimisation. The overall incidence was lowest in the Brisbane full‐cost clinic and highest in the Springwood low‐cost clinic. Male partners predominated over females, particularly in the low‐cost clinic. Hepatitis C was the most commonly detected infection with the highest incidence in the low‐cost clinic. HIV was the least commonly detected infection amongst those tested.
A Closer Look at Reporting Bias in Conflict Event Data
Authors: Weidmann Nils B.
Published: July 2015

Recent data collections about political violence are frequently based on media reports, which can lead to reporting bias. This is an issue in particular for the emergent literature on communication technology and conflict, since this technology may not only affect violence, but also the reporting about it. Using the effect of cellphones on violence as an example, this article presents a quantitative assessment of reporting bias in a micro‐level analysis. Comparing media‐based event reports and those from military sources, the results show that the purported violence‐increasing effect of cellphone coverage is partly due to higher reporting rates of violence in cellphone‐covered areas. A simple diagnostic procedure for this problem is implemented. Applied to the analysis of cellphones and violence in Africa, it produces a pattern that is consistent with reporting bias driving much of the effect found in the Pierskalla and Hollenbach (2013) study about this topic.
Where It Hurts: 2014 Year in Review
Authors: Morris Courtney Desiree
Published: July 2015

Anthropologists have increasingly used the term public anthropology to refer to a model of research and practice dedicated to bringing anthropological knowledge into public discourse to affect tangible social change (Low 2011). The increased visibility of what is variously referred to as public, engaged, activist, action, or applied anthropology challenges anthropologists to circulate their insights more widely and effectively in the public sphere. The question, however, is not merely whether anthropologists should participate in the public sphere but also how anthropologists should intervene. In this article, I examine the interventions that anthropologists made in debates on the Ebola epidemic, state violence and civil discourse, and the need for cultural change in the face of climate change. Using these cases as a theoretical point of departure, I question what would happen if we imagined our work as a practice of freedom, an act of imagination, a tool for transforming an unequal world? What if we did the work of anthropology as though our lives and the lives of others depended on it? [public anthropology, Ebola, Israel‐Palestine, Ferguson, climate change, year in review]
Fever‐Induced Brugada Syndrome Is More Common Than Previously Suspected: A Cross‐Sectional Study from an Endemic Area
Authors: Rattanawong Pattara , Vutthikraivit Wasawat , Charoensri Attawit , Jongraksak Tanawat , Prombandankul Awapa , Kanjanahattakij Napatt , Rungaramsin Sakda , Wisaratapong Treechada , Ngarmukos Tachapong
Published: July 2015

Background

Brugada syndrome (BrS) is defined as presenting of type‐1 Brugada pattern (BrP). BrS can also be induced by fever. This study demonstrated a highest prevalence of fever‐induced BrS ever reported.

Method

During May 2014, febrile (oral temperature ≥ 38 °C) and nonfebrile patients underwent standard and high leads (V1 and V2 at 2nd intercostal space) electrocardiogram. Risk factor and cardiac symptoms were recorded. Patients with a persistent of type‐1 BrP after fever had subsided were excluded. The prevalence of BrS, type‐2 BrP and early repolarization pattern (ERP) were demonstrated.

Results

A total of 401 patients, 152 febrile, and 249 nonfebrile, were evaluated. BrS was identified in six febrile patients (five males and one female) and two males in nonfebrile patients. The study demonstrated higher prevalence of BrS in febrile group compared to nonfebrile group (4.0% vs 0.8%, respectively, P = 0.037). Among fever‐induced BrS patients, three patients (50.0%) experienced cardiac symptoms before and at the time of presentation and two patients (33.3%) had history of first‐degree relative sudden death. No ventricular arrhythmia was observed. All of type‐1 BrP disappeared after fever had subsided. We found no difference in prevalence of type‐2 BrP in febrile and nonfebrile group (2.0% vs 2.8%, respectively, P > 0.05) as well as ERP (3.3% vs 6.4%, respectively, P > 0.05).

Conclusions

Our study showed a highest prevalence of fever induced BrS ever reported. A larger study of prevalence, risk stratification, genetic test and management of fever‐induced BrS should be done, especially in an endemic area.
Fragmented QRS Is Associated with Improved Predictive Value of Exercise Treadmill Testing in Patients with Intermediate Pretest Likelihood of Significant Coronary Artery Disease
Authors: Tusun Eyyup , Ilter Abdulselam , Besli Feyzullah , Erkus Emre , Altiparmak Ibrahim Halil , Bozbay Mehmet
Published: July 2015

Background

The predictive value of exercise treadmill testing (ETT) remains inadequate in diagnosing patients with suspected coronary artery disease (CAD) and needs to be improved.

Objective

The aim of this study was to investigate whether the presence of FQRS on 12‐lead ECG would increase the PPV of ETT in patients with an intermediate likelihood of CAD.

Methods

fQRS, defined as the presence of notched R or S waves without accompanying typical bundle branch block or the existence of an additional wave‐like RSR’ pattern in the original QRS complex (with a duration of <120 ms), was assessed in 95 patients with positive ETT. Coronary angiogram (CA) was performed in all patients, divided into two groups as the significant CAD group and nonsignificant CAD group according to coronary artery lesions. The differences between the groups in terms of the presence of fQRS and clinical characteristics were investigated.

Results

The mean age of patients was 51.3 ± 11.3 years, and 74 of them were males (77.9%). FQRS was present in 47 (49.5%) patients, and significant CAD was demonstrated in 51 subjects (53.7%) among the enrolled subjects. fQRS was more prevalent in the significant CAD group compared to nonsignificant CAD group (P < 0.001). The presence of FQRS increased the PPV of positive ETT from 53.7% to 85.1%. In addition, FQRS was associated with the increased risk of significant CAD in multivariate analysis (OR = 2.839, P < 0.001).

Conclusion

In clinical practice, the presence of fQRS in patients with positive ETT may support clinicians during the decision‐making process with regard to the referral for a coronary angiography.
Fetal sonographic characteristics associated with shoulder dystocia in pregnancies of women with type 1 diabetes
Authors: Secher Anna L. , Bytoft Birgitte , Tabor Ann , Damm Peter , Mathiesen Elisabeth R.
Published: July 2015

Introduction

Shoulder dystocia is a rare but severe complication of vaginal delivery and diabetic women are at high risk. The aim of this study was to identify fetal sonographic and maternal glycemic characteristics associated with shoulder dystocia in pregnant women with type 1 diabetes.

Material and methods

Twelve cases (5%) of shoulder dystocia among 241 consecutive vaginal deliveries in women with type 1 diabetes followed at Rigshospitalet University Hospital in 2009–2013 were retrospectively identified in a local database. Fetal sonographic and clinical data were compared with 69 women with type 1 diabetes and uncomplicated vaginal deliveries.

Results

Women experiencing shoulder dystocia compared with women with uncomplicated deliveries had a higher glycated hemoglobin (HbA1c) in early pregnancy [median 7.0% (range 5.9–8.1) vs. 6.6% (range 5.4–10.0, P = 0.04)], whereas in late pregnancy, HbA1c in the two groups of women was comparable [6.1% (range 5.5–6.9) vs. 6.0% (range 4.7–8.4, P = 0.30)]. Fetal biometry at 36 weeks showed a higher estimated fetal weight of 3597 g (range 3051–4069) vs. 2989 g (range 2165–4025), P < 0.001, corresponding to 20% (4–41%) vs. 5% (−20 to 44%) above the mean estimated fetal weight for gestational age (P = 0.002) and a greater abdominal circumference SD score of 2.51 (range 1.56–4.20) vs. 1.33 (range −1.08 to 4.25), P = 0.001). Head circumference was comparable. Vacuum extraction was more frequent during deliveries with shoulder dystocia (58 vs. 17%, P = 0.005). Seven (58%) newborns with shoulder dystocia had brachial plexus injuries, fractures, intra‐abdominal bleeding or needed resuscitation.

Conclusions

Excessive estimated fetal weight and abdominal circumference at 36 weeks' sonographic examination may help in identifying diabetic women at high risk of later shoulder dystocia.
Role of SOCS3 in the Jak/stat3 pathway in the human placenta: different mechanisms for preterm and term labor
Authors: Zhou Xin , Jiang Ziyan , Zou Yanfen , Yin Yin , Zuo Qing , Sun Lizhou
Published: July 2015

Introduction

To identify changes in interleukin (IL)‐6 levels and its pathway (Jak/stat3) in the human placenta during preterm and term labor, placental tissues were collected from primiparous women who underwent vaginal deliveries or cesarean sections in our hospital. The women were divided into three groups: preterm labor (n = 15), term labor (n = 15), and term not in labor (n = 15).

Material and methods

IL‐6 levels were detected by ELISA in placental supernatant, and p‐STAT3 and SOCS3 protein was detected by Western blot. TUNEL was used to detect apoptosis in trophoblasts. HTR‐8/SVneo cells were cultured after stimulation with IL‐6, and we measured p‐STAT3, SOCS3, and the rate of apoptosis.

Results

Expression of p‐STAT3 and SOCS3 in the placenta and trophoblast cells showed that IL‐6 levels were highest in the preterm labor group and lowest in the term not in labor group. The highest expression of placental SOCS3 protein was observed in the preterm labor group. More apoptotic cells were found in the preterm labor group than in the other two groups by TUNEL. SOCS3 and p‐STAT3 expression was significantly upregulated after stimulation by IL‐6 in trophoblast cells in a dose‐dependent manner. However, p‐STAT3 was significantly decreased after 50 ng/mL and 100 ng/mL IL‐6 for 72 h. A significant increase of apoptosis was observed with treatment of 50 ng/mL IL‐6 in HTR‐8/SVneo cells.

Conclusions

The role of the SOCS3 protein in the Jak/stat3 pathway is to mediate different mechanisms for preterm and term labor processes in the placenta.
QRS abnormalities of the fetal electrocardiogram, and their implications for ST‐interval analysis during labor
Authors: Sletten Julie , Kessler Jørg
Published: July 2015

Introduction

The objective of this study was to describe the QRS complex of the fetal electrocardiogram (fECG) in relation to fetal presentation, and explore the effect of abnormal QRS on automated ST‐interval analysis (STAN).

Material and methods

A case–control study was carried out at a University Hospital in Norway, between the years of 2004–2008. High‐risk singleton deliveries with a gestational age >35+6 weeks, were monitored with cardiotocography and STAN. Cases included breech presentations (n = 433) and controls included cephalic presentations (n = 433). The main outcome measures were QRS‐complex abnormalities and fECG abnormalities.

Results

An abnormal QRS complex was found in 13.9% of the cases and 16.6% of the controls (p = 0.257). Split R (8.4%) and deep S (8.2%) were the most common abnormalities, and deep Q (4.4% vs. 0.7%, p ≤ 0.001) and split Q (1.8% vs. 0, p ≤ 0.005) were more common in breech than in cephalic presentations. QRS abnormalities impacted on the fECG in 114/866 (13.2%) of the total population. The most common finding was an ambiguous placement of R and S in cases of a split vector (n = 112, 12.9%). Deviance of the ECG baseline above null occurred less frequently (n = 33, 3.8%), and was more common in breech presentation (5.3 vs. 2.3%, p = 0.021). ST events due to an erroneous identification of the QRS vectors and/or a misplacement of the ECG baseline were found in 26 (3.0%) fetuses, with no significant difference in frequency between cases and controls.

Conclusions

The appearance of the QRS complex of fECG is dependent upon the fetal presentation. QRS abnormalities impact automated fECG tracing and subsequent ST analysis. Clinicians should be aware of this finding in clinical practice.
Out‐of‐hospital deliveries have risen involving greater neonatal morbidity
Authors: Ovaskainen Katja , Ojala Riitta , Gissler Mika , Luukkaala Tiina , Tammela Outi
Published: July 2015

Aim

Most Finnish births take place in hospital, but out‐of‐hospital deliveries (OHDs) have increased. This study evaluated trends and reasons for OHDs in the Tampere University Hospital catchment area.

Methods

The study cohort included all planned and unplanned OHDs in the Hospital area from 1996 to 2011; the control group comprised two hospital births for each OHD. Trends in incidence and risk factors for OHDs, including neonatal morbidities, were established and compared to the controls.

Results

OHDs accounted for 67 (0.10%) of the 76 773 births in the area, the proportion remaining unchanged between 1996 and 2005, but then increasing. Risk factors associated with OHDs were smoking during pregnancy, short labour, higher number of previous births, single status, residence more than 35 kilometres from the delivery unit and fewer prenatal visits. OHD cases were more likely to be admitted to the neonatal care unit than controls and to be treated for suspected infections and hypothermia.

Conclusion

Smoking, short duration of labour, a higher number of previous births, single status and longer distances from the delivery unit were associated with OHDs. Eight (12%) mothers had OHDs without antenatal care, and their infants had more neonatal morbidities.
Physical activity and screen‐time of childhood haematopoietic stem cell transplant survivors
Authors: Bogg Tina FT , Shaw Peter J. , Cohn Richard J. , Wakefield Claire E. , Hardy Louise L , Broderick Carolyn , Naumann Fiona
Published: July 2015

Aim

Reduced bone mineral density, impaired cardiovascular fitness and increased risk of obesity are well‐known late effects of haematopoietic stem cell transplantation (HSCT) in survivors of childhood cancer. These comorbidities can be mitigated through physical activity and limiting screen‐time (ST). This study aims to increase the understanding of physical activity and ST behaviours for children following HSCT.

Methods

Children were recruited from two oncology follow‐up clinics and completed a questionnaire on their physical activity levels and screen‐time. Children were classified as short (≤2 years) and long‐term (>2 years) survivors.

Results

Fifty‐eight children were eligible, of whom forty children of age 6–18 years (60% males) participated in the study. Less than half (47.5%) met the daily recommendations for physical activity and one‐third met the ST recommendations. Late survivors reported higher daily physical activity and less ST than early survivors. Among late survivors, females reported higher daily physical activity and less ST than males.

Conclusion

Our findings suggest that the majority of children following HSCT were not sufficiently active and had excessive screen‐time; however, this was comparable to healthy populations. Appropriately designed physical activity and screen‐time intervention programmes should be explored early following transplant for children undergoing HSCT.
Breastfeeding and dummy use have a protective effect on sudden infant death syndrome
Authors: Alm Bernt , Wennergren Göran , Möllborg Per , Lagercrantz Hugo
Published: July 2015

We conducted a literature review on the effect of breastfeeding and dummy (pacifier) use on sudden infant death syndrome (SIDS). From 4343 abstracts, we identified 35 relevant studies on breastfeeding and SIDS, 27 on dummy use and SIDS and 59 on dummy use versus breastfeeding.

Conclusion

We found ample evidence that both breastfeeding and dummy use reduce the risk of SIDS. There has been a general reluctance to endorse dummy use in case it has a detrimental effect of breastfeeding. However, recent evidence suggests that dummy use might not be as harmful to breastfeeding as previously believed.
Guidelines for urinary tract infections and antenatal hydronephrosis should be gender specific
Authors: Moore Shiran S. , Bahat Hilla , Rachmiel Mariana , Ziv‐Baran Tomer , Youngster Ilan , Goldman Michael
Published: July 2015

Aim

Febrile urinary tract infections (UTIs) may be associated with long‐term renal damage. Our goal was to identify risk factors for future UTIs in children who had voiding cystourethrography (VCUG) as a part of an antenatal hydronephrosis (ANH) assessment or after a febrile UTI.

Methods

We conducted a cohort study based on the medical records of children aged 0–24 months who underwent a VCUG between January 2004 and December 2011 and had at least six months of follow‐up. The incidence of future UTIs was assessed.

Results

We included 285 children: 176 had a primary UTI and 109 had ANH. We recorded 28 UTIs during the follow‐up period, and the risk was 12.5% after a primary UTI and 5.5% after an ANH (p = 0.049). Multivariate analysis showed no risk difference was found between the groups. Females had a greater risk of febrile UTIs (hazard ratio 3.3, 95% confidence interval 1.03–9.2, p = 0.04), but the UTI risk did not differ between children with or without VURs.

Conclusion

Female infants were at greater risk of febrile UTIs, regardless of the presence of VUR, VUR degree, ANH or a previous UTI. Clinical guidelines for UTI and ANH assessment should preferably be gender specific.
Nitric oxide regulation of migrating motor complex: randomized trial of NG‐monomethyl‐l‐arginine effects in relation to muscarinic and serotonergic receptor blockade
Authors: Halim M. A. , Gillberg L. , Boghus S. , Sundbom M. , Karlbom U. , Webb D.‐L. , Hellström P. M.
Published: July 2015

Aim

The migrating motor complex (MMC) propels contents through the gastrointestinal tract during fasting. Nitric oxide (NO) is an inhibitory neurotransmitter in the gastrointestinal tract. Little is known about how NO regulates the MMC. In this study, the aim was to examine nitrergic inhibition of the MMC in man using NG‐monomethyl‐l‐arginine (l‐NMMA) in combination with muscarinic receptor antagonist atropine and 5‐HT3 receptor antagonist ondansetron.

Methods

Twenty‐six healthy volunteers underwent antroduodenojejunal manometry for 8 h with saline or NO synthase (NOS) inhibitor l‐NMMA randomly injected I.V. at 4 h with or without atropine or ondansetron. Plasma ghrelin, motilin and somatostatin were measured by ELISA. Intestinal muscle strip contractions were investigated for NO‐dependent mechanisms using l‐NMMA and tetrodotoxin. NOS expression was localized by immunohistochemistry.

Results

l‐NMMA elicited premature duodenojejunal phase III in all subjects but one, irrespective of atropine or ondansetron. l‐NMMA shortened MMC cycle length, suppressed phase I and shifted motility towards phase II. Pre‐treatment with atropine extended phase II, while ondansetron had no effect. l‐NMMA did not change circulating ghrelin, motilin or somatostatin. Intestinal contractions were stimulated by l‐NMMA, insensitive to tetrodotoxin. NOS immunoreactivity was detected in the myenteric plexus but not in smooth muscle cells.

Conclusion

Nitric oxide suppresses phase III of MMC independent of muscarinic and 5‐HT3 receptors as shown by nitrergic blockade, and acts through a neurocrine disinhibition step resulting in stimulated phase III of MMC independent of cholinergic or 5‐HT3‐ergic mechanisms. Furthermore, phase II of MMC is governed by inhibitory nitrergic and excitatory cholinergic, but not 5‐HT3‐ergic mechanisms.
Treatment of drug‐induced seizures
Authors: Chen Hsien‐Yi , Albertson Timothy E. , Olson Kent R.
Published: July 2015

Seizures are a common complication of drug intoxication, and up to 9% of status epilepticus cases are caused by a drug or poison. While the specific drugs associated with drug‐induced seizures may vary by geography and change over time, common reported causes include antidepressants, stimulants and antihistamines. Seizures occur generally as a result of inadequate inhibitory influences (e.g., gamma aminobutyric acid, GABA) or excessive excitatory stimulation (e.g. glutamate) although many other neurotransmitters play a role. Most drug‐induced seizures are self‐limited. However, status epilepticus occurs in up to 10% of cases. Prolonged or recurrent seizures can lead to serious complications and require vigorous supportive care and anticonvulsant drugs. Benzodiazepines are generally accepted as the first line anticonvulsant therapy for drug‐induced seizures. If benzodiazepines fail to halt seizures promptly, second line drugs include barbiturates and propofol. If isoniazid poisoning is a possibility, pyridoxine is given. Continuous infusion of one or more anticonvulsants may be required in refractory status epilepticus. There is no role for phenytoin in the treatment of drug‐induced seizures. The potential role of ketamine and levetiracetam is promising but not established.
Bile Acid‐Induced Toxicity in HepaRG Cells Recapitulates the Response in Primary Human Hepatocytes
Authors: Woolbright Benjamin L. , McGill Mitchell R. , Yan Huimin , Jaeschke Hartmut
Published: July 2015

Cholestatic liver injury is a pathological component of numerous disease states. Much of the current literature on cholestatic liver injury is derived from in vitro studies using rodent hepatocytes or cell lines transfected with bile acid (BA) uptake transporters. While these studies demonstrate BA‐driven apoptosis, it is debatable whether these models reflect the human pathophysiology, as primary human hepatocytes undergo primarily necrosis. HepaRG cells are a bipotential, human hepatoma line that express apical and basolateral BA transporters. Thus, we sought to determine whether HepaRG cells could replicate the response of primary human hepatocytes to BA exposure in vitro. HepG2 cells, primary murine hepatocytes (PMH) or HepaRG cells, were exposed to taurocholic acid (TCA), or glycochenodeoxycholate (GCDC) and lactate dehydrogenase release were measured to determine cell death. Cell death occurred dose‐responsively in HepaRG cells when exposed to GCDC; however, HepG2 cells died acutely only at very high concentrations of GCDC. In HepaRG cells, pre‐treatment with the caspase inhibitor z‐VD‐FMK had no effect on cell death, indicating a lack of apoptotic cell death, and while c‐jun N‐terminal kinase (JNK) protein was activated by GCDC treatment in HepaRG cells, the inhibition of JNK did not protect. Although previous data indicate that TCA stimulates pro‐inflammatory gene induction in PMH, there was no change in gene expression after TCA stimulation in HepaRG cells, which mimicked previous data found in primary human hepatocytes. These data provide evidence for HepaRG cells as a new model for the study of the effect of BA on human hepatocytes.