bluuebunny/crossref_metadata_2025 huggingface dataset:
TC‐325 versus the conventional combined technique for endoscopic treatment of peptic ulcers with high‐risk bleeding stigmata: A randomized pilot study
Authors: Kwek Boon Eu Andrew , Ang Tiing Leong , Ong Peng Lan Jeannie , Tan Yi Lyn Jessica , Ang Shih Wen Daphne , Law Ngai Moh , Thurairajah Prem Harichander , Fock Kwong Ming
Published: May 2017

OBJECTIVE

Preliminary studies on a new topical hemostatic agent, TC‐325, have shown its safety and effectiveness in treating active upper gastrointestinal (GI) bleeding. However, to date there have been no randomized trials comparing TC‐325 with the conventional combined technique (CCT). Our pilot study aimed to compare the efficacy and safety of TC‐325 with those of CCT in treating peptic ulcers with active bleeding or high‐risk stigmata.

METHODS

This was a comparative randomized study of patients with upper GI bleeding who had Forrest class I, IIA or IIB ulcers.

RESULTS

Altogether 20 patients with a mean age of 70 years (range 23–87 years) were recruited, including 16 men, with a mean hemoglobin of 97 g/L. Initial hemostasis was successful in 19 (95.0%) patients, including 90.0% (9/10) in the TC‐325 group and 100% (10/10) in the CCT group. TC‐325 monotherapy failed to stop bleeding in a patient with Forrest IB posterior duodenal wall ulcer. Rebleeding was seen in 33.3% (3/9) of the patients in the TC‐325 group and 10.0% (1/10) in the CCT group. One patient required angio‐embolization therapy while three had successful conventional endotherapy. Two patients from the TC‐325 group had serious adverse events that were not procedure‐ or therapy‐related. In patients with Forrest IIA or IIB ulcers, five received TC‐325 monotherapy; none had rebleeding.

CONCLUSIONS

Our pilot study showed that TC‐325 has a tendency towards a higher rebleeding rate than CCT, when treating actively bleeding ulcers. Larger trials are necessary for definitive results.
‘I swim like a frog that has lost the use of its hind legs’: The Pursuit of Health and Leisure in Buxton, 1781‐90
Authors: Collinge Peter
Published: May 2017

As the eighteenth century progressed, the number of spa resorts proliferated; so too did an elaborate range of leisure options associated with them. Such was the extent of these offerings that the therapeutic qualities of the waters have a tendency to be overlooked in assessments of spa culture as the century drew to a close. Using Hester Newdigate's correspondence and Jane Macartney's accounts relating to Buxton, Derbyshire, this article examines the extent to which the reputation and perceived benefits of a resort's waters determined the choice of destination and the significance of hydropathic regimens during visitors' repeat visits.
Auditors’ Response to Assessments of High Control Risk: Further Insights
Authors: Seidel Timothy A.
Published: May 2017

Auditing standards prescribe a risk‐based approach where auditors assess the risk of material misstatement and then design and perform audit procedures to reduce audit risk to an appropriately low level. Prior research suggests that auditors are responsive to high control‐risk assessment (CRA), but that this response is, perhaps, only partially effective at reducing audit risk, with relatively little insight into where and why this occurs. By refining analyses to more detailed levels of the audit, I extend this research by providing further insight into auditors’ response to high CRA. I examine and find that audit fees are significantly higher for high CRA in revenue relative to high CRA in other accounts, suggesting that auditor effort in response to high CRA is more pronounced in audit areas of particular interest and concern to investors and regulators. Despite this, I find evidence suggesting that revenue is the only audit area examined where auditor effort in response to high CRA does not attenuate the likelihood of misstatement. Finally, because auditors face time constraints, I examine whether increased effort in response to high CRA in certain audit areas diverts auditors’ attention from other areas with lower risk, thus contributing to the overall association between misstatements and internal control deficiencies documented in prior research. I find a greater likelihood of misstatement in non‐core operating accounts with lower CRA as audit effort increases in response to high CRA in revenue, consistent with the explanation that high CRA in revenue may divert auditors’ attention from other areas of the audit with lower CRA.
Ultrasound‐guidance outperforms the palpation technique for peripheral venous catheterisation in anaesthetised toddlers: a randomised study
Authors: Gopalasingam N. , Obad D. S. , Kristensen B. S. , Lundgaard P. , Veien M. , Gjedsted J. , Sloth E. , Juhl‐Olsen P.
Published: May 2017

Background

Traditional palpation technique for peripheral venous catheter (PVC) placement can be challenging. We aimed to compare the Dynamic Needle Tip Positioning (DNTP) ultrasound technique with the palpation technique for PVC placement in anaesthetised toddlers undergoing elective, low‐risk procedures.

Methods

The study was a randomised, controlled, crossover study. Five operators applied both techniques for PVC on 50 children < 4 years. The primary endpoint was first attempt success rate. The secondary endpoints were: (1) overall success rate, (2) number of skin perforations, (3) number of needle redirections, (4) number of catheters used, (5) total time, (6) needle manipulation time, (7) distance to the nearest flexion crease, (8) anatomical region of catheterisation, (9) size of the catheters and (10) the effects of visibility, and palpability of the veins.

Results

The first attempt success rate and the overall success rate were significantly higher in the DNTP group (42/50 vs. 30/50, P = 0.029), (50/50 vs. 42/50, P = 0.008). Furthermore, a lower number of skin perforations (60 vs. 84, P = 0.013) and needle redirections (14 vs. 131, P < 0.001) and increased distance to the nearest flexion crease (P < 0.001) were seen in the DNTP group. There were no significant differences in number of catheters used (60 vs. 75 P = 0.050) or total time (P = 0.073), however, the needle manipulation time was longer in the DNTP group (P = 0.011). The success rate decreased with less visible and palpable veins in the palpation group (p = 0.006).

Conclusion

Ultrasound‐guidance outperforms the traditional palpation technique for peripheral venous catheterisation in anaesthetised toddlers undergoing elective, low‐risk procedures.
Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review
Authors: Tran D. T. T. , Newton E. K. , Mount V. A. H. , Lee J. S. , Mansour C. , Wells G. A. , Perry J. J.
Published: May 2017

This systemic review was performed to determine whether rocuronium creates intubating conditions comparable to those of succinylcholine during rapid sequence intubation of the trachea. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 2), MEDLINE (1966 to February Week 2 2015), and EMBASE (1988 to February 14 2015) for any randomised controlled trials or controlled clinical trials that reported intubating conditions comparing rocuronium and succinylcholine for rapid or modified rapid sequence intubation. The dose of rocuronium was at least 0.6 mg.kg−1 and succinylcholine was at least 1 mg.kg−1. Sixty‐six studies were identified and 50 included, representing 4151 participants. Overall, succinylcholine was superior to rocuronium for achieving excellent intubating conditions (risk ratio (95%CI) 0.86 (0.81 to 0.92), n = 4151) and clinically acceptable intubation conditions (risk ratio (95%CI) 0.97 (0.95–0.99), n = 3992). A high incidence of detection bias amongst the trials coupled with significant heterogeneity means that the quality of evidence was moderate for these conclusions. Succinylcholine was more likely to produce excellent intubating conditions when using thiopental as the induction agent: risk ratio (95%CI) 0.81 (0.73–0.88), n = 2302) with or without the use of opioids (risk ratio (95%CI) 0.85 (0.78–0.93), n = 2292 or 0.85 (0.76–0.95), n = 1428).
Effect of grape pomace on fermentation quality and aerobic stability of sweet sorghum silage
Authors: Li Ping , Shen Yixin , You Minghong , Zhang Yu , Yan Jiajun , Li Daxue , Bai Shiqie
Published: May 2017

The objective of this study was to evaluate the effect of grape pomace (GP) with different adding levels (0%, 5%, 10% and 15%, fresh matter basis), alone (GP‐LAB) or in combine with an inoculant LAB (GP+LAB), on the fermentation quality and aerobic stability of sweet sorghum silage. After 90 days of ensiling in vacuumized mini‐silos, silages were subject to a 7‐day aerobic stability test, in which chemical, microbial and polyphenol composition were measured. In the GP‐LAB group, adding GP decreased (P < 0.05) concentrations of water‐soluble carbohydrate (WSC) and butyric acid in silage. In the GP+LAB group, adding GP increased (P < 0.05) concentrations of lactic acid, WSC and crude protein, decreased (P < 0.05) final pH value, NH3‐N ratio and butyric acid concentration in silage. Polyphenol level was reduced (P < 0.05) after silage fermentation. During aerobic exposure, the fungi count, pH value and silage temperature increased (P < 0.05), the levels of lactic acid, acetic acid and polyphenols (quercetin 3‐O‐glucoside and quercetin 3‐O‐glucuronid) decreased (P < 0.05) in silage. GP+LAB treated silage had a lag phase for aerobic spoilage. When the fermentation products, microbial counts, chemical and polyphenol composition were considered, the use of 10% GP+LAB at ensiling could provide a valuable source for improved fermentation quality and aerobic stability of sweet sorghum silage.
Telomere length is an independent prognostic marker in MDS but not in de novo AML
Authors: Williams Jenna , Heppel Nicole H. , Britt‐Compton Bethan , Grimstead Julia W. , Jones Rhiannon E. , Tauro Sudhir , Bowen David T. , Knapper Steven , Groves Michael , Hills Robert K. , Pepper Chris , Baird Duncan M. , Fegan Chris
Published: May 2017

Telomere dysfunction is implicated in the generation of large‐scale genomic rearrangements that drive progression to malignancy. In this study we used high‐resolution single telomere length analysis (STELA) to examine the potential role of telomere dysfunction in 80 myelodysplastic syndrome (MDS) and 95 de novo acute myeloid leukaemia (AML) patients. Despite the MDS cohort being older, they had significantly longer telomeres than the AML cohort (P < 0·0001) where telomere length was also significantly shorter in younger AML patients (age <60 years) (P = 0·02) and in FLT3 internal tandem duplication‐mutated AML patients (P = 0·03). Using a previously determined telomere length threshold for telomere dysfunction (3·81 kb) did not provide prognostic resolution in AML [Hazard ratio (HR) = 0·68, P = 0·2]. In contrast, the same length threshold was highly prognostic for overall survival in the MDS cohort (HR = 5·0, P < 0·0001). Furthermore, this telomere length threshold was an independent parameter in multivariate analysis when adjusted for age, gender, cytogenetic risk group, number of cytopenias and International Prognostic Scoring System (IPSS) score (HR = 2·27, P < 0·0001). Therefore, telomere length should be assessed in a larger prospective study to confirm its prognostic role in MDS with a view to integrating this variable into a revised IPSS.
Prognostic models for primary mediastinal (thymic) B‐cell lymphoma derived from 18‐FDG PET/CT quantitative parameters in the International Extranodal Lymphoma Study Group (IELSG) 26 study
Authors: Ceriani Luca , Martelli Maurizio , Conconi Annarita , Zinzani Pier L. , Ferreri Andrés J. M. , Botto Barbara , Stelitano Caterina , Gotti Manuel , Cabras Maria G. , Rigacci Luigi , Giovanella Luca , Zucca Emanuele , Johnson Peter W. M.
Published: May 2017

The International Extranodal Lymphoma Study Group‐26 study evaluated the prognostic role of 18‐fluorodeoxyglucose positron‐emission tomography (PET) in primary mediastinal large B‐cell lymphoma. We assessed quantitative PET parameters at diagnosis and post‐treatment in 100 patients. The end‐of‐therapy total lesion glycolysis (TLG) was the best individual outcome predictor, but the combination of baseline TLG and end‐of‐therapy visual analysis with Deauville Score (DS) showed a better positive predictive value. A model in which baseline TLG is combined with interim DS might identify patients with shorter progression‐free survival. PET metrics combined with interim DS may allow early risk assessment and warrants further studies.
A randomized phase II study of standard‐dose versus high‐dose rituximab with BEAM in autologous stem cell transplantation for relapsed aggressive B‐cell non‐hodgkin lymphomas: long term results
Authors: Srour Samer A. , Li Shaoying , Popat Uday R. , Qazilbash Muzaffar H. , Lozano‐Cerrada Sara , Maadani Farzeneh , Alousi Amin , Kebriaei Partow , Anderlini Paolo , Nieto Yago , Jones Roy , Shpall Elizabeth , Champlin Richard E. , Hosing Chitra
Published: May 2017

High‐dose rituximab (HD‐R) combined with carmustine, cytarabine, etoposide and melphalan (BEAM) and autologous stem cell transplant (ASCT) was effective and tolerable in a single‐arm prospective study of relapsed aggressive B‐cell non‐Hodgkin lymphoma (R‐NHL). We performed a randomized phase 2 study comparing HD‐R versus standard‐dose rituximab (SD‐R) in R‐NHL. Ninety‐three patients were randomized to HD‐R (1000 mg/m2) (n = 42) or SD‐R (375 mg/m2) (n = 51) administered on post‐transplant days +1 and +8, using a Bayesian adaptive algorithm. The 2 treatment arms were balanced in regards to patient demographic and clinical characteristics. At a median follow‐up of 7·92 years, the 5‐year disease‐free survival (DFS) and overall survival (OS) were 40% and 48%, respectively. We found no statistically significant differences between HD‐R and SD‐R in 5‐year DFS (36% vs. 43%; P = 0·205) and OS (43% vs. 52%; P = 0·392). In multivariate analyses, only disease status before ASCT [residual disease versus complete remission (CR)] (hazard ratio [HR] 1·79, 95% confidence interval [CI]: 1·08–2·95) and number of prior treatments received (>2 vs. ≤2 lines of treatment) (HR 1·89, 95% CI: 1·13–3·18) were associated with worse DFS and OS. Patients who had SCT while in CR or who received ≤2 lines of treatment prior to SCT had better 5‐year OS (57% vs. 35%; P = 0·02 and 54% vs. 30%, P = 0·001, respectively) in both arms. No differences in engraftments or adverse events were noted in the 2 arms. When combined with BEAM and ASCT in relapsed aggressive B‐cell NHL, HD‐R provided no DFS or OS advantage over SD‐R. In patients who have been exposed to rituximab in the frontline or salvage setting, the addition of rituximab in the peri‐transplant setting remains controversial.
The addition of etoposide to CHOP is associated with improved outcome in ALK+ adult anaplastic large cell lymphoma: A Nordic Lymphoma Group study
Authors: Cederleuf Henrik , Bjerregård Pedersen Martin , Jerkeman Mats , Relander Thomas , d'Amore Francesco , Ellin Fredrik
Published: May 2017

Anaplastic large cell lymphomas (ALCLs) are rare CD30+ peripheral T‐cell lymphomas (PTCLs) classified according to the expression of the anaplastic lymphoma kinase (ALK+) protein or not (ALK−). We have analysed the outcome and risk factors for survival in a population‐based bi‐national cohort of patients with systemic ALK+ ALCL. A total of 122 adult (≥18 years) patients diagnosed with ALK+ ALCL between 2000 and 2010 were identified from the Danish and Swedish lymphoma registries, representing 0·4% of all lymphomas. The median age of the cohort was 40 years (range 18–85). The 5‐year overall survival and progression‐free survival (PFS) was 78% and 64%, respectively. Age was strongly associated with outcome, and only bone marrow (BM) involvement was independently associated with poorer PFS in multivariate analysis (Hazard Ratio [HR] = 8·57, P < 0·001). Age stratification of the patients demonstrated an association between treatment with CHOEP (cyclophosphamide, doxorubicin, vincristine, etoposide, prednisolone) and improved overall survival for patients aged 41–65 years, even when adjusted for risk factors (HR = 0·38, P = 0·047). Our results suggest that the addition of etoposide to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) in the treatment for ALK+ ALCL seems reasonable in this age group.
Serum IgM level as predictor of symptomatic hyperviscosity in patients with Waldenström macroglobulinaemia
Authors: Gustine Joshua N. , Meid Kirsten , Dubeau Toni , Hunter Zachary R. , Xu Lian , Yang Guang , Ghobrial Irene M. , Treon Steven P. , Castillo Jorge J.
Published: May 2017

Symptomatic hyperviscosity is a common clinical manifestation in patients with Waldenström macroglobulinaemia (WM) and high serum IgM levels. Prompt intervention is required to prevent catastrophic events, such as retinal or central nervous system bleeding. Identifying patients at high risk of symptomatic hyperviscosity might support the decision to treat asymptomatic patients before irreversible damage occurs. We carried out a large retrospective study in 825 newly diagnosed WM patients, of who 113 (14%) developed symptomatic hyperviscosity. The median serum IgM level at the time of symptomatic hyperviscosity was 61·8 g/l (range 31–124 g/l). Forty‐four patients (36%) had symptomatic hyperviscosity at the time of WM diagnosis. A serum IgM level >60 g/l at diagnosis was associated with a median time to symptomatic hyperviscosity of 3 months, whereas the median time for patients with serum IgM level of 50·01–60 g/l was approximately 3 years. Adjusting for other clinical factors, the odds of developing symptomatic hyperviscosity were 370‐fold higher with serum IgM levels >60 g/l, and showed an association with CXCR4 mutational status. Symptomatic hyperviscosity did not impact overall survival (P = 0·12). The findings support the use of serum IgM level >60 g/l as a criterion for initiation of therapy in an otherwise asymptomatic WM patient.
Expression of Concern: Comparison of myo‐inositol and metformin on clinical, metabolic and genetic parameters in polycystic ovary syndrome: A randomized controlled clinical trial
Authors: Jamilian Mehri , Farhat Pegah , Foroozanfard Fatemeh , Afshar Ebrahimi Faraneh , Aghadavod Esmat , Bahmani Fereshteh , Badehnoosh Bita , Jamilian Hamidreza , Asemi Zatollah
Published: May 2017

Objective

To our knowledge, data on comparison of myo‐inositol and metformin on clinical, metabolic and genetic parameters in subjects with polycystic ovary syndrome (PCOS) are limited. This study was carried out to compare myo‐inositol and metformin on clinical, metabolic and genetic parameters in subjects with PCOS.

Design, patients and measurements:

This randomized controlled trial was conducted among 60 subjects with PCOS aged 18‐40 years. Subjects were randomly allocated into two groups to receive either myo‐inositol (N=30) or metformin (N=30) for 12 weeks. Gene expression of inflammatory cytokines was assessed in peripheral blood mononuclear cells (PBMCs) of PCOS women by RT‐PCR.

Results

After the 12‐week intervention, compared with metformin, myo‐inositol intake significantly decreased serum total testosterone (−1.4±4.2 vs +0.7±1.4 nmol/L, P=.03), modified Ferriman‐Gallwey (mF‐G) scores (−1.1±0.7 vs −0.5±0.8, P=.01) and serum high‐sensitivity C‐reactive protein (hs‐CRP) levels (−2.6±3.9 vs +0.2±1.5 mg/L, P<.001). RT‐PCR demonstrated that compared with metformin, myo‐inositol downregulated gene expression of interleukin‐1 (IL‐1) (P=.02) in PBMCs of subjects with PCOS. We did not observe any significant effect of myo‐inositol intake compared with metformin on other hormonal profiles, plasma nitric oxide (NO) or gene expression of IL‐8 and tumour necrosis factor alpha (TNF‐α).

Conclusions

Overall, taking myo‐inositol, compared with metformin, for 12 weeks in patients with PCOS with hyperinsulinism and normoinsulinism had beneficial effects on total testosterone, mFG scores, serum hs‐CRP levels and gene expression of IL‐1, but did not affect other hormonal profiles, NO levels or gene expression of IL‐8 and TNF‐α.
Spectrum of mucocutaneous, ocular and facial features and delineation of novel presentations in 62 classical Ehlers‐Danlos syndrome patients
Authors: Colombi M. , Dordoni C. , Venturini M. , Ciaccio C. , Morlino S. , Chiarelli N. , Zanca A. , Calzavara‐Pinton P. , Zoppi N. , Castori M. , Ritelli M.
Published: May 2017

Classical Ehlers‐Danlos syndrome (cEDS) is characterized by marked cutaneous involvement, according to the Villefranche nosology and its 2017 revision. However, the diagnostic flow‐chart that prompts molecular testing is still based on experts’ opinion rather than systematic published data. Here we report on 62 molecularly characterized cEDS patients with focus on skin, mucosal, facial, and articular manifestations. The major and minor Villefranche criteria, additional 11 mucocutaneous signs and 15 facial dysmorphic traits were ascertained and feature rates compared by sex and age. In our cohort, we did not observe any mandatory clinical sign. Skin hyperextensibility plus atrophic scars was the most frequent combination, whereas generalized joint hypermobility according to the Beighton score decreased with age. Skin was more commonly hyperextensible on elbows, neck, and knees. The sites more frequently affected by abnormal atrophic scarring were knees, face (especially forehead), pretibial area, and elbows. Facial dysmorphism commonly affected midface/orbital areas with epicanthal folds and infraorbital creases more commonly observed in young patients. Our findings suggest that the combination of ≥1 eye dysmorphism and facial/forehead scars may support the diagnosis in children. Minor acquired traits, such as molluscoid pseudotumors, subcutaneous spheroids, and signs of premature skin aging are equally useful in adults.
Pseudoginsenoside‐F11 attenuates cerebral ischemic injury by alleviating autophagic/lysosomal defects
Authors: Liu Yue‐Yang , Zhang Tian‐Yu , Xue Xue , Liu Dong‐Mei , Zhang Hao‐Tian , Yuan Lin‐Lin , Liu Ying‐Lu , Yang Han‐Lin , Sun Shi‐Bo , Zhang Cheng , Xu He‐Song , Wu Chun‐Fu , Yang Jing‐Yu
Published: May 2017

Summary

Aims

Pseudoginsenoside‐F11 (PF11), an ocotillol‐type ginsenoside, has been reported to exert wide‐ranging neuroprotective properties. The aim of this study was to investigate the effect and potential mechanisms of PF11 on the autophagic/lysosomal pathway following ischemic stroke.

Methods

Male Sprague‐Dawley rats underwent permanent middle cerebral artery occlusion (pMCAO). Cerebral ischemia outcome, TUNEL staining, Fluoro‐Jade B staining were carried out 24 hours poststroke. The autophagic/lysosomal‐related proteins were measured.

Results

A single administration of PF11 significantly decreased the infarct area, reduced the brain water content, and improved neurological functions, even 4 hours after the onset of pMCAO. Meanwhile, PF11 lessened the ischemic insult‐mediated loss of neurons and activation of astrocytes and microglia. Furthermore, PF11 attenuated pMCAO‐induced accumulations of autophagosomes and apoptosis. We further observed a remarkable effect of PF11 in reversing the ischemic insult‐induced accumulation of autophagosomes (LC3‐II) and abnormal aggregation of autophagic proteins (SQSTM1 and ubiquitin). Furthermore, PF11 was capable of improving lysosomal function and lysosome/autophagosome fusion following pMCAO, and this change was reversed by the lysosomal inhibitor chloroquine. Also, the improvement of ischemic outcome and the antiapoptotic effect induced by PF11 was reversed by CQ.

Conclusion

These findings indicate that the autophagic flux is impaired in a rat model of pMCAO, and that PF11 exerts an excellent protective effect against ischemic stroke by alleviating autophagic/lysosomal defects.
A cross‐sectional evaluation of the validity of a smartphone otoscopy device in screening for ear disease in Nepal
Authors: Mandavia R. , Lapa T. , Smith M. , Bhutta M.F.
Published: May 2017

Objectives

Hearing loss is a neglected international health problem. The greatest burden of ear disease is in low‐income countries where there is also a lack of resources. In this context, screening for otological disease may be worthwhile. Cupris© has developed an otoscopy device that offers the possibility of low‐cost mass screening in remote communities. We evaluated the validity of this device in diagnosing ear disease and in determining whether referral to an ENT centre is warranted.

Design

Cross‐sectional study.

Setting

Outpatient clinic, Nepal.

Participants

All adults and children were invited to take part over a 2‐day period. The Cupris© device was used to record participants otological history and examination. Stored history and images were assessed in the United Kingdom by a Consultant‐grade ENT Surgeon, who provided a diagnosis and decided whether referral to an ENT centre was warranted.

After screening with the Cupris© device, participants were immediately assessed by a UK trained ENT Consultant Surgeon using a standard otoscope (“standard assessment”). A diagnosis was recorded for each participant and a decision was made as to whether referral to an ENT centre was warranted.

Outcomes

Concordance in primary diagnosis (analysed per ear) and concordance in the decision to refer (analysed per patient). Cohen's kappa coefficient for inter‐rater agreement in diagnosis.

Results

Fifty‐six patients agreed to participate. In four patients, the quality of video recorded precluded a diagnosis or management plan. These patients were excluded from subsequent analysis, leaving 52 patients for analysis. The same diagnosis was reached for 99 of 104 ears when comparing the Cupris© device to standard assessment (95% concordance), with Cohen's kappa coefficient of 0.89. The decision as to whether a patient should be referred to an ENT centre for further assessment was the same for all 52 participants when comparing the Cupris© device to standard assessment.

Conclusions

When compared to standard assessment, the Cupris© device is a valid tool for the diagnosis of ear disease and decision for onward referral. It shows considerable promise for use by trained non‐medical workers, as a low‐cost and portable tool to screen for ear disease in remote settings, particularly in low‐ and middle‐income countries.
In‐transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern
Authors: Castaldelli‐Maia João Mauricio , Nicastri Sérgio , Cerdá Magdalena , Kim June H. , de Oliveira Lúcio Garcia , de Andrade Arthur Guerra , Martins Silvia S.
Published: May 2017

Introduction and Aims

Given a scenario of intense discussion about the legal situation of cannabis users worldwide, this paper aims to investigate the role of cannabis within a drug use sequencing pattern.

Design and Methods

Data came from a representative sample of college students from 27 Brazilian capitals (n = 12 711). We analysed the patterns of transition from/to the first use of cannabis to/from the first use of alcohol, tobacco and seven other illegal drugs. Survival analysis methods were used to analyse age of onset data on all potential drug pairs. Drugs that were not specified as the target drug pair tested in each survival model were included as time‐varying covariates in all models.

Results

We found significant transitions from alcohol [adjusted hazard ratio (aHR) = 1.41, 95% confidence interval (CI) 1.15–1.73, P < 0.001] and inhalants (aHR = 1.56, 95% CI 1.26–1.93, P < 0.001) to cannabis. Moreover, we found significant transitions from cannabis to alcohol (aHR = 2.40, 95% CI 1.47–3.91, P < 0.001), cocaine (aHR = 7.47, 95% CI = 4.26–13.09, P < 0.001), prescription opioids (aHR = 2.16, 95% CI 1.29–3.63, P < 0.01) and tranquilisers (aHR = 1.51, 95% CI 1.11–2.06, P < 0.01).

Discussion and Conclusions

Overall, our findings point to a strategic role of cannabis within drug first use sequence pattern. We had an important and unexpected finding—the bi‐directional relationship between alcohol and cannabis. In addition, the first use of cannabis still precedes the first use of cocaine and non‐medical use of tranquilisers and prescription opioids. [Castaldelli‐Maia JM, Nicastri S, Cerdá M, Kim JH, Oliveira LG, Andrade AG, Martins, SS. In‐transition culture of experimentation with cannabis in Latin American college students: A new role within a potential drug use sequencing pattern. Drug Alcohol Rev 2017;00:000‐000]
Risk of stroke in prescription and other amphetamine‐type stimulants use: A systematic review
Authors: Indave Blanca Iciar , Sordo Luis , Bravo María José , Sarasa‐Renedo Ana , Fernández‐Balbuena Sonia , De la Fuente Luis , Sonego Michela , Barrio Gregorio
Published: May 2017

Introduction and Aims

Amphetamine‐type stimulants (ATS) are a putative cause of stroke with high abuse potential. We aim to systematically review the association between use of ATS and stroke.

Design and Methods

To assure a sensitive search strategy, a broad definition of ATS was used. Cochrane Plus, EMBASE, IBECS/Lilacs, ISI WOK, Medline and Scopus were searched through 2016. Three researchers independently reviewed studies (Meta‐analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta‐analyses). Validity and bias were appraised.

Results

Of 3998 articles, four cohort studies and eight case–control studies (CCS) were selected; 11 focused on prescribed or over‐the‐counter ATS. Current ATS users showed a higher ischaemic stroke risk than non‐users in two cohort studies {adjusted rate ratio = 1.6 [95% confidence interval (CI) = 1.1, 2.4] and 3.4 [95% CI = 1.1, 10.6]}. One study observed increased risk of haemorrhagic stroke in former users versus non‐users [adjusted rate ratio = 2.3 (95% CI = 1.3, 4.1)]. Higher haemorrhagic stroke risk was seen in two CCS among women using ATS [adjusted odds ratio (aOR) = 16.6 (95% CI = 1.5, 182.2) and 3.9 (95% CI = 1.1, 13.1)]. All‐stroke was negatively associated with ATS in another CCS [aOR = 0.4 (95% CI = 0.2, 0.8)] and positively associated in the only study on non‐medical ATS [aOR = 3.8 (95% CI = 1.2, 12.6)]. Selection bias and uncontrolled confounding were common.

Discussion and Conclusions

This is the first systematic review on ATS and stroke. Limited epidemiological evidence suggests that ATS use increases stroke risk. Possible disparities in ATS effect across stroke type and higher effect in women deserve further clarification. Studies on non‐medical ATS use should be a priority. [Indave BI, Sordo L, Bravo MJ, Sarasa‐Renedo A, Fernández‐Balbuena S, De la Fuente L, Sonego M, Barrio G. Risk of stroke in prescription and other amphetamine‐type stimulants use: A systematic review. Drug Alcohol Rev 2018;37:56–69]
Evidenz von Silber in der Wundbehandlung – Metaanalyse der klinischen Studien von 2000–2015
Authors: Dissemond Joachim , Böttrich Johannes Georg , Braunwarth Horst , Hilt Jörg , Wilken Patricia , Münter Karl‐Christian
Published: May 2017

Hintergrund

Da die wissenschaftliche Evidenz für Silber in der Wundbehandlung meist als unzureichend angesehen wird, besteht für die Anwender eine Unsicherheit hinsichtlich des klinischen Einsatzes.

Material und Methodik

Von einer Expertengruppe wurden die publizierten klinischen Studien zu Silber in der Wundbehandlung für den Zeitraum 2000–2015 ausgewertet.

Ergebnisse

Es konnten 851 Artikel identifiziert werden, von denen 173 Artikel eingeschlossen und kategorisiert wurden. Hierbei fanden sich 31 randomisierte kontrollierte Studien (RCTs) und acht Kohortenstudien. Bei 28 dieser Studien fanden sich statistisch signifikante Endparameter zugunsten von Silber. Thematisch waren dies neun Studien zu Verbrennungen, 20 Studien zu anderen Indikationen (9 x Ulcus cruris venosum, 3 x Dekubitus, 2 x chronische Wunde, 1 x diabetisches Fußsyndrom und 5 x andere Wunden), 16 Studien mit dem Parameter Heilung, zwölf Studien bezogen sich auf Lebensqualität inklusive Schmerz, acht Studien mit Kosteneffektivität und drei Studien mit Reduktion der bakteriellen Keimlast. Auf der Basis dieser Ergebnisse wurde ein Behandlungsalgorithmus für Silber in der Wundbehandlung entwickelt.

Schlussfolgerungen

Diese aktuelle Metaanalyse zeigt, dass die Evidenzlage für Silber in der Wundbehandlung deutlich besser ist, als in der derzeitigen wissenschaftlichen Diskussion wahrgenommen wird. So ergeben sich bei gezieltem und zeitlich begrenztem Einsatz neben den antimikrobiellen Effekten unter anderem auch Hinweise auf eine Verbesserung der Lebensqualität sowie eine gute Kosteneffektivität.
New lasers and light sources – old and new risks?
Authors: Paasch Uwe , Schwandt Antje , Seeber Nikolaus , Kautz Gerd , Grunewald Sonja , Haedersdal Merete
Published: May 2017

Recent developments (new wavelengths, treatment concepts, and combinations) in the field of lasers, intense pulsed light (IPL), LED, as well as new energy and light sources have opened up new therapeutic options that extend beyond mere aesthetic indications. Thus, while fractional lasers used to be employed to merely treat wrinkles, the same devices – in the context of laser‐assisted drug delivery – have now become important tools in the treatment of scars, field cancerization, and epithelial tumors. The requirements posed to physicians, both with respect to establishing the indication and conducting treatment, have been growing along with the increase in technological complexity as well as the rising number of comorbidities and comedications in a patient population that continues to age.

At the same time, home‐use devices have been introduced for a variety of indications. These devices are characterized by low power and special safety features aimed at preventing accidents, risks, and side effects. Despite the reduced efficacy of such self‐treatment devices, there is an increased risk of misuse, given that the basic prerequisite for adequate treatment cannot be ensured, to wit, the exact diagnosis and therapeutic indication. Consequently, during hair removal or anti‐wrinkle treatment, pigmented lesions and cutaneous neoplasms may be altered, thus giving rise to expected, unexpected and new side effects and complications.

In the aforementioned setting, it is important that all potential users of these new technologies be properly trained in a manner that ensures those treated a maximum of safety and efficacy in accordance with the guiding principle “diagnosis certa – ullae therapiae fundamentum”.
Diagnostic precision of component‐resolved vs. extract‐based in vitro diagnosis of hymenoptera venom allergy: effects on clinical management
Authors: Seyfarth Florian , Miguel Diana , Schliemann Sibylle , Hipler Uta‐Christina
Published: May 2017

Background

The measurement of specific IgE (sIgE) antibodies plays a key role in the diagnosis of honeybee and wasp venom allergy. In recent years, component‐resolved diagnosis (CRD) has been introduced, which allows for the measurement of sIgE antibodies against Api m 1, Ves v 1, Ves v 5, and Pol d 5, as well as cross‐reactive carbohydrate determinants (CCDs). These tests are intended to help determine the clinical relevance of any given sensitization, especially in patients with dual sensitization.

Patients and methods

Specific IgE antibody levels were measured in 143 patients with bee and/or wasp venom allergy using the extract‐based ImmunoCAP® allergens i1 and i3 as well as the ImmunoCAP® allergen components i208‐211 and O214 (Api m 1, Ves v 1, Ves v 5, Pol d 5, CCDs). In patients with dual sensitization, inhibition testing was also performed. In a subgroup of the study population, sIgE to Api m 1, Api m 4, Pol d 5, and Ves v 5 were determined using the ISAC® allergy microarray (n = 44).

Results

The sensitivity of Ves v 5 in patients with isolated wasp venom allergy was 78.5 %; in combination with Ves v 1, that figure increased to 92.3 %. The sensitivity of Api m 1 in individuals with isolated bee venom allergy was 25 %. CRD and inhibition testing in individuals with dual sensitization showed divergent results. CRD using the ISAC® allergy microarray showed marked differences, especially with regard to Api m 1 and CCDs.

Conclusion

Component‐resolved tests are a valuable addition to the diagnostic spectrum as long as they are used in combination with established procedures. Apart from Ves v 5, measuring IgE antibodies to Ves v 1 should always be included in the diagnostic workup.
Chronic venous insufficiency – a review of pathophysiology, diagnosis, and treatment
Authors: Santler Bettina , Goerge Tobias
Published: May 2017

Chronic venous disease is a common disorder associated with a variety of symptoms in later disease stages but also with complications such as venous leg ulcer. This, in turn, has substantial socioeconomic effects and significantly impacts patients’ quality of life. While there are a number of diagnostic procedures available, color‐flow duplex ultrasound has become the gold standard. As regards therapeutic options, major advances have been made in recent decades. Today, there are alternatives to saphenofemoral ligation and stripping of the great saphenous vein, including endovenous thermal ablation techniques. However, treatment selection continues to depend on many factors such as individual anatomical circumstances and disease stage. The following article provides an overview of the anatomy and pathophysiology as well as current diagnostic and therapeutic standards.
Institutionalized corruption in Indonesian irrigation: An analysis of the upeti system
Authors: Suhardiman Diana , Mollinga Peter P.
Published: May 2017

This article analyzes the internal logic of the upeti system in Indonesian irrigation and brings to light how corruption rules are shaped through complex socio‐political relationships reflected in the organizational culture of the irrigation agency. Based on 100 interviews with water sector professionals the article highlights: (1) the importance of social relations in shaping institutionalized corruption, (2) how the upeti system justifies corruption practices as the prevailing social norm, and (3) the need for structural change to eradicate corruption. Illustrating how corruption rules are embedded in project management procedures, with projects highly dependent on donor funding, the article highlights the importance of the issue for international agencies and the need to be more politically grounded in promoting their development agenda.
Public‐private partnerships (PPPs) in development policy: Exploring the concept and practice
Authors: Brogaard Lena , Petersen Ole Helby
Published: May 2017

Public‐private partnerships (PPPs) have proliferated in development studies over the past decades. However, the partnership notion often remains loosely defined, thus making it difficult to grasp the concept and evaluate practice. This article aims to contribute to conceptual and empirical exploration of the PPP concept. Based on a comprehensive review of the literature, we frame eight characteristics of PPPs in development policy. Turning then to exploration of empirical practice, we present a longitudinal analysis of PPPs in Danish development policy over a 20‐year period. The conceptual and empirical insights are aimed at PPP development researchers and practitioners alike.
Measurement of soil‐surface heat flux with a multi‐needle heat‐pulse probe
Authors: Peng X. , Wang Y. , Heitman J. , Ochsner T. , Horton R. , Ren T.
Published: May 2017

Soil‐surface heat flux (G0), an important component of the surface energy balance, is often determined by summing soil heat flux (Gz) at a depth (z) below the surface and the rate of change in soil heat storage (ΔS) in the layer above z. The soil heat flux Gz is commonly measured with passive heat flux plates, but self‐calibrating plates or additional corrections are required to obtain accurate data. In some cases, ΔS is neglected because of the difficulty of monitoring the dynamics of volumetric heat capacity (C), which might lead to erroneous estimates of G0. To overcome these limitations, we introduce the heat‐pulse method for measuring G0 with a multi‐needle heat‐pulse probe (HPP). Soil temperature (T) distribution, thermal conductivity (λ) and C of the 0–52‐mm layer were measured hourly on five consecutive days with an 11‐needle HPP, and Gz at 50‐mm depth (G50) and ΔS of the 0–50‐mm layer (ΔS0–50) were determined by the gradient and calorimetric methods, respectively. Independent measurements of G50 with a self‐calibrating heat flux plate and ΔS0–50 calculated with the de Vries model C were used to evaluate the HPP data. With reliable G50 and ΔS0–50 measurements, the HPP‐based G0 data agreed well with those estimated from the independent method (with a mean absolute difference of 4.5 W m−2). Supporting measurements showed that determining Gz at the 50‐mm depth minimized the likelihood of errors from evaporation below the measurement depth. The multi‐needle HPP provides a reliable way to determine G0 in situ. Additional analysis demonstrated that by reducing the number of needles from 11 to 5, the datalogging requirement was reduced by half and G0 was still determined with acceptable accuracy.

Highlights

Heat flux at the soil surface (G0) was monitored by the heat‐pulse technique.

A multi‐needle heat‐pulse probe (HPP) was used to measure subsurface soil heat flux (Gz) and heat storage concurrently.

Appropriate measurement depths of Gz were determined to minimize the effects of subsurface latent heat sink on G0.

A simplified calculation reduced the datalogging requirement of the multi‐needle HPP.
Evolution of loess‐derived soil along a climatic toposequence in the Qilian Mountains, NE Tibetan Plateau
Authors: Yang F. , Huang L. M. , Rossiter D. G. , Yang F. , Yang R. M. , Zhang G. L.
Published: May 2017

Holocene loess has been recognized as the primary source of the silty topsoil in the northeast Qinghai‐Tibetan Plateau. The processes through which these uniform loess sediments develop into diverse types of soil remain unclear. In this research, we examined 23 loess‐derived soil samples from the Qilian Mountains with varying amounts of pedogenic modification. Soil particle‐size distribution and non‐calcareous mineralogy were changed only slightly because of the weak intensity of chemical weathering. Accumulation of soil organic carbon (SOC) and leaching of carbonate were both identified as predominant pedogenic responses to soil forming processes. Principal component analysis and structural analysis revealed the strong correlations between soil carbon (SOC and carbonate) and several soil properties related to soil functions. Accretion of SOC effectively decreased soil bulk density (R2= 0.81) and increased cation exchange capacity (R2= 0.96), soil water retention at saturation (R2= 0.77), field capacity (R2= 0.49) and wilting point (R2= 0.56). These results indicate that soil ecological functions are strengthened during pedogenic modification of such loess sediments. Soil C/N ratio was constant at small SOC contents, but after reaching a threshold of approximately 35 g kg−1SOC, soil C/N increased linearly with SOC. This indicates a change from a carbon‐limited loess ecosystem in arid regions to a nitrogen‐limited one in alpine settings. This research suggests that loess sequences within environmental gradients offer great potential as natural experiments to explore intrinsic soil behaviour and ecosystem evolution because the effect of parent material is well constrained.

Highlights

We examined pedogenic modifications of loess with uniform origin from contrasting environments.

Accumulation of SOC and depletion of carbonate coincide during pedogenesis of loess‐derived soil.

Pedogenesis underpins functional evolution of loess‐derived soil across the Qilian Mountains.

Loess sequences provide ideal natural experiments to study soil and ecosystem evolution.
Amendment with sugarcane pith improves the hydrophysical characteristics of saline‐sodic soil
Authors: Abd El‐Halim A. A. , Lennartz B.
Published: May 2017

The application of organic materials is an environmental practice in soil restoration, but the use of sugarcane pith, a by‐product of the paper industry, as an amendment in soil reclamation has not been tested so far. The objective of this study was to quantify the effects of the application of sugarcane pith on various hydrophysical properties of saline‐sodic soil. A 4‐month incubation pot trial under stagnant water and leaching conditions was carried out. Application of 5, 10 and 20 t ha−1pith led to a decrease in bulk density by 19, 41 and 42%, respectively, and a corresponding increase in drainable porosity. Likewise, soil structure expressed in terms of aggregate stability was enhanced substantially from 0.5 to 0.9. Water‐saturated hydraulic conductivity (Ks) and available water content were also positively affected by the amendments with pith; these changes were attributed to its spongy nature and the increase in organic matter with its decomposition. The doubling ofKsto 1.4 cm hour−1with the application of 20 t ha−1pith was considered crucial because it resulted in larger rates of leaching of salt. The fast decomposition of pith released Ca2+, Mg2+and K+ions, which accelerated the leaching of Na+. We recommend that saline‐sodic soil of the type that we investigated in this study should be amended with sugarcane pith powder up to a rate of 10 t ha−1. Future work should investigate the effects of pith amendments in field trials on a wide range of types of saline‐sodic soil.

Highlights

Is fresh sugarcane pith effective as an amendment for saline‐sodic soil?

Sugarcane pith could play a vital role in the management and reclamation of saline‐sodic soil.

Application of 10–20 t ha−1sugarcane pith positively affected soil physicochemical properties.

Sugarcane pith applied to saline‐sodic soil improves the hydrophysical characteristics.
Crystal structure of plant acetohydroxyacid synthase, the target for several commercial herbicides
Authors: Garcia Mario Daniel , Wang Jian‐Guo , Lonhienne Thierry , Guddat Luke William
Published: May 2017

Acetohydroxyacid synthase (AHAS, EC 2.2.1.6) is the first enzyme in the branched‐chain amino acid biosynthesis pathway. Five of the most widely used commercial herbicides (i.e. sulfonylureas, imidazolinones, triazolopyrimidines, pyrimidinyl‐benzoates and sulfonylamino‐cabonyl‐triazolinones) target this enzyme. Here we have determined the first crystal structure of a plant AHAS in the absence of any inhibitor (2.9 Å resolution) and it shows that the herbicide‐binding site adopts a folded state even in the absence of an inhibitor. This is unexpected because the equivalent regions for herbicide binding in uninhibited Saccharomyces cerevisiae AHAS crystal structures are either disordered, or adopt a different fold when the herbicide is not present. In addition, the structure provides an explanation as to why some herbicides are more potent inhibitors of Arabidopsis thaliana AHAS compared to AHASs from other species (e.g. S. cerevisiae). The elucidation of the native structure of plant AHAS provides a new platform for future rational structure‐based herbicide design efforts.

Database

The coordinates and structure factors for uninhibited AtAHAS have been deposited in the Protein Data Bank (www.pdb.org) with the PDB ID code 5K6Q.