bluuebunny/crossref_metadata_2025 huggingface dataset:
α‐Spinasterol: a COX inhibitor and a transient receptor potential vanilloid 1 antagonist presents an antinociceptive effect in clinically relevant models of pain in mice
Authors: Brusco Indiara , Camponogara Camila , Carvalho Fabiano Barbosa , Schetinger Maria Rosa Chitolina , Oliveira Mauro Schneider , Trevisan Gabriela , Ferreira Juliano , Oliveira Sara Marchesan
Published: August 2017

Background and Purpose

Postoperative pain is one of the most common manifestations of acute pain and is an important problem faced by patients after surgery. Moreover, neuronal trauma or chemotherapeutic treatment often causes neuropathic pain, which induces disabling and distressing symptoms. At present, treatments of both painful conditions are inadequate. α‐Spinasterol, which is well characterized as a transient receptor potential vanilloid 1 antagonist, has anti‐inflammatory, antioxidant and antinociceptive effects. Therefore, we investigated its antinociceptive potential on postoperative and neuropathic pain, as well as its effect on COX‐1 and COX‐2 activities.

Experimental Approach

Nociceptive responses in a postoperative pain model (surgical incision‐induced) or different neuropathic pain models (trauma or chemotherapy‐induced) were investigated in mice.

Key Results

Oral administration of α‐spinasterol reduced postoperative pain, when given as a pre‐ (0.5 h before incision) or post‐treatment (0.5 h after incision), and reduced cell infiltration in the injured tissue. α‐Spinasterol also reduced the mechanical allodynia induced by partial sciatic nerve ligation and the mechanical and cold allodynia induced by paclitaxel. Moreover, α‐spinasterol inhibited COX‐1 and COX‐2 enzyme activities without altering the body temperature of animals. Importantly, α‐spinasterol did not alter spontaneous or forced locomotor activity. Furthermore, it did not cause gastric damage or liver and kidney changes, nor did it alter cell viability in the cerebral cortex and spinal cord slices of mice.

Conclusion and Implications

α‐Spinasterol is an effective and safe COX inhibitor with antinociceptive effects in postoperative and neuropathic pain models. Therefore, it is an interesting prototype for the development of novel analgesic drugs.
Displaced Syrian children's reported physical and mental wellbeing
Authors: Hamdan‐Mansour Ayman M. , Abdel Razeq Nadin M. , AbdulHaq Bayan , Arabiat Diana , Khalil Amani A.
Published: August 2017

Background

Surviving a warzone inflicts harmful consequences on the physical health and the psychosocial wellbeing of children. This study aimed at exploring the physical and psychosocial perceived state of health of displaced Syrian refugee children in Jordan.

Methods

A cross‐sectional explorative design was applied. Structured questionnaires were used to collect data through face‐to‐face interviews with 250 Syrian refugee children. Descriptive and inferential statistics were used.

Results

Children had fair levels of physical health; their health concerns were minor. Psychosocially, 25% (n = 63) suffered from loneliness and 24% (n = 59) reported feeling depressed. The majority of children (>60%) had low rates of somatic pain. Age had a negative correlation with hyperactivity (r = −.14, p = .034); gender differences were found in anger expression and anger trait (p < .05).

Conclusions

The results in this study highlight a number of physical and psychosocial health concerns among refugee children. The health needs of displaced Syrian children need to be addressed using comprehensive assessment and care. Our findings documented the physical and psychosocial health needs of the displaced Syrian children in Jordan and addressed areas of focus to guide health promotion interventions and community health efforts for them.
Effectiveness of fluoride varnish in preventing early childhood caries in rural areas without access to fluoridated drinking water: A randomized control trial
Authors: Muñoz‐Millán Patricia , Zaror Carlos , Espinoza‐Espinoza Gerardo , Vergara‐Gonzalez Carolina , Muñoz Sergio , Atala‐Acevedo Claudia , Martínez‐Zapata Maria José
Published: August 2017

Objectives

Early childhood caries (ECC) constitutes a serious public health issue, especially in communities without water fluoridation. We assessed the effectiveness of biannual fluoride varnish applications to prevent ECC in children from nonfluoridated rural areas.

Methods

A triple‐blind randomized control trial with two parallel arms was conducted with 275 two‐ to three‐year‐old children without cavitated carious lesions from 28 rural public preschools in Chile. The preschools were located in areas of low socioeconomic status without access to fluoridated water. An oral health education component was administered to children, parents and educators. A new toothbrush and toothpaste for each child was delivered to the parents at baseline and at four follow‐up visits. The participants were randomly allocated to receive fluoride varnish or placebo applications every six months. Trained, calibrated dentists blind to the treatment arm performed visual dental assessments at 6, 12, 18 and 24 months. The primary endpoint was the development of cavitated carious lesions in children during the 24‐month follow‐up period using WHO criteria, and the secondary outcomes were an increase in caries measured as a change in the index of decayed, missing or filled teeth (dmft) since the beginning of the study and the development of adverse effects. An intention‐to‐treat (ITT) approach was used for the primary analysis.

Results

We included 131 participants in the intervention group and 144 participants in the placebo group; of these children, 89 (67.9%) in the intervention group and 100 (69.4%) in the control group completed the protocol. The comparative ITT analysis of caries incidence after 24 months of follow‐up showed a between‐group prevention fraction of 18.9% (−2.9%‐36.2%). Caries incidence was 45.0% for the experiment group and 55.6% for the control group (P = .081), with a mean dmft of 1.6 (SD = 2.4) and 2.1 (SD = 2.5), respectively. No adverse effects were reported.

Conclusions

In conclusion, biannual fluoride varnish application is not effective in preschool children from rural nonfluoridated communities at a high risk of caries.
Assessment of right ventricular systolic function in heart transplant patients: Correlation between echocardiography and cardiac magnetic resonance imaging. Investigation of the accuracy and reliability of echocardiography
Authors: Simsek Evrim , Nalbantgil Sanem , Ceylan Naim , Zoghi Mehdi , Kemal Hatice Soner , Engin Cagatay , Yagdi Tahir , Ozbaran Mustafa
Published: August 2017

Background

Right ventricular (RV) function has great impact on the survival of heart transplantation recipients; therefore, careful evaluation is of high clinical importance. However, there is no standard conventional echocardiographic parameter to assess RV systolic function. Herein, we evaluated the correlation between echocardiographic parameters of RV systolic function and ejection fraction assessed by cardiac magnetic resonance imaging (MRI RVEF) in heart transplantation recipients.

Method and Results

Forty‐three patients with at least 6‐month heart transplantation history were included in this study. Each patient had conventional echocardiography and cardiac MRI evaluation, followed by endomyocardial biopsy and right heart catheterization, which were performed in six hours. Echocardiographic parameters of RV systolic function, RV fractional area change (RV FAC), tricuspid annular plane systolic excursion (TAPSE), RV myocardial performance index, and RV global longitudinal strain, were compared with MRI RVEF (P values were <0.001, <0.3, <0.9, and <0.4, respectively). RV FAC was the only parameter to strongly correlate with MRI RVEF (r=0.747, P<0.001); and RV FAC 48.5% value had 90.5% sensitivity and 90.5% specificity to predict the pathologic reference value of MRI RVEF ≤50% (AUC:0.96; 95% CI, 0.908–1.013).

Conclusion

To our knowledge, this is the first prospective study to evaluate the correlation between the echocardiographic parameters for RV systolic function and MRI RVEF in heart transplantation recipients. RV FAC is the only parameter to correlate well with MRI RVEF, and its routine use in the follow‐up of heart transplantation recipients should be considered.
The lung water cascade in heart failure
Authors: Picano Eugenio , Scali Maria C.
Published: August 2017

In heart failure patients, we hypothesize the occurrence of the “lung water cascade,” with the various markers hierarchically ranked in a well‐defined time sequence: (1) early, proximal hemodynamic event with increase in pulmonary capillary wedge pressure; (2) intermediate, direct imaging sign of pulmonary edema (easily detectable at bedside by lung ultrasound as B‐lines); (3) late, distal clinical symptoms and signs such as dyspnea and pulmonary crackles. Completion of the cascade (from hemodynamic to pulmonary to clinical congestion) can require minutes (as with exercise), hours or even weeks (as with impending acute heart failure). Backward rewind of the downhill cascade can be achieved with timely pulmonary decongestion therapy, such as diuretics or dialysis, restoring a relatively dry lung. Any therapeutic intervention is more likely to succeed in the early steps of the cascade, at the imaging stage of asymptomatic pulmonary congestion, rather than downstream near to the end of the cascade, when clinical instability occurred.
Efficiency of different storage media for avulsed teeth in animal models: a systematic review
Authors: Longo Daniele L. , Fumes Ana C. , Küchler Erika C. , Paula‐Silva Francisco W. G. , Nelson‐Filho Paulo , Silva Léa A. B.
Published: August 2017

Background/Aims

Tooth avulsion consists of the complete displacement of a tooth from the alveolar socket. When immediate replantation is not possible, the avulsed tooth should be kept in a storage medium capable of maintaining the viability of periodontal ligament (PDL) cells on the root surface. However, there is no consensus on the best storage medium able to prevent sequels such as ankylosis and tooth resorption. The aim of this study was to perform a systematic review to evaluate the in vivo effectiveness of different storage media for avulsed teeth.

Methods

Two reviewers performed a database search for studies published between January 1950 and December 2015 which were indexed in the PubMed, Scopus, Web of Science, and Bireme databases. An additional manual search was performed. Studies with animal models that evaluated tooth avulsion, storage media, and replantation were included. After full‐text analysis of the potentially relevant studies, the selected studies were included in the systematic review.

Results

The database search found 157 distinct studies evaluating avulsed teeth storage media. However, only six studies met the selection criteria and were included in the review. There was a high variability in the study estimates for the parameters analyzed. When assessing the quality and level of evidence of each study, one study was rated as having a very low level of evidence, four studies had low levels of evidence, and one had a moderate level of evidence.

Conclusion

As a result of data heterogeneity and limitations of the studies, there was insufficient evidence to determine the most effective storage medium for avulsed teeth.
Thalidomide induces haematologic responses in patients with β‐thalassaemia
Authors: Chen Jiangming , Zhu Weijian , Cai Ning , Bu Shengdi , Li Jinyan , Huang Lan
Published: August 2017

Objective

This study aimed to evaluate the clinical and laboratory outcomes of a group of patients with β‐thalassaemia major or intermedia treated with thalidomide.

Methods

Clinical and laboratory data were obtained by analysing medical records of β‐thalassaemia patients. Using the self‐control method, the levels of haemoglobin (Hb), foetal haemoglobin (HbF), white blood cells (WBC) and platelets were detected before and after the treatment, and adverse reactions were recorded.

Results

Data from the medical records of 9 patients were analysed. The median haemoglobin levels of these patients increased from 5.13 ± 2.15 g/dL before treatment to 10.38 ± 1.19 g/dL after treatment. The average spleen size decreased from a pretreatment length of 8.19 ± 3.10 to 5.49 ± 1.80 cm below the costal margin after treatment. The mean HbF levels increased from a pretreatment value of 35.67% ± 26.82% to 75.67% ± 14.64% after treatment in the 9 patients for whom these measurements were available. All patients no longer needed transfusions by 1 month after treatment. No serious adverse reactions were observed in any of the thalidomide‐treated patients.

Conclusion

In this study, thalidomide showed an outstanding effect on β‐thalassaemia patients who required frequent red‐cell transfusions. Thalidomide increased haemoglobin levels without causing serious adverse reactions, but the long‐term curative outcomes and other side effects should be observed continuously.
The management of hodgkin lymphomas in pregnancies
Authors: Moshe Yakir , Bentur Ohad Shimshon , Lishner Michael , Avivi Irit
Published: August 2017

Hodgkin lymphoma is the most common hematological malignancy in pregnancy. Its management presents several unique challenges, as decisions have to take both maternal and fetal risks into consideration. Using three hypothetical cases, we review current evidence and guidelines and suggest our recommendations for managing pregnant Hodgkin lymphoma patients. The opportunity for a prompt and accurate diagnosis should not be missed; this may be achieved by vigilance to suggestive symptoms, performance of biopsy which is not contraindicated during pregnancy and use of MRI for staging. Most patients should receive treatment with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) after completion of the first trimester. Bridging therapy with corticosteroids or vinblastine should be considered during the first trimester. In most cases of early disease, the addition of chemotherapy cycles to the treatment plan seems preferable to radiation therapy. Diagnosis at relapse raises unique dilemmas regarding second‐line chemotherapeutic regimens and timing of consolidation with high‐dose therapy and autologous stem cell transplantation, an approach which is contraindicated during pregnancy. Considering the excellent outcomes of Hodgkin lymphoma outside pregnancy, every effort should be made to strive toward a curative treatment plan while balancing the multiple issues and dilemmas which arise when treating this malignancy in a pregnant patient.
Anti‐ictogenic and antiepileptogenic properties of perampanel in mature and immature rats
Authors: Dupuis Nina , Enderlin Julie , Thomas Jeremy , Desnous Béatrice , Dournaud Pascal , Allorge Delphine , Auvin Stéphane
Published: August 2017

Objective

Perampanel (PER) is a selective noncompetitive antagonist at α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid receptors, the first of its class approved for the adjunctive treatment of partial onset seizures and generalized seizures. This study explored anti‐ictogenic and antiepileptogenic effects of PER in rats at different stages of development.

Methods

Using a rapid kindling model in postnatal day 14 (P14), P21, P28, and P60 rats, we studied two doses of PER: 1 and 2 mg/kg injected intraperitoneally 30 min before afterdischarge assessment. We also assessed blood and brain concentrations of PER 30 min after the injection.

Results

PER 2 mg/kg significantly increased the afterdischarge threshold (ADT) at all ages, whereas PER at 1 mg/kg increased ADT only in P21 rats. PER 2 mg/kg also shortened the afterdischarge duration in P14 and P28 rats. PER increased the number of stimulations required to achieve a stage 4–5 seizure in a dose‐dependent manner in P14 and P21 rats, with almost complete elimination of stage 4–5 seizures. At P28, only PER 2 mg/kg increased the number of stimulations required to develop a stage 4–5 seizure. In contrast, PER had no effect on the number of stage 4–5 seizures at P60. We did not observed any age‐dependent significant difference in the serum and brain levels of PER 30 min after the injection.

Significance

PER exerted anti‐ictogenic effects from P14 to P60 independent of brain maturation. PER also exhibited antiepileptogenic effects with a stronger effect in the younger animals.
The effect of mean stress and stress biaxiality in high‐cycle fatigue
Authors: Koutiri Imade , Bellett Daniel , Morel Franck
Published: August 2017

This article presents a review of selected multiaxial high‐cycle fatigue criteria with an emphasis on their ability to take into account the mean stress effect and the effect of a biaxial stress state. It is shown that the predictions of the various criteria are very different for the case of biaxial tensile loads. This is in contrast to the case of combined tension‐torsion loads, where the predictions are very similar. The second part of the article investigates which mechanical parameter (eg, the hydrostatic stress or the normal stress) is the most appropriate to take into account these cyclic stress states.
Spatial distributions of Southern Ocean mesozooplankton communities have been resilient to long‐term surface warming
Authors: Tarling Geraint A. , Ward Peter , Thorpe Sally E.
Published: August 2017

The biogeographic response of oceanic planktonic communities to climatic change has a large influence on the future stability of marine food webs and the functioning of global biogeochemical cycles. Temperature plays a pivotal role in determining the distribution of these communities and ocean warming has the potential to cause major distributional shifts, particularly in polar regions where the thermal envelope is narrow. We considered the impact of long‐term ocean warming on the spatial distribution of Southern Ocean mesozooplankton communities through examining plankton abundance in relation to sea surface temperature between two distinct periods, separated by around 60 years. Analyses considered 16 dominant mesozooplankton taxa (in terms of biomass and abundance) in the southwest Atlantic sector of the Southern Ocean, from net samples and in situ temperature records collected during the Discovery Investigations (1926–1938) and contemporary campaigns (1996–2013). Sea surface temperature was found to have increased significantly by 0.74°C between the two eras. The corresponding sea surface temperature at which community abundance peaked was also significantly higher in contemporary times, by 0.98°C. Spatial projections indicated that the geographical location of community peak abundance had remained the same between the two eras despite the poleward advance of sea surface isotherms. If the community had remained within the same thermal envelope as in the 1920s–1930s, community peak abundance would be 500 km further south in the contemporary era. Studies in the northern hemisphere have found that dominant taxa, such as calanoid copepods, have conserved their thermal niches and tracked surface isotherms polewards. The fact that this has not occurred in the Southern Ocean suggests that other selective pressures, particularly food availability and the properties of underlying water masses, place greater constraints on spatial distributions in this region. It further demonstrates that this community is thermally resilient to present levels of sea surface warming.
Long‐term ecological changes in marine mammals driven by recent warming in northwestern Alaska
Authors: Szpak Paul , Buckley Michael , Darwent Christyann M. , Richards Michael P.
Published: August 2017

Carbon and nitrogen isotopes analyses were performed on marine mammal bone collagen from three archaeological sites (ad 1170–1813) on Cape Espenberg (Kotzebue Sound, northwestern Alaska) as well as modern animals harvested from the same area to examine long‐term trends in foraging ecology and sea ice productivity. We observed significant and dramatic changes in ringed seal stable isotope values between the early 19th and early 21st centuries, likely due to changing sea ice productivity and reduced delivery of organic matter to the benthos driven by recent warming in the Arctic. These data highlight the importance of the archaeological record for providing a long‐term perspective on environmental variation and interpreting recent changes driven by anthropogenic processes.
Patient powered prophylaxis: A 12‐month study of individualized prophylaxis in adults with severe haemophilia A
Authors: Sun Haowei (Linda) , McIntosh Kam A. , Squire Sandra J. , Yang Ming , Bartholomew Claude , Gue Deb S. , Camp Pat G. , Jackson Shannon C.
Published: August 2017

Introduction

Adults with severe haemophilia A (SHA) may experience breakthrough bleeds despite standard weight‐based FVIII prophylaxis three times weekly. Individualized prophylaxis has evolved to optimize patient outcomes.

Aims

This study aimed to evaluate the impact of a standardized approach to individualized prophylaxis on annualized bleeding rates (ABR), factor utilization, physical activity and quality of life in adults with SHA.

Methods

In this prospective cohort study, patients with baseline FVIII:C <2% and ABR >3 on weight‐based prophylaxis received a standardized approach to individualized prophylaxis. Changes in ABR, annualized FVIII consumption and adherence from the 12‐month prestudy and 12‐month intervention period were compared. Changes in Haemo‐QoL‐A total score, Physical Functioning (PF) subscale and physical activity level measured by accelerometry were also examined.

Results

Eighteen patients participated (median age 26 years). Individualized prophylaxis decreased total bleeds in the population by 69% and traumatic bleeds by 73%. The median ABR decreased from 7.5 to 2 (P<.001). Annualized factor consumption increased by 7.3%, as a result of 66% reduction in factor utilization for treatment of bleeds and 25% increase in factor utilization for prophylaxis. Adherence scores for frequency and dosing did not change. There was a significant increase in the Haemo‐QoL‐A total score (P=.02) and PF score (P=.01) from baseline to 4 months but no change in physical activity.

Conclusion

Patients with SHA who switched from standard to individualized prophylaxis show reduced ABR and increased FVIII consumption, and also improved their health‐related quality of life. The mechanism is independent of adherence to prescribed prophylactic regimen.
Preference‐based valuation of treatment attributes in haemophilia A using web survey
Authors: Steen Carlsson K. , Andersson E. , Berntorp E.
Published: August 2017

Introduction

Clinical trials have shown promising results for extended half‐life factor VIII concentrates but little is known about individuals' valuation of haemophilia treatment attributes.

Aim

To assess patient/caregiver and population valuation of treatment attributes of prophylactic regimens for people with severe haemophilia A.

Methods

Members ≥16 years of the Swedish Haemophilia Society (FBIS) and of a web‐panel representative of the Swedish population were invited to participate in a web‐survey investigating preferences for haemophilia treatment attributes using the Time Trade‐Off methodology which ranks health states on a scale 0 (dead) to 1 (full health). All respondents assessed the same four treatment scenarios for severe haemophilia A, each described by three stylized attributes: injection interval (every 2nd or 5th day); participation in physical activity (Y/N); annual risk of bleed (1‐2 or 5‐6 bleeds).

Results

The survey had 1657 respondents (68% complete responses; 184/1233 from FBIS/web‐panel gave informed consent; mean age 52 years, 51% men). Respondents from FBIS and from the web‐panel had the same preference ranking of the four treatment scenarios, but members of FBIS consistently rated significantly higher health utilities; range 0.67‐0.73 vs 0.54‐0.60. Participation in physical activity implied +0.023 (95% confidence interval 0.015‐0.030); a longer injection interval implied +0.038 (0.03; 0.45); and fewer bleeds implied +0.022 (0.015‐0.029) utility points.

Conclusions

Patient/caregiver and population preferences indicate that treatment attributes such as frequency of injections and the possibility of participating in physical activity are important attributes impacting quality of life in addition to the control and prevention of bleeding episodes.
Immunologic properties and therapeutic efficacy of a multivalent epitope‐based vaccine against four Helicobacter pylori adhesins (urease, Lpp20, HpaA, and CagL) in Mongolian gerbils
Authors: Guo Le , Yin Runting , Xu Guangxian , Gong Xiaojuan , Chang Zisong , Hong Dantong , Liu Hongpeng , Ding Shuqin , Han Xuebo , Li Yuan , Tang Feng , Liu Kunmei
Published: August 2017

Background

Therapeutic vaccination is a desirable alternative for controlling Helicobacter pylori (H. pylori) infection. Attachment to the gastric mucosa is the first step in establishing bacterial colonization, and adhesins, which are on the surface of H. pylori, play a pivotal role in binding to human gastric mucosa.

Materials and Methods

In the present study, we constructed a multivalent epitope‐based vaccine named CFAdE with seven carefully selected antigenic fragments from four H. pylori adhesins (urease, Lpp20, HpaA and CagL). The specificity, immunogenicity and ability to produce neutralizing antibodies of CFAdE were evaluated in BALB/c mice. After that, its therapeutic efficacy and protective immune mechanisms were explored in H. pylori‐infected Mongolian gerbils.

Results

The results indicated that CFAdE could induce comparatively high levels of specific antibodies against urease, Lpp20, HpaA and CagL. Additionally, oral therapeutic immunization with CFAdE plus polysaccharide adjuvant (PA) significantly decreased H. pylori colonization compared with oral immunization with urease plus PA, and the protection was correlated with IgG and sIgA antibody and antigen‐specific CD4+ T cells.

Conclusions

This study indicated that the multivalent epitope‐based vaccine, which targeted multiple adhesins in adherence of H. pylori to the gastric mucosa, is more effective than the univalent vaccine targeting urease only. This multivalent epitope‐based vaccine may be a promising therapeutic candidate vaccine against H. pylori infection.
Interlaboratory concordance of PD‐L1 immunohistochemistry for non‐small‐cell lung cancer
Authors: Scheel Andreas H , Baenfer Gudrun , Baretton Gustavo , Dietel Manfred , Diezko Rolf , Henkel Thomas , Heukamp Lukas C , Jasani Bharat , Jöhrens Korinna , Kirchner Thomas , Lasitschka Felix , Petersen Iver , Reu Simone , Schildhaus Hans‐Ulrich , Schirmacher Peter , Schwamborn Kristina , Sommer Ulrich , Stoss Oliver , Tiemann Markus , Warth Arne , Weichert Wilko , Wolf Jürgen , Büttner Reinhard , Rüschoff Josef
Published: August 2017

Aims

Programmed death ligand 1 (PD‐L1) immunohistochemistry has become a mandatory diagnostic test in the treatment of lung cancer. Several research initiatives have started to harmonise the five PD‐L1 immunohistochemistry assays that have been used in clinical trials. Here, we report data on interlaboratory and interassay concordance for commercial assays (‘assays’) and laboratory‐developed tests (LDTs) at 10 German testing sites.

Methods and results

To assess interlaboratory concordance, a tissue microarray containing 21 pulmonary carcinoma specimens was centrally prepared. Pre‐cut sections were stained at 10 sites by the use of assays 28‐8, 22C3, SP263, and SP142, as well as 11 LDTs. Assay performance was evaluated with a second tissue microarray containing 11 cell lines with defined PD‐L1 expression. Quality control was centrally performed by manual and digital analyses. The assays yielded reproducible IHC staining patterns at all sites. In agreement with previous studies, 22C3, 28‐8 and SP263 showed similar staining patterns, whereas SP142 was distinct. Among the LDTs, six of 11 protocols showed staining patterns similar to those of assays 22C3 and 28‐8. Interlaboratory concordance of tumour cell scoring by use of a six‐step system was moderate (Light's κ = 0.43–0.69), whereas the clinically approved cut‐offs of ≥1% and ≥50% showed substantial concordance (κ = 0.73–0.89). Immune cell scoring by the use of SP142 yielded moderate concordance (κ = 0.42).

Conclusions

The data confirm the previously described staining patterns of the assays, and show that they can be reproducibly employed at different sites. LDTs with staining results similar to those of the assays are implementable, but have to be carefully validated.
Perception of nurse prescribing among nurses and psychiatrists in a developing country: A cross‐sectional survey
Authors: Badnapurkar Ashish , Bressington Daniel , Jones Martin , Nelson Deborah , Thomas Dona , Mehndi Mohammed , Gray Richard
Published: August 2017

Nurse prescribing has the potential to improve patients’ access to, and experiences of, treatment. The aim of the present study was to examine nurse and psychiatrist attitudes about this extended role in a developing country. We conducted a cross‐sectional survey using a previously‐used, 65‐item, seven subscale measure of attitudes to nurse prescribing in mental health. We achieved a 79% response rate. The majority of participants had trained in developing countries where nurse prescribing has yet to be implemented. Across five subscales (general beliefs, impact, uses, training, and supervision), both groups reported positive attitudes about nurse prescribing. Both groups scored the training subscale particularly highly. Compared with psychiatrists, nurses were more confident about the range of clinical settings where nurse prescribing could be applied (e.g. acute inpatient and substance use). Although both groups had less favourable attitudes on the two subscales relating to clinical and legal responsibility, compared to nurses, psychiatrists were more undesirable. Although, overall, clinician attitudes do not seem to represent a barrier towards the potential implementation of nurse prescribing in the study setting, clarity about clinical and legal responsibility needs to be addressed.
Challenges in providing end‐of‐life care for people with intellectual disability: Health services access
Authors: Wark Stuart , Hussain Rafat , Müller Arne , Ryan Peta , Parmenter Trevor
Published: August 2017

Background

Increasing life expectancy for people with intellectual disability is resulting in greater need for end‐of‐life care services. However, limited knowledge is available regarding what barriers to accessing end‐of‐life care support are evident, particularly comparatively across rural and metropolitan locations.

Methods

Focus group interviews were undertaken with 35 direct‐care staff from four rural and two metropolitan locations. A semistructured interview guide was used, with a focus on health service access. All focus group data were independently transcribed, with thematic analysis then performed.

Results

Frequency analysis identified 262 statements relating to health services access. Thematic analysis identified four key areas of “isolation,” “support from doctors,” “general health support access” and “internal staffing issues.”

Conclusions

Improved access to end‐of‐life services is urgently required across both rural and metropolitan areas. Development of specialist training and support models for both disability and general healthcare staff may assist to reduce some identified barriers.
Teledermoscopy images acquired in primary health care and hospital settings – a comparative study of image quality
Authors: Dahlén Gyllencreutz J. , Johansson Backman E. , Terstappen K. , Paoli J.
Published: August 2017

Background

The incidence of melanoma and non‐melanoma skin cancer is increasing, which has also lead to an increase in referrals between primary health care (PHC) and dermatology departments, putting a strain on healthcare services. Teledermoscopy (TDS) referrals from PHC can improve the triage process for patients with suspicious skin tumours, but the quality of the images included could potentially affect its usefulness.

Objective

To critically appraise the quality of the dermoscopic images of a smartphone TDS system, by comparing the TDS referral images with images of the same tumours acquired at the department of dermatology.

Methods

Two dermatologists rated the image quality of two image sets from 172 skin tumours separately. The dermatologists also decided on a main diagnosis, differential diagnoses and described the visible dermoscopic structures.

Results

The images acquired in PHC were rated as having slightly lower quality, but there was no significant difference. PHC images and dermatology images were of intermediate‐to‐high quality in 95.5%–97.7% and 96.5%–98.8%, respectively. There was no difference in agreement between the TDS diagnosis based on the two image sets with the final clinical or histopathological diagnosis. Most image pairs (81.4% and 83.7%) received the same main diagnosis by the two evaluators. When this was not the case, the most common reasons were poor focus, excessive pressure applied when acquiring the image or inadequate amount of zoom.

Conclusion

TDS performed in PHC with a smartphone‐based system does not seem to negatively affect the usefulness of TDS referrals. Thus, physicians at PHC do not necessarily need to be trained photographers to ensure adequate TDS image quality. Knowledge about technical difficulties could however be used when training PHC staff, to improve the image quality further.
Nail apparatus melanoma: dermoscopic and histopathologic correlations on a series of 23 patients from a single centre
Authors: Starace M. , Dika E. , Fanti P.A. , Patrizi A. , Misciali C. , Alessandrini A. , Bruni F. , Piraccini B.M.
Published: August 2017

Background

Nail apparatus melanoma (NAM) is an uncommon tumour, and there are few studies focused on its dermoscopic features.

Objective

The aims of our study were to evaluate the diagnostic accuracy of dermoscopy in NAM. A diagnostic algorithm for adult patients with suspected NAM is proposed.

Methods

We collected NAM dermoscopic images of patients with a proven histopathology from 2008 until 2015. Clinical and dermoscopic images were blindly examined by two dermatologists, and correlations between histopathological aspects and dermoscopic features were investigated.

Results

We retrospectively collected NAM dermoscopic images associated with a proven histopathology of 23 Caucasian patients. Only cases with available both preoperative dermoscopic images and bioptic specimens were included. Seventeen women and six men were included. The mean age at diagnosis was 63 years (range 18–92).

Conclusion

We created an algorithm to indicate the correct way to follow an adult patient with suspected NAM. This algorithm may ameliorate management in case of suspected NAM and possibly facilitate an early diagnosis.
An investigation into the nutritional composition and cost of gluten‐free versus regular food products in the UK
Authors: Fry L. , Madden A. M. , Fallaize R.
Published: August 2017

Background

The gluten‐free (GF) food market has expanded considerably, although there is limited comparative evidence for the nutritional quality and cost of GF food products. The present study aims to compare the nutrient composition and cost of GF and gluten‐containing (regular) foods across 10 food categories in the UK.

Methods

Nutritional information and the cost of GF foods available in the UK (n = 679) and comparable regular foods (n = 1045) were systematically collected from manufacturer and supermarket websites. Foods were classified using UK front‐of‐pack labelling for content of fat, saturated fat, sugar and salt and nutrient content, and cost per 100 g were identified and compared between GF and regular foods.

Results

Overall, more GF foods were classified as containing high and medium fat, saturated fat, sugar and salt than regular foods, although this was not universally consistent. More GF bread and flour products contained high fat and sugar, whereas fewer GF crackers contained high fat and sugar compared to regular foods. High salt content was found more frequently in GF than regular products. On average, GF products were 159% more expensive than regular (£0.44/100 g versus £1.14/100 g). GF items were also more likely to be lower in fibre and protein content than regular foods.

Conclusions

Differences exist in the nutritional composition of GF and regular food. GF food is unlikely to offer healthier alternatives to regular foods, except for those who require a GF diet for medically diagnosed conditions, and it is associated with higher costs.
Depressive symptoms account for differences between self‐reported versus polysomnographic assessment of sleep quality in women with myofascial TMD
Authors: Dubrovsky B. , Janal M. N. , Lavigne G. J. , Sirois D. A. , Wigren P. E. , Nemelivsky L. , Krieger A. C. , Raphael K. G.
Published: August 2017

Patients with temporomandibular disorder (TMD) report poor sleep quality on the Pittsburgh Sleep Quality Index (PSQI). However, polysomnographic (PSG) studies show meagre evidence of sleep disturbance on standard physiological measures. The present aim was to analyse self‐reported sleep quality in TMD as a function of myofascial pain, PSG parameters and depressive symptomatology. PSQI scores from 124 women with myofascial TMD and 46 matched controls were hierarchically regressed onto TMD presence, ratings of pain intensity and pain‐related disability, in‐laboratory PSG variables and depressive symptoms (Symptoms Checklist‐90). Relative to controls, TMD cases had higher PSQI scores, representing poorer subjective sleep and more depressive symptoms (both P < 0·001). Higher PSQI scores were strongly predicted by more depressive symptoms (P < 0·001, R2 = 26%). Of 19 PSG variables, two had modest contributions to higher PSQI scores: longer rapid eye movement latency in TMD cases (P = 0·01, R2 = 3%) and more awakenings in all participants (P = 0·03, R2 = 2%). After accounting for these factors, TMD presence and pain ratings were not significantly related to PSQI scores. These results show that reported poor sleep quality in TMD is better explained by depressive symptoms than by PSG‐assessed sleep disturbances or myofascial pain. As TMD cases lacked typical PSG features of clinical depression, the results suggest a negative cognitive bias in TMD and caution against interpreting self‐report sleep measures as accurate indicators of PSG sleep disturbance. Future investigations should take account of depressive symptomatology when interpreting reports of poor sleep.
Ursodeoxycholic acid: Effects on hepatic unfolded protein response, apoptosis and oxidative stress in morbidly obese patients
Authors: Mueller Michaela , Castro Rui E. , Thorell Anders , Marschall Hanns‐Ulrich , Auer Nicole , Herac Merima , Rodrigues Cecilia M.P. , Trauner Michael
Published: August 2017

Background & Aims

Ursodeoxycholic acid (UDCA) is a secondary hydrophilic bile acid (BA) used as therapy for a range of hepatobiliary diseases. Its efficacy in non‐alcoholic fatty liver disease (NAFLD) is still under debate. Here, we aimed to decipher molecular mechanisms of UDCA in regulating endoplasmic reticulum (ER) homeostasis, apoptosis and oxidative stress in morbidly obese patients.

Methods

In this randomized controlled pharmacodynamic study, liver and serum samples from 40 well‐matched morbidly obese NAFLD‐patients were analysed. Patients received UDCA (20 mg/kg/d) or no treatment 3 weeks before samples were obtained during bariatric surgery.

Results

Patients treated with UDCA displayed higher scoring of steatosis (S), activity (A) and fibrosis (F), the so called SAF‐scoring. UDCA partially disrupted ER homeostasis by inducing the expression of the ER stress markers CHOP and GRP78. However, ERDJ4 and sXBP1 levels were unaffected. Enhanced CHOP expression, a suggested pro‐apoptotic trigger, failed to induce apoptosis via BAK and BAX in the UDCA treated group. Potentially pro‐apoptotic miR‐34a was reduced in the vesicle‐free fraction in serum but not in liver after UDCA treatment. Thiobarbituric acid reactive substances, 4‐hydroxynonenal and mRNA levels of several oxidative stress indicators remained unchanged after UDCA treatment.

Conclusion

Our data suggest that UDCA treatment has ambivalent effects in NAFLD patients. While increased SAF‐scores and elevated CHOP levels may be disadvantageous in the UDCA treated cohort, UDCA's cytoprotective properties potentially changed the apoptotic threshold as reflected by absent induction of pro‐apoptotic triggers. UDCA treatment failed to improve the oxidative stress status in NAFLD patients.
Contextualizing language attitudes: An interactional perspective
Authors: Liebscher Grit , Dailey‐O'Cain Jennifer
Published: August 2017

Language attitudes research has had a history spanning several decades largely influenced by quantitative approaches. More recently, interactional perspectives have added new impetus to the field. This article provides an overview of interactional approaches to language attitudes, which are divided into three main groups: (a) discursive psychology, (b) approaches that draw on conversational analysis and interactional sociolinguistics, and (c) approaches based in the theory of motivated information management. The authors argue that these approaches can instigate new questions and yield new insights into our understanding of language attitudes. In positioning qualitative, largely interactional, approaches with respect to one another (and, briefly, to language attitude study more broadly), this article also re‐evaluates some terminological inconsistencies across the field and touches on areas that ought to be considered in future research addressing language attitudes.
Evaluation of discharge documentation after hospitalization for stroke patients discharged home in Australia: A cross‐sectional, pilot study
Authors: Kable Ashley , Pond Dimity , Baker Amanda , Turner Alyna , Levi Christopher
Published: August 2017

Abstract

In this cross‐sectional study, we evaluated the quality of discharge documentation for stroke patients discharged home. Participants were stroke patients discharged from a regional tertiary acute and rehabilitation hospital in Australia from 2014 to 2015. Compliance with expected discharge documentation and its relationship with readmission was measured using an audit instrument for stroke patients (n = 54), and a post‐discharge survey of carers was conducted. There were deficits in the documentation of the mechanism of stroke (70%), functional assessments (58%), pending test results (39%), types of support services required after discharge (35%), and patient/carer meetings with the multi‐disciplinary stroke team (20%). Readmission was associated with lower compliance scores for information provided to patients or their carer. The survey results suggested that carer burden was high for carers of stroke patients discharged home. Documentation of carer/family meetings with the stroke team, functional assessments, medications, and adequate support services needs to be improved. General practitioners and carers need this information, so that they can address the post‐discharge needs of these vulnerable patients.
Survey of factors influencing learner engagement with simulation debriefing among nursing students
Authors: Roh Young Sook , Jang Kie In
Published: August 2017

Abstract

Simulation‐based education has escalated worldwide, yet few studies have rigorously explored predictors of learner engagement with simulation debriefing. The purpose of this cross‐sectional, descriptive survey was to identify factors that determine learner engagement with simulation debriefing among nursing students. A convenience sample of 296 Korean nursing students enrolled in the simulation‐based course completed the survey. A total of five instruments were used: (i) Characteristics of Debriefing; (ii) Debriefing Assessment for Simulation in Healthcare – Student Version; (iii) The Korean version of the Simulation Design Scale; (iv) Communication Skills Scale; and (v) Clinical‐Based Stress Scale. Multiple regression analysis was performed using the variables to investigate the influencing factors. The results indicated that influencing factors of learning engagement with simulation debriefing were simulation design, confidentiality, stress, and number of students. Simulation design was the most important factor. Video‐assisted debriefing was not a significant factor affecting learner engagement. Educators should organize and conduct debriefing activities while considering these factors to effectively induce learner engagement. Further study is needed to identify the effects of debriefing sessions targeting learners' needs and considering situational factors on learning outcomes.
Colonic immune cells in irritable bowel syndrome: A systematic review and meta‐analysis
Authors: Bashashati M. , Moossavi S. , Cremon C. , Barbaro M. R. , Moraveji S. , Talmon G. , Rezaei N. , Hughes P. A. , Bian Z. X. , Choi C. H. , Lee O. Y. , Coëffier M. , Chang L. , Ohman L. , Schmulson M. J. , McCallum R. W. , Simren M. , Sharkey K. A. , Barbara G.
Published: August 2017

Background & Aims

Increases in mucosal immune cells have frequently been observed in irritable bowel syndrome (IBS) patients. However, this finding is not completely consistent between studies, possibly due to a combination of methodological variability, population differences and small sample sizes. We performed a meta‐analysis of case–control studies that compared immune cell counts in colonic biopsies of IBS patients and controls.

Methods

PubMed and Embase were searched in February 2017. Results were pooled using standardized mean difference (SMD) and were considered significant when zero was not within the 95% confidence interval (CI). Heterogeneity was assessed based on I2 statistics where I2 ≤ 50% and I2 > 50% indicated fixed and random effect models, respectively.

Key Results

Twenty‐two studies on 706 IBS patients and 401 controls were included. Mast cells were increased in the rectosigmoid (SMD: 0.38 [95% CI: 0.06‐0.71]; P = .02) and descending colon (SMD: 1.69 [95% CI: 0.65‐2.73]; P = .001) of IBS patients. Increased mast cells were observed in both constipation (IBS‐C) and diarrhea predominant IBS (IBS‐D). CD3+ T cells were increased in the rectosigmoid (SMD: 0.53 [95% CI: 0.21‐0.85]; P = .001) and the descending colon of the IBS patients (SMD: 0.79, 95% CI [0.28‐1.30]; P = .002). This was possibly in relation to higher CD4+ T cells in IBS (SMD: 0.33 [95% CI: 0.01‐0.65]; P = .04) as there were no differences in CD8+ T cells.

Conclusions & Inferences

Mast cells and CD3+ T cells are increased in colonic biopsies of patients with IBS vs non‐inflamed controls. These changes are segmental and sometimes IBS‐subtype dependent. The diagnostic value of the quantification of colonic mucosal cells in IBS requires further investigation.