bluuebunny/crossref_metadata_2025 huggingface dataset:
Down-regulation of Kv4.3 channels and a-type K+ currents in V2 trigeminal ganglion neurons of rats following oxaliplatin treatment
Authors: Viatchenko-Karpinski Viacheslav , Ling Jennifer , Gu Jianguo G
Published: January 2018

Chemotherapy drugs such as oxaliplatin can increase nociceptive neuron excitability to result in neuropathic pain in orofacial and other regions in patients following chemotherapy. However, mechanisms underlying chemotherapy-induced increases of nociceptive neuron excitability are not fully understood. Kv4.3 channels are voltage-gated K+ channels mediating A-type K+ (IA) currents to control neuronal excitability. In the present study, we examined Kv4.3 channel expression on trigeminal neurons that innervate orofacial regions (V2 TG neurons) of rats using immunostaining method. We showed that strong Kv4.3 immunoreactivity (Kv4.3-ir) was present mainly in small-sized V2 TG neurons. The numbers of Kv4.3-ir positive V2 TG neurons were significantly reduced in oxaliplatin-treated rats, suggesting down-regulation of Kv4.3 channel expression on V2 TG neurons by the chemotherapy drug. Patch-clamp recordings from acutely dissociated rat V2 TG neurons showed that almost all nociceptive-like V2 TG neurons displayed IA currents with slow inactivation kinetics. The amplitudes of IA currents were significantly reduced in these nociceptive-like V2 TG neurons of oxaliplatin-treated group. Furthermore, we found that the excitability of nociceptive-like V2 TG neurons was significantly higher in the oxaliplatin-treated group than in the control group. These findings raise a possibility that down-regulation of Kv4.3 channels and IA currents in nociceptive V2 TG neurons is an underlying mechanism of oxaliplatin-induced orofacial neuropathic pain.
Extracellular N-acetylaspartylglutamate released in the nucleus accumbens modulates the pain sensation: Analysis using a microdialysis/mass spectrometry integrated system
Authors: Watanabe Moe , Sugiura Yuki , Sugiyama Eiji , Narita Michiko , Navratilova Edita , Kondo Takashige , Uchiyama Naohiko , Yamanaka Akihiro , Kuzumaki Naoko , Porreca Frank , Narita Minoru
Published: January 2018

Various small molecules act as neurotransmitters and orchestrate neural communication. Growing evidence suggests that not only classical neurotransmitters but also several small molecules, including amino acid derivatives, modulate synaptic transmission. As conditions of acute and chronic pain alter neuronal excitability in the nucleus accumbens, we hypothesized that small molecules released in the nucleus accumbens might play important roles in modulating the pain sensation. However, it is not easy to identify possible pain modulators owing to the absence of a method for comprehensively measuring extracellular small molecules in the brain. In this study, through the use of an emerging metabolomics technique, namely ion chromatography coupled with high-resolution mass spectrometry, we simultaneously analyzed the dynamics of more than 60 small molecules in brain fluids collected by microdialysis, under both the application of pain stimuli and the administration of analgesics. We identified N-acetylaspartylglutamate as a potential pain modulator that is endogenously released in the nucleus accumbens. Infusion of N-acetylaspartylglutamate into the nucleus accumbens significantly attenuated the pain induced by the activation of sensory nerves through optical stimulation. These findings suggest that N-acetylaspartylglutamate released in the nucleus accumbens could modulate pain sensation.
Poly (ADP-ribose) polymerase inhibitors in the management of ovarian cancer
Authors: Markman Maurie
Published: January 2018

There is considerable interest and enthusiasm within the clinical gynecologic oncology community regarding the potential for poly (ADP-ribose) polymerase inhibitors to play a critically relevant role in the management of epithelial ovarian cancer and particularly (although not exclusively) in the setting of known mutations in the BRCA gene. This review will briefly highlight the biological rational for the use of poly (ADP-ribose) polymerase inhibitors in this malignancy, followed by summary of currently available clinical data supporting the delivery of agents approved by the US Food and Drug Administration for non-investigative use.
Image fusion based on shift invariant shearlet transform and stacked sparse autoencoder
Authors: Wang Peng-Fei , Luo Xiao-Qing , Li Xin-Yi , Zhang Zhan-Cheng
Published: January 2018

Stacked sparse autoencoder is an efficient unsupervised feature extraction method, which has excellent ability in representation of complex data. Besides, shift invariant shearlet transform is a state-of-the-art multiscale decomposition tool, which is superior to traditional tools in many aspects. Motivated by the advantages mentioned above, a novel stacked sparse autoencoder and shift invariant shearlet transform-based image fusion method is proposed. First, the source images are decomposed into low- and high-frequency subbands by shift invariant shearlet transform; second, a two-layer stacked sparse autoencoder is adopted as a feature extraction method to get deep and sparse representation of high-frequency subbands; third, a stacked sparse autoencoder feature-based choose-max fusion rule is proposed to fuse the high-frequency subband coefficients; then, a weighted average fusion rule is adopted to merge the low-frequency subband coefficients; finally, the fused image is obtained by inverse shift invariant shearlet transform. Experimental results show the proposed method is superior to the conventional methods both in terms of subjective and objective evaluations.
Research on anti-disturbance performance for servo system with a high dynamic performance velocity acquisition method
Authors: Hua Ji , Shuang Wang
Published: January 2018

In order to achieve the requirements of high anti-disturbance and robustness performance for servo system, the acceleration control with disturbance observer is adopted in this paper, where the disturbance observer is used to estimate and compensate the load disturbance. To accomplish the accurate disturbance estimation, higher cut-off frequency of disturbance observer and exact acceleration information are required, where accurate speed estimation is crucial. Thus, a novel velocity acquisition method for servo control system with optical encoder is proposed. At the same time, dynamic error is put forward as a new performance metrics to scientifically explain the dynamic performance of this algorithm. The proposed velocity acquisition method is implemented based on a field programmable gate array. Experimental results show that this novel velocity acquisition method can improve dynamic response performance on the premise of guaranteeing the invariable velocity precision, and at the same time can effectively improve the anti-disturbance and robustness performance of the servo system.
Untangling the concept of coercive control: Theorizing domestic violent crime
Authors: Walby Sylvia , Towers Jude
Published: January 2018

The article assesses three approaches to domestic violence: two that use the concept of ‘coercive control’ and one that uses ‘domestic violent crime’. These are: Stark’s concept of coercive control; Johnson’s distinction between situational couple violence and intimate terrorism, in which coercive control is confined to the latter; and that of domestic violent crime, in which all physical violence is conceptualized as coercive and controlling. The article assesses these three approaches on seven issues. It offers original analysis of data from the Crime Survey for England and Wales concerning variations in repetition and seriousness in domestic violent crime. It links escalation in domestic violent crime to variations in the economic resources of the victim. It concludes that the concept of domestic violent crime is preferable to that of coercive control when seeking to explain variations in domestic violence.
A rare reaction to synthetic mono-filament sutures: a report of two cases
Authors: Bali Radhika , Kankam Hadyn KN , Agrawal Amit
Published: January 2018

Due to their clinical advantages, synthetic mono-filament sutures are dominantly used for postoperative wound closures. We present two patients who suffered rare skin reactions to either poliglecaprone 25 or glyconate sutures, following breast cancer lumpectomy. This report aims to make perioperative practitioners and clinicians aware of reactions to sutures and possible management options.
Metaphor and ideology: Conceptual structure and conceptual content in Spanish political discourse
Authors: Díaz-Peralta Marina
Published: January 2018

This article presents the results of the analysis of a number of linguistic metaphors found in a corpus of opinion articles published in the Spanish newspaper El País. The authors included in the corpus, who tend towards the left of the political spectrum, use metaphor to express moral judgements on the actions and decisions of the conservative, centre-right People’s party ( Partido Popular or PP), which governs Spain with an overall majority. With the aim of describing this discourse, we have undertaken a qualitative analysis with a conceptual framework deriving from CDA and cognitive linguistics. First, therefore, we have made use of the methodology developed by Steen and the Pragglejaz group to extract the discourse units that could be considered as the lexical expression of an underlying mapping between domains, that is, the metaphors; second, according to the descriptions of Talmy, Croft, Sweetser, Sullivan, and Dancygier and Sweetser, we have verified that the different types of grammatical structure in which the lexical items appeared also indicated the existence of a metaphorical thought process; and third, in the words of van Dijk, we have studied the ideological semantics underlying conceptual structures and conceptual content. As we have demonstrated, all the samples of linguistic metaphors found led readers to construct the same interpretation of the meaning: The Spanish People’s party government is the past, a past that provokes rejection and which was thought to be definitively ended.
‘It was just you and your child’: Single migrant mothers, generational storytelling and Australia’s migrant heritage
Authors: Dellios Alexandra
Published: January 2018

On the 10 and 11 February 2016, former residents of one of Australia’s post-war ‘holding’ centres for migrant arrivals presented evidence at a hearing for the site’s inclusion on the Victorian Heritage Register. They were aware that the Victorian Heritage Register held few places of significance to post-war migrant communities, let alone working migrant women, which Benalla largely accommodated. They chose to retell their mothers’ stories and explicitly expressed a desire to honour their mothers’ memory at this hearing. This article will explore the impetus expressed by these former child migrants of Benalla to tell their mothers’ stories and unpack its associated implications for the history and collective remembrance of Australia’s post-war migrants. These former child migrants found a platform in the heritage hearing, a platform from which they could piece together their mothers’ history and insist that it is a history worthy of heritage listing and public acknowledgement. On a broad level, I ask, what can a contentious history like Benalla’s offer the history of post-war migration in Australia? Specifically, what role do generational stories of single working migrant women have in the remembering of migrant history and heritage practice in Australia?
IVIg for apparently autoimmune small-fiber polyneuropathy: first analysis of efficacy and safety
Authors: Liu Xiaolei , Treister Roi , Lang Magdalena , Oaklander Anne Louise
Published: January 2018

Objectives:

Small-fiber polyneuropathy (SFPN) has various underlying causes, including associations with systemic autoimmune conditions. We have proposed a new cause; small-fiber-targeting autoimmune diseases akin to Guillain-Barré and chronic inflammatory demyelinating polyneuropathy (CIDP). There are no treatment studies yet for this ‘apparently autoimmune SFPN’ (aaSFPN), but intravenous immunoglobulin (IVIg), first-line for Guillain-Barré and CIDP, is prescribed off-label for aaSFPN despite very high cost. This project aimed to conduct the first systematic evaluation of IVIg’s effectiveness for aaSFPN.

Methods:

With IRB approval, we extracted all available paper and electronic medical records of qualifying patients. Inclusion required having objectively confirmed SFPN, autoimmune attribution and other potential causes excluded. IVIg needed to have been dosed at ⩾1 g/kg/4 weeks for ⩾3 months. We chose two primary outcomes – changes in composite autonomic function testing (AFT) reports of SFPN and in ratings of pain severity – to capture objective as well as patient-prioritized outcomes.

Results:

Among all 55 eligible patients, SFPN had been confirmed by 3/3 nerve biopsies, 62% of skin biopsies, and 89% of composite AFT. Evidence of autoimmunity included 27% of patients having systemic autoimmune disorders, 20% having prior organ-specific autoimmune illnesses and 80% having ⩾1/5 abnormal blood-test markers associated with autoimmunity. A total of 73% had apparent small-fiber-restricted autoimmunity. IVIg treatment duration averaged 28 ± 25 months. The proportion of AFTs interpreted as indicating SFPN dropped from 89% at baseline to 55% ( p ⩽ 0.001). Sweat production normalized ( p = 0.039) and the other four domains all trended toward improvement. Among patients with pre-treatment pain ⩾3/10, severity averaging 6.3 ± 1.7 dropped to 5.2 ± 2.1 ( p = 0.007). Overall, 74% of patients rated themselves ‘improved’ and their neurologists labeled 77% as ‘IVIg responders’; 16% entered remissions that were sustained after IVIg withdrawal. All adverse events were expected; most were typical infusion reactions. The two moderate complications (3.6%) were vein thromboses not requiring discontinuation. The one severe event (1.8%), hemolytic anemia, remitted after IVIg discontinuation.

Conclusion:

These results provide Class IV, real-world, proof-of-concept evidence suggesting that IVIg is safe and effective for rigorously selected SFPN patients with apparent autoimmune causality. They provide rationale for prospective trials, inform trial design and indirectly support the discovery of small-fiber-targeting autoimmune/inflammatory illnesses.
Cabozantinib in the treatment of advanced renal cell carcinoma in adults following prior vascular endothelial growth factor targeted therapy: clinical trial evidence and experience
Authors: Osanto Susanne , van der Hulle Tom
Published: January 2018

Cabozantinib is an oral multitargeted tyrosine kinase inhibitor (TKI) that potently inhibits MET and AXL, both associated with poor prognosis in renal cell carcinoma (RCC), next to vascular endothelial growth factor receptor 2, KIT, FLT3 and RET. Chronic treatment with vascular endothelial growth factor receptor (VEGFR)-targeting sunitinib upregulates MET and AXL in RCC, indicating that cabozantinib may be particularly effective in patients with advanced RCC whose disease progressed on prior VEGFR-targeted treatment. Cabozantinib (60 mg once daily) has been investigated in comparison to everolimus (10 mg once daily) in a phase III randomized controlled trial (RCT) in 658 patients with advanced RCC of whom 71% had received one prior and 29% had received at least two prior lines of VEGR-targeted therapy. This study demonstrated highly significant improved progression-free survival of 7.4 months versus 3.9 months with a hazard ratio (HR) of 0.51 [95% confidence interval (CI) 0.41–0.62] in favour of cabozantinib. Cabozantinib also showed a superior overall survival of 21.4 months versus 16.5 months (HR 0.66; 95% CI 0.53–0.83). Objective response rate was higher in cabozantinib-treated patients, 17% versus 3%. Clinical benefit was shown in all subgroups of patients, including in patients with bone or visceral metastases. The safety profile was acceptable with manageable side effects. Based on this study, cabozantinib is a highly effective approved second-line treatment option for patients with advanced RCC with a manageable toxicity profile. Other recently approved second-line agents include checkpoint inhibitor nivolumab and VEGF-targeting agent lenvatinib combined with everolimus. In the absence of predictive markers as well as head-to-head comparisons of these three recently approved treatments, the choice between these drugs in second-line treatment will probably be made based on comorbidities, tolerability of previous treatment and presence of high tumour burden with rapidly progressive disease. Future pretreatment assessment of MET and AXL tumour aberration may aid clinicians to make a rational choice between currently approved second-line treatment options.
Social business process management in practice
Authors: Suša Vugec Dalia , Tomičić-Pupek Katarina , Vukšić Vesna Bosilj
Published: January 2018

Business process management (BPM) is a well-known holistic discipline used widely in practice for managing business processes and achieving better organizational performance. However, recently, due to technological development, using a traditional approach to BPM is not enough anymore. The answer to the limitations of the traditional BPM has been found in the introduction and application of the social software principles in the management of business processes within a new and emerging area called social BPM. In order to investigate its implementation and usage within the companies, a literature review has been conducted. It confirmed that social BPM is a developing phenomenon. Overall, 31 papers with case studies dealing with the usage of social BPM have been selected for further analysis. The case studies have been analysed with regard to structure, process and content dimensions as well as risk management and crisis.
Enablers and barriers to the successful implementation of project control systems in the petroleum and chemical industry
Authors: Jawad Sahar , Ledwith Ann , Panahifar Farhad
Published: January 2018

Project budget and schedule overruns are becoming critical challenges within the petroleum and chemical industry due to a sharp decline in the oil prices and the subsequent impact this has had on the global financial market. Although innovative project control systems (PCSs) are typically employed in this sector, experience reveals that such systems do not guarantee project success unless they are effectively implemented. The effective implementation of such systems should show financial governance and control, improved profit and financial forecasting, and the ability to forecast and mitigate negative cost impact. This study aims to identify, examine, and prioritize the enablers and barriers linked with successful implementation of PCS. A multicriteria model was used to collect, evaluate, and analyze data from petroleum and chemical firms in Saudi Arabia. A total of 9 enablers and 15 barriers were identified. The research revealed that skilled project team members and clear definition of roles and responsibilities are key enablers of successful PCS. The most critical barriers identified by this study were poor skills in scheduling and controlling along with a distrust of the control system. Other barriers identified include disparate control systems between owner and contractor and vague contract deliverables. These findings emphasize the need to (1) build a project team with the right skills and clear roles, (2) develop a control system that is accurate and trusted by the project team, and (3) develop a shared understanding between owner and contractor about the control system and contract deliverables, in order to successfully implement PCS.
Plantar Fibromatosis: Pathophysiology, Surgical and Nonsurgical Therapies: An Evidence-Based Review
Authors: Carroll Paul , Henshaw Robert M. , Garwood Caitlin , Raspovic Katherine , Kumar Dhruv
Published: January 2018

Plantar fibromatosis (morbus Ledderhose), an extra-abdominal desmoid tumor of the plantar foot, is a rare benign hyperproliferative disorder of the plantar fascia with an unknown etiology. The main clinical characteristics include slow growing nodules on the medial and central bands of the plantar fascia, which may become painful and negatively affect ambulation. Most established conservative therapies today target symptomatic relief. As symptoms progress, therapies such as injections, shockwave ablation, radiation, and/or surgery may be required. This review aims to provide insight into the pathophysiology of this condition in addition to detailing current and investigational therapies for this disorder. Many therapies have been proven in similar conditions, which could lead to promising treatment options for plantar fibromatosis.

Levels of Evidence: Level V: Expert opinion
Zancolli Technique for Delayed Repair of Tibialis Anterior Tendon Rupture: A Case Report and Literature Review
Authors: Valisena Silvia , Petri Gianfranco John , Ferrero Andrea
Published: January 2018

Background. Several techniques for repair of tibialis anterior tendon ruptures (TATRs) are reported, although it is a rare lesion. We describe a case of TATR, discuss our treatment, and review the criteria for the choice of treatment. Methods. In November 2015, a 61-year-old woman presented to our department 13 days after an injury to her left ankle, with avulsion of TAT. Because of the stump retraction, we performed a Zancolli-like plasty, anchoring the tendon to the navicular bone. Evidence about the timing and type of surgery has been reviewed. Results. The patient was followed up for 16 months before being discharged. The American Orthopaedic Foot and Ankle Society score improved from an initial value of 32 to a final score of 90. Conclusions. The choice of treatment depends on several factors. Patients’ physical demands and the type of rupture guide the choice of surgical technique.

Levels of Evidence: Therapeutic, Level IV: Retrospective
Parents’ perceptions of healthy eating practices in north-east Trinidad
Authors: Francis-Granderson Isabella , McDonald Andrea
Published: January 2018

Aim:

The purpose of this study was to explore perceptions, facilitators, and barriers to healthy eating behaviors among parents of primary school-aged children.

Methods:

A purposive sampling design was used to select parents of primary school children from four different communities in north-east Trinidad. They were recruited via the school system with letters containing the research purpose and background. Four focus group sessions were conducted between May and June 2013. Each focus group had an average of five participants and lasted for approximately 60 min. The participants were asked to define healthy eating, identify healthy foods, and describe their concerns regarding healthy eating. The interview questions were developed and validated by the research team members. The data were transcribed and analyzed for themes.

Results:

Twenty-three ( N = 23) parents (78% female and 22% male) participated in the study. The participants define healthy foods as vegetables, starchy foods, porridge, tea, fiber, and foods low in fat. Parents also acknowledged that food cost, availability, parent’s inability to influence children to consume fruits and vegetables, and social barriers are some major challenges impeding healthy eating.

Conclusion:

Our study demonstrates that several barriers exist to healthy eating among primary school children in Trinidad. Community health professionals, school teachers, dietitians, and nutritionists need to play a more prominent role in teaching children and parents about the benefits of healthy eating. Future studies need to address the barriers to healthy eating. This might help to reduce the growing obesity prevalence in Trinidad.
Collective adhesion and displacement of retinal progenitor cells upon extracellular matrix substrates of transplantable biomaterials
Authors: Thakur Ankush , Mishra Shawn , Pena Juan , Zhou Jing , Redenti Stephen , Majeska Robert , Vazquez Maribel
Published: January 2018

Strategies to replace retinal photoreceptors lost to damage or disease rely upon the migration of replacement cells transplanted into sub-retinal spaces. A significant obstacle to the advancement of cell transplantation for retinal repair is the limited migration of transplanted cells into host retina. In this work, we examine the adhesion and displacement responses of retinal progenitor cells on extracellular matrix substrates found in retina as well as widely used in the design and preparation of transplantable scaffolds. The data illustrate that retinal progenitor cells exhibit unique adhesive and displacement dynamics in response to poly-l-lysine, fibronectin, laminin, hyaluronic acid, and Matrigel. These findings suggest that transplantable biomaterials can be designed to improve cell integration by incorporating extracellular matrix substrates that affect the migratory behaviors of replacement cells.
Linguo-didactic environment for teaching foreign-speaking communication in the process of studying French
Authors: Bourina Helena V , Dunaeva Larisa A
Published: January 2018

In recent years, in Russia and abroad, we may have noticed the following tendency: the complex of education-related sciences become increasingly interested in learning about the environment which surrounds a human, its role, its potential and its possible use in education. The initial message is represented by the notion that the outside environment should not be analyzed as a whole but from the position of its influence on the learner. This approach allows creating an environment for handling specific pedagogical tasks by wisely using the outside environment potential and achieving the process of optimal pedagogical interaction with this environment. The linguo-didactic influence of the language environment is a methodical fact, which effects a learner by the following factors: by methodically building an educational system considering the presence of the natural language environment (real and/or virtual) and forming an inner learning motivation, which, by arising from the contact with the language environment, stimulates the learners’ oral activity both during the learning process and outside its framework. Besides, this motivation preconditions the significant intensification of the learning process.
A comparison of the achievement of statistics students enrolled in online and face-to-face settings
Authors: Christmann Edwin P
Published: January 2018

This study compared the achievement of male and female students who were enrolled in an online univariate statistics course to students enrolled in a traditional face-to-face univariate statistics course. The subjects, 47 graduate students enrolled in univariate statistics classes at a public, comprehensive university, were randomly assigned to groups that used either online instruction or traditional face-to-face instruction. The effects of the independent variables of online univariate statistics instruction versus traditional face-to-face instruction on the dependent variable of statistics achievement were analyzed with a two-way analysis of variance. There was a significant difference between the achievement of students who used online univariate statistics instruction and those who used traditional face-to-face instruction (p = .001). The traditional face-to-face group scored higher with an effect size of 0.979, indicating that, on the average, those who were enrolled in a traditional face-to-face univariate statistics class outperformed 83.4% of those enrolled in the online statistics course. Moreover, females using online instruction outperformed males using online instruction and males enrolled in a traditional face-to-face course scored higher than females, with an effect size of 0.651, indicating that, on the average, those males outperformed 74.22% of the females enrolled in a traditional face-to-face statistics course.
A prospective year-long follow-up of lurasidone use in clinical practice: factors predicting treatment persistence
Authors: Osborne Ian J. , Mace Shubhra , Taylor David
Published: January 2018

Background:

Our aim was to follow up patients prescribed lurasidone over 1 year to determine factors predicting treatment persistence.

Methods:

We used noninterventional, observational, prospective follow up of patients consecutively prescribed lurasidone in a large inner-city NHS mental health trust. We also performed retrospective analysis of outcomes from patient case notes.

Results:

Data were available for 69 patients consecutively prescribed lurasidone, of whom three (4%) were lost to follow up. Out of the 66 patients not lost to follow-up, 21 (32%) remained on lurasidone at 1 year. The main reasons for discontinuation were perceived ineffectiveness (49% of discontinuers) and adverse effects (36% of discontinuers), whilst a further seven refused all treatment. Median treatment time on lurasidone was 154 days (95% confidence interval (CI), 33–275). Patients who were not treatment-resistant had a substantially reduced risk of discontinuation, relative risk (RR) 0.18 [95% CI 0.08, 0.41, p < 0.001]. Medium doses (>37–74 mg) of lurasidone reduced the risk of discontinuation by 75% [RR 0.25 (95% CI 0.11, 0.58, p = 0.001)]; high doses (>74–148 mg) reduced the risk of discontinuation by 86% [RR 0.14 (95% CI 0.06, 0.35, p < 0.001)]. Risk of discontinuation was approximately doubled when the reason for prescribing lurasidone was poor tolerability of prior treatment [RR 2.01 (95% CI 1.05, 3.85, p = 0.035)].

Conclusion:

The likelihood of treatment continuation with lurasidone can be vastly improved by targeting individuals most likely to benefit and by using optimal doses.
Right atrial mechanics provide useful insight in pediatric pulmonary hypertension
Authors: Hope Kyle D. , Calderón Anyosa Renzo José Carlos , Wang Yan , Montero Andrea E. , Sato Tomoyuki , Hanna Brian D. , Banerjee Anirban
Published: January 2018

Right atrial (RA) mechanics have been studied infrequently in children in the past due to technical constraints. With the advent of strain imaging, RA physiology can now be studied in greater detail. The principal aim of this study was to describe functional changes in right heart mechanics of children with idiopathic pulmonary arterial hypertension (PAH), by using new applications of RA strain. In this retrospective study, we evaluated RA mechanics of 20 patients (age range = 3–23 years) with PAH and 18 control patients. RA longitudinal strain (RALS) and longitudinal displacement (LD) were calculated by speckle‐tracking echocardiography. RALS was plotted against LD, producing a characteristic strain‐displacement (S‐D) loop. Standard indices of right heart function and right heart catheterization data were obtained. Patients were clinically subdivided into “compensated” and “decompensated” PAH. A chart review was performed to identify patients who subsequently developed adverse outcomes, including death, awaiting or received lung and/or heart transplantation. RALS was significantly lower in decompensated PAH compared with both controls and compensated PAH. Area enclosed by S‐D loops differed significantly between the compensated and decompensated PAH subgroups (5.33 [3.90–9.44] versus 1.83 [1.17–2.36], P < 0.05). S‐D loop area and RALS possessed high sensitivity and specificity compared to other parameters for identifying children with PAH who subsequently developed adverse outcomes. In particular, their sensitivities and specificities were greatly superior compared to those of tricuspid annular plane systolic excursion (TAPSE). RALS may represent a useful metric for assessing right ventricular (RV) dysfunction. S‐D loops, composed over an entire cardiac cycle, may present useful, composite information regarding both systolic and diastolic right heart function. RA mechanics may serve as useful tools for identifying patients with more severe PAH, who are at risk for future adverse outcomes associated with RV failure.
Pulmonary micro‐tumor emboli resulting in paradoxical emboli: a case report
Authors: Morin‐Thibault Louis‐Vincent , Wiseman Daniel , Fortin Michelle , Couture Christian , Provencher Steeve
Published: January 2018

Pulmonary tumor embolism (PTE) is a rare manifestation of cancer. It is characterized by the presence of tumor cell emboli in the pulmonary arterioles and capillaries leading to an elevation of pulmonary vascular resistance. The ante‐mortem diagnosis is difficult. We report a case of PTE associated with recurrent breast cancer that presented with neurological symptoms due to paradoxical cerebral embolism.
The prognostic significance of improvement in exercise capacity in heart failure patients who participate in cardiac rehabilitation programme
Authors: Sabbag Avi , Mazin Israel , Rott David , Hay Ilan , Gang Nelly , Tzur Boaz , Goldkorn Ronen , Goldenberg Ilan , Klempfner Robert , Israel Ariel
Published: January 2018

Introduction

There are limited contemporary data regarding the association between improvement in cardiovascular fitness in heart failure patients who participate in a cardiac rehabilitation programme and the risk of subsequent hospitalisations.

Methods

The study population comprised 421 patients with heart failure who participated in our cardiac rehabilitation programme between the years 2009 and 2016. All were evaluated by a standard exercise stress test before initiation, and underwent a second exercise stress test on completion of 3 ± 1 months of training. Participants were dichotomised by fitness level at baseline, according to the percentage of predicted age and sex norms achieved. Each group was further divided according to its degree of functional improvement, between the baseline and the follow-up exercise stress test. Major improvement was defined as improvement above the median value in each group. The combined primary endpoint was cardiac hospitalisation or all-cause mortality.

Results

A total of 211 (50%) patients had low baseline fitness (<73% (median)) for age and sex-predicted metabolic equivalents of task value. Compared to patients with higher fitness, those with a low baseline fitness were more commonly smokers, had diabetes and were obese ( P < 0.05 for all). Multivariable Cox proportional hazard regression analysis showed that, independent of baseline capacity, an improvement of 5% of predicted fitness was associated with a corresponding 10% reduced risk of cardiac hospitalisation or all-cause mortality ( P < 0.001).

Conclusion

In heart failure patients participating in a cardiac rehabilitation programme, improved cardiovascular fitness is associated with reduced mortality or cardiac hospitalisation risk during long-term follow-up, independent of baseline fitness.
Effectiveness, acceptability and usefulness of mobile applications for cardiovascular disease self-management: Systematic review with meta-synthesis of quantitative and qualitative data
Authors: Coorey Genevieve M , Neubeck Lis , Mulley John , Redfern Julie
Published: January 2018

Background

Mobile technologies are innovative, scalable approaches to reducing risk of cardiovascular disease but evidence related to effectiveness and acceptability remains limited. We aimed to explore the effectiveness, acceptability and usefulness of mobile applications (apps) for cardiovascular disease self-management and risk factor control.

Design

Systematic review with meta-synthesis of quantitative and qualitative data.

Methods

Comprehensive search of multiple databases (Medline, Embase, CINAHL, SCOPUS and Cochrane CENTRAL) and grey literature. Studies were included if the intervention was primarily an app aimed at improving at least two lifestyle behaviours in adults with cardiovascular disease. Meta-synthesis of quantitative and qualitative data was performed to review and evaluate findings.

Results

Ten studies of varying designs including 607 patients from five countries were included. Interventions targeted hypertension, heart failure, stroke and cardiac rehabilitation populations. Factors that improved among app users were rehospitalisation rates, disease-specific knowledge, quality of life, psychosocial well-being, blood pressure, body mass index, waist circumference, cholesterol and exercise capacity. Improved physical activity, medication adherence and smoking cessation were also characteristic of app users. Appealing app features included tracking healthy behaviours, self-monitoring, disease education and personalised, customisable content. Small samples, short duration and selection bias were noted limitations across some studies, as was the relatively low overall scientific quality of evidence.

Conclusions

Multiple behaviours and cardiovascular disease risk factors appear modifiable in the shorter term with use of mobile apps. Evidence for effectiveness requires larger, controlled studies of longer duration, with emphasis on process evaluation data to better understand important system- and patient-level characteristics.
Validity, reliability and Norwegian adaptation of the Stroke-Specific Quality of Life (SS-QOL) scale
Authors: Pedersen Synne Garder , Heiberg Guri Anita , Nielsen Jørgen Feldbæk , Friborg Oddgeir , Stabel Henriette Holm , Anke Audny , Arntzen Cathrine
Published: January 2018

Background:

There is a paucity of stroke-specific instruments to assess health-related quality of life in the Norwegian language. The objective was to examine the validity and reliability of a Norwegian version of the 12-domain Stroke-Specific Quality of Life scale.

Methods:

A total of 125 stroke survivors were prospectively recruited. Questionnaires were administered at 3 months; 36 test–retests were performed at 12 months post stroke. The translation was conducted according to guidelines. The internal consistency was assessed with Cronbach’s alpha; convergent validity, with item-to-subscale correlations; and test–retest, with Spearman’s correlations. Scaling validity was explored by calculating both floor and ceiling effects. A priori hypotheses regarding the associations between the Stroke-Specific Quality of Life domain scores and scores of established measures were tested. Standard error of measurement was assessed.

Results:

The Norwegian version revealed no major changes in back translations. The internal consistency values of the domains were Cronbach’s alpha = 0.79–0.93. Rates of missing items were small, and the item-to-subscale correlation coefficients supported convergent validity (0.48–0.87). The observed floor effects were generally small, whereas the ceiling effects had moderate or high values (16%–63%). Test–retest reliability indicated stability in most domains, with Spearman’s rho = 0.67–0.94 (all p < 0.001), whereas the rho was 0.35 (p < 0.05) for the ‘Vision’ domain. Hypothesis testing supported the construct validity of the scale. Standard error of measurement values for each domain were generated to indicate the required magnitudes of detectable change.

Conclusions:

The Norwegian version of the Stroke-Specific Quality of Life scale is a reliable and valid instrument with good psychometric properties. It is suited for use in health research as well as in individual assessments of persons with stroke.
Young Asian men with diabetes have the highest risk for acute coronary events: retrospective cohort analyses
Authors: Basu Ansu , Sukumar Nithya , Ryder Robert EJ
Published: January 2018

Objective

To understand the ethnic differences in coronary heart disease risk among inpatients with diabetes following acute coronary syndrome.

Design

Single-centre retrospective cohort-analysis of patients with type II diabetes over a six-year period receiving standard care.

Setting

Birmingham, UK.

Participants

One thousand and one hundred and five patients with type II diabetes from a multi-ethnic background.

Main outcome measures

Odds ratios of coronary heart disease events among three ethnic groups.

Results

The prevalence of coronary heart disease events was 20.7% in Asian, 13.2% in Caucasian and 7.7% in Afro-Caribbean patients. Asian patients were younger at diagnosis of diabetes (−5.1 years p < 0.001 versus Afro-Caribbeans and −7.1 years p < 0.001 versus Caucasians). The mean number of events was highest amongst Asian (1.2) compared to Caucasian (1.1) and Afro-Caribbean (1.0) patients (p = 0.04). The mean age at first event was 61.3 years for Asians, 62.5 years and 65.8 for Afro-Caribbeans and Caucasians, respectively (analysis of variance F[2,131] = 2.36 p = 0.09). Un-adjusted odds ratios for at least one coronary heart disease event were highest among Asian men (OR 5.04; 95% CI 2.31–11.01; p < 0.0001) with Afro-Caribbean women as baseline (OR 1.0). The odds ratios remain largely unchanged (1.0 Afro-Caribbeans [baseline], 1.27 [p = 0.56] Caucasians and 3.2 [p = 0.001] for Asians) when corrected for age, gender, duration of diabetes, insulin dependency, mean low-density lipoprotein-cholesterol, triglycerides and high-density lipoprotein-cholesterol, mean glycated haemoglobin, mean systolic and diastolic blood pressure (logistic regression; ROC: 79% AUC). Afro-Caribbean patients had the highest mean high-density lipoprotein-cholesterol (1.6 mmol/L) and the lowest risk for coronary heart disease events.

Conclusions

Asian patients were younger at their first event and diagnosed earlier with diabetes. Asian men had the highest risk of coronary heart disease event which correlated with the lowest levels of high-density lipoprotein-cholesterol.
DUALarm: An open-source and 3D-printable device for upper limb neurorehabilitation
Authors: Dinon Tito , Caimmi Marco , Chiavenna Andrea , Malosio Matteo , Prini Alessio , Scano Alessandro , Molinari Tosatti Lorenzo , Currò Cristian , Lenzi Bruno , Megale Valentino
Published: January 2018

Positively advocating that low-cost additive 3D-printing technologies and open-source licensed software/hardware platforms represent an optimal solution to realize low-cost equipment, a mechanical and 3D-printable device for bilateral upper-limb rehabilitation is presented. The design and manufacturing process of this wheel-geared mechanism, enabling in-phase and anti-phase movements, will be openly provided online with the aim of making a set of customizable devices for neurorehabilitation exploitable all over the world even by people/countries with limited economical and technological resources. In order to characterize the interaction with the device, preliminary trials with EMG and kinematics recordings were performed on healthy subjects.
Intensive care survivors’ experiences of recovery after hospital discharge: A qualitative interview study
Authors: Nelderup Maria , Simonsson Angelica , Samuelson Karin
Published: January 2018

To suffer from a critical illness or injury requiring treatment in an Intensive Care Unit (ICU) is a traumatic experience that may affect patients and their relatives for a long time. This study aimed to explore intensive care survivors’ experiences of recovery after hospital discharge, from the patient perspective. A qualitative interview study with 12 interviews was conducted and analyzed using inductive content analysis. Four categories emerged from the data: Bodily changes, Emotional experiences, A prolonged struggle and Gratitude. The findings indicate that the life situation of intensive care survivors is changed, that recovery takes time and that the feeling of gratitude for having survived is strong.
Coexistence of Right Ventricular Myxoma and Atrioventricular Septal Defect
Authors: Aoyagi Shigeaki , Kosuga Tomokazu , Wada Kumiko , Nakamura Eiji , Yasunaga Hiroshi
Published: January 2018

Although a small number of atrial myxomas are found in association with congenital cardiac defects, ventricular myxomas coexisting with congenital cardiac anomalies are extremely rare. We report a case of right ventricular (RV) myxoma coexistent with atrioventricular septal defect in an adolescent. Echocardiography showed an RV mass, a small ostium primum atrial septal defect, and a cleft of the left atrioventricular valve. Magnetic resonance imaging revealed a mass, suggesting a myxoma. The mass was excised simultaneously with repair of the anomalies and was histologically confirmed as a myxoma.
Programmatic Changes to Reduce Mortality and Morbidity in Humanitarian Congenital Cardiac Surgery
Authors: Wallen Tyler J. , Arnaoutakis George J. , Blenden Randa , Soto Rodrigo
Published: January 2018

Background:

This report documents the outcomes of cardiac surgical mission trips organized by the International Children's Heart Foundation (ICHF), a nongovernmental organization that provides congenital heart surgery services to the developing world, and discusses factors associated with a reduction of mortality and morbidity in this setting.

Methods:

A retrospective review of a prospectively maintained database was conducted to identify any patient who underwent surgical intervention during the course of an ICHF mission trip.

Results:

From 2008 to 2016, a total of 223 trips were made to 23 countries and 3,783 operations were performed. Over 40 unique types of operations were performed with repairs of atrial septal defects (ASDs; n = 479), ventricular septal defects (VSDs; n = 760), teratology of Fallot (n = 473), and ligation of patient ductus arteriosus (PDA; n = 242), comprising the majority of cases. Several organizational policy changes were instituted in 2015. These include the requirement of the host site to have a fully functional blood bank and access to medical subspecialties, the ICHF providing 24-hour intensivist coverage, and not performing surgery on patients weighing less than 10 kg until local capacity has been developed. The overall mortality rate fell to 2.3% from 8.1% after the implementation of these policies. The mortality for ASD repair, VSD repair, PDA ligation, and the repair of tetralogy of Fallot fell from 1.2% to 0%, 1.8% to 0%, 0% to 0%, and 5.6% to 5.1%, respectively. The reoperation rate fell from 11% to 3% and reoperation for a bleeding indication fell from 6% to 2%.

Conclusions:

Programmatic-level changes have been associated with reduced rates of mortality and morbidity in humanitarian congenital cardiac surgery.
Arrhythmias in Children in Early Postoperative Period After Cardiac Surgery
Authors: Sahu Manoj Kumar , Das Anupam , Siddharth Bharat , Talwar Sachin , Singh Sarvesh Pal , Abraham Atul , Choudhury Arin
Published: January 2018

Background:

Postoperative arrhythmias are a known complication after cardiac surgical repairs for congenital heart disease.

Methods:

Data were reviewed pertaining to incidence, diagnosis, potential risk factors, and management of postoperative arrhythmias in 369 consecutive patients under 18 years of age, undergoing elective open heart surgery. All children were admitted to the intensive care unit and continuous electrocardiographic monitoring was performed. Patient factors such as Aristotle Basic Complexity Score, total surgical duration, hypotension, tachycardia, serum lactate level, and inotropic score were analyzed. Univariate analysis was done to assess associations between these factors and the occurrence of postoperative arrhythmias.

Results:

Twenty-five (6.7%) patients developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia occurring in 15 (60%) patients, followed by supraventricular tachycardia in 3 (12%), ventricular premature contractions in 3 (12%), hemodynamically unstable ventricular tachycardia and fibrillation in 3 (12%), and atrial fibrillation in 1 (4%) patient. Different grades of heart block were noted in 13 patients. Aristotle score (P = .014), total surgical duration (P < .01), hypotension (P = .02), heart rate (beats per minute) (P = .001), serum lactate level (P = .04), and inotropic score (P = .02) in the early postoperative period were associated with arrhythmia occurrence. Surgeries for ventricular septal defect alone or in association with other diseases including tetralogy of Fallot (TOF) and transposition of the great arteries (TGA) were found to be associated with higher risk of arrhythmias.

Conclusion:

This study showed a low incidence of arrhythmias, JET being the commonest, seen more in TOF repair and these could be treated efficiently. Higher Aristotle score, longer surgical time, hypotension, tachycardia, high inotropic score, and high serum lactate levels were associated with the occurrence of arrhythmias postoperatively.