bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of fasting on the appetite-associated factors and energy sensors expression in the hypothalamus of different TI broilers
Authors: Sun Lili , Liu Jie , Tian Ping , Ni Yingdong , Zhao Ruqian
Published: February 2018

Tonic immobility (TI) is a behaviour related to fear and stress response. Birds can exhibit a short (STI) or long (LTI) tonic immobility phenotype on the basis in TI duration. In this study, the differences in the hypothalamic appetite-associated factors and energy sensor gene expression between STI and LTI broilers were evaluated under free feed access or 16-h fasting. The results showed that the concentrations of cholesterol, high density lipoprotein-cholesterol, non-esterified fatty acid, malonaldehyde, lactate dehydrogenase, creatine kinase, alanine aminotransferase and aspartate aminotransferase in plasma were significantly increased (P < 0.05) in fasting broilers compared with broilers fed ad libitum, whereas plasma glucose, triglyceride, and total antioxidant capacity concentrations were decreased (P < 0.05). With respect to TI, however, only low density lipoprotein-cholesterol and glutathione peroxidase concentrations in plasma showed significant differences between LTI and STI broilers, with higher concentrations in LTI compared with STI. Real-time PCR results showed that only NPY mRNA expression demonstrated a tendency to increase in STI broilers compared with LTI (P = 0.095). Fasting downregulated SREBP-1 and its target gene FAS but upregulated CPT1 in the hypothalamus. Additionally, levels of hypothalamic p-GR and p-AMPK protein expression decreased after fasting. These results indicate that a 16-h fasting results in a negative energy status, and is accompanied with changes in expression of hypothalamic energy sensor and appetite-associated factors.
Effect of the acute heat stress on serum endotoxin concentration and the expression of TLR4 mRNA in liver of Arbor Acres broiler chickens
Authors: Huang Shu-cheng , Fu Ya-Fen , Rehman Mujeeb Ur , Li Kun , Lan Yan-fang , Liu Wei , Luo Hou-qiang , Zhang Hui , Zhang Li-hong , Hao Ya-nan , Tong Zong-xi
Published: February 2018

This study was undertaken to investigate the relationship between gut-derived endotoxin and the Toll-like receptor 4 (TLR4) expression in the liver of broilers under acute heat stress (AHS). For this purpose, 120 Arbor Acres chicks were randomised into two groups: control temperature group (CT group, 22 ± 1°C) and high temperature group (HT group, 38 ± 1°C). The chicks received AHS at Day 28 and their small intestine, liver and blood samples were collected after 2 h, 5 h and 10 h to examine the histopathology, biochemical parameters, endotoxin concentrations and TLR4 expression. The results showed that damaged intestinal villi and severe congestion of the hepatic sinusoids were observed, especially after 10 h of AHS in the HT group. In addition, the levels of alanine transferase, aspartate transaminase, and direct bilirubin, except alkaline phosphataseafter were significantly elevated (P < 0.05) and total bilirubin (P < 0.01) and albumin (P < 0.05) were decreased after 10 h of AHS as compared with the CT group, which are associated with liver function. Moreover, the mRNA expression of TLR4 in the liver was noticeably upregulated (P < 0.05) during AHS with significantly increased in endotoxin concentration (P < 0.01) of broilers. Altogether, these findings suggest that the upregulated expression of TLR4 mRNA was triggered via gut-derived endotoxin in heat stress-induced liver injury.
The effect of a gradual or rapid dietary changeover from a grazed pasture to a conserved forage-based diet on milk yield, cow condition and rumen pH of late-lactation dairy cows
Authors: McDonnell R. P. , Staines M. vH.
Published: February 2018

A 40-day experiment was conducted to determine the effect of a gradual versus rapid changeover from grazed pasture to grass silage on production and performance in late-lactation Holstein–Friesian cows. Eighty cows were assigned to one of the following two treatments (two groups of 20 cows each): (1) gradual changeover from grazed pasture to grass silage over a 10-day adaptation period (GRAD), or (2) immediate changeover from grazed pasture to grass silage, with no adaptation period (RAPID). In addition to grazed pasture and grass silage, cows also received equal daily amounts of supplementary concentrates throughout the 40 days (ranging from 6.6 to 7.5 kg DM/cow). The experiment was divided into three periods. In Period 1 (Days 1–12), all cows received a generous pasture allowance and no grass silage was offered. In Period 2 (Days 13–22), GRAD cows were gradually introduced to grass silage on a stepwise basis, while still consuming grazed pasture, while RAPID cows received grazed pasture until Day 17, before switching to ad libitum grass silage from Day 18 onward. In Period 3 (Days 23–40), all cows received ad libitum pasture silage and no grazed pasture. Feed intake, milk volume and composition, and rumen pH were measured. Treatment did not affect estimated dry-matter intake of grazed pasture or measured dry-matter intake of silage. Milk yield did not differ between treatments from Day 1 to Day 18 (mean 29.3 L/cow; P > 0.05), but was greater in GRAD cows from Day 19 to Day 27 (mean 25.6 vs 22.1 L/cow; P < 0.001). From Day 28 onward, no effect of treatment was detected apart from a 3-day juncture from Day 34 to Day 36, where milk yield in the GRAD treatment was greater (mean 22.8 vs 21.0 L/cow; P = 0.02). Milk fat and protein concentrations were unaffected by treatment throughout (mean 4.15% for milk fat, 3.37% for milk protein; P > 0.05). Mean rumen pH was also unaffected by treatment in periods 1 and 2 (mean 6.27; P > 0.05), but were greater in Period 3 in GRAD cows (6.34 vs 6.26 for GRAD vs RAPID; P < 0.001), while the amount of time spent under pH 6.0 did not differ between treatments (mean 2.45 h/day; P > 0.05). Changing the dietary forage source from grazed pasture to grass silage over a 10-day period increased milk yield, compared with having no dietary adaptation period, and the cumulative difference for the duration of this experiment amounted to 37 L/cow.
Enzymatic hydrolysis drastically reduces fibre content of palm-kernel expeller, but without enhancing performance in broiler chickens
Authors: Chen W. L. , Jahromi M. F. , Candyrine S. C. L. , Liang J. B. , Abdullah N. , Idrus Z.
Published: February 2018

The effectiveness of enzymatic hydrolysis of palm-kernel expeller (PKE) is dependent on various factors that influence the stability and functionality of the enzymes. In the present study, parameters influencing the enzymatic treatment of PKE were optimised employing response surface methodology. In addition, the effectiveness of enzymatic hydrolysed PKE in increasing inclusion rates in broiler diets was evaluated. Results showed that temperature, enzyme concentration and duration of hydrolysis had significant (P < 0.01) effects on the enzymatic hydrolysis of PKE. Using the crude enzyme produced by Aspergillus terreus K1 isolated in our laboratory, maximum reduction of crude fibre (40%) was achieved by fermenting the PKE at 60% initial moisture with 9.0 U/g PKE mannanase at 51°C for 18 h, with the production of 9.9% (w/w) of monosaccharides and oligosaccharides. Results of the growth-performance study indicated that inclusion rate of PKE with or without enzyme treatment in broiler diet is 5% for starter period and 20% for the finisher diet, without any detrimental effect on animal performance. Although the inclusion rate of enzyme-treated PKE can be increased to 30% without affecting average daily gain, feed conversion ratio of the birds will be compromised.
Life without water: how do bacteria generate biomass in desert ecosystems?
Authors: Bay Sean , Ferrari Belinda , Greening Chris
Published: February 2018

Many of the world's most arid deserts harbour surprisingly diverse communities of heterotrophic bacteria. These organisms persist in surface soils under extreme climatic conditions, despite lacking obvious energy inputs from phototrophic primary producers. A longstanding conundrum has been how these communities sustain enough energy to maintain their diversity and biomass. We recently helped to resolve this conundrum by demonstrating that some desert communities are structured by a minimalistic mode of chemosynthetic primary production, where atmospheric trace gases, not sunlight, serve as the main energy sources. These findings are supported by pure culture studies that suggest atmospheric trace gases are dependable energy sources for the long-term survival of dormant soil bacteria. We predict that atmospheric trace gases may be a major energy source for desert ecosystems worldwide.
Protonation state of inhibitors determines interaction sites within voltage-gated sodium channels
Authors: Buyan Amanda , Sun Delin , Corry Ben
Published: February 2018

Significance

Voltage-gated sodium channels are integral in electrical signaling within the human body and are key targets for anesthetics and antiepileptic compounds used in surgeries and the treatment of neurological disorders. We have used molecular simulations to determine where a number of these compounds bind inside the pore of a voltage-gated sodium channel to aid the design of new compounds for treating chronic pain, heart conditions, and epilepsy. We uncover two distinct binding sites inside the pore harnessed by neutral and charged drugs, respectively. This explains why so many anesthetic compounds have both neutral and charged forms: The neutral form more easily enters the pore, but the charged form binds more tightly to effectively block the pore and prevent electrical signaling.
Viral insulin-like peptides activate human insulin and IGF-1 receptor signaling: A paradigm shift for host–microbe interactions
Authors: Altindis Emrah , Cai Weikang , Sakaguchi Masaji , Zhang Fa , GuoXiao Wang , Liu Fa , De Meyts Pierre , Gelfanov Vasily , Pan Hui , DiMarchi Richard , Kahn C. Ronald
Published: February 2018

Significance

Although there has been tremendous progress in understanding hormone action and its relationship to human physiology and disease, there has been no comprehensive approach to search the viral genome for the presence of human-like hormones. Here, using a bioinformatics approach, we have identified 16 different human peptide hormones/growth factors, including four insulin/insulin growth factor (IGF)1-like peptides (VILPs) that have homologous sequences in viruses. When these VILPs were chemically synthesized, the resulting peptides could bind to human and murine insulin and IGF1 receptors, stimulate postreceptor signaling, increase glucose uptake, and activate proliferation of cells. Injection of VILPs into mice can significantly lower the blood glucose. Thus, VILPs are members of the insulin superfamily and first characterized viral hormones.
The religious-sublime in music, literature and architecture
Authors: Cifuentes-Aldunate Claudio E.
Published: February 2018

The present article is an attempt to propose the semiotic aspect that produces the ”religious- sublime”. Most of the semiotic
characteristics that we use to represent (and produce) the signifiers of the religious-sublime, nevertheless, share their
mechanisms with other modalities of ”sublimeness”. The sublime will be regarded as the representation (in the sense of staging) of
a perception. I will propose how the subjective perception – in this case of the divinity – is (re)constructed by the subject in a
piece of Spanish Gothic literature, in sacred music and in architecture – the room which houses the subjective perception of
divinity.
‘The Space that Divides and Connects.’ Betweenness and the Intersubjective Perspective
Authors: Pitruzzella Salvo
Published: February 2018

In my opinion, the most important aspect of Roger Grainger's legacy is that his many books and articles are not only a guide to understand the meaning of dramatherapy, but also a vast inquiry on human nature, as well as a hymn of joy for what such a nature is, with its bliss and its misery. My ideas about what dramatherapy is are largely inspired from his thought, yet I reckon that my understanding of how it works derives primarily from my experiences of live meetings with him. Therefore in this article, which will mingle personal feelings with theoretical considerations, I will recall some of the encounters I had with him.
Mechanotransduction in tumor progression: The dark side of the force
Authors: Broders-Bondon Florence , Nguyen Ho-Bouldoires Thanh Huong , Fernandez-Sanchez Maria-Elena , Farge Emmanuel
Published: February 2018

Cancer has been characterized as a genetic disease, associated with mutations that cause pathological alterations of the cell cycle, adhesion, or invasive motility. Recently, the importance of the anomalous mechanical properties of tumor tissues, which activate tumorigenic biochemical pathways, has become apparent. This mechanical induction in tumors appears to consist of the destabilization of adult tissue homeostasis as a result of the reactivation of embryonic developmental mechanosensitive pathways in response to pathological mechanical strains. These strains occur in many forms, for example, hypervascularization in late tumors leads to high static hydrodynamic pressure that can promote malignant progression through hypoxia or anomalous interstitial liquid and blood flow. The high stiffness of tumors directly induces the mechanical activation of biochemical pathways enhancing the cell cycle, epithelial–mesenchymal transition, and cell motility. Furthermore, increases in solid-stress pressure associated with cell hyperproliferation activate tumorigenic pathways in the healthy epithelial cells compressed by the neighboring tumor. The underlying molecular mechanisms of the translation of a mechanical signal into a tumor inducing biochemical signal are based on mechanically induced protein conformational changes that activate classical tumorigenic signaling pathways. Understanding these mechanisms will be important for the development of innovative treatments to target such mechanical anomalies in cancer.
A Kobayashi pseudo-distance for holomorphic bracket generating distributions
Authors: Seo Aeryeong
Published: February 2018

We generalize the Kobayashi pseudo-distance to complex manifolds which admit holomorphic bracket generating distributions. The generalization is based on Chow’s theorem in sub-Riemannian geometry. Let

G
G

be a linear semisimple Lie group. For a complex

G
G

-homogeneous manifold

M
M

with a

G
G

-invariant holomorphic bracket generating distribution

D
D

, we prove that

(
M
,
D
)

(M,D)

is Kobayashi hyperbolic if and only if the universal covering of

M
M

is a canonical flag domain and the induced distribution is the superhorizontal distribution.
Longitudinal changes in physical function and physical activity in older adults
Authors: Metti Andrea L , Best John R , Shaaban C Elizabeth , Ganguli Mary , Rosano Caterina
Published: February 2018

Background

physical function (PF) and physical activity (PA) both decline as adults age and have been linked to negative outcomes, including dementia, depression and cardiovascular diseases. Although declines in each are associated with numerous negative outcomes, the longitudinal relationship between these two measures is unclear.

Objective

to examine the dynamic, bidirectional associations between declines in PF and PA.

Design

prospective cohort.

Setting

the Monongahela–Youghiogheny Healthy Aging Team (MYHAT) study.

Subjects

about 1,404 men and women, 76.96 ± 7.2 years, 62.4% female and 95.2% white.

Methods

over nine annual assessment cycles, PF was evaluated via the timed Up-and-Go task and PA via a self-reported questionnaire. Piecewise latent growth models examined bidirectional associations between PA and PF to determine whether the initial values (intercept) or early slope (cycles 1–5) (in either PF or PA) predicted later slope (cycles 5–9) (in either PF or PA).

Results

initial PF significantly predicted early (standardised β= −0.10, P < 0.001) and later (standardised β= −0.09, P = 0.01) PA slopes. Initial PA significantly predicted later (standardised β = −0.09, P = 0.04) but not early PF slope. Associations were independent of baseline memory test scores, baseline cognitive status, later cognitive status and age. Early physical function slope neither predicts later PA slope nor did early PA slope predict later PF slope (both P values >0.10).

Conclusions

the relationship between PF and PA is bidirectional, with PF more consistently predicting declines of PA, both in the short- and long-term. Intervening on PF impairments may improve PA engagement, which could in turn promote PF and translate to beneficial effects on cognitive function, cardiovascular health and mood.
Clinical Trials of Blood Pressure Lowering and Antihypertensive Medication: Is Cognitive Measurement State-of-the-Art?
Authors: Elias Merrill F , Torres Rachael V , Davey Adam
Published: February 2018

Randomized controlled trials of blood pressure (BP) lowering and antihypertensive medication use on cognitive outcomes have often been disappointing, reporting mixed findings and small effect sizes. We evaluate the extent to which cognitive assessment protocols used in these trials approach state-of-the-art. Overall, we find that a primary focus on cognition and the systematic selection of cognitive outcomes across trials take a backseat to other trial goals. Twelve trials investigating change in cognitive functioning were examined and none met criteria for state-of-the-art assessment, including use of at least 4 tests indexing 2 cognitive domains. Four trials investigating incident dementia were also examined. Each trial used state-of-the-art diagnostic criteria to assess dementia, although follow-up periods were relatively short, with only 2 trials lasting for at least 3 years. Weaknesses in each trial may act to obscure or weaken the positive effects of BP lowering on cognitive functioning. Improving trial designs in terms of cognitive outcomes selected and length of follow-up periods employed could lead to more promising findings. We offer logical steps to achieve state-of-the-art assessment protocols, with examples, in hopes of improving future trials.
Aesthetic Improvement of Undeveloped Calves After Treatment of Congenital Clubfoot Deformity
Authors: Andjelkov Katarina , Llull Ramon , Colic Milan , Atanasijevic Tatjana C , Popovic Vesna M , Colic Miodrag
Published: February 2018

Background

Even when clubfoot deformity is treated in a timely manner, the consequences observed in adulthood include hypoplasia of the calf muscles, gait impairment, decreases in foot size, and it can also affect the tibial length. These consequences may have negative impacts on the patient’s subjective appraisal of long-term outcomes, and can influence the patient’s self-esteem in both male and female patients.

Objectives

We present our experience in the treatment of undeveloped calves after surgical treatment of congenital clubfoot.

Methods

In total, 72 patients underwent corrective surgery in order to improve undeveloped calves resulting from a congenital clubfoot deformity. We used calf silicone implants in combination with fat grafting in multistaged procedures, in order to decrease complication rates and improve aesthetic outcome.

Results

Amongst our patients there were 54 (75%) females and 18 (25%) males. All of the patients, except one, had unilateral calf hypoplasia. The procedures were divided into several groups: (1) medial calf augmentation with silicone implants; (2) medial calf augmentation with silicone implants and fat grafting; and (3) medial and lateral calf augmentation with silicone implants and fat grafting. We had one case of a hyperpigmented scar and one case of partial scar dehiscence. There were no cases of compartment syndrome. The average follow-up period was 9.8 months.

Conclusions

Calf enhancement surgery in patients with congenital clubfoot deformity is very gratifying. When combining calf implants with fat grafting in multistaged procedures, we can achieve excellent results with low complication rates.

Level of Evidence: 4
Evaluating habitat, prey, and mesopredator associations in a community of marine birds
Authors: Goyert Holly F , Gardner Beth , Veit Richard R , Gilbert Andrew T , Connelly Emily , Duron Melissa , Johnson Sarah , Williams Kathryn
Published: February 2018

Offshore wind energy development on the US Atlantic Continental Shelf has brought attention to the need for marine spatial planning efforts to reduce potential conflict between wind turbines and marine animals, including seabirds. We evaluated the effects of marine mammals, fishes, and habitat characteristics on the distribution and relative abundance of marine birds off the coast of Delaware, Maryland, and Virginia. From May 2012 to 2014, we collected line transect data from 14 shipboard surveys, and novel high-resolution digital videography data from 14 aerial surveys. We compiled five habitat covariates: three static (distance to shore, sea floor slope, and sediment grain size), and two dynamic (sea surface temperature, salinity). We additionally analysed two seabird community covariates: the density of observed marine mammals and detected fish. Using zero-altered models, we tested our hypothesis that plunge-diving seabird species would show positive associations with marine mammals. Our results provide statistical evidence that, alongside competition, facilitative interactions occur among pelagic communities, where subsurface predators improve the detectability and accessibility of prey to surface-feeding seabirds. This study highlights the importance of quantifying community and ecological influences on avian abundance, particularly in predicting the potential exposure of marine birds and mammals to offshore development.
NGC628 with SITELLE: I. Imaging spectroscopy of 4285 H ii region candidates
Authors: Rousseau-Nepton L , Robert C , Martin R P , Drissen L , Martin T
Published: February 2018

This is the first paper of a series dedicated to nebular physics and the chemical evolution of nearby galaxies by investigating large samples of H ii regions with the Canada–France–Hawaii Telescope imaging spectrograph SITELLE (Spectro-Imageur à Transformée de Fourier pour l’Étude en Long et en Large des raies d’Émission). We present a technique adapted to imaging spectroscopy to identify and extract parameters from 4285 H ii region candidates found in the disc of NGC 628. Using both the spatial and spectral capabilities of SITELLE, our technique enables the extraction of the position, dust extinction, velocity, H α profile, diffuse ionized gas (DIG) background, luminosity, size, morphological type, and the emission-line fluxes for individual spaxels and the integrated spectrum for each region. We have produced a well-sampled H ii region luminosity function and studied its variation with galactocentric radius and level of the DIG background. We found a slope α of −1.12 ± 0.03 with no evidence of a break at high luminosity. Based on the width of the region profile, bright regions are rather compact, while faint regions are seen over a wide range of sizes. The radius function reveals a slope of −1.81 ± 0.02. BPT diagrams of the individual spaxels and integrated line ratios confirm that most detections are H ii regions. Also, maps of the line ratios show complex variations of the ionization conditions within H ii regions. All this information is compiled in a new catalogue for H ii regions. The objective of this data base is to provide a complete sample which will be used to study the whole parameter space covered by the physical conditions in active star-forming regions.
Web-Enabled Mechanistic Case Diagramming: A Novel Tool for Assessing Students’ Ability to Integrate Foundational and Clinical Sciences
Authors: Ferguson Kristi J. , Kreiter Clarence D. , Haugen Thomas H. , Dee Fred R.
Published: February 2018

Problem

As medical schools move from discipline-based courses to more integrated approaches, identifying assessment tools that parallel this change is an important goal.

Approach

The authors describe the use of test item statistics to assess the reliability and validity of web-enabled mechanistic case diagrams (MCDs) as a potential tool to assess students’ ability to integrate basic science and clinical information. Students review a narrative clinical case and construct an MCD using items provided by the case author. Students identify the relationships among underlying risk factors, etiology, pathogenesis and pathophysiology, and the patients’ signs and symptoms. They receive one point for each correctly identified link.

Outcomes

In 2014–2015 and 2015–2016, case diagrams were implemented in consecutive classes of 150 medical students. The alpha reliability coefficient for the overall score, constructed using each student’s mean proportion correct across all cases, was 0.82. Discrimination indices for each of the case scores with the overall score ranged from 0.23 to 0.51. In a G study using those students with complete data (n = 251) on all 16 cases, 10% of the variance was true score variance, and systematic case variance was large. Using 16 cases generated a G coefficient (relative score reliability) equal to 0.72 and a Phi equal to 0.65.

Next Steps

The next phase of the project will involve deploying MCDs in higher-stakes settings to determine whether similar results can be achieved. Further analyses will determine whether these assessments correlate with other measures of higher-order thinking skills.
Hospitalized Patients With and Without Hemodialysis Have Markedly Different Vancomycin Pharmacokinetics: A Population Pharmacokinetic Model-Based Analysis
Authors: Goti Vineet , Chaturvedula Ayyappa , Fossler Michael J. , Mok Steve , Jacob Jesse T.
Published: February 2018

Background:

Despite being in clinical use for about 6 decades, vancomycin dosing remains perplexing and complex.

Methods:

A population pharmacokinetic modeling and simulation approach was used to evaluate the efficiency of the current nomogram-based dosing of vancomycin. Serum vancomycin concentrations were obtained as a part of routine therapeutic drug monitoring from two 500-bed academic medical centers. A population pharmacokinetic model was first built using these therapeutic drug monitoring data. Population pharmacokinetic modeling was conducted using NONMEM (7.2 and 7.3). The forward addition–backward elimination approach was used to test the covariate effects. Appropriate numerical and visual criteria were used as model diagnostics for checking model appropriateness and model qualification. The current nomogram efficiency was evaluated by determining the percentage of subjects in the therapeutic range (10–20 mg/L).

Results:

A 2-compartment model with between-subject variability on clearance (CL), central volume of distribution (Vc), and peripheral volume of distribution best fit the data. Blood urea nitrogen, age, creatinine clearance, and hemodialysis status were significant covariates on clearance. Hemodialysis status was a significant covariate on Vc and peripheral volume of distribution. In the final model, creatinine clearance was retained as a covariate on CL whereas hemodialysis status was retained as covariate on both CL and Vc. Using Monte Carlo simulations, the current nomogram was optimized by the addition of a loading dose and reducing the maintenance doses. The current nomogram is suboptimal. Optimization of the nomogram resulted in >40% subjects consistently being in the therapeutic range at troughs collected after the first 6 doses.

Conclusions:

CL and Vc differ markedly between patients undergoing hemodialysis and those not undergoing hemodialysis. Dosing nomogram based on these covariate relationships may potentially help in accurate dosing of vancomycin.
Prevention and Management of Thromboembolism in Pregnancy When Heparins Are Not an Option
Authors: JAMES ANDRA H.
Published: February 2018

Heparins, unfractionated heparin, and low molecular weight heparin, are the preferred anticoagulants in pregnancy. There are circumstances, however, in which an alternative to heparin should be considered. These circumstances include, the presence of heparin resistance, a heparin allergy manifesting as heparin-induced skin reactions or heparin-induced thrombocytopenia, and the presence of a mechanical heart valve. From time to time, the obstetrician is called on to make recommendations about anticoagulants in pregnancy, including in circumstances in which an alternative to heparin has been suggested or is necessary. In this article, these circumstances are reviewed and alternative anticoagulants are discussed.
Neoadjuvant chemotherapy and the complexity of operative procedure in advanced epithelial ovarian cancer: a retrospective analysis
Authors: Refky Basel , Elalfy Amr , Nabil Hanan , El-Emam Doaa , Abdelwahab Khaled M. , Malik Eduard , Soliman Amr A.
Published: February 2018

Introduction:

Complete tumor resection for epithelial ovarian cancer (EOC) generally incorporates complex surgical maneuvers, especially bowel resection. This study retrospectively analyzed the impact of neoadjuvant chemotherapy (NAC) on complexity of surgical procedures for EOC (represented by bowel resection) and postoperative morbidity.

Methods:

We retrospectively recruited all patients with Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stages IIIC–IVB EOC who were treated in our center between 2011 and 2016. Patients were divided into those who received primary debulking followed by chemotherapy (group A), and those who received NAC followed by interval debulking (group B). Patient age, tumor stage, grade, dates of commencement and completion of therapy, intraoperative events, completion of surgical resection, and postoperative events were evaluated.

Results:

Of 92 patients, 42 were assigned to group A and 50 to group B. Their FIGO stages were group A—stages IIIC: 34 (80.9%), IVA: 6 (14.3%), and IVB: 2 (4.8%); and group B—stages IIIC: 45 (90%), IVA: 5 (10%), and IVB: 0 (0%). The 2 groups did not significantly differ in completeness of surgical cytoreduction or rates of bowel resection, intraoperative complications, or postoperative morbidities.

Conclusion:

NAC did not reduce rates of bowel resection, intraoperative complications, and postoperative morbidity in advanced EOC compared with primary surgical cytoreduction. Future prospective studies will be required to corroborate our results.
Dihydrotestosterone and cancer risk
Authors: Chan Yi X. , Yeap Bu B.
Published: February 2018

Purpose of review

Androgens have been implicated in prostate growth; however, the role of androgens in prostate cancer development is not clear. Furthermore, studies suggest a role for androgens in female-hormone-dependent cancers and common nonhormone dependent cancers. This study aims to review key studies and more recent studies of dihydrotestosterone (DHT) and cancer risk.

Recent findings

Epidemiological studies are reassuring as they have not associated endogenous androgens with prostate cancer risk. Intraprostatic regulation of DHT is becoming recognized as an important area of research to clarify the role of DHT in prostate cancer development. In females, further understanding of intracrine regulation of sex hormones and interactions between androgens and estrogens in influencing breast and endometrial cancer risk are required. Studies show a signal for DHT in modulating lung and colorectal cancer growth; however, research in this area is relatively scarce and further studies are required to clarify these associations.

Although concerns of prostate cancer risk remain, there is also potential for androgens to modulate the growth and development of other common cancers. Further research is required as this may have clinical implications.
Digested Early Preterm Human Milk Suppresses Tumor Necrosis Factor–induced Inflammation and Cytotoxicity in Intestinal Epithelial Cells
Authors: Chen Yimin , Patel Aloka , Meier Paula P. , Fantuzzi Giamila
Published: February 2018

Objectives:

The aim of this study was to determine the effect of digested whole human milk (HM; first sample available after birth from mothers of premature infants) on inflammation, oxidative stress, and cytotoxicity in Caco‐2 human intestinal epithelial cells stimulated with lipopolysaccharides or tumor necrosis factor (TNF) to mimic the potential in vivo insults facing the premature infant's gastrointestinal tract.

Methods:

Fully differentiated Caco‐2 cells were exposed to digested HM (n = 10; samples from 10 different individuals) before stimulation with lipopolysaccharides, TNF, or no stimulation overnight. Inflammation was determined by production of interleukin‐8, oxidative stress by levels of F2‐isoprostane, and cytotoxicity by released lactate dehydrogenase.

Results:

HM significantly suppressed interleukin‐8 production and cytotoxicity in TNF‐stimulated cells, while also suppressing cell death under baseline conditions. Individual HM samples differed widely in their ability to modulate cellular responses.

Conclusions:

Results from this study provide evidence that digested HM can reduce both an exaggerated inflammatory response and intestinal damage that contribute to the pathogenesis of necrotizing enterocolitis.
Competitively Selected Donor Fecal Microbiota Transplantation
Authors: Barnes Danielle , Ng Katharine , Smits Sam , Sonnenburg Justin , Kassam Zain , Park K.T.
Published: February 2018

In this prospective cohort study, we examine the feasibility of a protocol to optimize microbiota for fecal microbiota transplantation (FMT). Donor stool metrics generally accepted as markers of gut health were used to select a stool donor based on superior microbial diversity, balanced constitution of Bacteroidetes versus Firmicutes and high concentration of fecal butyrate. Selected donor microbiota was then administered via FMT. A total of 10 patients with median age of 12 years with recurrent Clostridium difficile infection received the intervention. The rate of recurrence‐free resolution with 1‐2 FMTs was 100% at Week 10. With a single FMT, 80% of patients cleared Clostridium difficile infection without recurrence, whereas 20% of patients required a single re‐treatment. No serious adverse events occurred. Microbiota sequencing revealed that recipients’ gut microbiota phylogenic diversity increased by 72‐hours post‐transplantation, with sustainment over 10‐week follow‐up. This study highlights the feasibility of purposefully selecting the most ideal microbiota for transplantation.
Pregnancy after Solid Organ Transplantation
Authors: Kurz Jane M.
Published: February 2018

Purpose:

To explore the reproductive decision-making process with women who were organ transplant recipients (renal, lung, & heart transplants).

Study Design and Methods:

Grounded theory guided data collection and analyses. Mixed methods with audiotaped telephone interviews and a written survey measuring social support were used. As social support is critical for women who are organ transplant recipients considering pregnancy, a search for disconfirming evidence for social support via a survey and interviews was included.

Analyses:

Verbatim responses were analyzed through the constant comparative method using open, axial, and selective coding. Trustworthiness was established through prolonged engagement, member checking, and thick descriptions.

Results:

Participants included 10 women who were solid organ recipients (2 lung, 1 heart, and 7 renal transplant recipients). The core theme was Wanting a child. Other themes included Getting information, Advocating, Dealing with problems, Preparing, Talking, Supporting, Coping, and Advising
others. There was no evidence of a lack of social support as evaluated via the survey or interviews.

Clinical Implications:

This study provides new knowledge on clinical decision-making about pregnancy for women who are solid organ recipients and for healthcare professionals. Nurses can use these data to help guide women on how to obtain the most accurate information to make a personal decision about pregnancy and to develop support from their healthcare team and family.
Facilitating Early Breast Milk Expression in Mothers of Very Low Birth Weight Infants
Authors: Parker Leslie Ann , Hoffman Jacqueline , Darcy-Mahoney Ashley
Published: February 2018

Background:

Although early initiation of human milk (HM) expression after birth is known to increase lactation success in mothers of very low birthweight (VLBW) infants, initiation is frequently delayed, potentially decreasing both short- and long-term HM production. Obstetrical (OB) nurses are typically the healthcare provider responsible for facilitating the initial HM expression session. As delays in initiation are common, it is likely that nurses experience obstacles to facilitation of an early initiation of HM expression. The purpose of this study was to determine barriers OB nurses perceive in facilitating early initiation of HM expression in mothers of VLBW infants.

Study Design and Methods:

An online survey was administered to nurses from three tertiary care OB units in Florida to determine perceived barriers to early initiation of HM expression in mothers of VLBW infants.

Results:

Eighty-three nurses completed the survey. The following barriers were identified: (1) lack of time and personnel to assist mothers with HM expression, (2) nurse's perception of the mother's acuity level, and (3) nurse's perception of maternal pain and stress. Discrepancies between nursing judgment, action, and knowledge of unit policies were evident.

Clinical Implications:

Obstetric nurses encounter barriers when facilitating early HM expression in mothers giving birth to VLBW infants. It is possible these barriers could be removed through improvements in education, use of innovative staffing strategies, and maintenance of evidence-based policies.
The Business, Ethics, and Quality Cases for Consumer Engagement in Nursing
Authors: Hassmiller Susan , Bilazarian Ani
Published: February 2018

OBJECTIVE

The aims of this study were to illustrate the quality, safety, cost-effectiveness, and ethics of consumer engagement initiatives and identify promising practices and leadership strategies used by nursing leaders.

METHODS

A literature review was performed with supplementary interviews conducted with 25 key nursing informants including nursing executives and chief nursing officers at acute care hospitals, community health centers, policy institutions, and quality and safety organizations. A narrative synthesis approach was used to identify and compare existing measures of consumer engagement and compassionate care in acute care settings. One-hour semistructured interviews were performed, and information was gathered by notes and audio recordings.

RESULTS

Consumer engagement activities focusing on compassionate patient and provider interactions involving patients and family as partners on the care team are associated with increases in treatment savings and patient safety in terms of length of stay and reduced medication errors. Engagement initiatives support employee health and reduce compassion fatigue.

CONCLUSION

Findings illustrate the impact of patients and family engagement in decision making and promising organizational practices that reinforce engagement.
Old Pathogen, New Challenges: A Narrative Review of the Multilevel Drivers of Syphilis Increasing in American Men Who Have Sex With Men
Authors: Mayer Kenneth H.
Published: February 2018

Since the turn of the current century, syphilis incidence and prevalence have been increasing more rapidly among men who have sex with men (MSM) than any other US subpopulation, exceeding their previously high rates in the 1970s and 1980s, before the AIDS epidemic. The reasons for these trends are multifactorial and complex, involving individual behavioral, sociocultural, structural, and biological factors, which will be reviewed in this article. Men who have sex with men tend to have more sexual partners than heterosexuals, and engage in practices (e.g., anal sex) that are highly efficient for syphilis transmission and nondetection of primary chancres. In the era of highly active antiretroviral therapy rendering adherent patients noninfectious and the use of preexposure prophylaxis, there is substantially less concern about HIV transmission and acquisition among MSM, resulting in higher levels of condomless sex. The increased concentration of syphilis among black MSM is partially related to assortative mixing, that is, black MSM being more likely to have other black sex partners, as well as decreased access to preventive services and treatment due to economic marginalization, Societal rejection and discrimination may also potentiate factors that may increase sexual risks resulting in syphilis, for example, depression and substance use. The anticipation of experiencing homophobic discrimination in health care settings may lead many sexually active MSM to delay needed screening and treatment, thus being infectious to partners for longer periods than other populations. To effectively control the syphilis epidemic among MSM, scaling up a combination of programs, ranging from enhanced community education to training clinicians and health care systems to provide culturally competent care, will be necessary.
Pathologic Features of Infectious Gastritis
Authors: Yee Eric U. , Kuo Enoch , Goldsmith Jeffrey D.
Published: February 2018

This manuscript presents a review of infectious causes of gastritis aimed at the practicing anatomic pathologist. We shall highlight unique histologic findings and clinical attributes that will assist those analyzing endoscopically obtained mucosal biopsies of the stomach or resection specimens.
Near-Infrared Cerebral Oximetry to Predict Outcome After Pediatric Cardiac Surgery: A Prospective Observational Study*
Authors: Flechet Marine , Güiza Fabian , Vlasselaers Dirk , Desmet Lars , Lamote Stoffel , Delrue Heidi , Beckers Marc , Casaer Michaël P. , Wouters Pieter , Van den Berghe Greet , Meyfroidt Geert
Published: February 2018

Objectives:

To assess whether near-infrared cerebral tissue oxygen saturation, measured with the FORESIGHT cerebral oximeter (CAS Medical Systems, Branford, CT) predicts PICU length of stay, duration of invasive mechanical ventilation, and mortality in critically ill children after pediatric cardiac surgery.

Design:

Single-center prospective, observational study.

Setting:

Twelve-bed PICU of a tertiary academic hospital.

Patients:

Critically ill children and infants with congenital heart disease, younger than 12 years old, admitted to the PICU between October 2012 and November 2015. Children were monitored with the FORESIGHT cerebral oximeter from PICU admission until they were weaned off mechanical ventilation. Clinicians were blinded to cerebral tissue oxygen saturation data.

Interventions:

None.

Measurements and Main Results:

Primary outcome was the predictive value of the first 24 hours of postoperative cerebral tissue oxygen saturation for duration of PICU stay (median [95% CI], 4 d [3–8 d]) and duration of mechanical ventilation (median [95% CI], 111.3 hr (69.3–190.4 hr]). We calculated predictors on the first 24 hours of cerebral tissue oxygen saturation monitoring. The association of each individual cerebral tissue oxygen saturation predictor and of a combination of predictors were assessed using univariable and multivariable bootstrap analyses, adjusting for age, weight, gender, Pediatric Index of Mortality 2, Risk Adjustment in Congenital Heart Surgery 1, cyanotic heart defect, and time prior to cerebral tissue oxygen saturation monitoring. The most important risk factors associated with worst outcomes were an increased sd of a smoothed cerebral tissue oxygen saturation signal and an elevated cerebral tissue oxygen saturation desaturation score.

Conclusions:

Increased sd of a smoothed cerebral tissue oxygen saturation signal and increased depth and duration of desaturation below the 50% saturation threshold were associated with longer PICU and hospital stays and with longer duration of mechanical ventilation after pediatric cardiac surgery.
Small Lymph Node Metastasis Detected by 68Ga–Prostate-Specific Membrane Antigen But Not 18F-Fluciclovine PET/CT in Low–Prostate-Specific Antigen Biochemical Recurrence of Prostate Cancer
Authors: Chaussé Guillaume , Abikhzer Gad , Probst Stephan
Published: February 2018

A 58-year-old man with Gleason 4+3 prostate cancer was initially treated by radical prostatectomy followed by salvage radiotherapy to the prostate bed for postoperative biochemical failure. One year later, 18F-fluorocholine PET/CT detected a pelvic lymph node recurrence, which was treated with radiation therapy and 6 months of androgen deprivation. PSA started to rise again 18 months later, but 18F-fluciclovine PET/CT failed to demonstrate the site of recurrence at a PSA of 0.63 ng/mL. However, 68Ga-PSMA PET/CT revealed a single positive 4-mm perirectal lymph node (PSA 0.80 ng/mL at time of scan), in retrospect anatomically apparent but negative on 18F-fluciclovine PET/CT.
FDG PET and MRI Findings in a Case of Bing-Neel Syndrome
Authors: Bund Caroline , Lhermitte Benoît , De Seze Jérôme , Kremer Stéphane , Namer Izzie-Jacques
Published: February 2018

A 64-year-old man was admitted for expressive aphasia with lack of words. He had been diagnosed with Waldenström 4 years before. At that time, he received 6 cycles of single-agent fludarabine, and remission was obtained. Because of acute expressive aphasia, he underwent brain MRI, which showed frontoparietal and insular subcortical gadolinium enhancement; Bing-Neel syndrome was suspected. Fronto-temporo-insular hypometabolism and left parietal hypometabolism were highlighted on FDG PET/CT. Structural and functional brain imaging revealed impairment of brain areas due to white matter changes and reinforced the diagnosis.
Oligogenic inheritance of congenital heart disease involving a NKX2-5 modifier
Authors: Gifford Casey A. , Ranade Sanjeev S. , Samarakoon Ryan , Salunga Hazel T. , de Soysa T. Yvanka , Huang Yu , Zhou Ping , Elfenbein Aryé , Wyman Stacia K. , Bui Yen Kim , Cordes Metzler Kimberly R. , Ursell Philip , Ivey Kathryn N. , Srivastava Deepak
Published: February 2018

Complex genetic inheritance is thought to underlie many human diseases, yet experimental proof of this model has been elusive. Here, we show that a human congenital heart defect, left ventricular non-compaction (LVNC), can be caused by a combination of rare, inherited heterozygous missense single nucleotide variants. Whole exome sequencing of a nuclear family revealed novel single nucleotide variants of MYH7 and MKL2 in an asymptomatic father while the offspring with severe childhood-onset LVNC harbored an additional missense variant in the cardiac transcription factor, NKX2-5, inherited from an unaffected mother. Mice bred to compound heterozygosity for the orthologous missense variants in Myh7 and Mkl2 had mild cardiac pathology; the additional inheritance of the Nkx2-5 variant yielded a more severe LVNC-like phenotype in triple compound heterozygotes. RNA sequencing identified genes associated with endothelial and myocardial development that were dysregulated in hearts from triple heterozygote mice and human induced pluripotent stem cell–derived cardiomyocytes harboring the three variants, with evidence for NKX2-5’s contribution as a modifier on the molecular level. These studies demonstrate that the deployment of efficient gene editing tools can provide experimental evidence for complex inheritance of human disease.

One sentence summary

A combination of three inherited heterozygous missense single nucleotide variants underlying a familial congenital heart defect.