bluuebunny/crossref_metadata_2025 huggingface dataset:
Slow Infusion of Low‐dose Ketamine Reduces Bothersome Side Effects Compared to Intravenous Push: A Double‐blind, Double‐dummy, Randomized Controlled Trial
Authors: Clattenburg Eben J. , Hailozian Christian , Haro Daniel , Yoo Tina , Flores Stefan , Louie Derex , Herring Andrew A.
Published: April 2018

Objective

We compared the analgesic efficacy and incidence of side effects when low‐dose (0.3 mg/kg) ketamine (LDK) is administered as a slow infusion (SI) over 15 minutes versus an intravenous push (IVP) over 1 minute.

Methods

This was a prospective, randomized, double‐blind, double‐dummy, placebo‐controlled trial of adult ED patients presenting with moderate to severe pain (numerical rating scale [NRS] score ≥ 5). Patients received 0.3 mg/kg ketamine administered either as a SI or a IVP. Our primary outcome was the proportion of patients experiencing any psychoperceptual side effect over 60 minutes. A secondary outcome was incidence of moderate or greater psychoperceptual side effects. Additional outcomes included reduction in pain NRS scores at 60 minutes and percent maximum summed pain intensity difference (%SPID).

Results

Fifty‐nine participants completed the study. A total of 86.2% of the IVP arm and 70.0% of the SI arm experienced any side effect (difference = 16.2%, 95% confidence interval [CI] = –5.4 to 37.8). We found a large reduction in moderate or greater psychoperceptual side effects with SI administration—75.9% reported moderate or greater side effects versus 43.4% in the SI arm (difference = 32.5%, 95% CI = 7.9 to 57.1). Additionally, the IVP arm experienced more hallucinations (n = 8, 27.6%) than the SI arm (SI n = 2, 6.7%, difference = 20.9%, 95% CI = 1.8 to 43.4). We found no significant differences in analgesic efficacy. At 60 minutes, the mean %SPID values in the IVP and SI arms were 39.9 and 33.5%, respectively, with a difference of 6.5% (95% CI = –5.8 to 18.7).

Conclusion

Most patients who are administered LDK experience a psychoperceptual side effect regardless of administration via SI or IVP. However, patients receiving LDK as a SI reported significantly fewer moderate or greater psychoperceptual side effects and hallucinations with equivalent analgesia.
Editorial: symptom association probability during reflux testing—what is the gain?
Authors: Triggs J. R. , Kahrilas P. J.
Published: April 2018

Linked Content

This article is linked to Choksi et al paper. To view this article visit https://doi.org/10.1111/apt.14528.
Editorial: patient‐reported outcomes in chronic HCV—a PROMISing approach to an ongoing problem
Authors: Acharya C. , Bajaj J. S.
Published: April 2018

Linked Content

This article is linked to Evon et al and Evon papers. To view these articles visit https://doi.org/10.1111/apt.14531 and https://doi.org/10.1111/apt.14608.
Editorial: isolated duodenal eosinophilia—clinical condition or just seeing spots?
Authors: Singh P. , Leffler D. A.
Published: April 2018

Linked Content

This article is linked to Genta paper. To view this article visit https://doi.org/10.1111/apt.14558.
Editorial: patient‐reported outcomes in chronic HCV—a PROMISing approach to an ongoing problem. Authors' reply
Authors: Evon D. M.
Published: April 2018

Linked Content

This article is linked to Evon et al and Acharya and Bajaj papers. To view these articles visit https://doi.org/10.1111/apt.14531 and https://doi.org/10.1111/apt.14585.
European experience of robot‐assisted kidney transplantation: minimum of 1‐year follow‐up
Authors: Territo Angelo , Gausa Lluis , Alcaraz Antonio , Musquera Mireia , Doumerc Nicolas , Decaestecker Karel , Desender Liesbeth , Stockle Michael , Janssen Martin , Fornara Paolo , Mohammed Nasreldin , Siena Giampaolo , Serni Sergio , Sahin Selcuk , Tuǧcu Volkan , Basile Giuseppe , Breda Alberto
Published: April 2018

Objectives

To evaluate functional results, graft survival and late complications in patients who underwent robot‐assisted kidney transplantation (RAKT) and who had a minimum of 1 year of follow‐up data, and to analyse the correlations between surgical data and functional results at a minimum of 1‐year postoperatively and between renal function in the immediate postoperative period and after 1 year.

Materials and Methods

A common prospectively collected RAKT database was created by the European Robotic Urological Section (ERUS) RAKT working group, which included eight different European centres. In each centre RAKTs were performed with kidneys from living donors. Data on demographic variables, surgical results, graft survival, functional outcomes (creatinine and estimated glomerular filtration rate [eGFR]) on postoperative days 7 and 30 and at 1 year, and late complications were extracted from the common database.

Results

A total of 147 RAKTs were performed by the ERUS RAKT working group. Of the 147 patients, 83 had at least 1‐year follow‐up (mean [range] 21 [13–27] months). Of these 83 patients, 30 were women. The patients’ median (range) age was 43 (30–75) years, body mass index was 25.3 (20–40) kg/m2, pre‐transplantation serum creatinine was 517 (198–1 414) μmol/L and estimated GFR (eGFR) was 10 (3–29) mL/min per 1.73 m2. Of the 83 cases, 46 were pre‐emptive. The median (range) overall ischaemia time was 116 (53–377) min. The median (range) rewarming time was 60 (35–110) min. At 1‐year follow‐up, the median (range) serum creatinine was 131 (66–244) μmol/L, with a median (range) eGFR of 57.4 (28–97) mL/min per 1.73 m2. There was no statistically significant difference between functional data at postoperative day 30 and those at 1 year for creatinine (P = 0.78) or eGFR (P = 0.91). Regarding the correlation between the surgical data and the functional outcomes, the data showed that overall operating time and rewarming time did not affect the graft function at 1 year. Three cases of graft loss occurred as a result of massive arterial thrombosis within the first postoperative week. Late complications comprised one case of ureteric stenosis and one case of graft pyelonephritis. No late vascular complications or cases of incisional hernia were recorded.

Conclusion

Findings at 1‐year follow‐up indicate RAKT from a living donor to be a safe procedure in a properly selected group of recipients. RAKT was associated with a low complication rate and there was maintenance of excellent graft survival and function. This is the first and largest study to report functional results after RAKT from a living donor with a minimum follow‐up of 1 year.
Functional and oncological outcomes of open, laparoscopic and robot‐assisted partial nephrectomy: a multicentre comparative matched‐pair analyses with a median of 5 years’ follow‐up
Authors: Chang Ki Don , Abdel Raheem Ali , Kim Kwang Hyun , Oh Cheol Kyu , Park Sung Yul , Kim Young Sik , Ham Won Sik , Han Woong Kyu , Choi Young Deuk , Chung Byung Ha , Rha Koon Ho
Published: April 2018

Objectives

To compare outcomes at a 5‐year median follow‐up among different partial nephrectomy (PN) approaches: robot‐assisted (RAPN), laparoscopic (LPN) and open partial nephrectomy (OPN).

Patients and Methods

We retrospectively analysed 1 308 patients who underwent PN (RAPN, n = 380; LPN, n = 206; OPN, n = 722) between 2006 and 2012 at one of four academic centres. We performed 1:1:1 propensity‐score‐matching adjustment based on confounding variables among groups, and 366 patients (122 in each group) were included in the final analysis. Survival rates were analysed using the Kaplan–Meier method.

Results

The median follow‐up periods were 60, 59.8 and 64.1 months for RAPN, LPN and OPN, respectively. In the matched groups, RAPN resulted in significantly lower mean estimated blood loss compared with LPN (P = 0.025) and OPN (P = 0.040), while LPN was associated with a longer mean operating time compared with RAPN (P = 0.001) and OPN (P = 0.001). The hospital stay was shorter in the RAPN group (P = 0.008). Regarding the oncological outcomes, there were no significant differences among the three groups in local recurrence rate (P = 0.882), distant metastasis rate (P = 0.816) or deaths from cancer (P = 0.779). At latest follow‐up, the incidence of chronic kidney disease (CKD) upstaging was significantly lower in RAPN compared with LPN (20.55% vs 32%; P = 0.035) and OPN (20.5% vs 33.6%; P = 0.038). The 5‐year CKD free‐survival rate was significantly higher (78.4%) in the RAPN group compared with 58.8% and 65.8% in the LPN and OPN groups, respectively (log‐rank P = 0.031).

Conclusions

In the present study, RAPN, LPN and OPN had similar local recurrence, distant metastasis and cancer‐related death rates at a 5‐year median follow‐up. In terms of functional outcomes, RAPN was associated with a lower incidence of CKD upstaging compared with OPN and LPN.
Left out? Housing insecurity for one‐person, low‐income, non‐senior households in Cape Breton Regional Municipality
Authors: Leviten‐Reid Catherine , Parker Brenda
Published: April 2018

Key Messages

Low‐income, one‐person, non‐senior households experience significant housing insecurity and homelessness in the Cape Breton Regional Municipality.

This population has limited income and job opportunities and faces lower levels of assistance and fewer rental housing options.

This is a result of changing economic and social geographies, a gendered and colonial welfare state that has focused on “deserving” families, a neoliberal political economy, and neoliberal discourses.
Die Wirksamkeit einer neuen Nagelspange für die Behandlung von eingewachsenen Nägeln
Authors: Liu Che‐Wei , Huang Yu‐Chen
Published: April 2018

Hintergrund und Ziele

Die Behandlung kompliziert eingewachsener Zehennägel ist eine Domäne der Chirurgie. Allerdings liegen Berichte vor, nach denen alternative Therapieformen mit Nagelspangen eine gute Wirksamkeit zeigen. Ziel der vorliegenden Studie war es, die Wirksamkeit einer neuen Nagelspange zur Behandlung eingewachsener Zehennägel zu untersuchen.

Patienten und Methoden

Wir führten eine retrospektive Studie an Patienten mit eingewachsenen Zehennägeln durch, die zwischen dem 1. Juni 2015 und dem 30. Mai 2016 im Krankenhaus Wan Fang behandelt wurden. Eingewachsene Zehennägel wurden in akut entzündete/infizierte (AI) und chronisch dystrophische (CD) Typen eingeteilt. Unter Verwendung des Physician Global Assessment (PGA) wurde die Wirksamkeit von Nagelspangen für die beiden Typen von eingewachsenen Zehennägeln 1, 2, 3 und 6 Monate nach Beginn der Behandlung und während des letzten Arztbesuchs verglichen.

Ergebnisse

21 Patienten (42 Stellen) hatten eingewachsene Zehennägel des CD‐Typs; 25 Patienten (36 Stellen) hatten eingewachsene Zehennägel des AI‐Typs. Von den betroffenen Stellen zeigten nach 1, 3 bzw. 6 Monaten 81 %, 94 % bzw. 100 % ein ausgezeichnetes oder akzeptables Ergebnis. Die Rezidivrate betrug 10,3 %, die Komplikationsrate 7,7 %. Während eingewachsene Zehennägel des AI‐Typs in den ersten drei Monaten schneller hervorragende Ergebnisse erzielten als CD‐Typ‐Nägel, glichen sich die Ergebnisse nach sechs Monaten an.

Schlussfolgerungen

Nagelspangen sind eine wirksame therapeutische Option, insbesondere für eingewachsene Zehennägel vom CD‐Typ.
Cicatricial alopecia
Authors: Kanti Varvara , Röwert‐Huber Joachim , Vogt Annika , Blume‐Peytavi Ulrike
Published: April 2018

In the classification of the North American Hair Research Society, primary cicatricial alopecias (PCA) are divided into four groups according to their prominent inflammatory infiltrate: PCAs with lymphocytic, neutrophilic, mixed or nonspecific cell inflammation pattern. The hair loss can begin subclinically and progress slowly so that the exact onset of the disease is often difficult to determine. The diagnosis is often delayed. While most forms of cicatricial alopecia can be clearly diagnosed based on clinical presentation in the acute disease stage, diagnosis can be challenging in the subacute, early or late disease stages. At first presentation, a detailed patient history and dermatological examination of the body, including trichoscopy, should be performed. In clinically unclear cases, a biopsy should be performed. Due to the scarcity of primary cicatricial alopecia, there is little evidence on the efficacy of the various therapies. The aims of treatment are to stop or at least delay hair loss and progression of the scarring process, reduce clinical inflammation signs as well as to alleviate subjective symptoms. Hair re‐growth in already scarred areas should not be expected. Anti‐inflammatory treatment with topical corticosteroids class III to IV and / or with intracutaneous intralesional triamcinolone acetonide injections can be considered in most of the primary cicatricial alopecias. The choice of systemic therapy depends on the type of predominant inflammatory infiltrate and includes antimicrobial, antibiotic or immunomodulating/immunosuppressive agents. Psychological support and camouflage techniques should be offered to the patients.
Anomalous systemic and pulmonary veins—An unusual coexistence
Authors: Arunakumar Priyadarshini , Ayyappan Anoop , Sasikumar Deepa , Krishnamoorthy KM
Published: April 2018

A 12‐year‐old child presented with recurrent respiratory infections and was diagnosed with Scimitar syndrome. Drainage of IVC and course of aberrant arterial supply from aorta were not clear by echocardiogram, and hence, additional imaging was planned. CT unraveled the presence of a rare combination of anomalous pulmonary venous connection (APVC) to IVC, with near‐atresia/severe stenosis of IVC, superior to the drainage of scimitar vein. There was a prominent azygos vein with preferential contrast opacification on lower limb injection.
Safety of nifedipine in threatened preterm labor: Investigation by three‐dimensional echocardiography
Authors: Grin Leonti , Laish‐Farkash Avishag , Shenhav Simon , Piltz Xavier , Ganelin Liah , Rabinovich Mark , Anteby Eyal Y. , Yosefy Chaim
Published: April 2018

Objective

To evaluate atrial and ventricular parameters using real time three‐dimensional transthoracic echocardiography (RT3DTTE) in women treated with nifedipine in the early third trimester (III‐T) of pregnancy.

Methods

A prospective single‐subject design study in a university‐affiliated hospital, where each participant served as her own control. We studied 25 pregnant women at a gestational age of 25–33 weeks with TPTL prior to vs 48 hours postnifedipine treatment. Two‐dimensional transthoracic echocardiography (2DTTE) and RT3DTTE were used to study 3D left atrial (LA) volumes and indexes, emptying fraction, left ventricular and LA cavities, and total vascular resistance (TVR).

Results

Two‐dimensional transthoracic echocardiography showed a significant increase in LA area (from 15.2 ± 2.62 to 16.16 ± 2.21 mm2, P = .02) before vs after nifedipine; RT3DTTE showed a significant change in LA end‐diastolic volume index (from 23.7 ± 4.2 to 26.75 ± 3.8 mL/m2, P = .008). LA end‐systolic volume and index were not significantly different before vs after nifedipine (from 24.56 ± 8 to 25.3 ± 5.5 mL, from 13.6 ± 5.3 to 14.8 ± 3.4 mL/m2); P > .05, respectively. E/a ratio, E‐tdi, and E/E‐tdi did not change significantly ([from 2.54 ± 4.46 to 2.54 ± 4.1], [from 11.9 ± 1.9 to 11.9 ± 2], [from 7.8 ± 1.4 to 7.6 ± 1.1], respectively, P > .05). Tricuspid annular plane systolic excursion (TAPSE) did not change significantly from 23.77 ± 4.2 to 23.9 ± 3.3, P = .1. There was a significant decrease in pulmonary pressure (from 25.4 ± 4.2 to 23 ± 2.5 mm Hg, P = .02), in mean arterial pressure (from 80 ± 4 to 76 ± 3 mm Hg, P < .001) and in TVR (from 1160 ± 260 to 1050 ± 206 dyne s/cm−5, P = .04).

Conclusions

According to RT3DTTE measurements, in pregnant women treated with nifedipine for tocolysis, there were no detrimental cardiovascular effects detected 48 hours postnifedipine treatment. RT3DTTE could show accurately the compensatory response of the left heart to the cardiovascular changes induced by treatment with nifedipine.
Structural plasticity of the TDRD3 Tudor domain probed by a fragment screening hit
Authors: Liu Jiuyang , Zhang Shuya , Liu Mingqing , Liu Yaqian , Nshogoza Gilbert , Gao Jia , Ma Rongsheng , Yang Yang , Wu Jihui , Zhang Jiahai , Li Fudong , Ruan Ke
Published: April 2018

As a reader of di‐methylated arginine on various proteins, such as histone, RNA polymerase II, PIWI and Fragile X mental retardation protein, the Tudor domain of Tudor domain‐containing protein 3 (TDRD3) mediates transcriptional activation in nucleus and formation of stress granules in the cytoplasm. Despite the TDRD3 implication in cancer cell proliferation and invasion, warheads to block the di‐methylated arginine recognition pocket of the TDRD3 Tudor domain have not yet been uncovered. Here we identified 14 small molecule hits against the TDRD3 Tudor domain through NMR fragment‐based screening. These hits were further cross‐validated by using competitive fluorescence polarization and isothermal titration calorimetry experiments. The crystal structure of the TDRD3 Tudor domain in complex with hit 1 reveals a distinct binding mode from the nature substrate. Hit 1 protrudes into the aromatic cage of the TDRD3 Tudor domain, where the aromatic residues are tilted to accommodate a sandwich‐like π–π interaction. The side chain of the conserved residue N596 swings away 3.1 Å to form a direct hydrogen bond with hit 1. Moreover, this compound shows a decreased affinity against the single Tudor domain of survival motor neuron protein, but no detectable binding to neither the tandem Tudor domain of TP53‐binding protein 1 nor the extended Tudor domain of staphylococcal nuclease domain‐containing protein 1. Our work depicts the structural plasticity of the TDRD3 Tudor domain and paves the way for the subsequent structure‐guided discovery of selective inhibitors targeting Tudor domains.

Database

Structural data are available in the PDB under the accession number 5YJ8.
Long‐term nitrogen fertilization decreases bacterial diversity and favors the growth of Actinobacteria and Proteobacteria in agro‐ecosystems across the globe
Authors: Dai Zhongmin , Su Weiqin , Chen Huaihai , Barberán Albert , Zhao Haochun , Yu Mengjie , Yu Lu , Brookes Philip C. , Schadt Christopher W. , Chang Scott X. , Xu Jianming
Published: April 2018

Long‐term elevated nitrogen (N) input from anthropogenic sources may cause soil acidification and decrease crop yield, yet the response of the belowground microbial community to long‐term N input alone or in combination with phosphorus (P) and potassium (K) is poorly understood. We explored the effect of long‐term N and NPK fertilization on soil bacterial diversity and community composition using meta‐analysis of a global dataset. Nitrogen fertilization decreased soil pH, and increased soil organic carbon (C) and available N contents. Bacterial taxonomic diversity was decreased by N fertilization alone, but was increased by NPK fertilization. The effect of N fertilization on bacterial diversity varied with soil texture and water management, but was independent of crop type or N application rate. Changes in bacterial diversity were positively related to both soil pH and organic C content under N fertilization alone, but only to soil organic C under NPK fertilization. Microbial biomass C decreased with decreasing bacterial diversity under long‐term N fertilization. Nitrogen fertilization increased the relative abundance of Proteobacteria and Actinobacteria, but reduced the abundance of Acidobacteria, consistent with the general life history strategy theory for bacteria. The positive correlation between N application rate and the relative abundance of Actinobacteria indicates that increased N availability favored the growth of Actinobacteria. This first global analysis of long‐term N and NPK fertilization that differentially affects bacterial diversity and community composition provides a reference for nutrient management strategies for maintaining belowground microbial diversity in agro‐ecosystems worldwide.
Prevalence, risk factors and adverse outcomes of anticholinergic burden in patients with advanced chronic conditions at hospital admission
Authors: Sevilla‐Sánchez Daniel , Molist‐Brunet Núria , González‐Bueno Javier , Solà‐Bonada Núria , Espaulella‐Panicot Joan , Codina‐Jané Carles
Published: April 2018

Aim

To evaluate the anticholinergic burden (ACB), the risk factors associated with its onset and the clinical consequences for patients with advanced chronic conditions.

Methods

A 10‐month cross‐sectional study was carried out in an acute hospital care geriatric unit. Patients with advanced chronic conditions were identified by the NECessity of PALliative care (NECPAL) test. The ACB was established using the Anticholinergic Drug Scale and Drug Burden Index (DBI) tools. Demographic, pharmacological and clinical patient data were collected with the objective of determining risk factors related to ACB. Measured clinical outcomes were the presence of acute confusional state, bone fractures, length of stay, mortality and 12‐month survival rate.

Results

A total of 235 patients were recruited (mean age 86.80 years, SD 5.37 years; 65.50% women), and 82.10% (DBI) and 93.6% (Anticholinergic Drug Scale) of the patients were treated with anticholinergic medications. Excessive polypharmacy (≥10 drugs) was identified as a risk factor for the presence of anticholinergic medication (Anticholinergic Drug Scale: OR 6.26, 95% CI 1.38–28.42; DBI: OR 3.44, 95% CI 1.60–7.38). High anticholinergic burden (by DBI >2 points) was an independent risk factor for the presence of acute confusional state on hospital admission (OR 2.98, 95% CI 1.04–8.50). However, ACB was not related to bone fractures on admission, length of stay, mortality or survival.

Conclusions

Patients with advanced chronic conditions are frequently treated with anticholinergic drugs, with excessive polypharmacy as a risk factor. Anticholinergic drugs are a risk factor for the presence of acute confusional state on hospital admission, but have no other effect in terms of morbimortality. Geriatr Gerontol Int 2018; 18: 1159–1165.
Potential role of the pancreatic hormone insulin in resetting human peripheral clocks
Authors: Kajimoto Jun , Matsumura Ritsuko , Node Koichi , Akashi Makoto
Published: April 2018

Mammalian circadian rhythms are phase‐adjusted and amplified by external cues such as light and food. While the light input pathway via the central clock, the suprachiasmatic nucleus, has been well defined, the mechanism of feeding‐induced circadian resetting remains undefined, particularly in humans. Animal studies have indicated that insulin, a pancreatic hormone that is secreted rapidly in response to feeding, is an input factor for a few peripheral clocks, such as liver and adipose tissue. In this study, using plucked and cultured hair follicles as a representative human peripheral clock, we examined the effect of insulin on circadian characteristics of clock gene expression. Our results demonstrate that insulin phase‐shifts or amplifies the clock gene expression rhythms of ex vivo cultured hair follicles in a phase‐responsive manner. To reduce the possibility that differences in species, genetic or environmental background, and experimental methods affected experimental outcomes, we also treated surgically extracted whisker follicles of Period2::Luciferase (Per2Luc) mice with insulin and found that the effect of insulin on clock gene expression was reproducible. These results suggest the possibility that feeding‐induced insulin resets peripheral circadian clocks in humans.
A humanized TCR retaining authentic specificity and affinity conferred potent anti‐tumour cytotoxicity
Authors: Chen Lin , Tian Ye , Zhan Kai , Chen Anan , Weng Zhiming , Huang Jiao , Li Yanyan , Sun Yongjie , Zheng Hongjun , Li Yi
Published: April 2018

The affinity of T‐cell receptor (TCR) determines the efficacy of TCR‐based immunotherapy. By using human leucocyte antigen (HLA)‐A*02 transgenic mice, a TCR was generated previously specific for human tumour testis antigen peptide MAGE‐A3112–120 (KVAELVHFL) HLA‐A*02 complex. We developed an approach to humanize the murine TCR by replacing the mouse framework with sequences of folding optimized human TCR variable domains for retaining binding affinity. The resultant humanized TCR exhibited higher affinity and conferred better anti‐tumour activity than its parent murine MAGE‐A3 TCR (SRm1). In addition, the affinity of humanized TCR was enhanced further to achieve improved T‐cell activation. Our studies demonstrated that the human TCR variable domain frameworks could provide support for complementarity‐determining regions from a murine TCR, and retain the original binding activity. It could be used as a generic approach of TCR humanization.
Large strain response with low driving field in Bi1/2Na1/2TiO3–Bi1/2K1/2TiO3–Bi(Mg2/3Nb1/3)O3 ceramics
Authors: Dong Guangzhi , Fan Huiqing , Shi Jing , Li Qiang
Published: April 2018

The (1−x)(0.8Bi1/2Na1/2TiO3–0.2Bi1/2K1/2TiO3)−xBiMg2/3Nb1/3O3 (100xBMN) ternary solid solutions were designed and prepared using a conventional solid‐state reaction. Temperature and compositional dependent ferroelectric, piezoelectric, dielectric features, and structural evolution were systematically studied. At the critical composition of 2BMN, a large bipolar strain of 0.43% was achieved at 55 kV/cm, and the normalized strain reaches to 862 pm/V at a low driving electric field of 40 kV/cm. It was found that the substitution of BiMg2/3Nb1/3O3 induces a transformation from ferroelectric to relaxor phase by disrupting the long range ferroelectric order. Therefore, as the external electric field was applied, a relaxor‐ferroelectric phase transition will be induced. This is contributed to the giant strain. The results above suggest that such a ternary composition is a promising candidate for application to actuator.
Production and characterization of enzyme‐treated spray‐dried soursop (Annona muricata L.) powder
Authors: Chang Lee S. , Karim Roselina , Abdulkarim Sabo Mohammed , Ghazali Hasanah Mohd
Published: April 2018

Easily perishable soursop (Annona muricata L.) fruit was converted into powder for value‐addition. Soursop puree obtained from fruit pulp that had been treated with different concentrations (0–2% v/w) of Celluclast 1.5 L at fixed (1.5% v/w) concentration of Pectinase Ultra SP‐L were spray‐dried at various inlet temperatures (130–160 °C) after mixing the puree with maltodextrin (20–40% w/w). Multiple responses optimization from Response Surface Methodology (RSM) indicated puree that was pretreated with 1.3% (v/w) cellulase and incorporated with 37% w/w maltodextrin and spray‐dried at an inlet temperature of 156 °C could be transformed into powder that had the following physicochemical properties: moisture content, 2.03% (wb); Aw, 0.18; hygroscopicity, 29.02 g/100g; stickiness, 173.02 g and yield 70.56% of powder. The glass transition temperature (Tg) was found to range between 46.53 and 58.25 °C, indicating the spray‐dried powder was an amorphous material. Surface morphology of the powder particles, viewed using Scanning Electron Microscopy, showed they exhibited spherical in shape and possessed a continuous wall (crust) without surface cracks.

Practical applications

This work offers an alternative way of reducing wastage in soursop plantation due to short shelf life and perishable properties of soursop fruit. Soursop fruit was transformed to soursop puree without the addition of water by enzymatic–liquefaction. The soursop puree produced by enzymatic pretreatment is suitable to be used as spray drying feed as the puree produced is smooth. This is significant especially to the food processing industry to understand the potential application of enzyme in pretreatment step to liquefy and reduce the viscosity in the production of puree instead of using conventional method (addition of water). Soursop powder was produced by spray drying which is a commercial method in the production of fruit powder. This indicates it is feasible with the spray drying to produce soursop powder that exhibited amorphous particle characteristic. Production of soursop powder also broadens its potential applications in food industry.
Linking Neighborhood Context and Health in Community‐Dwelling Older Adults in the Medicare Advantage Program
Authors: Jung Daniel , Kind Amy , Robert Stephanie , Buckingham William , DuGoff Eva
Published: April 2018

OBJECTIVES

To examine whether neighborhood context moderates the relationship between multiple chronic conditions (MCCs) and function in Medicare Advantage (MA) beneficiaries.

DESIGN

Cross‐sectional study.

SETTING

Medicare Health Outcome Survey Cohort 16 baseline data from 2013.

PARTICIPANTS

MA beneficiaries aged 65 and older (N=187,434).

MEASUREMENTS

We defined disadvantaged neighborhoods as those with an Area Deprivation Index greater than the 85th percentile. MCCs was defined as having 2 or more chronic conditions. The primary outcome was any self‐reported functional limitations with a basic or instrumental activity of daily living. We used survey‐weighted multivariate linear probability regression to examine whether the neighborhood disadvantage moderates the relationship between MCCs and report of a functional limitation.

RESULTS

More than one third (35.6%) of the sample reported a functional limitation. Beneficiaries with MCCs were more likely to report a functional limitation those with 0 or 1 chronic condition (odds ratio (OR)=2.63, 95% confidence interval (CI)=2.50–2.77). Beneficiaries in more‐disadvantaged neighborhoods were more likely to report a functional limitation than those in less‐disadvantaged neighborhoods (OR=1.14, 95% CI=1.08–1.21). In older adults with MCCs, the probability of reporting a functional limitation was 12 percentage points greater in those living in more‐disadvantaged neighborhoods than in those living in less‐disadvantaged neighborhoods.

CONCLUSION

Neighborhood context is a significant predictor of functional limitation and moderates the association between chronic conditions and functional limitations. Health plans and public health officials could use publicly available indicators such as the ADI to target interventions to reduce functional impairment.
The GABAergic system as a therapeutic target for Alzheimer's disease
Authors: Calvo‐Flores Guzmán Beatriz , Vinnakota Chitra , Govindpani Karan , Waldvogel Henry J. , Faull Richard L.M. , Kwakowsky Andrea
Published: April 2018

Glutamatergic and cholinergic dysfunction are well‐attested features of Alzheimer's disease (AD), progressing with other pathological indices of the disorder and exacerbating neuronal and network dysfunction. However, relatively little attention has been paid to the inhibitory component of the excitatory/inhibitory (E/I) network, particularly dysfunction in the gamma‐aminobutyric acid (GABA) signaling system. There is growing evidence in support of GABAergic remodeling in the AD brain, potentially beginning in early stages of disease pathogenesis, and this could thus be a valid molecular target for drug development and pharmacological therapies. Several GABAergic drugs have been tested for efficacy in attenuating or reversing various features and symptoms of AD, and this could represent a novel path by which we might address the growing need for more effective and benign therapies.

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Neuropeptide and steroid hormone mediators of neuroendocrine regulation
Authors: Heck A. L. , Crestani C. C. , Fernández‐Guasti A. , Larco D. O. , Mayerhofer A. , Roselli C. E.
Published: April 2018

To maintain the health and well‐being of all mammals, numerous aspects of physiology are controlled by neuroendocrine mechanisms. These mechanisms ultimately enable communication between neurones and glands throughout the body and are centrally mediated by neuropeptides and/or steroid hormones. A recent session at the International Workshop in Neuroendocrinology highlighted the essential roles of some of these neuropeptide and steroid hormone mediators in the neuroendocrine regulation of stress‐, reproduction‐ and behaviour‐related processes. Accordingly, the present review highlights topics presented in this session, including the role of the neuropeptides corticotrophin‐releasing factor and gonadotrophin‐releasing hormone in stress and reproductive physiology, respectively. Additionally, it details an important role for gonadal sex steroids in the development of behavioural sex preference.
Effect of simultaneously started clomiphene citrate and gonadotropins in antagonist regimes, on cumulative live births, fresh‐cycle live births and cost of stimulation in IVF cycles
Authors: Satwik Ruma , Kochhar Mohinder
Published: April 2018

Aim

The aim of the study was to compare simultaneously started clomiphene citrate (CC) and gonadotropins (Gn) with gonadotropins alone in conventional antagonist regimes with respect to fresh‐cycle live births, cumulative live births and cost of ovarian stimulation per started cycle.

Methods

This was a single‐center prospective cohort study conducted over 1 year. Women undergoing autologous in vitro fertilization (IVF) treatment in antagonist protocols and who consented to participate in the study were divided into two cohorts. The CC cohort (n = 86) received 50 mg CC for 5 days and individualized Gn daily until the hCG trigger, both starting from day 2 and antagonist daily from day 8 of menstrual cycle. The Gn‐only cohort (n = 349) received individualized Gn from day 2 and the antagonist from day 7 of menstrual cycle. IVF outcomes and cost of stimulation were compared between two cohorts across expected ovarian response categories.

Results

The CC cohort used a mean lower dose of Gn (1741.38 ± 604.46 vs 1980.54 ± 686.42; MD = −239.16; 95%CI = −348.03 to −189.24; P = 0.003) over fewer days (8.54 ± 1.86 vs 9.25 ± 1.97; MD =−0.71;95% CI = −1.17 to −0.25;
P = 0.0026) to achieve similar retrieved oocytes, (9.19 ± 5.92 vs 9.36 ± 6.96; MD = −0.17; 95%CI −1.77 to + 1.43; P = 0.83), positive bhCG rates (40% vs 29.6%, MD = 10.4%; OR = 1.65, 95%CI = 0.95–2.86; P = 0.078) and live births in fresh cycles (32.31% vs 21.30%; MD = 11.01%; OR = 1.76; 95%CI = 0.97–3.19; P = 0.06) and cumulative live births per initiated cycle (30.23% vs 20.34%; MD = 9.89%; OR = 1.697; 95%CI = 0.99–2.88; P = 0.0501). The dose lowering achieved a 28–40% reduction in the cost of stimulation, which was most noticeable in the hyper‐responder category for both hMG cycles, (Rs.11 602.3 ± 3365.9 vs 19615 ± 2677.1; MD = −8012.7; %age reduction: 40.8%; P = 0.0007) and recombinant FSH cycles (Rs. 22 459.6 ± 6255.3 vs 33 022.1 ± 9891.2; MD: −10 562; %age reduction: ‐32%; P = 0.0001).

Conclusion

CC started simultaneously with Gn in antagonist regimes helps lower the cost of stimulation without affecting IVF outcomes.
Correlation of quality of life with risk factors for first‐incident hip fracture in postmenopausal women
Authors: Chen Fang‐Ping , Fu Tsai‐Sheng , Lin Yu‐Ching , Fan Chih‐Ming
Published: April 2018

Aim

The aim of this study was to identify the correlation between health‐related quality of life (HRQOL) and risk factors of first‐incidence hip fracture in postmenopausal women.

Methods

This case–control study included 99 postmenopausal women with first‐incident hip fracture and 101 women without hip fracture who were matched according to age. Evaluation consisted of clinical factors, 36‐item Short‐Form Health Survey (SF‐36) and dual‐energy X‐ray absorptiometry for bone mineral density of hip and spine.

Results

The mean age of patients with an accidental first‐incident hip fracture was 78.0 years. Patients with hip fractures had significantly lower scores for SF‐36 domains at enrollment and 4‐month follow up compared with the controls. Mental health also deteriorated significantly 4 months after hip fracture.

Aside from lower HRQOL, clinical factors, including increased body height, no experience with estrogen therapy, rheumatoid arthritis, use of walking aids, less weight‐bearing exercise, and diuretics use, were significant risk factors for hip fracture in univariate analysis. After multivariate adjustment, only the use of walking aids and decreased physical component summary were independent risk factors of hip fracture. Besides aging, use of walking aids, weight‐bearing exercise, and psychological medication were the main factors affecting HRQOL when considering their relationship with hip fractures.

Conclusion

The occurrence of first‐incidence hip fracture is highly associated with HRQOL. Aside from aging, clinical factors affecting HRQOL correlated with hip fracture incidence. Thus, in elderly women, exercise or physical therapy to improve physical function and mental support is crucial and should be considered the most important factors for first‐incidence hip fracture prevention.
A forest‐based environment as a site of literacy and meaning making for kindergarten children
Authors: Streelasky Jodi
Published: April 2018

This study analyses the valued school experiences of 15 five‐ and six‐year‐old Canadian children, through their creation of multimodal texts. Throughout the school year, the students spent a large portion of each school day in the expansive forest on the school grounds, and their texts revealed their significant interest in this natural outdoor environment. Specifically, the data revealed that the outdoor space provided a context where the children could engage with each other and the environment in meaningful, creative and collaborative ways. This research has the potential to contribute to our understanding of the capacity of young children to share their thoughts on their school experiences by drawing on a range of modes and to contribute to our understanding of the power of alternative learning spaces, such as forest environments, on children's literacy learning and development.
Factors influencing the uptake of a mass media intervention to improve child feeding in Bangladesh
Authors: Kim Sunny S. , Roopnaraine Terry , Nguyen Phuong H. , Saha Kuntal K. , Bhuiyan Mahbubul I. , Menon Purnima
Published: April 2018

Mass media are increasingly used to deliver health messages to promote social and behaviour change, but there has been little evidence of mass media use for improving a set of child feeding practices, other than campaigns to promote breastfeeding. This study aimed to examine the factors influencing the uptake of infant and young child feeding messages promoted in TV spots that were launched and aired nationwide in Bangladesh. We conducted a mixed‐methods study, using household surveys (n = 2,000) and semistructured interviews (n = 251) with mothers of children 0–23.9 months and other household members. Factors associated with TV spot viewing and comprehension were analysed using multivariable logistic regression models, and interview transcripts were analysed by systematic coding and iterative summaries. Exposure ranged from 36% to 62% across 6 TV spots, with comprehension ranging from 33% to 96% among those who viewed the spots. Factors associated with comprehension of TV spot messages included younger maternal age and receipt of home visits by frontline health workers. Three direct narrative spots showed correct message recall and strong believability, identification, and feasibility of practicing the recommended behaviours. Two spots that used a metaphorical and indirect narrative style were not well understood by respondents. Understanding the differences in the uptake factors may help to explain variability of impacts and ways to improve the design and implementation of mass media strategies.
Altered gastrointestinal motility involving autoantibodies in the experimental autoimmune encephalomyelitis model of multiple sclerosis
Authors: Spear E. T. , Holt E. A. , Joyce E. J. , Haag M. M. , Mawe S. M. , Hennig G. W. , Lavoie B. , Applebee A. M. , Teuscher C. , Mawe G. M.
Published: April 2018

Background

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system that, in addition to motor, sensory, and cognitive symptoms, also causes constipation, which is poorly understood. Here, we characterize gastrointestinal (GI) dysmotility in the experimental autoimmune encephalomyelitis (EAE) mouse model of MS and evaluate whether autoantibodies target the enteric nervous system (ENS) and cause dysmotility.

Methods

EAE was induced in male SJL and B6 mice. GI motility was assessed in vivo and ex vivo in wild type (WT) and B cell‐deficient mice. MS and EAE serum was used to survey potential targets in the ENS and changes in the ENS structure were characterized using immunohistochemistry.

Key Results

EAE mice developed accelerated gastric emptying and delayed whole GI transit with reduced colonic motility. Fecal water content was reduced, and colonic migrating myoelectrical complexes (CMMC) and slow waves were less frequent. Colons from EAE mice exhibited decreased GFAP levels in glia. Sera from MS patients and from EAE mice targeted ENS neurons and glia. B‐cell deficiency in EAE protected against colonic dysmotility.

Conclusions & Inferences

Consistent with symptoms experienced in MS, we demonstrate that EAE mice widely exhibit features of GI dysmotility that persisted in the absence of extrinsic innervation, suggesting direct involvement of ENS neurocircuitry. The absence of GI dysmotility in B cell‐deficient mice with EAE together with EAE and MS serum immunoreactivity against ENS targets suggests that MS could be classified among other diseases known to induce autoimmune GI dysmotility.
Perinuclear antineutrophil cytoplasmic antibody–positive vasculitis, oligoarthritis, tendinitis, and myositis associated with isotretinoin in a 15‐year‐old boy: Case report and review of literature
Authors: Mangodt Thomas C. , Joos Rik , Siozopoulou Vasiliki , Cortoos Pieter‐Jan , Baeten Hans , Docx Martine , van den Akker Machiel
Published: April 2018

We present a patient in whom a combination of perinuclear antineutrophil cytoplasmic antibody–positive vasculitis, oligoarthritis, tendinitis, and myositis was considered to be associated with isotretinoin use. Discontinuation of the drug resulted in complete clinical and biochemical remission (normalization of perinuclear antineutrophil cytoplasmic antibody titer). Although we were unable to prove causality, no other underlying cause for the patient's course was found. We report this occurrence to bring it to the attention of physicians prescribing isotretinoin.
Implementing the End TB Strategy in the Western Pacific Region: Translating vision into reality
Authors: Rahevar Kalpeshsinh , Fujiwara Paula I. , Ahmadova Shalala , Morishita Fukushi , Reichman Lee B.
Published: April 2018

The End TB Strategy aims to end the global tuberculosis (TB) epidemic by 2035 in line with the sustainable development goals targets and has been implemented in the World Health Organization (WHO) Western Pacific Region since 2015. Significant progress has been made in implementing this strategy. However, several challenges still remain. In 2016, an estimated 1.8 million people developed TB in the region, and of these about 20% were missed by national TB programmes. The gap in diagnosis and enrolment as well as treatment completion is greater with drug‐resistant TB. Many TB‐affected families face catastrophic costs due to the disease. Sustaining financing for TB care is a long‐term challenge in many countries. This article emphasizes targeted interventions in high‐risk populations, including systematic screening and patient‐centred TB care. Several other approaches including improving TB diagnostic tools and algorithm, and engaging all care providers are suggested to find missing TB patients. Drug‐resistant TB requires additional resourcing for laboratories, enrolment and patient support. Specific measures are required at different levels to mitigate financial burden due to TB including linking TB to overall social protection schemes. The Moscow Ministerial conference in 2017 and upcoming United Nations (UN) 2018 high‐level meeting provide an opportunity to raise TB higher on the global agenda, forge partnerships and move towards universal health coverage.
In vitro quality of apheresis platelets divided into paediatric‐sized units and stored in PVC bags plasticised with TOTM, BTHC or DINCH
Authors: Bashir S. , Meli A. , Cardigan R.
Published: April 2018

Background and Objectives

Two of the predictive factors of the quality of small volumes of platelets suitable for paediatric use are bag size and material. This study evaluated the storage properties of paediatric platelet aliquots in TOTM‐, BTHC‐ or DINCH‐PVC bags.

Methods/Materials

(i) Three apheresis platelet concentrates (PC) were pooled and split into three units. One was retained as an adult unit (control; polyolefin bag). The second and third units were split into four MacoPharma TOTM‐PVC and BTHC‐PVC paediatric bags, respectively. (ii) Two apheresis PC were pooled and split into two units. One PC was retained as an adult unit, and the other was split into four Fresenius DINCH‐PVC paediatric bags. Testing was performed on storage for pH, blood gases, hypotonic shock response, soluble CD62P, LDH, glucose and lactate, ATP, CD62P, CD63, platelet‐derived microparticles and annexin V.

Results

The volumes, platelet yields and pH of all paediatric units met local specifications. The TOTM‐PVC bag showed no worse quality than the adult bag up to day 7 for all parameters studied, and it maintained pH higher than BTHC‐PVC and DINCH‐PVC over storage. The BTHC‐PVC bag was shown to be the most gas permeable; however, it had the highest glucose consumption rates and the highest platelet activation.

Conclusion

All bags showed an acceptable in vitro quality. Overall, the TOTM‐PVC paediatric bag showed better platelet quality compared to the other storage bags, whereas storage in the BTHC‐PVC bag resulted in poorer platelet quality.