bluuebunny/crossref_metadata_2025 huggingface dataset:
Melatonin Modulation of Sirtuin-1 Attenuates Liver Injury in a Hypercholesterolemic Mouse Model
Authors: Bonomini Francesca , Favero Gaia , Rodella Luigi Fabrizio , Moghadasian Mohammed H. , Rezzani Rita
Published: February 2018

Hypercholesterolemia increases and exacerbates stress signals leading also to liver damage (LD) and failure. Sirtuin1 (SIRT1) is involved in lifespan extension and it plays an essential role in hepatic lipid metabolism. However, its involvement in liver hypercholesterolemic damage is not yet completely defined. This in vivo study evaluated the role of SIRT1 in the hypercholesterolemic-related LD and, then, investigated how oral supplementation of melatonin, pleiotropic indoleamine, may be protective. Control mice and apolipoprotein E-deficient mice (ApoE−/−) of 6 and 15 weeks of age were treated or not treated with melatonin at the dose of 10 mg/kg/day for 9 weeks. In this study, we evaluated serum biochemical markers, liver SIRT1 expression, and oxidative stress markers. We observed that hypercholesterolemia increased significantly serum cholesterol and triglycerides, reduced significantly liver SIRT1, and, in turn, induced hepatic oxidative stress in untreated ApoE−/− mice with respect to control mice. Interestingly, melatonin treatment improved serum biochemical markers and hepatic morphological impairment and inhibited oxidative stress through its antioxidant properties and also by SIRT1 upregulation. In summary, melatonin oral supplementation may represent a new protective approach to block hypercholesterolemic liver alterations involving also a SIRT1-dependent mechanism.
Effects of a Single Dose of Parecoxib on Inflammatory Response and Ischemic Tubular Injury Caused by Hemorrhagic Shock in Rats
Authors: Takaku Mariana , da Silva Andre Carnevali , Iritsu Nathalie Izumi , Vianna Pedro Thadeu Galvao , Castiglia Yara Marcondes Machado
Published: February 2018

Parecoxib, a selective COX-2 inhibitor, is used to improve analgesia in postoperative procedures. Here we evaluated whether pretreatment with a single dose of parecoxib affects the function, cell injury, and inflammatory response of the kidney of rats subjected to acute hemorrhage. Inflammatory response was determined according to serum and renal tissue cytokine levels (IL-1α, IL-1β, IL-6, IL-10, and TNF-α). Forty-four adult Wistar rats anesthetized with sevoflurane were randomized into four groups: placebo/no hemorrhage (Plc/NH); parecoxib/no hemorrhage (Pcx/NH); placebo/hemorrhage (Plc/H); and parecoxib/hemorrhage (Pcx/H). Pcx groups received a single dose of intravenous parecoxib while Plc groups received a single dose of placebo (isotonic saline). Animals in hemorrhage groups underwent bleeding of 30% of blood volume. Renal function and renal histology were then evaluated. Plc/H showed the highest serum levels of cytokines, suggesting that pretreatment with parecoxib reduced the inflammatory response in rats subjected to hemorrhage. No difference in tissue cytokine levels between groups was observed. Plc/H showed higher percentage of tubular dilation and degeneration, indicating that parecoxib inhibited tubular injury resulting from renal hypoperfusion. Our findings indicate that pretreatment with a single dose of parecoxib reduced the inflammatory response and tubular renal injury without altering renal function in rats undergoing acute hemorrhage.
The Potential and Action Mechanism of Polyphenols in the Treatment of Liver Diseases
Authors: Li Sha , Tan Hor Yue , Wang Ning , Cheung Fan , Hong Ming , Feng Yibin
Published: February 2018

Liver disease, involving a wide range of liver pathologies from fatty liver, hepatitis, and fibrosis to cirrhosis and hepatocellular carcinoma, is a serious health problem worldwide. In recent years, many natural foods and herbs with abundant phytochemicals have been proposed as health supplementation for patients with hepatic disorders. As an important category of phytochemicals, natural polyphenols have attracted increasing attention as potential agents for the prevention and treatment of liver diseases. The striking capacities in remitting oxidative stress, lipid metabolism, insulin resistance, and inflammation put polyphenols in the spotlight for the therapies of liver diseases. It has been reported that many polyphenols from a wide range of foods and herbs exert therapeutic effects on liver injuries via complicated mechanisms. Therefore, it is necessary to have a systematical review to sort out current researches to help better understand the potentials of polyphenols in liver diseases. In this review, we aim to summarize and update the existing evidence of natural polyphenols in the treatment of various liver diseases by in vitro, in vivo, and clinical studies, while special attention is paid to the action mechanisms.
Convergence Theorems for Operators Sequences on Functionals of Discrete-Time Normal Martingales
Authors: Chen Jinshu
Published: February 2018

We aim to investigate the convergence of operators sequences acting on functionals of discrete-time normal martingales M. We first apply the 2D-Fock transform for operators from the testing functional space S(M) to the generalized functional space S⁎(M) and obtain a necessary and sufficient condition for such operators sequences to be strongly convergent. We then discuss the integration of these operator-valued functions. Finally, we apply the results obtained here and establish the existence and uniqueness of solution to quantum stochastic differential equations in terms of operators acting on functionals of discrete-time normal martingales M. And also we prove the continuity and continuous dependence on initial values of the solution.
Human Hand Motion Analysis during Different Eating Activities
Authors: Hussain Zakia , Zainul Azlan Norsinnira , Yusof Arif Zuhairi bin
Published: February 2018

The focus of this research is to analyse both human hand motion and force, during eating, with respect to differing food characteristics and cutlery (including a fork and a spoon). A glove consisting of bend and force sensors has been used to capture the motion and contact force exerted by fingers during different eating activities. The Pearson correlation coefficient has been used to show that a significant linear relationship exists between the bending motion of the fingers and the forces exerted during eating. Analysis of variance (ANOVA) and independent samples t-tests are performed to establish whether the motion and force exerted by the fingers while eating is influenced by the different food characteristics and cutlery. The middle finger motion showed the least positive correlation with index fingertip and thumb-tip force, irrespective of the food characteristics and cutlery used. The ANOVA and t-test results revealed that bending motion of the index finger and thumb varies with respect to differing food characteristics and the type of cutlery used (fork/spoon), whereas the bending motion of the middle finger remains unaffected. Additionally, the contact forces exerted by the thumb tip and index fingertip remain unaffected with respect to differing food types and cutlery used.
A Chemical Synthesis of Benzo[a]pyrene Hapten and Its Application in a Streptavidin-Horseradish Peroxidase-Based Enzyme-Linked Immunological Analysis
Authors: Ma Zhen , Zhuang Huisheng
Published: February 2018

A specific BaP hapten was synthesized and BaP antigens (immunogen, coating antigen) were prepared using diverse methods. Based on these works, a streptavidin-horseradish peroxidase-based enzyme-linked immunological analysis was developed and firstly used to detect BaP. Several physiochemical factors that may influence the assay performance were optimized in the assay. Under optimal conditions, a detection limit of 0.0094 ng mL−1 was obtained and good linearity was achieved within a range of 0.03–35.40 ng mL−1. Satisfactory recovery of spiked samples (91.12–109.23%) was obtained and the coefficient of variation was acceptable. Finally, the detection results of BaP in environmental and food samples were consistent with those obtained using high-performance liquid chromatography. The proposed immunoassay is reliable and has great potential for detecting trace amounts of BaP.
Pediatric Germ Cell Tumors: A Developmental Perspective
Authors: Pierce Joshua L. , Frazier A. Lindsay , Amatruda James F.
Published: February 2018

Germ cell tumors (GCTs) arising in infants, children, and adolescents present a set of special challenges. GCTs make up about 3% of malignancies in children aged 0–18 and nearly 15% of cancers in adolescents. Epidemiologic and molecular evidence suggests that GCTs in young children likely represent a distinct biologic group as compared to GCTs of older adolescents and adults. Despite this difference, pediatric GCTs are typically treated with cisplatin-based multiagent regimens similar to those used in adults. There is evidence that children are particularly vulnerable to late effects of conventional therapy, including ototoxicity, pulmonary abnormalities, and secondary malignancies, motivating the search for molecular targets for novel therapies. Evidence is accumulating that the genes and mechanisms controlling normal germ cell development are particularly relevant to the understanding of germ cell tumorigenesis. Perturbations in the epigenetic program of germ cell differentiation, with resulting effects on the regulation of pluripotency, may contribute to the marked histologic variability of GCTs. Perturbations in the KIT receptor signaling pathway have been identified via next-generation sequencing studies and in genome-wide association studies of testicular cancer susceptibility. Here, we review these and other biological insights that may fuel further translational and clinical research in childhood GCTs.
Novel Treatment of Small-Cell Neuroendocrine of the Vagina
Authors: Kostamo Kathryn , Peart Mishka , McKenzie Nathalie , Holloman Conisha , Carlan S. J. , Ge Li , Maksem John
Published: February 2018

Background. Primary vaginal small-cell neuroendocrine carcinoma is an extremely rare and highly aggressive malignancy. Eighty-five percent of patients die within one year of diagnosis from metastatic disease despite multimodal therapy. Gene expression profiling of tumor tissue may be useful for treatment options for various malignancies. Case. A 34-year-old nulliparous woman was diagnosed with primary vaginal small-cell neuroendocrine carcinoma. Twenty weeks after the initial visit, she was diagnosed with recurrence and started on chemoradiation based on the results of gene expression profile of tumor tissue. She died 34 months after the initial visit and had a 14-month progression-free survival (PFS). Conclusion. Gene expression profile of tumor tissue in the management of primary vaginal small-cell neuroendocrine carcinoma may be helpful in extending progression-free survival.
Multidrug-ResistantAcinetobacter baumannii: An Emerging Health Threat in Aseer Region, Kingdom of Saudi Arabia
Authors: Almaghrabi Mohammed K. , Joseph Martin R. P. , Assiry Mohammed M. , Hamid Mohamed E.
Published: February 2018

Objective. The study aims to determine the prevalence of multidrug-resistantA. baumanniiin Aseer Region, Kingdom of Saudi Arabia.Methods. This study evaluated the antibiotic susceptibility of ninety-four (n = 94) clinical isolates ofA. baumannii. The isolates were collected from the south region of Saudi Arabia, and notably Aseer Region, during the period from 15 October 2014 to 15 January 2015. The isolates were tentatively identified asA. baumanniiby routine bench tests and were confirmed by using VITEK® 2 Compact. The latest instrument was used to identify antibiotic susceptibility of these isolates.Results. Antibiotic susceptibility in this study showed that 69% of these isolates were multidrug-resistant strains. Moreover, they were highly resistant to carbapenem drugs. Several strains of these isolates were found to be extremely resistant to test antibiotics and were only sensitive to one or two of them.Conclusion. High rate of multidrug-resistantA. baumanniibacteraemia has emerged in the south region of Saudi Arabia as an important health problem. Therefore, it is considered as a new threat in hospitals, which requires a tremendous effort to stop its escalation and spread.
Physicochemical Characterization of Geopolymer Binders and Foams Made from Tunisian Clay
Authors: Ben Messaoud Imen , Hamdi Noureddine , Srasra Ezzeddine
Published: February 2018

Illito‐kaolinitic clay rich in hematite from south Tunisia was investigated in view of producing geopolymer materials. Geopolymers with two different densities were elaborated: cement and foam. The effects of activator concentrations on compressive strength, water absorption (durability), open porosity, and bulk density of geopolymers cement were examined, in order to assure optimal geopolymerization conditions. Geopolymer cements aged 28 days with optimum performances were achieved for 13 M of alkaline solution concentration. At these conditions, the compressive strength of prepared geopolymer reaches 27.8 MPa. The addition of silica fume to reactant geopolymer mixture induces modification of geopolymer density and decrease in the compressive strength of the final product. Geopolymer materials based on calcined Tunisian clay can be suggested as sustainable and cost‐effective cement that may be applied to alternate Portland cement in many construction applications.
Nocturnal Hypoxia Improves Glucose Disposal, Decreases Mitochondrial Efficiency, and Increases Reactive Oxygen Species in the Muscle and Liver of C57BL/6J Mice Independent of Weight Change
Authors: Ioja Simona , Singamsetty Srikanth , Corey Catherine , Guo Lanping , Shah Faraaz , Jurczak Michael J. , McVerry Bryan J. , Shiva Sruti , O’Donnell Christopher P.
Published: February 2018

Although acute exposure to hypoxia can disrupt metabolism, longer‐term exposure may normalize glucose homeostasis or even improve glucose disposal in the presence of obesity. We examined the effects of two‐week exposure to room air (Air), continuous 10% oxygen (C10%), and 12 hr nocturnal periods of 10% oxygen (N10%) on glucose disposal, insulin responsiveness, and mitochondrial function in lean and obese C57BL/6J mice. Both C10% and N10% improved glucose disposal relative to Air in lean and obese mice without evidence of an increase in insulin responsiveness; however, only the metabolic improvements with N10% exposure occurred in the absence of confounding effects of weight loss. In lean mice, N10% exposure caused a decreased respiratory control ratio (RCR) and increased reactive oxygen species (ROS) production in the mitochondria of the muscle and liver compared to Air‐exposed mice. In the absence of hypoxia, obese mice exhibited a decreased RCR in the muscle and increased ROS production in the liver compared to lean mice; however, any additional effects of hypoxia in the presence of obesity were minimal. Our data suggest that the development of mitochondrial inefficiency may contribute to metabolic adaptions to hypoxia, independent of weight, and metabolic adaptations to adiposity, independent of hypoxia.
Test Point Selection Method for Analog Circuit Fault Diagnosis Based on Similarity Coefficient
Authors: Ma Qingfeng , He Yuzhu , Zhou Fuqiang , Song Ping
Published: February 2018

The demand for testability analysis has increased with the integration densities and complexity of circuits. As an important part of testability analysis, the test point selection method needs to be researched in depth. A new similarity coefficient criterion is proposed to determine the fault isolation degree because output responses of a circuit with component tolerance are approximately subject to the normal distribution. Then, a new test point selection method is proposed based on the fault-pair similarity coefficient criterion information table. Simulation experiments are used to validate the accuracy of the proposed method in terms of the optimum test point set and fault isolation degree. The results show that the proposed method improves the performance of test point selection by comparing with the other reported methods.
Computer-Assisted Optimization of the Acetabular Rotation in Periacetabular Osteotomy Using Patient’s Anatomy-Specific Finite Element Analysis
Authors: Park Sung-Jae , Lee Sung-Jae , Chen Wen-Ming , Park Jung-Hong , Cho Yong-Soo , Shin Taejin , Kwon Soon-Yong
Published: February 2018

Periacetabular osteotomy (PAO) is a complex surgical procedure to restore acetabular coverage in the dysplastic hip, and the amount of acetabular rotation during PAO plays a key role. Using computational simulations, this study assessed the optimal direction and amount of the acetabular rotation in three dimensions for a patient undergoing PAO. Anatomy-specific finite element (FE) models of the hip were constructed based on clinical CT images. The calculated acetabular rotation during PAO were 9.7°, 18°, and 4.3° in sagittal, coronal, and transverse planes, respectively. Based on the actual acetabular rotations, twelve postoperative FE models were generated. An optimal position was found by gradually varying the amount of the acetabular rotations in each anatomical plane. The coronal plane was found to be the principal rotational plane, which showed the strongest effects on joint contact pressure compared to other planes. It is suggested that rotation in the coronal plane of the osteotomized acetabulum is one of the primary surgical parameters to achieve the optimal clinical outcome for a given patient.
Placenta-Derived Decidua Stromal Cells for Hemorrhagic Cystitis after Stem Cell Transplantation
Authors: Aronsson-Kurttila Wictor , Baygan Arjang , Moretti Gianluca , Remberger Mats , Khoein Bita , Moll Guido , Sadeghi Behnam , Ringdén Olle
Published: February 2018

Background/Aims: Hemorrhagic cystitis (HC) is a serious complication after hematopoietic stem cell transplantation (HSCT). Stromal cells have been tested as therapy for HC. Decidua stromal cells (DSCs) protect the fetus from the mother's immune system. Methods: Eleven patients with HC of grades 3-4 were treated with DSCs after HSCT. The median age was 33 years (range 8-50), and the median dose of DSCs was 1.5 × 106/kg (range 0.7-2.5). The patients were given 1 dose (1-4). Results: In 5 patients, HC disappeared within 5 days after DSC infusion. Patients who received DSCs within 3 days after the start of HC had a duration of HC of 5 days and a shorter duration of pain than patients who were given DSCs later (p = 0.02). Three patients received DSCs prepared in albumin instead of AB-plasma and tended to have a shorter duration of pain (p = 0.07). There was no infusion toxicity. Adverse events were those often seen after HSCT. Nine of the 11 patients (82%) were alive 1 year after HSCT. Conclusions: Based on this pilot study, we started a randomized, placebo-controlled double-blind study using 2 doses of 1 × 106 DSCs/kg suspended in albumin for treatment of early HC.
Identifying Signalling Pathways Regulated by GPRC5B in β-Cells by CRISPR-Cas9-Mediated Genome Editing
Authors: Atanes Patricio , Ruz-Maldonado Inmaculada , Hawkes Ross , Liu Bo , Persaud Shanta J. , Amisten Stefan
Published: February 2018

Background/Aims: CRISPR-Cas9, a RNA-guided targeted genome editing tool, has revolutionized genetic engineering by offering the ability to precisely modify DNA. GPRC5B is an orphan receptor belonging to the group C family of G protein-coupled receptors (GPCRs). In this study, we analysed the functional roles of the Gprc5b receptor in MIN6 β-cells using CRISPR-Cas9 and transient over-expression of Gprc5b. Methods: The optimal transfection reagent for use in MIN6 β-cells was determined by analysing efficiency of GFP plasmid delivery by cell sorting. A MIN6 β-cell line in which Gprc5b expression was knocked down (Gprc5b KD) was generated using CRISPR-Cas9 technology. Gprc5b receptor mRNA expression, proliferation, apoptosis, Cignal 45-Pathway Reporter Array signalling and western blot assays were carried out using Gpcr5b KD MIN6 β-cells that had been transiently transfected with different concentrations of mouse Gprc5b plasmid to over-express Gprc5b. Results: JetPRIME® was the best candidate for MIN6 β-cell transfection, providing approximately 30% transfection efficiency. CRISPR-Cas9 technology targeting Gprc5b led to stable knock-down of this receptor in MIN6 β-cells and its re-expression induced proliferation and potentiated cytokine- and palmitate-induced apoptosis. The Cignal 45 Reporter analysis indicated Gprc5b-dependent regulation of apoptotic and proliferative pathways, and western blotting confirmed activation of signalling via TGF-β and IFNγ. Conclusion: This study provides evidence of CRISPR-Cas9 technology being used to down-regulate Gprc5b expression in MIN6 β-cells. This strategy allowed us to identify signalling pathways linking GPRC5B receptor expression to β-cell proliferation and apoptosis.
Between human rights and nationalism: Silencing as a mechanism of memory in the post-Yugoslav wars' Serbia
Authors: David Lea
Published: February 2018

Just as norm-complying states adapt their practices to expected behaviors, post-conflict states are forced to adapt their practices and rhetoric to better resist pressures to comply with particular norms. Building on this insight, this paper analyzes three mechanisms through which the ruling elite in present day Serbia strategically constructed commemorative arenas for the purpose of dealing with the opposing demands and norms made both on the international as well as the national level: 1) de-contextualization of memory contents, 2) creation of social narratives of suffering and 3) promotion of the Holocaust memory as a screen memory. These are strategies of silencing which prevent public debate, representation, negotiation and are intended to reduce the tension between the contradicting demands at the international and the domestic levels. I suggest that the gap between the local and global forces and the changing role of the state, makes it possible for memory content to become a currency, a means of achieving certain real or symbolic benefits.
World War II 2.0: Digital memory of fascism in Russia in the aftermath of Euromaidan in Ukraine
Authors: Gaufman Elizaveta
Published: February 2018

The events in Ukraine in 2013-2014 will have long-lasting ramifications for the future of international security being in essence the end of a post Cold War order. While the scale of Russia's involvement in Ukraine is still debated, the discursive construction of Ukrainian crisis in Russian media undeniably draws heavily on the World War II narrative of fascism. Representing Euromaidan participants as being on the 'wrong side of history' helps bolster an existential threat frame that resonates extremely well on the Post-Soviet space. This paper explores the digital memory of fascism on Russian social media in the aftermath of Euromaidan in Ukraine by analysing debates on Russian segments of social networks, such as Twitter, Livejournal.com and Vkontakte.com.
Nation-building under the societal security dilemma: The case of Macedonia
Authors: Sazdovski Aleksandar
Published: February 2018

In 2009, the Government of the Republic of Macedonia announced the Skopje 2014 Project, a project that envisioned an urban reconstruction of the city through a series of monuments of historical and religious figures, as well as various public buildings resembling neo-classical, or neo-baroque style. The Project was the culmination of a wider nation-building project initiated several years earlier that became known as 'antiquisation' that sought to reconstruct and redefine Macedonian national identity, in which the uppermost importance was given to the figure of Alexander the Great. The nation-building project stressed a linear continuity of Macedonian national identity from antiquity to the present thereby emphasizing the nation's unceasing existence and affirmation throughout the centuries. But what were the underlying causes that shaped the nation-building project? How have historical, political and other factors influenced the nation-building project in Macedonia? And why was ancient Macedonia chosen as the narrative around which the nation-building project could take place? These are the questions that the present article will attempt to answer. The aim of this article is to examine the complex interplay between security policy and nation-building, in the Macedonian context. More specifically, it will argue that the current nation-building project in Macedonia has been developed as a response to internal and external perceived identity threats. Namely, ever since declaring independence the Republic of Macedonia has been facing a double societal security dilemma - an external, stemming from the country's immediate neighbors who constantly dispute the existence of a distinct Macedonian national identity, and an internal reflected in the constant challenges of the character of the State, by the country's ethnic Albanian community. In response, the nation-building project sought to address these concerns.
Images of war: The place of the war past of the parents in the second generation's identity
Authors: Yordanova Kalina
Published: February 2018

Memory is an organizing phenomenon for both individuals and societies. Memory allows us to organize our past, foster an identity and ensure our belonging to a group1. Memory plays a central role in the shaping of contemporary identities because it helps us re-construct our identity in relation to our past and other people's past. How does the memory of war shape the second generation's identity? By using data collected in 26 families of war survivors from Bosnia and Herzegovina, this paper examines how the identity of the second generation is being shaped by their parents' war experience.
Social Media among Medical Students and Personnel Here to Stay
Authors: Ta Andrew Q. , Tang Christopher G.
Published: February 2018

Social media is no longer new, even in the professional medical world. It is an established and relatively public medium, and all users would do well to understand the risks associated with it. Medical personnel—whether medical student or staff physician—must familiarize themselves with it to ensure positive outcomes. As with other technologies, best practices will evolve with time, but existing and ongoing research can establish working use guidelines.
Venous Thromboembolism Risk in Head and Neck Cancer: Significance of the Preoperative Platelet‐to‐Lymphocyte Ratio
Authors: Tham Tristan , Rahman Lauren , Persaud Christina , Olson Caitlin , Costantino Peter
Published: February 2018

Objective

We aimed to investigate the association between the preoperative platelet‐to‐lymphocyte ratio (PLR) and venous thromboembolism (VTE) in patients with head and neck cancer (HNC) undergoing major surgery.

Study Design

Retrospective cohort study.

Setting

Academic tertiary hospital from 2011 to 2017.

Subjects and Methods

Patients with confirmed HNC undergoing major surgery were included in this study. The preoperative PLR was recorded for all patients. Known VTE risk factors, including Caprini score, age, sex, smoking, body mass index, prior VTE, and anticoagulation, were also recorded. Risk factors were screened in univariate analysis using Wilcoxon's rank sum test and χ2 test (Bonferroni corrected). Significant covariates were included in a multivariate regression model. Bootstrap techniques were used to obtain credible confidence intervals (CIs).

Results

There were 306 patients enrolled with 7 cases of VTE (6 deep vein thromboses and 1 pulmonary embolism. On univariate analysis, length of stay (P =. 0026), length of surgery (P =. 0029), and PLR (P =. 0002) were found to have significant associations with VTE. A receiver operator characteristic (ROC) curve was constructed that yielded an area under the ROC of 0.905 (95% CI, 0.82‐0.98). Using an optimized cutoff, the multivariate model showed that length of surgery (β 95% CI, 0.0001‐0.0006; P =. 0056) and PLR (β 95% CI, 5.3256‐5.3868; P <. 0001) were significant independent predictors of VTE.

Conclusion

This exploratory pilot study has shown that PLR offers a potentially accurate risk stratification measure as an adjunct to current tools in VTE risk prediction, without additional cost to health systems.
Partnering with parents to advance child health research
Authors: Curran Janet A. , Bishop Andrea , Chorney Jill , MacEachern Lauren , Mackay Rebecca
Published: February 2018

Although patient engagement in research is widely touted as an important foundation for improving the relevance and sustainability of research findings, there is little consensus on how to do it in practice. This article describes our research team’s experiences working with and engaging parents throughout the entire research process to reach full partnership in the identification, management, and dissemination of research. Our report of these experiences includes lessons learned along the way regarding how healthcare and research organizations can better support researchers and patients to achieve successful partnerships.
Fellowship Program in Health System Improvement: A novel approach integrating leadership development and patient-centred health system transformation
Authors: Philippon Donald J. , Montesanti Stephanie , Stafinski Tania
Published: February 2018

This article highlights a novel approach to professional development, integrating leadership, development and patient-centred health system transformation in the new Fellowship Program in Health System Improvement offered by the School of Public Health at the University of Alberta. Early assessment of the program is also provided.
Weak Signals and Wild Cards Leading to Transformative Disruption: A Consumer Delphi Study on the Future of e-Commerce in China
Authors: Qi Yuan , Tapio Petri
Published: February 2018

The future of businesses is not only orchestrated by emerging trends and megatrends but also to a greater extent struck by surprising events. With the accelerating presence of high-tech innovations and smart technologies, business activities are exposed to an increasingly volatile, uncertain, complex, and ambiguous environment. Any unexpected changes in the environment could lead to the malfunction or even collapse of a company, a business, or even an industry. Discerning the seeds of change and anticipating the potential disruptions in the external environment is a precondition for avoiding potential risks and threats. The present study contributes to the conceptual and methodological discussion of disruptive transformation by identifying, analyzing, and interpreting the potential disruptive factors in the external business environment. The venture is undertaken through the lens of probing into the dynamism of China’s e-commerce industry, considering its growing influence both domestically and abroad. Any unexpected disruptions would result in a significant ripple effect on interrelated businesses, industries, and even economies. The research adopts a combined mode of qualitative and quantitative methods in the form of horizon scanning and a Consumer Delphi study. Horizon scanning collects futures signals indicating the seeds of change (i.e., weak signals) and potential disruptions (i.e., wild cards), whereas Delphi study solicits the evaluations on the degree of likelihood and impact of the collected factors from an expert panel. As a result, twenty-seven potential disruptive factors are discovered, categorized, estimated, and discussed.
The prevalence of constant supportive observations in high, medium and low secure services
Authors: Lambert Katie , Chu Simon , Duffy Chris , Hartley Victoria , Baker Alison , Ireland Jane L.
Published: February 2018

Aims and method

We explored the prevalence and use of constant supportive observations (CSO) in high, medium and low secure in-patient services in a single National Health Service (NHS) mental health trust. From clinical records, we extracted data on the length of time of CSO, the reason for the initiation of CSO and associated adverse incidents for all individuals who were placed on CSO between July 2013 and June 2014.

Results

A small number of individuals accounted for a disproportionately large proportion of CSO hours in each setting. Adverse incident rates were higher on CSO than when not on CSO. There was considerable variation between different settings in terms of CSO use and the reasons for commencing CSO.

Clinical implications

The study describes the prevalence and nature of CSO in secure forensic mental health services and the associated organisational costs. The marked variation in CSO use between settings suggests that mental health services continue to face challenges in balancing risk management with minimising restrictive interventions.

Declaration of interest

A.B. and J.L.I. are both directly employed by the NHS trust in which the study was conducted.
Teaching Medical Students Clinical Anesthesia
Authors: Curry Saundra E.
Published: February 2018

There are many reasons for evaluating our approach and improving our teaching of America’s future doctors, whether they become anesthesiologists (recruitment) or participate in patient management in the perioperative period (general patient care). Teaching medical students the seminal aspects of any medical specialty is a continual challenge. Although no definitive curricula or single clinical approach has been defined, certain key features can be ascertained from clinical experience and the literature. A survey was conducted among US anesthesiology teaching programs regarding the teaching content and approaches currently used to teach US medical students clinical anesthesia. Using the Accreditation Council for Graduate Medical Education website that lists 133 accredited anesthesiology programs, residency directors were contacted via e-mail. Based on those responses and follow-up phone calls, teaching representatives from 125 anesthesiology departments were identified and asked via e-mail to complete a survey. The survey was returned by 85 programs, yielding a response rate of 68% of individuals contacted and 63% of all departments. Ninety-one percent of the responding departments teach medical students, most in the final 2 years of medical school. Medical student exposure to clinical anesthesia occurred as elective only at 42% of the institutions, was requirement only at 16% of responding institutions, and the remainder had both elective and required courses. Anesthesiology faculty at 43% of the responding institutions reported teaching in the preclinical years of medical school, primarily in the departments of pharmacology and physiology. Forty-five percent of programs reported interdisciplinary teaching with other departments teaching classes such as gross anatomy. There is little exposure of anesthesiology faculty to medical students in other general courses. Teaching in the operating room is the primary teaching method in the clinical years. Students are allowed full access to patient care, including performing history and physical examinations, participating in the insertion of IVs and airway management. Simulation-based teaching was used by 82% of programs during medical student anesthesia clerkships. Sixty-eight percent of respondents reported that they have no formal training for their anesthesiology faculty teachers, 51% stated that they do not receive nonclinical time to teach, and 38% of respondents stated that they received some form of remuneration for teaching medical students, primarily nonclinical time. This article presents a summary of these survey results, provides a historical review of previous evaluations of teaching medical students clinical anesthesia, and discusses the contributions of anesthesiologists to medical student education.
Effect-Site Target-Controlled Infusion in the Obese: Model Derivation and Performance Assessment
Authors: Cortínez Luis I. , Sepúlveda Pablo , Rolle Augusto , Cottin Pauline , Guerrini Alexandre , Anderson Brian J.
Published: February 2018

BACKGROUND:

The aim of this study is to derive a propofol pharmacokinetic (PK) pharmacodynamic (PD) model to perform effect-site target-controlled infusion (TCI) in obese patients, and to analyze its performance along with that of other available PK models.

METHODS:

In the first step of the study, a 3-compartment PK model linked to a sigmoidal inhibitory E
max PD model by a first-order rate constant (keo) was used to fit propofol concentration–bispectral index (BIS) data. Population modeling analysis was performed by nonlinear mixed effects regression in NONMEM (ICON, Dublin, Ireland). PK data from 3 previous studies in obese adult patients (n = 47), including PD (BIS) data from 1 of these studies (n = 20), were pooled and simultaneously analyzed. A decrease in NONMEM objective function (ΔOBJ) of 3.84 points, for an added parameter, was considered significant at the 0.05 level. In the second step of the study, we analyzed the predictive performance (median predictive errors [MDPE] and median absolute predictive errors [MDAPE]) of the current model and of other available models using an independent data set (n = 14).

RESULTS:

Step 1: The selected PKPD model produced an adequate fit of the data. Total body weight resulted in the best size scalar for volumes and clearances (ΔOBJ, −18.173). Empirical allometric total body weight relationships did not improve model fit (ΔOBJ, 0.309). A lag time parameter for BIS response improved the fit (ΔOBJ, 89.593). No effect of age or gender was observed. Step 2: Current model MDPE and MDAPE were 11.5% (3.7–25.0) and 26.8% (20.7–32.6) in the PK part and 0.4% (−10.39 to 3.85) and 11.9% (20.7–32.6) in the PD part. The PK model developed by Eleveld et al resulted in the lowest PK predictive errors (MDPE = <10% and MDAPE = <25%).

CONCLUSIONS:

We derived and validated a propofol PKPD model to perform effect-site TCI in obese patients. This model, derived exclusively from obese patient’s data, is not recommended for TCI in lean patients because it carries the risk of underdosing.
SmartTots Update Regarding Anesthetic Neurotoxicity in the Developing Brain
Authors: Orser Beverley A. , Suresh Santhanam , Evers Alex S.
Published: February 2018

SmartTots (http://smarttots.org/) represents a public–private partnership between the International Anesthesia Research Society and the US Food and Drug Administration. Over the past 7 years, SmartTots has worked in collaboration with various stakeholders to determine whether anesthetic drugs have detrimental effects on the developing brain. SmartTots has funded clinical and preclinical studies, organized meetings, served as a repository of peer-reviewed information, and facilitated the development of consensus-based statements. Here, we report advances in the field of anesthetic neurotoxicity and provide an update on SmartTots’ activities. Clinical studies have provided some reassurance that a brief exposure to anesthetic drugs does not cause overt, persistent cognitive deficits. New recommendations aim to increase the reproducibility and “clinical relevance” of data from studies of laboratory animals. Overall, the field has advanced substantially; however, it remains paramount to definitively resolve whether anesthetic drugs are neurotoxic to the immature brain. The results of SmartTots efforts will either ally unwarranted fears or substantially change pediatric anesthetic practice and prompt studies to identify neuroprotective strategies.
The Effect of Intermittent Oxytocin Pretreatment on Oxytocin-Induced Contractility of Human Myometrium In Vitro
Authors: Talati Chiraag , Carvalho Jose C. A. , Luca Alice , Balki Mrinalini
Published: February 2018

BACKGROUND:

Prolonged continuous oxytocin administration during labor may induce oxytocin receptor desensitization, which attenuates the response of the myometrium to further oxytocin, increasing the risk of postpartum hemorrhage. The literature comparing pulsatile (intermittent) versus continuous oxytocin administration for induction and augmentation of labor is inconsistent with regard to maternal outcomes. We aimed to determine the effect of intermittent versus continuous oxytocin preexposure on myometrial responsiveness to subsequent oxytocin. We hypothesized that intermittent oxytocin pretreatment would result in superior subsequent oxytocin-induced contractility than continuous oxytocin pretreatment.

METHODS:

This in vitro study was undertaken using myometrium obtained from women undergoing elective cesarean deliveries. Each myometrial strip was mounted in an individual organ bath with physiological salt solution under homeostatic conditions and allocated to one of 3 groups: (1) control (no pretreatment); (2) continuous (pretreatment with oxytocin 10−5 M for 2 hours); or (3) intermittent (pretreatment with alternating oxytocin 10−5 M and physiological salt solution every 15 minutes, for 2 hours). After pretreatment, dose–response testing to oxytocin 10−10 to 10−5 M was performed and contractile parameters were measured. The primary outcome was motility index (MI, amplitude × frequency) of contractions.

RESULTS:

Eighteen women were recruited, and 86 successful experiments were performed (control n = 29, continuous n = 28, intermittent n = 29). The means (standard errors) of MI (√g·contractions/10 min) in the control, continuous, and intermittent groups were 2.34 (0.09), 1.78 (0.09), and 2.13 (0.11), respectively. The MI was significantly reduced in the continuous group when compared to the control (estimated difference [95% confidence interval {CI}], −0.56 [−0.81 to −0.31]; P < .01) and intermittent group (estimated difference [95% CI], −0.35 [−0.62 to −0.08]; P = .01). There was no significant difference in MI between the intermittent and control group (estimated difference [95% CI], −0.21 [−0.51 to 0.09]; P = .17).

CONCLUSIONS:

Human myometrium remains more responsive to subsequent oxytocin after intermittent compared to continuous exposure to oxytocin, most likely due to reduction in oxytocin receptor desensitization, or facilitation of receptor resensitization in the intermittent group. Hence, intermittent oxytocin administration during labor warrants further investigation as a technique to preserve uterine oxytocin responsiveness.
Comparison of Nasal Intubations by GlideScope With and Without a Bougie Guide in Patients Who Underwent Maxillofacial Surgeries: Randomized Clinical Trial
Authors: Pourfakhr Pejman , Ahangari Ailar , Etezadi Farhad , Moharari Reza Shariat , Ahmadi Ayat , Saeedi Negin , Najafi Atabak
Published: February 2018

BACKGROUND:

Nasotracheal intubation is commonly performed to provide a secure airway for the maintenance of general anesthesia in maxillofacial surgeries. Routine nasotracheal intubation is performed under general anesthesia by direct laryngoscopy, frequently with the aid of Magill forceps. This method can be time-consuming and may cause bleeding in the field of view. A gum elastic bougie (GEB) is a cheap, slender, and flexible device that could expedite nasotracheal intubation. The aim of this study was to evaluate the use of a GEB during nasotracheal intubation to facilitate the procedure and reduce the rate of complications.

METHODS:

In this randomized clinical trial study, 110 patients with American Society of Anesthesiologists (ASA) physical status I–II from 15 to 65 years of age were randomized into 2 equal groups. In both groups, a GlideScope and armored tube were used. In the GEB group, GEB was used to facilitate nasal intubation while the nasal intubation was performed without the aid of GEB in the routine group. The difficult intubation (defined as >1 attempt for intubation) was the primary outcome, and the duration of the intubation, the presence of traces of bleeding, the need for a tube replacement, and the usage of Magill forceps were the secondary outcomes.

RESULTS:

The incidence of bleeding in the GEB group was 1.81% vs 43.63% in the routine group (P < .001). In 5.5% of the GEB group, Magill forceps were used to advance the tube versus 67.3% in the routine group (P < .001). The mean time for intubation in GEB group was 48.63 ± 8.53 vs 55.9 ± 10.76 seconds in the routine group (P < .001).

CONCLUSIONS:

The GEB is a useful aid to nasotracheal intubation, reducing bleeding, the requirement for Magill forceps and, to a small degree, intubation time. A case exists for its routine use for this purpose.
Abdominal Muscle Density Is Inversely Related to Adiposity Inflammatory Mediators
Authors: VAN HOLLEBEKE RACHEL B. , CUSHMAN MARY , SCHLUETER EMMA F. , ALLISON MATTHEW A.
Published: February 2018

Purpose

Skeletal muscle is the largest regulator of glucose metabolism, but few population-based studies have examined the associations between muscle and inflammation. We studied the relationships between abdominal muscle area and density with selected adiposity-associated inflammatory mediators.

Methods

Nearly 2000 subjects underwent computed tomography of the abdomen and had venous fasting blood drawn concomitantly. The computed tomography scans were interrogated for visceral and subcutaneous fat, as well as abdominal lean muscle areas and densities. We then categorized the muscle into locomotion (psoas) and stabilization (rectus, obliques, and paraspinal) groups. Blood samples were assayed for interleukin-6 (IL-6), resistin, C-reactive protein, and TNF-α.

Results

The mean age was 64.7 yr, and 49% were female. Forty percent were white, 26% Hispanic/Latino American, 21% African American, and 13% Chinese American. The mean body mass index was 28.0 kg·m−2, and 30% were obese (body mass index, >30 kg·m−2). Using multivariable linear regression models that included adjustment for abdominal muscle area, a 1-SD increment in the mean densities for total, stabilization, and locomotive abdominal muscle were each significantly associated with lower levels of IL-6 (β = −15%, −15%, and −9%, P < 0.01 for all) and resistin (β = −0.11, −0.11, and −0.07 ng·mL−1, P < 0.02 for all), but not C-reactive protein or TNF-α. Conversely, muscle area was not independently associated with any of the inflammatory mediators studied.

Conclusions

Higher densities of several muscle groups in the abdomen are significantly associated with lower IL-6 and resistin levels, independent of the muscle area in these groups. Techniques that enhance muscle density may reduce levels of adiposity-associated inflammatory mediators.
La evolución de la carrera académica en universidades con foco en investigación en Chile
Authors: Veliz-Calderon Daniela , Theurillat Daniel , Paredes Victoria , Pickenpack Astrid
Published: February 2018

El cuerpo académico es fundamental para el desarrollo y el éxito de las instituciones de educación superior, y la conformación de equipos académicos sólidos es un desafío importante, especialmente para las universidades de investigación. Si bien no hay universidades de investigación en Chile (Bernasconi, 2007), algunas se esfuerzan por acercarse a ese ideal, a través de la profesionalización de su cuerpo académico. Este estudio fue guiado por la siguiente pregunta ¿Cuál es la evolución de los reglamentos académicos y planes de desarrollo institucional en universidades con orientación de investigación en Chile desde 1967 a la fecha? Los hallazgos preliminares señalan que las universidades estudiadas coinciden actualmente en tener una jerarquía académica similar al menos en cuanto a sus responsabilidades y se han vuelto más estrictos con el tiempo. Sin embargo, los académicos adjuntos experimentan poca regulación de sus deberes, derechos de gobernabilidad y beneficios, aunque todavía constituyen la proporción más alta de los académicos en dichas instituciones. Por último, parece que estas universidades han cambiado sus regulaciones académicas a lo largo del tiempo como respuesta a procesos internos en lugar de presiones externas.