bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of crop production practices on soil characteristics and metabolic diversity of microbial communities under winter wheat
Authors: Gajda Anna M. , Czyż Ewa A. , Furtak Karolina , Jończyk Krzysztof
Published: January 2019

The aim of this research was to compare the effects of organic (ORG, no mineral fertilisers and pesticides) and conventional (CON, with mineral fertilisation and plant protection chemicals) crop production systems on some soil properties: soil organic matter (SOM) and particulate organic matter (POM) contents, dehydrogenase activity and metabolic microbial diversity (Biolog EcoPlate™). Samples of Haplic Luvisol soil were collected from 23-year-old experimental fields under winter wheat from the depth layers of 0–5, 5–10, 15–20 and 30–35cm. Soil under ORG showed higher contents of SOM, POM and POM expressed as a percentage of SOM by 16.0%, 25.6% and 23.9% respectively, in particular down to 5cm depth, compared with the CON system. Also, dehydrogenase activity was 47.5% higher under the ORG than the CON system. The Biolog EcoPlate revealed higher metabolic microbial diversity in soil under ORG crop production system compared with CON. This result was supported by the average well colour development and Shannon’s diversity index values. Significant correlations between soil quality parameters and winter wheat yield confirmed their effectiveness as indicators of soil disturbance. The results showed that the ORG system much better maintained SOM and soil fertility compared with CON.
3. Lizards
Authors: Kemp T. S.
Published: January 2019

More than half of all reptiles alive today are lizards, with over 6,000 species. Lizards are truly worldwide in distribution, although like all reptiles they are most diverse and abundant in the tropics. ‘Lizards’ explains that evidence from the DNA sequences of genes has provided a pretty clear idea of how the modern lizards evolved. It describes the key features of ‘typical’ lizards—their predatory lifestyle, the specialized feeding mechanism called cranial kinesis, and their reproductive arrangements. It also discusses more specialized species such as limbless lizards; aquatic lizards; arboreal lizards such as chameleons; geckos; airborne lizards; and the large predators such as monitor lizards and the Gila monster.
4. Snakes
Authors: Kemp T. S.
Published: January 2019

The roughly 3,500 species of snakes are really a group of limbless lizards, although they are so distinctive, with so many unique features, that they are placed in their own reptile subclass, Ophidia or Serpentes. They have a worldwide distribution, occupying habitats from deserts to rainforests and seas. ‘Snakes’ describes how snakes feed, move, and make sense of their surroundings, as well as their social and reproductive behaviour. The main aspect of snake biology that accounts for their great success as hunting organisms is the way they acquire and ingest their food. The rear-fanged (colubrids) and front-fanged groups (elapids and viperids) are described along with their venom production.
C. S. Lewis: A Very Short Introduction
Authors: Como James
Published: January 2019

Beloved by children and adults worldwide, the writings of C. S. Lewis have a broad and enduring appeal. Although best known for the iconic Chronicles of Narnia series, C. S. Lewis was a man of many literary parts. Already well known as a scholar in the 1930s, he became a famous broadcaster during World War II and wrote in many genres: satire (The Screwtape Letters), science fiction (Perelandra), novels, poetry, and books on Christian belief. C. S. Lewis: A Very Short Introduction delves into the vast corpus of his work, discussing its core themes and lasting appeal. Moving chronologically through Lewis’s life, it provides a picture of the whole man, his work, and his enduring legacy.
Lewis ascendant
Authors: Como James
Published: January 2019

‘Lewis ascendant’ considers C. S. Lewis’s time in Oxford as a fellow at Magdalen College. It discusses his life as a tutor and lecturer, his writing through this period, and his friendships with the Inklings, an informal group of like-minded men who met regularly to converse and to read works-in-progress aloud. The literary result of Lewis’s conversion to Christianity was The Pilgrim’s Regress (1933), which displayed a dynamic new voice backed by a steel-trap mind and an imagination to match. The Allegory of Love (1936), a landmark of literary history, established Lewis as among the major literary medievalists in the world. Very different in tone are his sermons, including ‘Learning in War Time’ and ‘Transposition’.
Darkness and light
Authors: Como James
Published: January 2019

‘Darkness and light’ begins with a discussion of George MacDonald: An Anthology and Miracles (both 1947). It also describes Lewis’s home life, his wedding to Joy Gresham in 1955, and his appointment as Professor of Medieval and Renaissance Literature at Magdalene College, Cambridge. Other key works around this time included English Literature in the Sixteenth Century and De Descriptione Temporum, but the most famous of his works—The Chronicles of Narnia—were finally completed in 1953. The seven books—The Lion, the Witch, and the Wardrobe; Prince Caspian; The Voyage of the ‘Dawn Treader’; The Silver Chair; The Horse and His Boy; The Magician’s Nephew; and The Last Battle—describe the world of Narnia.
A new day
Authors: Como James
Published: January 2019

In The Chronicles, Lewis comes as close to mysticism as he has in any other book, for Aslan, the holy of holies is the numinous made present. Though his apologetic writing becomes less polemical, a public not-avowedly Christian Lewis remains militant. Lewis has undergone many changes: near-despair, forgiveness, marriage, a monumental professional move, and a steady, but very new, rhythm that was less urgent. ‘A new day’ describes his one real novel, Till We Have Faces (1956), and other works: ‘Meditation in a Toolshed’, ‘Membership’, ‘The Seeing Eye’, Reflections on the Psalms, and The Four Loves. After the death of Joy in 1960, Lewis published A Grief Observed under the pseudonym N. W. Clerk.
Heidegger: A Very Short Introduction
Authors: Inwood Michael
Published: January 2019

Heidegger: A Very Short Introduction provides an invaluable guide to the complex and voluminous thought of one of the 20th century’s greatest yet most enigmatic and divisive philosophers. It focuses on Martin Heidegger’s most important work, Being and Time, to explore its major themes of existence in the world, inauthenticity, guilt, destiny, truth, and the nature of time. These themes are then reassessed in the light of Heidegger’s multifaceted later thought, and how, despite its diversity, it hangs together as a single, coherent project. Finally, this VSI turns to Heidegger’s Nazism and anti-Semitism, to reveal its deep connection with his personality and overall view of philosophy.
3. Being
Authors: Inwood Michael
Published: January 2019

‘Being’ describes the importance that Heidegger ascribed to considering the nature of an object, or its Being, before addressing knowledge of it. Whereas other philosophers, including Aristotle, treated all entities as vorhanden, ‘present at hand’, as appropriate objects of disinterested description, Heidegger argued for multiple conceptions of Being. These conceptions included the existence of the object, qualities that distinguish it from others, and its mode of Being—as a real entity rather than an ideal one, for instance. Heidegger was convinced that Being must be considered in the context of the world around and of the relationship of the subject of inquiry to the object considered.
11. St Martin of Messkirch?
Authors: Inwood Michael
Published: January 2019

‘St Martin of Messkirch?’ assesses Heidegger’s relationship with Nazism, his anti-Semitism, and his philosophical standing. Nazism did not inform his philosophy, nor can his philosophy be applied to it. Heidegger saw Nazism in terms of its possibilities, hoping it would bring about a spiritual renewal of life. Heidegger’s philosophy did more than adopt the ideas and problems current in his immediate environment; it asked new questions and reinterpreted other philosophers. Rootlessness plays an important part in Heidegger’s thought. He links rootlessness with ‘technology’ and the capitalist mindset, and Jews with capitalism as well as with Bolshevism, which he regarded as another version of technology.
Investigating Variability in L2 Development: Extending a Complexity Theory Perspective on L2 Writing Studies and Authorial Voice
Authors: Fogal Gary G
Published: January 2019

Applying a complex dynamic systems view of writing development, this study explored how developmental variability can contribute to conceptualizing changes in L2 writing. Forty-two writing samples were collected from one Thai university student in Thailand studying actuary science in English. The writing samples were composed over four years and were holistically coded for degrees of appropriate authorial voice. Descriptive techniques, including linear and polynomial trend lines and a min-max graph, informed a visual inspection of the data. These techniques revealed quantitatively distinct projections of authorial voice that were marked by periods of progress and regress. A Monte Carlo simulation then tested the hypothesis that the variability was not due to chance. The analysis showed that variability played a statistically significant role in constructing authorial voice. This work demonstrates developmental behavior consistent with complex systems and how other measures of L2 writing mature and substantiates findings on the meaningful role variability contributes to L2 development. This study also expands the explanatory potential of complex dynamic systems theory for conceptualizing writing and more generally L2 development.
Death and Dying
Authors: Mackowiak Philip A.
Published: January 2019

Chapter 9 (“Death and Dying”) concerns a number of issues related to the end of life: the age-old question of what happens to one after death, the litany of problems encountered in old age, the mixed benefits of defying death, and the long history of assisted dying. These weighty issues and others are addressed in a series of compelling works that celebrate dying in the presence of friends and family, both glorify and demonize death in battle, and question the value of ICU care that suspends patients in a web of tubes and wires simply to create a kind of purgatory between life and death.
Altered Sex Ratios in Offspring of U.S. Submariners Urban Legend or Fact – Do Submariners Have More Daughters?
Authors: Kramer Kathleen , Raiciulescu Sorana , Olsen Cara , Hickey Kimberly , Ottolini Martin
Published: January 2019

Introduction

There is a widespread and long-held belief in the submarine community that submariners father more daughters than the general population. The U.S. Sex Ratio at birth (males/females) has remained around 1.05 since the early 2000s. Limited evidence exists that certain environmental exposures including chemicals, heavy metals, radiation and g-forces may influence sex ratio at birth. A reduction in male births in a population has been associated with lower male fertility. A 1970 single site study showed a higher ratio of female offspring in personnel serving aboard U.S. Navy nuclear submarines than the general population. A 2004 study concluded that this was probably not true. However, this study was small, and did not evaluate the difference between children conceived during sea duty versus shore duty. They did note a higher chance of female offspring correlated with a longer time in the community, as well as an increased ratio in sonar technicians. These findings warrant further investigation.

Methods

An electronic survey was e-mailed to submariners, after receiving required IRB and Navy approvals. Participants were asked birth year, year they entered submarine service, and how many children they had. For each child they were asked sex, child’s birth year, mother’s birth year, and whether they were on sea duty or shore duty at the time of conception. Those who were on sea duty at the time of conception were asked what their job was, where they were stationed and what type of submarine they were on. Those who were on shore duty at the time of conception were asked whether they were in contact with submarines on a regular basis, whether they were officer or enlisted, and what region they were stationed in for shore duty.

Results

Four thousand eight hundred responses were received with a total of 6,958 children included in the analysis. Respondents had a SR of 0.95 compared to 1.05 U.S. population in 2015 (p < 0.0001). Submariners on sea duty had a SR of 0.88 compared to 1.02 on shore duty (p = 0.007). Those who had regular submarine contact on shore duty had a SR of 0.72 compared to 1.17 in those who did not (p < 0.001). Geographical location during shore duty did show differences that were statistically significant (p = 0.018). Geographical location during sea duty did not show significant differences. No significant differences were seen for paternal age, maternal age, job during sea duty, type of submarine assigned to or time in community.

Conclusion

The submariners surveyed reported greater numbers of daughters than the general population, especially when on sea duty or in regular contact with submarines during shore duty. Further study should be done to confirm results and explore possible etiologies of differences in sex ratio.
The Relationship Between Gait Symmetry and Metabolic Demand in Individuals With Unilateral Transfemoral Amputation: A Preliminary Study
Authors: Mahon Caitlin E , Darter Benjamin J , Dearth Christopher L , Hendershot Brad D
Published: January 2019

Introduction

Temporal-spatial symmetry allows for optimal metabolic economy in unimpaired human gait. The gait of individuals with unilateral transfemoral amputation is characterized by temporal-spatial asymmetries and greater metabolic energy expenditure. The objective of this study was to determine whether temporal-spatial asymmetries account for greater metabolic energy expenditure in individuals with unilateral transfemoral amputation.

Materials and Methods

The relationship between temporal-spatial gait asymmetry and metabolic economy (metabolic power normalized by walking speed) was retrospectively examined in eighteen individuals with transfemoral amputation walking at a self-selected velocity overground. Pearson’s product-moment correlations were used to assess the relationship between: (1) step time symmetry and metabolic economy and (2) step length symmetry and metabolic economy. The retrospective analysis of this data was approved by the Walter Reed National Military Medical Center Institutional Review Board and all individuals provided written consent. Additional insights on this relationship are presented through a case series describing the temporal-spatial and metabolic responses of two individuals with transfemoral amputation who completed a split-belt treadmill walking test.

Results

For the cohort of individuals, there was no significant relationship between metabolic economy and either step time asymmetry or step length asymmetry. However, the case series showed a positive relationship between step length asymmetry and metabolic power as participants adapted to split-belt treadmill walking.

Conclusion

There is mixed evidence for the relationship between temporal-spatial asymmetries and metabolic energy expenditure. This preliminary study may suggest optimal metabolic energy expenditure in individuals with transfemoral amputation occurs at an individualized level of symmetry and resultant deviations incur a metabolic penalty. The results of this study support the idea that addressing only temporal-spatial gait asymmetries in individuals with transfemoral amputation through rehabilitation may not improve metabolic economy. Nevertheless, future prospective research is necessary to confirm these results and implications for clinical practice.
Risk Factors for Development of Carbapenem Resistance Among Gram-Negative Rods
Authors: Richter Stefan E , Miller Loren , Needleman Jack , Uslan Daniel Z , Bell Douglas , Watson Karol , Humphries Romney , McKinnell James A
Published: January 2019

Background

Infections due to carbapenem-resistant Gram-negative rods (CR-GNR) are increasing in frequency and result in high morbidity and mortality. Appropriate initial antibiotic therapy is necessary to reduce adverse consequences and shorten length of stay.

Methods

To determine risk factors for recovery on culture of CR-GNR, cases were retrospectively analyzed at a major academic hospital system from 2011 to 2016. Ertapenem resistance (ER-GNR) and antipseudomonal (nonertapenem) carbapenem resistance (ACR-GNR) patterns were analyzed separately. A total of 30951 GNR isolates from 12370 patients were analyzed, 563 of which were ER and 1307 of which were ACR.

Results

In multivariate analysis, risk factors for ER-GNR were renal disease, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-methicillin-resistant Staphylococcus aureus (anti-MRSA) agent in the prior 30 days (c-statistic, 0.74). Risk factors for ACR-GNR were male sex, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-MRSA agent in the prior 30 days (c-statistic, 0.76).

Conclusions

A straightforward scoring system derived from these models can be applied by providers to guide empiric antimicrobial therapy; it outperformed use of a standard hospital antibiogram in predicting infections with ER-GNR and ACR-GNR.
Bacteremic Community-Acquired Pneumonia in Ethiopian Children: Etiology, Antibiotic Resistance, Risk Factors, and Clinical Outcome
Authors: Negash Abel Abera , Asrat Daniel , Abebe Workeabeba , Hailemariam Tewodros , Hailu Tsegaye , Aseffa Abraham , Vaneechoutte Mario
Published: January 2019

Background

Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality. We sought to determine the magnitude, etiology, and risk factors of CAP in children 5 years after introduction of pneumococcal conjugate vaccine (PCV) 10 in Ethiopia.

Methods

We conducted a prospective observational study on the bacterial etiology and risk factors of CAP among children aged 0–15 years in 2 pediatric emergency departments in Addis Ababa, Ethiopia. Blood culture, antibiotic susceptibility testing, and amplification of pneumococcal lytA and cpsB genes were performed. Serotypes of Streptococcus pneumoniae were determined by Quellung reaction and sequencing the cpsB gene.

Results

Out of 643 eligible children, 549 were enrolled. The prevalence of bacteremic pneumonia was 5.6%. Staphylococcus aureus (26.5%) was the predominant pathogenic species, followed by Enterococcus faecium (11.8%), Escherichia coli (11.8%), and Klebsiella pneumoniae (11.8%). In univariate analysis, parental smoking and nonvaccination with PCV10 were associated with bacteremic CAP. In multivariable analysis, female sex (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1–4.9), weight-for-age z-score (WAZ) <–2 SDs (aOR, 2.2; 95% CI, 1.1–4.8), and lower chest indrawing (aOR, 0.44; 95% CI, 0.2–0.95) were independently associated with bacteremic CAP. The overall in-hospital case fatality rate was 2.37% (13/549), and WAZ <–3 SDs (OR, 13.5; 95% CI, 3.95–46.12) was associated with mortality.

Conclusions

Five years after the introduction of PCV10 in Ethiopia, S. aureus was the main cause of bacteremic CAP in children, the contribution of S. pneumoniae was low, and there was a high level of antibiotic resistance among isolates.
Controlled Pedicle Subtraction Osteotomy Site Closure Using Flexible Hinge-Powered Operating Table
Authors: Jones Kristen E , Hunt Matthew A , Martin Christopher T , Polly David W
Published: January 2019

BACKGROUND AND IMPORTANCE

Pedicle subtraction osteotomy (PSO) is a 3-column osteotomy used to correct rigid, large magnitude sagittal spinal deformity. PSO is an inherently destabilizing procedure intraoperatively, with high risk of neurological deficits from vertebral body subluxation or translation during osteotomy closure. Traditionally, PSO closure has been performed utilizing compression or cantilevering forces across adjacent level instrumentation. Such forces can loosen the instrumentation or cause abrupt subluxation or translation due to the magnitude of force required for PSO closure, resulting in neurological injury. Here, we report using a flexible hinge-powered operating table for controlled closure of PSO in 1º increments via remote-control power of the table, without compression or cantilevering force required across implants.

CLINICAL PRESENTATION

The patient is a 68-yr-old man with a history of prior L2-S1 anterior-posterior fusion, healed sacral fracture, and left sacroiliac joint fusion presenting to our institution with severe back pain while standing. X-rays demonstrated significant sagittal malalignment with pelvic incidence (PI) of 79º and lumbar lordosis (LL) of 37º, while computed tomography scan confirms complete bone healing around prior interbody fusion sites, resulting in rigid sagittal deformity. Due to rigid PI-LL mismatch of 42º, we planned for L2-pelvis revision fusion with L4 PSO.

CONCLUSION

Here we demonstrate the utility of a flexible hinge-powered operating table for closure of PSO site. This technique eliminates force application to adjacent implants, minimizing vertebral body subluxation, or translation. We believe this allows for safer, more controllable osteotomy closure that minimizes risk of neurological injury.
Beyond the Brochure
Authors: Knutzen Dana , Stoll Katie
Published: January 2019

Remarkable advancements related to preconception and prenatal genetic screening have emerged in recent years. While technology and testing options are more numerous and complex; fundamental genetic counseling issues remain the same. It is essential that with any prenatal genetic testing, women have an opportunity to make informed and autonomous decisions that are consistent with their personal needs and values. Opportunities to discuss testing options, including potential benefits and limitations, are often limited in obstetric visits due to time constraints or lack of sufficient provider education. As genetic testing is not considered a routine component of antepartum care, review of information regarding testing options is imperative so women can decide which, if any, testing to pursue. Developing new strategies to address the growing complexity of prenatal testing while ensuring provider education is accurate is crucial in imparting evidence-based care. This article will arm providers with the knowledge needed to educate women about currently available prenatal genetic screening and diagnostic tests along with guidance on the essential elements and importance of genetic counseling.
Plantar Pressure During Gait in Pregnancy-Related Pelvic Girdle Pain and the Influence of Pelvic Belts
Authors: Bertuit Jeanne , Leyh Clara , Feipel Veronique
Published: January 2019

Introduction

Many pregnant women experience pelvic girdle pain (PGP) during pregnancy. Etiologies are multifactorial and affect the joint stability of the sacroiliac joint. Pelvic belts could restore stability and help reduce pain during gait. The objectives were to analyze plantar pressure during gait in pregnant women with PGP, to evaluate the effect of pelvic belts, and to compare the effects of two types of belts on plantar pressure parameters.

Materials and Methods

Forty-six pregnant women with PGP, 58 healthy pregnant women, and 23 nonpregnant women were recruited. The motor task consisted of three-gait trials on a walkway. Plantar pressure was analyzed with four variables. Two types of pelvic belts for pregnant women were used.

Results

Plantar pressure in women with PGP compared with controls showed differences in all parameters: they displayed lower gait velocity and lower values for most pressure variables at the rear and forefoot (medial side). Conversely, these values were higher for the midfoot (lateral side). These alterations were also found in healthy pregnant women. There was no difference in plantar pressure between groups, those who had or had not used belts, and between the types of belt.

Conclusions

Pregnant women, with or without PGP, showed nearly the same changes in plantar pressure during gait. PGP did not change plantar pressure parameters. Wearing any of the belts during pregnancy did not have an effect on plantar pressure parameters during gait in pregnant women with PGP.
Three-dimensional printing of facial contour based on preoperative computer simulation and its clinical application
Authors: Zeng Hui , Yuan-Liang Shih , Xie Gan , Lu Feng , Fu Rong
Published: January 2019

Facial contouring is a complex procedure performed to alter tissue contents and restore facial appearance. However, it is difficult to measure the amount of the tissue volume that is needed. This study demonstrated the use of preoperative computer simulation (PCS) and 3-dimensional (3D) printing in contouring procedure to maximize outcomes.

Three-dimensional surface imaging (3DSI) or computed tomography imaging (CTI) data were reconstructed into a 3D model by Mimics software. PCS was performed by simulating the changes in bone and soft tissue. The stimulating volume change was calculated by Boolean operations. Finally, the virtual model was exported into 3D printer to produce physical templates to guide surgical plan. PCS and actual postoperative results were compared using objective rating scales and by cephalometrical measurements.

With the direct guidance of PCS and 3D templates, contouring procedure was performed accurately. Satisfactory facial contouring was achieved with less operative time. As the plastic surgery panel rated, 45.8% of the 3DSI results and 41.7% of the CTI results were identical with the actual outcome, and 0% of them was poor. There were no significant differences in patient satisfaction between the PCS of 3DSI and CTI.

Preoperative computer simulation is an accurate method for designing contour adjustment plans, and can be an efficient and reliable predictor of outcomes with customized templates.
A case report of successful treatment of necrotizing fasciitis using negative pressure wound therapy
Authors: de Paula Fabiana Martins , Pinheiro Edivania Anacleto , Oliveira Vanessa Marcon de , Ferreira Cristiane Munaretto , Monreal Maria Tereza Ferreira Duenhas , Rolan Marisa Dias , Matos Vanessa Terezinha Gubert de
Published: January 2019

Rationale:

Necrotizing fasciitis is a destructive tissue infection with rapid progression and high mortality. Thus, it is necessary that high-performance dressings be introduced as possibilities of treatment.

Patient concerns:

Female patient, 44 years of age, admitted to hospital unit complaining of lesion in the gluteal region and drainage of purulent secretion in large quantity followed by necrosis.

Diagnoses:

The diagnosis of necrotizing fasciitis was carried out with the computerized tomography examination result and its association with the patient's clinical condition.

Interventions:

Initially, successive debridements were carried out in lower limbs as well as primary dressing with enzymatic debriding action until indication of negative pressure wound therapy, for the period of 2 weeks in the right lower limb and for 5 weeks in the left lower limb, with changes every 72 h. Dressing with saline gauze was used at the end of this therapy until hospital discharge.

Outcomes:

After the use of negative pressure wound therapy, we observed the presence of granulation tissue, superficialization and reduction of lesion extension. The patient presented good tolerance and absence of complications.

Lessons:

Negative pressure wound therapy constituted a good option for the treatment of necrotizing fasciitis, despite the scarcity of protocols published on the subject.
Clinicopathologic and prognostic significance of tumor-infiltrating CD8+ T cells in patients with hepatocellular carcinoma
Authors: Xu Xuezhong , Tan Yulin , Qian Yan , Xue Wenbo , Wang Yibo , Du Jianguo , Jin Lei , Ding Wei
Published: January 2019

Background:

In patients with hepatocellular carcinoma (HCC), the clinicopathologic and prognostic roles of tumor-infiltrating CD8+ T cells for survival are still controversial. A meta-analysis was performed to resolve this issue.

Methods:

We identified studies from PubMed, Embase, and the Cochrane Library to evaluate the clinicopathologic and prognostic value of tumor-infiltrating CD8+ T cells in patients with HCC. A meta-analysis was conducted to estimate clinicopathologic characteristics, overall survival (OS), and disease-free survival. The hazard ratio (HR) and 95% confidence interval (CI) were calculated employing fixed-effect or random-effect models depending on the heterogeneity of the included trials.

Results:

A total of 3509 patients from 21 observational studies were enrolled. The meta-analysis revealed that high levels of intratumoral CD8+ tumor-infiltrating lymphocytes (TILs) were associated with better OS (OS; HR = 0.676, P = .001) and disease-free survival (disease-free survival [DFS]; HR = 0.712, P = .002). The pooled analysis also demonstrated high density of infiltration of CD8+ TILs in margin of tumor (MT) was statistically significant associated with better OS (HR = 0.577; P <.001). Moreover, the patients with low CD8+ TILs infiltration had negative HBSAg (OR = 1.67, P = .02), large tumor size (OR = 1.74, P <.01), and later TNM stage (OR = 1.70, P <.01).

Conclusions:

Our findings suggested that low levels of CD8+ TILs predict large tumor size, later TNM stage and might be a promising prognostic factor of HCC especially for Asian patients. High-quality randomized controlled trials are needed to determine if CD8+ TILs could serve as targets for immunotherapy in hepatocellular carcinoma.
Statin therapy and erythropoiesis-stimulating agent hyporesponsiveness in patients with nondialysis chronic kidney disease
Authors: Sui Zhun , Wang Mi , Zuo Li
Published: January 2019

Erythropoiesis-stimulating agents (ESAs) are frequently used among patients with renal anemia, while a significant proportion of patients exhibit ESA hyporesponsiveness despite adequate dosing. Previous studies have suggested an inverse association between ESA hyporesponsiveness and statin use among patients receiving dialysis therapy. However, studies based on predialysis patients are extremely limited.

Based on electronic medical records of a tertiary hospital in Beijing, China between April 2010 and April 2015, we investigated the association between statin use and ESA hyporesponsiveness among patients with predialysis-chronic kidney disease (CKD).

Altogether 232 patients with CKD initiating ESA therapy and with hemoglobin levels monitored for at least 6 months were included in our analyses. Among them, 77 (38.5%) were long-term statin users (regular statin treatment for more than 3 months) before ESA initiation. Overall, 6.5% of the statin users and 17.1% of nonusers were considered to have ESA hyporesponsiveness. Long-term statin therapy was significantly associated with a lower proportion of ESA hyporesponsiveness in fully adjusted model (odds ratio 0.15, 95% confidence interval: 0.03–0.64).

We found that long-term statin therapy was inversely associated with ESA hyporesponsiveness among predialysis patients with CKD. Further studies are needed to validate our observations, and to explore the potential mechanisms between ESA resistance and statin therapy.
Tenascin-C expression is significantly associated with the progression and prognosis in gastric GISTs
Authors: Shen Chaoyong , Wang Chengshi , Yin Yuan , Chen Huijiao , Yin Xiaonan , Cai Zhaolun , Chen Zhixin , Zhang Bo , Zhou Zongguang
Published: January 2019

Tenascin-C (TNC), an extracellular matrix glycoprotein, has been implicated in progression of various types of cancer. However, few reports exist on TNC expression in gastrointestinal stromal tumors (GISTs). We here attempted to investigate the expression pattern and prognostic significance of TNC in gastric GISTs. We studied TNC expression in 122 gastric GISTs tissue samples by immunohistochemistry, and examined the correlations of TNC expression with clinicopathological parameters and survival of gastric GISTs. The TNC-high expression was observed in 30 (24.6%) of 122 of gastric GISTs. The high levels of TNC expression in gastric GISTs was significantly associated with tumor size (P < .001), multivisceral resection (P = .006), metastasis at initial diagnosis (P = .006), mitotic count (P = .002) and NIH risk classification (P = .015). The TNC mRNA and protein levels were found to significantly downregulated in tumors without progression compared to those tumors which occurred tumor progression during the follow-up period (P < .05). As for the prognostic analysis, it revealed that tumor size, mitotic count, surgical margins, multivisceral resection, and TNC expression were independent predictors of PFS for gastric GISTs (P < .05). The overexpression of TNC may be as a possible marker for the metastatic potential of gastric GISTs patients.
The effectiveness of problem-based learning in pediatric medical education in China
Authors: Ma Yimei , Lu Xiaoxi
Published: January 2019

Background:

The aim of this meta-analysis is to assess the effectiveness of problem-based learning (PBL) in pediatric medical education in China.

Methods:

We searched Chinese electronic databases, including the China National Knowledge Infrastructure, WanFang Data, the China Science Periodical Database, and the Chinese BioMedical Literature Database. We also searched English electronic databases, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials. We searched for published studies that compared the effects of PBL and traditional lecture-based learning (LBL) on students’ theoretical knowledge, skill, and case analysis scores during pediatric medical education in China. All randomized controlled trials (RCTs) were included.

Results:

A total of 12 RCTs were included, with a total sample size of 1003 medical students. The PBL teaching model significantly increased theoretical knowledge scores (95% confidence interval [CI], 0.79–1.52; P < .00001), skill scores (95% CI, 0.87–2.25; P < .00001), and case analysis scores (P < .00001, I
2 = 88%) compared with those using the LBL teaching model alone.

Conclusion:

The current meta-analysis shows that PBL in pediatric medical education in China appears to be more effective than the traditional teaching method in improving theoretical knowledge, skill, and case analysis scores. However, a more controlled design of RCT is needed to confirm the above conclusions in future work.
Clinical characteristics and follow-up of benign convulsions with mild gastroenteritis among children
Authors: Ma Xiaohong , Luan Shaoyong , Zhao Yiming , Lv Xiumin , Zhang Ruiyun
Published: January 2019

Benign convulsions with mild gastroenteritis have a high incidence in the North China, previous reports it has been caused by rotavirus infection, which is a non-febrile convulsion. In recent years, we observed that norovirus infection gradually increased all the years round and most of them are febrile convulsion.

Retrospective analysis was performed on 55 pediatric patients with benign convulsions with mild gastroenteritis (CWG) who were admitted between January 2010 and January 2015.

The median age of the norovirus infection group was greater than that of the rotavirus infection group. Norovirus infection has no obvious seasonality. The peak age of benign CWG onset was less than 3 years (74.5%). In 69.1% of all cases, the temperature was less than 38 °C. In 70.9% of cases, children had experienced more than 2 episodes. In 96.4% of all cases, convulsive episodes were shorter than 5 min. Convulsions mostly occurred within the first 2 days (78.2%) after gastroenteritis tract symptoms. Most episodes featured generalized tonic-clonic seizure (87.3%). Serum Na+ levels were lower while other biochemical test results were normal. Follow-up 2 years attack again (16.8%), intelligence quotient was not reduced.

CWG febrile or afebrile occurs most frequently among young children. In addition to the rotavirus, the norovirus might also cause this syndrome. The prognosis is favorable and long-term anti-seizure treatment is considered to be unnecessary.
The safety and efficacy of acupuncture for erectile dysfunction
Authors: Wang Jisheng , Zhou Yu , Dai Hengheng , Bao Binghao , Dang Jin , Li Xiao , Wang Bin , Li Haisong
Published: January 2019

Background:

Erectile dysfunction is a common male disease, the constant pace of life, increasing pressure on life, and changes in diet, living environment, lifestyle, etc., lead to an increase in the number of patients with erectile dysfunction (ED). Acupuncture has been widely used in clinical trials of ED in recent years. There are many clinical trials that confirm that acupuncture can improve male erectile function. This study used a network meta-analysis (NMA) to compare the effectiveness and safety of different forms of acupuncture on ED.

Methods:

We will search for PubMed, Cochrane Library, AMED, EMBASE, WorldSciNet; Nature, Science online and China Journal Full-text Database (China National Knowledge Infrastructure), China Biomedical Literature CD-ROM Database (CBM), and related randomized controlled trials (RCTs) included in the China Resources Database. The time is limited from the construction of the library to December 2018. The quality of the included RCTs will be evaluated with the risk of bias tool and evidence will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. STATA 13.0 and WinBUGS 1.4.3 through the GeMTC package will be used to perform an NMA to synthesize direct and indirect evidence.
Prognostic value of pretreatment lymphocyte-to-monocyte ratio in patients with urologic tumors
Authors: Li Jialin , Cheng Yusheng , Ji Zhigang
Published: January 2019

Background:

The prognostic value of pretreatment lymphocyte to monocyte ratio (LMR) in patients with urologic tumors remains controversial. Therefore, we herein conducted a meta-analysis to systematically assess the prognostic value of LMR in patients with urologic tumors.

Methods:

We comprehensively searched PubMed, EMBASE and Web of Science to identify eligible studies. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to assess the prognostic value of LMR in patients with urologic tumors. This meta-analysis was registered in PROSPERO (CRD42018108959).

Results:

A total of 20 studies were included in this meta-analysis. Our synthesized analysis showed that low LMR was significantly correlated with poor overall survival (OS) and progression-free survival (PFS) in patients with upper tract urothelial cancer (UTUC). We also found that renal cell cancer (RCC) patients with low LMR had poor OS, PFS and cancer-specific survival (CSS). Besides, it was observed that low LMR predicted poor OS, RFS and CSS in patients with bladder cancer (BC).

Conclusion:

This meta-analysis demonstrated that pretreatment LMR is associated with survival, and may be a useful prognostic parameter in urologic tumors. Nevertheless, more prospective and heterogeneous studies with large samples are required to further confirm our findings before it is applied for daily clinical decision making.
Comparison of keyhole endoscopy and craniotomy for the treatment of patients with hypertensive cerebral hemorrhage
Authors: Sun Guoqing , Li Xiaolong , Chen Xiangtao , Zhang Yuhai , Xu Zhen
Published: January 2019

By comparing the intraoperative and postoperative conditions under different surgical methods, namely, keyhole endoscopy and craniotomy, we aim to provide more reasonable surgical treatment for patients with hypertensive cerebral hemorrhage.

Eighty-nine patients with cerebral hemorrhage at Rizhao People's Hospital between January 2015 and December 2016 were analyzed retrospectively. Patients were assigned to the keyhole endoscopy group and the craniotomy group. The intraoperative (the duration of operation, operative blood transfusion and loss, and hematoma clearance rate) and the postoperative parameters (death rate, rebleeding rate, edema, and postoperative activity of daily living [ADL] scores) of the 2 groups were compared.

Compared with the craniotomy group, the keyhole endoscopy group exhibited decreases in mean blood loss (P < .05, 180 ± 13.6 mL vs 812 ± 35.2 mL), blood transfusion (P < .05, 0 mL vs 480 ± 13.6 mL), the average surgical duration of operation (P < .05, 113 ± 14.3 minutes vs 231 ± 26.1 minutes), and the severe edema rate (P < .05, 10.9% vs 72.1%) and increases in the average hematoma clearance rate (P < .05, 95.6% vs 82.3%) and postoperative ADL scores (P < .05, 85.2% vs 39.0%). Neither the death rate (P > .05, 4.3% vs 4.7%) nor rebleeding rate (P > .05, 2.2% vs 2.3%) showed any obvious changes.

Keyhole endoscopy for the treatment of hypertensive intracerebral hemorrhage has the advantages of minimal trauma with good effects, and its main reason for short operation time, reduced bleeding, and high hematoma clearance rate is the “brain-hematoma” pressure gradient. Use of the intraoperative micropull technique and removal of intracerebral hematoma in the shortest time possible are critical factors contributing to the high ADL scores in the keyhole endoscopy group. However, further validation on a larger sample size is required.
Diagnostic and Therapeutic Approach in Paediatric Inflammatory Bowel Diseases
Authors: Bronsky Jiri , de Ridder Lissy , Ruemmele Frank M. , Griffiths Anne , Buderus Stephan , Hradsky Ondrej , Hauer Almuthe Christina
Published: January 2019

Objectives:

Despite existence of international guidelines for diagnosis and management of inflammatory bowel diseases (IBD) in children, there might be differences in the clinical approach.

Methods:

A survey on clinical practice in paediatric IBD was performed among members of the ESPGHAN Porto IBD working group and interest group, PIBD‐NET, and IBD networks in Canada and German‐speaking countries (CIDsCANN, GPGE), using a web‐based questionnaire. Responses to 63 questions from 106 paediatric IBD centres were collected.

Results:

Eighty‐four percentage of centres reported to fulfil the revised Porto criteria in the majority of patients. In luminal Crohn disease (CD), exclusive enteral nutrition is used as a first‐line induction therapy and immunomodulators (IMM) are used since diagnosis in the majority of patients. Infliximab (IFX) is mostly considered as first‐line biological. Sixty percentage of centres have experience with vedolizumab and/or ustekinumab and 40% use biosimilars. In the majority of ulcerative colitis (UC) patients 5‐aminosalicylates are continued as concomitant therapy to IMM (usually azathioprine [AZA]/6‐MP). After ileocaecal resection (ICR) in CD patients without postoperative residual disease, AZA monotherapy is the preferred treatment.

Conclusions:

A majority of centres follows both the Porto diagnostic criteria as well as paediatric (ESPGHAN/ECCO) guidelines on medical and surgical IBD management. This reflects the value of international societal guidelines. However, potentially desirable answers might have been given instead of what is true daily practice, and the most highly motivated people might have answered, leading to some bias.
Impact of Immunosuppression on Executive Functioning After Pediatric Liver Transplantation
Authors: Goldschmidt Imeke , van Dick Rolf , Jacobi Christoph , Junge Norman , Pfister Eva , Richter Nico , Baumann Ulrich
Published: January 2019

Objectives:

Children after liver transplantation show increased rates of impaired cognitive functioning. We aimed to assess the potential effects of immunosuppressive therapy on executive functioning measured by the Children's Color Trail Test and the cognitive functioning module of the PedsQL (cogPedsQL) in liver transplanted children to explore potential targets for intervention to improve executive functioning.

Methods:

We performed a cross‐sectional study in 155 children (78 girls) aged 10.4 (2–18) years at 5.0 (0.1–17) years after liver transplantation, with follow‐up at 6 months in n = 114. Executive functioning was assessed by Children's Color Trail Test (ages 8–16) and by patients and parent‐proxy cogPedsQL (ages 5–18/2–18, respectively). Results were correlated with clinical parameters. Stability of results over time was compared between n = 23 patients who for clinical reasons switched from twice daily calcineurin inhibitor (CNI) to once‐daily slow‐release tacrolimus (Tac) during the study period, and patients with unchanged CNI.

Results:

Worse executive functioning was associated with longer stay in the intensive care unit and longer time elapsed since transplantation. No difference was found between users of cyclosporine and Tac. Children on once‐daily slow‐release Tac performed better than children on twice‐daily Tac. In children who switched from twice‐daily CNI to once‐daily Tac, parent‐proxy cogPedsQL improved significantly compared to stable results in the nonswitch group.

Conclusions:

In addition to a strong impact of disease burden around transplantation, executive functioning appears to deteriorate over time. Although there is no clear‐cut advantage of any CNI, once‐daily Tac appears to be advantageous compared to twice‐daily Tac.
Pediatric Endoscopy and High‐risk Patients
Authors: Lightdale Jenifer R. , Liu Quin Y. , Sahn Benjamin , Troendle David M. , Thomson Mike , Fishman Douglas S. ,   NASPGHAN Endoscopy and Procedures Committee
Published: January 2019

Pediatric gastrointestinal endoscopy has been established as safe and effective for diagnosis and management of many pediatric gastrointestinal diseases. Nevertheless, certain patient and procedure factors should be recognized that increase the risk of intra‐ and/or postprocedural adverse events (AEs). AEs associated with endoscopic procedures can broadly be categorized as involving sedation‐related physiological changes, bleeding, perforation, and infection. Factors which may increase patient risk for such AEs include but are not limited to, cardiopulmonary diseases, anatomical airway or craniofacial abnormalities, compromised intestinal luminal wall integrity, coagulopathies, and compromised immune systems. Examples of high‐risk patients include patients with congenital heart disease, craniofacial abnormalities, connective tissues diseases, inflammatory bowel disease, and children undergoing treatment for cancer. This clinical report is intended to help guide clinicians stratify patient risks and employ clinical practices that may minimize AEs during and after endoscopy. These include use of CO2 insufflation, endoscopic techniques for maneuvers such as biopsies, and endoscope loop‐reduction to mitigate the risk of such complications such as bleeding and intestinal perforation. Endoscopic infection risk and guidance regarding periprocedural antibiotics are also discussed.
Factors Influencing Discharge Readiness After Total Knee Replacement
Authors: Causey-Upton Renee , Howell Dana M. , Kitzman Patrick H. , Custer Melba G. , Dressler Emily V.
Published: January 2019

Total knee replacement (TKR) surgery has been found to achieve positive outcomes for many patients such as reduced pain and increased function. However, some patients experience suboptimal outcomes including falls, readmission to hospital, and reduced functional performance. Preparation for discharge after TKR surgery is often defined related to pain control, walking, knee function, and ability to climb stairs. These measures may not fully encompass aspects of recovery that impact patients' readiness for discharge after surgery. The purpose of this article is to review discharge readiness following TKR surgery and discuss factors that are known to impact preparedness for discharge.