bluuebunny/crossref_metadata_2025 huggingface dataset:
Mobilising Q methodology within a realist evaluation: Lessons from an empirical study
Authors: Harris Kevin , Henderson Steven , Wink Brian
Published: April 2019

Realist evaluation and Q methodology are established approaches in social science. However, integration of Q methodology within a realist evaluation is scarce. This article attempts to illustrate (through a recent evaluation) how Q methodology can support a realist evaluation. The article attempts to capture the philosophical compatibility of the two approaches creating an argument for Q’s integration within realist evaluation. Through the case study selected (a realist evaluation of an evaluation capacity building framework), the iterative methodological process is presented, capturing a snapshot of the findings from the evaluation. This illuminates how Q met the philosophical aims of a realist evaluation to make sense of how, why and under what circumstances a programme or intervention works. It is argued that Q methodology is entirely suitable for capturing the three key stages in a realist evaluation of developing, testing and refining programme theory. It is intended that this article can contribute to inspire other realist evaluators and methodologists to make use of Q as a tool in their evaluation.
Thinking an ethics of gender exploration: Against delaying transition for transgender and gender creative youth
Authors: Ashley Florence
Published: April 2019

Youth explore their genders – both theirs and those of others. Exploration is not only a vessel of discovery and understanding but also of creation. Centring the notion of gender exploration, this article inquires into the ethical issues surrounding care for transgender youth. Arguing that exploration is best seen not as a precondition to transition-related care but as a process that can operate through transitioning, the article concludes that the gender-affirmative approach to trans youth care best fosters youth’s capacity for healthy exploration. Unbounded social transition and ready access to puberty blockers ought to be treated as the default option, and support should be offered to parents who may have difficulty accepting their youth.
Specialist training influences the ability to recognise orthodontic case complexity
Authors: Akyalcin Sercan
Published: April 2019

General dentists and other dental specialists may be treating orthodontic cases without a proper understanding of the key components of malocclusion. This mini-review aims to identify the discrepancies in recognition of orthodontic case complexity and to give an insight as to why advanced speciality training is a must for the provision of comprehensive orthodontic care.
Quantum chemical study of the mechanism of the palladium-catalysed C−H acetoxylation of benzene
Authors: Beyzaie Nazanin , Tayyari Sayyed Faramarz , Vakili Mohammad , Beyramabadi Safar Ali
Published: April 2019

In this work, the mechanism of the palladium-catalysed acetoxylation of benzene C-H has been studied theoretically in detail. Based on experimental studies, a four-step mechanism for this reaction had been proposed, that is, C−H activation of benzene is the rate-determining step which forms an intermediate ( k1 pathway) which is subsequently oxidized to produce a high-valent Pd intermediate ( k2 pathway). Using quantum chemical calculations, all pathways were investigated, and the activation energy, activation enthalpy and activation Gibbs free energy for all steps were calculated and compared with each other. It was determined that the RDS proceeds through a square complex instead of a T-shaped complex. The activation energy related to the k2 pathway is higher than that of the RDS, and therefore, a new mechanism is proposed.
Characteristics of software used in self-management of vitamin K antagonist therapy: A systematic review
Authors: Naderi Haji Mohammadreza , Moghaddasi Hamid , Sharif-Kashani Babak , Kazemi Alireza , Rahimi Forugh
Published: April 2019

Introduction and goal:

Currently, 1–2% of the population in developed countries are under treatment with oral anticoagulants. An appropriate strategy to deal with this increase in demand of treatment with oral anticoagulants and to manage the costs is the transfer of part or all of the responsibility for managing treatment to the patients. The use of information technology, particularly electronic health software, can be an appropriate method to improve the quality of self-management of treatment with these drugs. Therefore, this systematic review investigated studies that discuss the characteristics of electronic health software in self-management of oral anticoagulation therapy.

Method:

A systematic review based on PRISMA protocol was conducted. In this study, articles were investigated that were in English. Articles existing in Cochrane, EMBASE and PubMed databases were searched up to 14 May 2017. Then, articles searched through Google Scholar were added to this study.

Findings:

The common characteristics used in most software included ‘encryption in exchanging information’, having an ‘instruction module’ and ‘being Android-based’. In terms of functionality, ‘communication between the patient and healthcare team’ existed in most of the software.

Conclusion:

The results of the study showed that the accuracy of administration of the dose of the drug using computer to reach a target international normalized ratio level was not less than those administered with experienced medical staff. In addition, the results indicated that important characteristics of the software include encryption in exchanging information, instruction module and Android-based instruction module. The most important characteristic was the interaction between the patient and the healthcare team.
Governing of young people ‘at risk’ with the alliance of employability and precariousness in the EU youth policy steering
Authors: Mertanen Katariina , Pashby Karen , Brunila Kristiina
Published: April 2019

This article focuses on neoliberal governing by the European Union of cross-sectoral youth policies directed at young people ‘at risk’. The aim is to show how the alliance of discourses of employability and precariousness in these policies has emerged and how these discourses operate in policy. In the article, we analyse European Council and European Commission policy documents from 2000 to 2016 by drawing on the idea of discourses and governing with neoliberal political rationality. Our results show that the financial crisis and policy initiatives launched to mitigate its consequences made it possible to mainstream the neoliberal rationality of individual competition and flexibility as an inseparable part of youth policy steering.
Optimization of air permeability of spunlaced filter fabrics using the Box–Behnken experimental design
Authors: Maduna Lebo , Patnaik Asis , Mvubu Mlando , Hunter Lawrance
Published: April 2019

One of the most important characteristics that a filter must possess is high air permeability. A good filter fabric must be able to capture the dust particles while maintaining a good airflow through it in order to reduce high pressure drop. Therefore, producing a filter fabric with the desired air permeability can be challenging as several process parameters such as fiber types, area weight and water jet pressure will interact with each other during spunlacing process and influence the fabric air permeability. To study the effects of these independent variables on the air permeability of three different types of spunlaced fabrics, the Box–Behnken design was used to model their effects. The fibers used were polyacrylonitrile, polyphenylene sulfide and blend of polyphenylene sulfide/polyimide. In addition, filtration properties of some of the filter samples were also evaluated. Based on the effects of the fiber types, area weight and water jet pressure on the fabric air permeability, the optimum conditions for achieving higher air permeability were fiber types (+1 level), area weight (0 level) and pressure (−1 level), respectively. The air permeability of the fabrics decreased with increasing water jet pressure for all fiber types and increasing area weight decreased the air permeability. It was observed that the independent variables had a significant effect on the air permeability. Filtration efficiency of the selected filters samples were ≥95%. Among the selected samples, polyphenylene sulfide/polyimide (440 g/m2) fabric has the lowest pressure drop whereas polyacrylonitrile (560 g/m2) has the highest pressure drop.
Impact of Coexisting Overactive Bladder in Medicare Patients With Dementia on Clinical and Economic Outcomes
Authors: Caplan Eleanor O. , Abbass Ibrahim M. , Suehs Brandon T. , Ng Daniel B. , Gooch Katherine , van Amerongen Derek
Published: April 2019

Background:

Patients with dementia commonly suffer from symptoms of overactive bladder (OAB); however, limited research exists on the clinical impact of coexisting OAB among patients with dementia. As such, the objective of this study was to examine the impact of OAB on clinical outcomes, health-care resource use, and associated costs among patients with dementia.

Methods:

We conducted a retrospective cohort analysis of patients with dementia using 3861 matched pairs of patients with and without OAB. Analyses were based on administrative claims data from January 1, 2007, to September 30, 2015, and compared clinical outcomes, health services use, and associated costs.

Results:

Patients with dementia and OAB were more likely than those without OAB to have least one fall (incidence rate ratio [IRR]: 1.43, 95% confidence interval [CI], 1.22-1.68, P < .001), fracture (IRR: 1.23, 95% CI, 1.05-1.44, P = .008), combined fall/fracture (IRR: 1.25, 95% CI, 1.11-1.42, P < .001), or urinary tract infection (IRR: 2.75, 95% CI, 2.55-2.96, P < .001). Patients with dementia and OAB demonstrated greater utilization of all-cause encounter types compared to similar patients without coexisting OAB ( P < .01). All-cause and dementia-related total health-care costs were approximately 23% (95% CI, 0.19-0.28, P < .001) and 13% (95% CI, 0.05-0.20, P = .001), respectively, greater than similar patients without coexisting OAB.

Conclusion:

Coexisting OAB was associated with impacts on clinical outcomes, health-care resource utilization, and costs in patients with dementia.
Cancer registries - guardians of breast cancer biomarker information: A systematic review
Authors: Voith von Voithenberg Lena , Crocetti Emanuele , Martos Carmen , Dimitrova Nadya , Giusti Francesco , Randi Giorgia , Rooney Roisin , Dyba Tadeusz , Bettio Manola , Negrão Carvalho Raquel
Published: April 2019

Background:

Breast cancer is the most common cancer and the leading cause of cancer-related death in females, with a large societal and economic impact. Decisions regarding its treatment are largely affected by the categorization into different subtypes with hormone receptor status and HER2 status being the most important predictive factors. Other biological markers play an important role for prognostic and predictive reasons. The data collection and harmonization of cancer cases are performed by cancer registries whose collection of parameters largely differs, partially including results from biomarker testing.

Methods:

This systematic literature review consisting of a total of 729 reports determined whether information about biomarker testing in breast cancer cases is collected and published by cancer registries worldwide.

Results:

The number of publications using breast cancer biomarker data from registries steeply rose with the beginning of the 21st century and some hospital-based and population-based cancer registries reacted with immediate collection of biomarker data following the recommendation of clinical guidelines. For female breast cancer, biomarkers have achieved an essential clinical value and this review points to a steady increase in the collection of biomarker data by cancer registries during the last decade.

Conclusions:

In the future, recommendations for biomarker data collection and coding by cancer registries may be required to ensure harmonization and comparability of the data.
Association of STMN1 with survival in solid tumors: A systematic review and meta-analysis
Authors: Zhang Dan , Dai Lizhen , Yang ZengXi , Wang XiChen , LanNing Yin
Published: April 2019

Background:

The prognostic value of Stathmin 1 (STMN1) in malignant solid tumors remains controversial. Thus, we conducted this meta-analysis to summarize the potential value of STMN1 as a biomarker for predicting overall survival in patients with solid tumor.

Methods:

We systematically searched eligible studies in PubMed, Web of Science, and EMBASE from the establishment date of these databases to September 2018. Hazard ratio (HR) and its 95% confidence interval (CI) was used to assess the association between STMN1 expression and overall survival.

Results:

A total of 25 studies with 4625 patients were included in this meta-analysis. Our combined results showed that high STMN1 expression was associated with poor overall survival in solid tumors (HR = 1.85, 95% CI 1.55, 2.21). In general, our subgroup and sensitivity analyses demonstrated that our combined results were stable and reliable. However, from the results of the subgroups we found that high STMN1 expression was not related to overall survival in colorectal cancer and endometrial cancer anymore, suggesting that much caution should be taken to interpret our combined result, and more studies with large sample sizes are required to further explore the prognostic value of STMN1 expression in the specific type of tumors, especially colorectal cancer and endometrial cancer.

Conclusions:

STMN1 could serve as a prognostic biomarker and could be developed as a valuable therapeutic target for patients with solid tumors. However, due to the limitations of the present meta-analysis, this conclusion should be taken with caution. Further studies adequately designed are required to confirm our findings.
Cell-free microRNAs as non-invasive biomarkers in glioma: a diagnostic meta-analysis
Authors: Wang Jinfeng , Che Fengyuan , Zhang Jinling
Published: April 2019

Objective:

Since the diagnostic value of microRNAs for detecting glioma is contentious, we aimed to carry out a meta-analysis to synthetically evaluate the diagnostic significance of cell-free microRNAs in cerebrospinal fluid and blood in the detection of glioma.

Methods:

A systematic document retrieval of public databases was performed to obtain eligible studies. Specificity was applied to draw the summary receiver operator characteristic (SROC) curve against sensitivity, and the pooled diagnostic efficiency was assessed by generating the area under the SROC curve. Meta-regression and subgroup analyses were utilized to explore the latent sources of heterogeneity. STATA 12.0, RevMan 5.3 and Meta-DiSc 1.4 were used to conduct all statistical analyses.

Results:

A total of 47 studies from 20 articles comprising 2262 glioma patients and 1986 controls were included in our meta-analysis. Cell-free microRNAs exhibited relatively good diagnostic efficiency in glioma detection, with a sensitivity of 0.83, a specificity of 0.87, and an area under the curve of 0.91. Cell-free miR-21 performed best with pooled area under the curve of 0.88, followed by miR-125 and miR-222. Subgroup analyses and meta-regression indicated that there was substantial heterogeneity existing among the studies, which was in part caused by sample size, World Health Organization grade, reference gene, microRNA origin (extracellular vesicles or non-extracellular vesicle-based-microRNA), microRNA profiling (single- or multiple-microRNA), specimen types, and ethnicity.

Conclusions:

Cell-free microRNAs in cerebrospinal fluid and blood may play an important role as promising non-invasive biomarkers in the early diagnosis of glioma. Further comprehensive forward-looking research is required to validate their clinical significance in glioma diagnosis.
Concerns, coping and the electronic Holistic Needs Assessment: experiences of UK breast cancer survivors
Authors: Briggs Lydia , Cooper Joanne , Cox Karen , Blake Holly
Published: April 2019

Background

Physical and psychological concerns associated with a breast cancer diagnosis continue long after treatment. Macmillan Cancer Support developed an electronic Holistic Needs Assessment (eHNA) to help identify these concerns and allow a healthcare professional to address these as part of The Recovery Package.

Aims

The study aim was to understand the women’s experiences of having breast cancer, and of completing Macmillan’s eHNA as part of their care.

Methods

A qualitative approach was adopted. Semi-structured interviews were undertaken with 15 women, 12–18 months following surgical treatment for invasive breast cancer. Thematic analysis identified key themes.

Results

Four main themes were identified in relation to experiences of the eHNA, experiences of breast cancer, coping with breast cancer and the psychological effects of surviving. Perceptions towards the eHNA varied; some women viewed the eHNA as a research tool for hospital use rather than a beneficial aspect of their care. Several participants felt unable to raise their psychological concerns on the eHNA.

Conclusions

Although experiences differ, psychological issues remain a key factor for women with breast cancer, lasting long after treatment. The eHNA is not currently used to its potential or recognised by women as a tool to support their care. Further research is needed into how the eHNA can be used effectively to capture psychological concerns and determine best approaches to implementation of the tool to support individualised care.
A design framework for realizing multifunctional wings for flapping wing air vehicles using solar cells
Authors: Holness Alex E , Solheim Hannah , Bruck Hugh A , Gupta Satyandra K
Published: April 2019

Long flight durations are highly desirable to expand mission capabilities for unmanned air systems and autonomous applications in particular. Flapping wing aerial vehicles are unmanned air system platforms offering several performance advantages over fixed wing and rotorcraft platforms, but are unable to reach comparable flight times when powered by batteries. One solution to this problem has been to integrate energy harvesting technologies in components, such as wings. To this end, a framework for designing flapping wing aerial vehicle using multifunctional wings using solar cells is described. This framework consists of: (1) modeling solar energy harvesting while flying, (2) determining the number of solar cells that meet flight power requirements, and (3) determining appropriate locations to accommodate the desired number of solar cells. A system model for flapping flight was also developed to predict payload capacity for carrying batteries to provide energy only for power spikes and to enable time-to-land safely in an area where batteries can recharge when the sun sets. The design framework was applied to a case study using flexible high-efficiency (>24%) solar cells on a flapping wing aerial vehicle platform, known as Robo Raven IIIv5, with the caveat that a powertrain with 81% efficiency is used in place of the current servos. A key finding was the fraction of solar flux incident on the wings during flapping was 0.63 at the lowest solar altitude. Using a 1.25 safety factor, the lowest value for the purposes of design will be 0.51. Wind tunnel measurements and aerodynamic modeling of the platform determined integrating solar cells in the wings resulted in a loss of thrust and greater drag, but the resulting payload capacity was unaffected because of a higher lift coefficient. A time-to-land of 2500 s was predicted, and the flight capability of the platform was validated in a netted test facility.
Simulating unmanned aerial vehicle swarms with the UB-ANC Emulator
Authors: Modares Jalil , Mastronarde Nicholas , Dantu Karthik
Published: April 2019

Recent advances in multi-rotor vehicle control and miniaturization of hardware, sensing, and battery technologies have enabled cheap, practical design of micro air vehicles for civilian and hobby applications. In parallel, several applications are being envisioned that bring together a swarm of multiple networked micro air vehicles to accomplish large tasks in coordination. However, it is still very challenging to deploy multiple micro air vehicles concurrently. To address this challenge, we have developed an open software/hardware platform called the University at Buffalo’s Airborne Networking and Communications Testbed (UB-ANC), and an associated emulation framework called the UB-ANC Emulator. In this paper, we present the UB-ANC Emulator, which combines multi-micro air vehicle planning and control with high-fidelity network simulation, enables practitioners to design micro air vehicle swarm applications in software and provides seamless transition to deployment on actual hardware. We demonstrate the UB-ANC Emulator’s accuracy against experimental data collected in two mission scenarios: a simple mission with three networked micro air vehicles and a sophisticated coverage path planning mission with a single micro air vehicle. To accurately reflect the performance of a micro air vehicle swarm where communication links are subject to interference and packet losses, and protocols at the data link, network, and transport layers affect network throughput, latency, and reliability, we integrate the open-source discrete-event network simulator ns-3 into the UB-ANC Emulator. We demonstrate through node-to-node and end-to-end measurements how the UB-ANC Emulator can be used to simulate multiple networked micro air vehicles with accurate modeling of mobility, control, wireless channel characteristics, and network protocols defined in ns-3.
Surgical treatment of chronic anterior radial head dislocations in missed Monteggia lesions in children: A rationale for treatment and pearls and pitfalls of surgery
Authors: Langenberg LC , Beumer ACH , The B , Koenraadt KLM , Eygendaal D
Published: April 2019

Introduction

The treatment of chronic radial head dislocations after Monteggia lesions in children can be challenging. This article provides a detailed description of the most frequently performed surgical technique: an ulna osteotomy followed by annular ligament reconstruction. Accordingly, we present the clinical and radiological results of 10 paediatric cases.

Material and methods

All paediatric patients that had a corrective osteotomy of the ulna for a missed Monteggia lesion between 2008 and 2014 were evaluated with standard radiographs and clinical examination. A literature search was performed to identify the relevant pearls and pitfalls of surgery. Primary outcome was range of motion.

Results

We included 10 patients, with a mean follow-up of 2.5 years. Postoperative range of motion generally improved 30.7°. Even in a patient with obvious deformity of the radial head, range of motion improved after surgery, without residual dislocation of the radial head.

Conclusion

Corrective proximal ulna osteotomy with rigid plate fixation and annular ligament reconstruction yields good results in patients with chronic radial head dislocation following a Monteggia lesion. Surgery should be considered regardless of patient age or time since trauma. Given substantial arguments in literature, we discourage surgery if a CT scan shows dome-shaped radial head dysmorphic features in work-up to surgery.
The management of infected shoulder arthroplasty by two-stage revision
Authors: Brown Matthew , Eseonu Kelechi , Rudge Will , Warren Simon , Majed Addie , Bayley Ian , Higgs Deborah , Falworth Mark
Published: April 2019

Background

There remains no gold standard management for deep shoulder periprosthetic joint infection (PJI). This case series aims to present our experience of two-stage revision arthroplasty, including eradication of infection and reoperation rates.

Methods

We retrospectively reviewed patients undergoing revision arthroplasty for shoulder PJI between 2006 and 2015. Cases were confirmed using Musculoskeletal Infection Society (MSIS) and American Academy of Orthopaedic Surgeons (AAOS) guidelines. TSA removal, debridement and irrigation preceded antibiotic-loaded cement spacer insertion and a minimum of six weeks intravenous antibiotics. Reimplantation was performed as a second stage following a negative aspirate.

Results

Twenty-eight patients underwent a first stage procedure (mean age 69 years; 16 male, 12 female). Propionibacterium acnes, Methicillin-sensitive Staphylococcus aureus, Coagulase-negative Staphylococcus and Staphylococcus epidermidis were the commonest microorganisms cultured. Five cases had mixed growths and six cases provided no growth. Three patients did not proceed to a second stage. Twenty-five patients underwent reimplantation (mean interval 6.7 months), with 80% remaining infection-free (mean follow-up 38.3 months).

Discussion

Managing complex and late presentation shoulder PJI with two-stage revision is associated with high rates of infection eradication (80%). In the absence of a management consensus, our experience supports two-stage revision arthroplasty for eradicating infection in this complex patient group.
European criminal justice in the European and global context
Authors: Vervaele John A.E.
Published: April 2019

European criminal justice is not only about harmonization and Europeanization of the domestic criminal justice systems but also about common criminal policies and shared values, including key values related to the rule of law. What has been achieved in the European integration process and what are the challenges ahead of us? The author assesses this in the area of harmonization of substantive criminal law and criminal procedure; mutual recognition; European judicial agencies and the external dimension of the Area of Freedom, Security and Justice.
Poor adherence to guideline recommendations among patients with atrial fibrillation and acute myocardial infarction
Authors: Jortveit Jarle , Pripp Are H , Langørgen Jørund , Halvorsen Sigrun
Published: April 2019

Background

The prevalence of atrial fibrillation in patients with acute myocardial infarction is largely unknown. The aims of the present study were to assess the prevalence of atrial fibrillation in a nationwide cohort of patients with acute myocardial infarction, to assess the prescription of anticoagulation therapy, and to study the long-term outcomes.

Design

A nationwide registry-based cohort study.

Methods

All patients registered in the Norwegian Myocardial Infarction Registry between 2013 and 2016 were included and followed up through 2017. Stroke rates during follow-up were obtained through linkage with the Norwegian Patient Registry.

Results

In total, 47,204 patients were registered in the Norwegian Myocardial Infarction Registry. Atrial fibrillation on admission was recorded in 5393 (11%) patients, and 2190 (5%) additional patients developed atrial fibrillation during their hospital stay. Only 45% of patients with atrial fibrillation on admission and CHA2DS2-VASc score ≥ 2 were treated with anticoagulation therapy prior to myocardial infarction, and 56% of patients with atrial fibrillation and CHA2DS2-VASc score ≥ 2 were prescribed anticoagulation therapy at discharge. Patients with myocardial infarction and atrial fibrillation had an increased risk of stroke or death during 822 (426, 1278) days of follow-up compared with patients without atrial fibrillation (multivariate adjusted hazard ratio 1.4, 95% confidence interval 1.3–1.4).

Conclusions

Almost half of patients with atrial fibrillation and myocardial infarction were not prescribed the guideline recommended treatment with anticoagulation therapy at discharge, and their long-term risk of stroke and death was increased compared with patients without atrial fibrillation. Increased efforts to improve the treatment of patients with myocardial infarction and atrial fibrillation are needed.
Association between sleep duration, sleep quality and hyperlipidemia in middle-aged and older Chinese: The Dongfeng–Tongji Cohort Study
Authors: Wang Dongming , Chen Jianghao , Zhou Yun , Ma Jixuan , Zhou Min , Xiao Lili , He Meian , Zhang Xiaomin , Guo Huan , Yuan Jing , Chen Weihong
Published: April 2019

Aims

This study aimed to evaluate the relationship between sleep duration, sleep quality and hyperlipidemia in middle-aged and older Chinese.

Methods

We included 20,712 individuals at baseline from September 2008 to June 2010, and they were followed-up until October 2013. Hyperlipidemia was defined according to the Chinese guidelines on the prevention and treatment of dyslipidemia in adults. Sleep duration was self-reported and sleep quality was evaluated with a questionnaire that was designed according to the Pittsburgh Sleep Quality Index. Logistic regression and Cox proportional hazard models were conducted to explore the associations.

Results

In the cross-sectional analyses, longer sleep duration (≥10 h) was significantly associated with higher prevalence of hyperlipidemia (odds ratio (OR) = 1.17, 95% confidence interval (CI) = 1.02–1.35) after adjusting for potential confounders. The ORs of hyperlipidemia were significantly elevated among participants with impaired sleep quality (OR = 1.14, 95% CI = 1.08–1.22) and poor sleep quality (OR = 1.20, 95% CI = 1.08–1.34) when compared to those with good sleep quality. In the longitudinal analyses, compared to participants with a sleep duration of 7–<8 h, those with a sleep duration of 9–<10 h (hazard ratio (HR) = 1.19, 95% CI = 1.04–1.35) and ≥10 h (HR = 1.27, 95% CI = 1.02–1.58) showed significantly higher risk of hyperlipidemia after adjusting for potential confounders. However, no statistically significant association was found between impaired or poor sleep quality and hyperlipidemia.

Conclusions

Longer sleep duration was significantly associated with higher risk of hyperlipidemia. Impaired or poor sleep quality were associated with elevated prevalence of hyperlipidemia, but not with the incidence of hyperlipidemia.
Impact of a cardiovascular disease risk screening result on preventive behaviour in asymptomatic participants of the ROBINSCA trial
Authors: Denissen Sabine JAM , van der Aalst Carlijn M , Vonder Marleen , Oudkerk Matthijs , de Koning Harry J
Published: April 2019

Introduction

A teachable moment for preventive behavioural change can occur when asymptomatic individuals receive their cardiovascular disease screening result. This study investigated prevention-seeking behaviour and compliance with preventive treatment of participants of the population-based Risk Or Benefit IN Screening for CArdiovascular disease (ROBINSCA) trial after receiving a screening result.

Methods

Asymptomatic Dutch individuals ( n = 43,447) were randomly assigned (1:1:1) to screening for cardiovascular disease by either traditional risk assessment (intervention arm A), or determining the amount of coronary artery calcification (intervention arm B), or to usual care (control arm). A random sample ( n = 600) of ROBINSCA participants with a screening result (arms A and B) received an online questionnaire (in 2017) to measure the impact of a cardiovascular disease screening result in low and increased (arm A: risk > 10%; arm B: Agatston ≥ 100) risk groups.

Results

Of all respondents (438/600; 73%) 63.5% were men and the mean age ( ± standard deviation) was 63.8 ± 6.9 years. Individuals with an increased coronary artery calcification score consulted their general practitioner more often compared to increased risk individuals from arm A: 140/149 (94%) and 86/137 (62.8%), respectively ( P < 0.001). Current use of blood pressure and cholesterol-lowering drugs was significantly higher in the increased coronary artery calcification score group (108/140; 77.1%), compared to the group with an increased traditional risk (35/80, 43.8%; P < 0.001). Self-reported compliance was high (98.1–100%).

Conclusion

Receiving the screening result might be a teachable moment that can enhance cardiovascular disease prevention-seeking behaviour through consulting a general practitioner and high compliance with preventive treatment. The impact of the screening result was more profound in the increased coronary artery calcification score group. Trial registration number: NTR6471
Stem cell therapy for stress urinary incontinence
Authors: Whiting D , Hamdoon M , Sriprasad S
Published: April 2019

Stress urinary incontinence is the involuntary loss of urine on effort or physical exertion. It is a highly prevalent condition affecting both men and women. Treatment is performed in a step-wise approach involving conservative measures, such as weight loss and pelvic floor exercises, medical treatment with duloxetine and a variety of surgical treatment options. However, recent restrictions in the use of synthetic mesh and tape have limited the surgical treatment options, leading to the need for new and novel treatment for stress urinary incontinence. Stem cell therapy is a developing medical field and offers the potential to restore normal physiological function of the urethral sphincter. The effectiveness of stem cell therapy in stress urinary incontinence has been demonstrated in pre-clinical studies, leading to its evaluation in several clinical studies. This review assesses the current evidence for the safety and efficacy of stem cell treatment for patients with stress urinary incontinence who have failed conservative and/or medical management and have not undergone previous surgical treatment for stress urinary incontinence.

Evidence Level: Not applicable
Imperial Manila: How institutions and political geography disadvantage Philippine provinces
Authors: Tusalem Rollin F
Published: April 2019

Critics of Philippine democracy have pointed out that the unitary system employed since the country became a sovereign state in 1946 led to the prolonged underdevelopment of sub-national regions (provinces). Hence, policy makers have put forward the argument that a shift to a Federal system is necessary because of the imperial Manila syndrome. This is the notion that political, economic, and social underdevelopment is more prevalent the farther away a province is from the capital, Metro-Manila, which has been a longstanding theory of ‘core-periphery’ dynamics in political geography. Using sub-national data derived from Philippine provinces, the study finds that provinces farther away from Manila in terms of geodesic distance are indeed disadvantaged not only in terms of economic, poverty, and human development indicators, but also in terms of dependence on internal revenue allotments which inhibits local growth. Physical distance from the capital also decreases rural funds for provincial development. The implications suggest that a Federal arrangement can promote peripheral growth and development, but it certainly is not a panacea.
Lifelong immunoglobulin replacement is not always necessary: A case description of a patient with recurrent infections and hypogammaglobulinemia
Authors: Napiorkowska-Baran Katarzyna , Janicki Radoslaw , Koltan Sylwia , Szynkiewicz Ewa , Bartuzi Zbigniew
Published: April 2019

Humoral immunodeficiency with accompanying infections is an indication for human immunoglobulin replacement therapy. Whether treatment will be lifelong or necessary only temporarily depends on the nature of deficiency: primary (persistent) or secondary (persistent or transient). It is not always easy to distinguish between primary and secondary immunodeficiency, especially in adults. The article presents a case of a 39-year-old patient with anamnesis and medical tests results that suggested primary humoral immunodeficiency. The deficiency was diagnosed for the first time at the age of 38, when the patient was pregnant. The patient was qualified for immunoglobulin G replacement therapy. Clinical improvement was achieved. After the end of pregnancy, systematic improvement in immunological parameters was observed, suggesting the resolution of immunodeficiency. A decision was made to discontinue immunoglobulin replacement. Due to the ability to respond to vaccine, confirmed during diagnosis, preventive vaccines were recommended. There was no recurrence of serious infections. The clinical course finally enabled a diagnosis of secondary immunodeficiency. The presented case shows the importance of an active approach to the diagnostic and therapeutic process, constant assessment of clinical course, monitoring of IgG concentrations, and the awareness that in the situation when we do not have a genetic confirmation of the disease, the diagnosis may change.
Is dextran sulfate sodium a good inducer of acute experimental enteritis?
Authors: Chen Wei , Zhang Jing , Li Chen , Pan Quan , Wu Jingtong , Fan Lina , Chen Chunyan , Huang Xiaoqing , Teng Fei , Zhu Jinshui
Published: April 2019

Animal models play critical roles in exploring the pathogenesis of human diseases and designing novel therapeutic schemes. Acute experimental colitis (AEC) models have been reported to be established in mice principally by oral administration of dextran sulfate sodium (DSS). However, little knowledge is known about whether DSS can be used to induce the acute experimental enteritis (AEE). In this study, different concentrations of DSS (0%, 2%, 3%, and 5%) were used to induce AEC and AEE models in two cohorts. After the establishment of these two models, the symptoms of the mice induced by DSS were noted, the length and average weight of each colon and small intestine were measured, and hematoxylin and eosin (HE) staining was conducted for assessing the inflammatory infiltration in these models. Generally, the comparison of the inflammatory scoring between AEC and AEE models was analyzed. As a consequence, we found that, the mice with 2%–5% DSS administration in a week could develop into AEC models in two cohorts and AEE models in one cohort, followed by the signs of diarrhea, gross rectal bleeding, weight loss of the body, and shortened colon and intestine length, as compared with the control group. HE staining showed that the inflammatory scoring was dramatically increased by 3%–5% DSS in AEC models in two cohorts but slightly elevated in AEE models in one cohort. Meanwhile, as compared with the severe AEC models, the extent of inflammatory infiltration induced by 3%–5% DSS in AEE models was much milder. In conclusion, oral administration of 3%–5% DSS is a good inducer of AEC models, but not AEE models.
Immunotherapy in gliomas: Are we reckoning without the innate immunity?
Authors: Vismara Marco Flavio Michele , Donato Annalidia , Malara Natalia , Presta Ivan , Donato Giuseppe
Published: April 2019

Innate immunity plays a central role in neoplasms, including those affecting the central nervous system (CNS). Nowadays, tumors classification, especially that regarding gliomas, is based on molecular features such as mutations in isocitrate dehydrogenase (IDH) genes and the presence of co-deletion 1p/19q. Therapy, in most cases, is based on surgery, radiotherapy, and pharmacological treatment with chemotherapeutic agents such as temozolomide. However, the results of the treatments, after many decades, are not completely satisfactory. There is a class of drugs, used to treat cancer, which modulates immune response; in this class, the immune checkpoint inhibitors and vaccines play a prominent role. These drugs were evaluated for the treatment of gliomas, but they exhibited a poor outcome in clinical trials. Those scarce results could be due to the response of tumor-associated macrophage that creates imbalances between innate and adaptive immunity and changes in blood–brain barrier properties. Here, we have briefly reviewed the current literature on this topic, focusing on the possible role for innate immunity in the failure of immunotherapies against brain tumors.
Metastatic neuroendocrine tumour mimicking endometriosis highlights the importance of excision for tissue diagnosis
Authors: Wong Shian-Li , To Valerie , Lam Justin , Lam Alan
Published: April 2019

Introduction:

Endometriosis is a common gynaecological condition, usually presenting with pelvic pain or infertility in women of reproductive age. Diagnosis is made on histopathology of deposits excised during laparoscopy, given diagnosis solely made by macroscopic examination can be challenging for even experienced gynaecological surgeons.

Case description:

A 45-year-old during laparoscopy for fibroids is found to have peritoneal deposits resembling endometriosis. Histopathology reveals multifocal metastatic grade 1 neuroendocrine tumour of the appendix.

Conclusion:

This incidental finding highlights the importance of thorough examination of the appendix and abdominal cavity for unexpected pathology during gynaecological laparoscopy. Incidental finding of appendiceal pathology at time of laparoscopy for endometriosis is not uncommon; however, the finding of metastatic malignancy is far rarer. While several case studies have reported severe endometriosis mimicking advanced stage cancer, this is the first documented occurrence of an advanced, metastatic tumour, mimicking endometriosis.
African isolates show a high proportion of multiple copies of the Plasmodium falciparum plasmepsin-2 gene, a piperaquine resistance marker
Authors: Leroy Didier , Macintyre Fiona , Adoke Yeka , Ouoba Serge , Barry Aissata , Mombo-Ngoma Ghyslain , Ndong Ngomo Jacques Mari , Varo Rosauro , Dossou Yannelle , Tshefu Antoinette Kitoto , Duong Tran Thanh , Phuc Bui Quang , Laurijssens Bart , Klopper Roland , Khim Nimol , Legrand Eric , Ménard Didier
Published: April 2019

Background

Today, the development of new and well-tolerated anti-malarial drugs is strongly justified by the emergence of Plasmodium falciparum resistance. In 2014–2015, a phase 2b clinical study was conducted to evaluate the efficacy of a single oral dose of Artefenomel (OZ439)–piperaquine (PPQ) in Asian and African patients presenting with uncomplicated falciparum malaria.

Methods

Blood samples collected before treatment offered the opportunity to investigate the proportion of multidrug resistant parasite genotypes, including P. falciparum kelch13 mutations and copy number variation of both P. falciparum plasmepsin 2 (Pfpm2) and P. falciparum multidrug resistance 1 (Pfmdr1) genes.

Results

Validated kelch13 resistance mutations including C580Y, I543T, P553L and V568G were only detected in parasites from Vietnamese patients. In Africa, isolates with multiple copies of the Pfmdr1 gene were shown to be more frequent than previously reported (21.1%, range from 12.4% in Burkina Faso to 27.4% in Uganda). More strikingly, high proportions of isolates with multiple copies of the Pfpm2 gene, associated with piperaquine (PPQ) resistance, were frequently observed in the African sites, especially in Burkina Faso and Uganda (> 30%).

Conclusions

These findings were considered to sharply contrast with the recent description of increased sensitivity to PPQ of Ugandan parasite isolates. This emphasizes the necessity to investigate in vitro susceptibility profiles to PPQ of African isolates with multiple copies of the Pfpm2 gene and estimate the risk of development of PPQ resistance in Africa.

Trial registration Clinicaltrials.gov reference: NCT02083380. Study title: Phase II efficacy study of artefenomel and piperaquine in adults and children with P. falciparum malaria. https://clinicaltrials.gov/ct2/results?cond=&term=NCT02083380&cntry=&state=&city=&dist=. FSFV: 23-Jul-2014; LSLV: 09-Oct-2015
A randomized, double-blind, placebo-controlled investigation of BCc1 nanomedicine effect on survival and quality of life in metastatic and non-metastatic gastric cancer patients
Authors: Hafizi Maryam , Kalanaky Somayeh , moaiery Hassan , Khayamzadeh Maryam , Noorian Sajad , Kaveh Vahid , Gharib Behrooz , Foudazi Hossein , Razavi Mohsen , Jenabian Arash , Salimi Saeid , Sereshki Mohammad Mahdi Adib , Mirzaei Hamid Reza , Zarghi Afshin , Fakharzadeh Saideh , Nazaran Mohammad Hassan , Akbari Mohammad Esmaeil
Published: April 2019

Background

Currently, the main goal of cancer research is to increase longevity of patients suffering malignant cancers. The promising results of BCc1 in vitro and vivo experiments made us look into the effect of BCc1 nanomedicine on patients with cancer in a clinical trial.

Methods

The present investigation was a randomized, double-blind, placebo-controlled, parallel, and multicenter study in which 123 patients (30-to-85-year-old men and women) with metastatic and non-metastatic gastric cancer, in two separate groups of BCc1 nanomedicine or placebo, were selected using a permuted block randomization method. For metastatic and non-metastatic patients, a daily dose of 3000 and 1500 mg was prescribed, respectively. Overall survival (OS) as the primary endpoint and quality of life (measured using QLQ-STO22) and adverse effects as the secondary endpoints were studied.

Results

In metastatic patients, the median OS was significantly higher in BCc1 nanomedicine (174 days [95% confidence interval (CI) 82.37–265.62]) than in placebo (62 days [95% CI 0–153.42]); hazard ratio (HR): 0.5 [95% CI 0.25–0.98; p = 0.046]. In non-metastatic patients, the median OS was significantly higher in BCc1 nanomedicine (529 days [95% CI 393.245–664.75]) than in placebo (345 days [95% CI 134.85–555.14]); HR: 0.324 [95% CI 0.97–1.07; p = 0.066]. The QLQ-STO22 assessment showed a mean difference improvement of 3.25 and 2.29 (p value > 0.05) in BCc1 nanomedicine and a mean difference deterioration of − 4.42 and − 3 (p-value < 0.05) in placebo with metastatic and non-metastatic patients, respectively. No adverse effects were observed.

Conclusion

The findings of this trial has provided evidence for the potential capacity of BCc1 nanomedicine for treatment of cancer.

Trial registration IRCTID, IRCT2017101935423N1. Registered on 19 October 2017, http://www.irct.ir/ IRCT2017101935423N1
The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis
Authors: Wei Jingkai , Hou Ruixue , Zhang Xiaotao , Xu Huiwen , Xie Liyang , Chandrasekar Eeshwar K. , Ying Meiling , Goodman Michael
Published: April 2019

Background

Late-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.

Aim

To estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults.

Method

We conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings.

Results

A total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression.

Conclusion

Late-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.

Declaration of interest

None.