bluuebunny/crossref_metadata_2025 huggingface dataset:
The end of emergency medicine as we know it
Authors: Dinh Michael M , Bein Kendall J
Published: January 2016

Several health, social and professional factors are forcing Emergency Physicians to rethink their role in the health system. Despite these challenges, there are a number of ways that we can evolve, including an increasing role for academic and subspecialty emergency medicine, which will ensure our specialty, remains vital and viable in the 21st century and beyond.
Relationship Between Diastolic Dysfunction and Atherosclerosis and Vascular Calcification in Hemodialysis Patients: Diagnostic Potential of the Cardio‐Ankle Vascular Index
Authors: Unagami Kohei , Nitta Kosaku , Tago Kiichiro , Matsushita Kazumichi
Published: January 2016

Diastolic dysfunction (DD) commonly causes heart failure with preserved ejection fraction (EF). Here, we examine associations between DD severity and atherosclerosis/vascular calcification in hemodialysis patients. Echocardiography was performed on 101 patients undergoing hemodialysis therapy. Twelve patients (EF < 50% or chronic atrial fibrillation) were excluded; DD of the remaining 89 patients was classified into four grades. We then investigated the relationship between their DD grades and the cardio‐ankle vascular index (CAVI), ankle‐brachial pressure index (ABI), toe‐brachial pressure index (TBI), and aortic calcification area index (ACAI). Seventy‐seven patients (86.5%) with EF ≥ 50% had DD. Associations with advanced age and comorbid diabetes mellitus and cardiovascular disease were observed. The CAVI, TBI, and ACAI, but not ABI, increased proportionally with DD grades. Thus, many hemodialysis patients developed DD, with systolic function maintained. Strong associations between DD grades and progression of both atherosclerosis and vascular calcification could be inferred.
Safety and Tolerability of Nafamostat Mesilate and Heparin as Anticoagulants in Leukocytapheresis for Ulcerative Colitis: Post Hoc Analysis of a Large‐Scale, Prospective, Observational Study
Authors: Sawada Koji , Ohdo Maiko , Ino Tomoko , Nakamura Takashi , Numata Toyoko , Shibata Hiroshi , Sakou Jun‐ichi , Kusada Masahiro , Hibi Toshifumi
Published: January 2016

Nafamostat mesilate is the first anticoagulant of choice for leukocytapheresis (LCAP) with a Cellsorba E column for treating ulcerative colitis (UC). However, because of complications, mainly due to allergy to nafamostat mesilate, heparin may be used as a substitute. To evaluate the safety and tolerability of nafamostat mesilate and heparin as anticoagulants in LCAP for UC, we conducted post hoc analysis of data from a large‐scale, prospective, observational study of LCAP, which was conducted at 116 medical facilities in Japan between May 2010 and December 2012. Of 832 patients included in this analysis, nafamostat mesilate and heparin were used in 676 (81.3%) and 113 (13.6%), respectively. There were no significant differences in the incidence of adverse reactions (8.6% vs. 7.1%) and intrafilter pressure increases (12.7% vs. 16.8%) between the nafamostat mesilate and heparin groups. Adverse reactions of hemorrhage or blood pressure decreases associated with heparin use were not observed. There were no significant differences in rates of clinical remission (69.1% vs. 68.1%) and mucosal healing (62.9% vs. 63.6%) between the nafamostat mesilate and heparin groups. Thus, the safety and tolerability were comparable in the nafamostat mesilate and heparin groups, indicating that both nafamostat mesilate and heparin can be well tolerated as anticoagulants in LCAP for UC.
Enhancement of Curcumin Solubility by Phase Change from Crystalline to Amorphous in Cur‐TPGS Nanosuspension
Authors: Shin Gye Hwa , Li Jinglei , Cho Jin Hun , Kim Jun Tae , Park Hyun Jin
Published: January 2016

Nanosuspensions (NSs) were fabricated to enhance water solubility, dissolution rate, and oral adsorption of water insoluble curcumin using sonoprecipitation method. As a good stabilizer, d‐α‐Tocopherol polyethylene glycol 1000 succinate (TPGS) was used to improve the stability of curcumin‐TPGS NSs (Cur‐TPGS NSs). Ultrasonic homogenization (UH) could effectively enhance the solubility of curcumin and to produce homogeneous NSs with small particle sizes. Water solubility of curcumin was significantly improved from 0.6 μg/mL in pure water to 260 μg/mL in the mixture of curcumin and TPGS (1:10) with UH treatment. The mean particle size of Cur‐TPGS NSs was decreased significantly after UH and maintained between 208 and 246 nm. Lyophilized powder of Cur‐TPGS NSs was dissolved about 91.08% whereas the pristine curcumin powder was dissolved only 6.5% at pH 7.4. This study showed a great potential of Cur‐TPGS NSs as a good nano‐formulation of curcumin with enhanced solubility and improved oral adsorption.
Evaluation of cone beam computed tomography and periapical radiography in the diagnosis of root resorption
Authors: Lima TF , Gamba TO , Zaia AA , Soares AJ
Published: January 2016

Background

This study aimed to evaluate the accuracy of cone beam computed tomography (CBCT) and periapical radiography in diagnosing root resorption and verify the influence of filling material in detecting these lesions.

Methods

Digital periapical radiographs and CBCT images of patients with root resorption and a history of dental trauma from a radiology clinic were reviewed retrospectively. The sample comprised 40 teeth with root resorption and 20 normal teeth as controls. Images were analysed by two radiologists and two endodontists. The sensitivity, specificity and accuracy were determined. The kappa coefficient assessed interobserver agreement and the t test determined significant differences between the imaging methods.

Results

The accuracy of CBCT in diagnosing external (P = 0.0144) and internal (P = 0.0038) inflammatory resorption was significantly higher than for periapical radiography. For replacement resorption, no statistical difference was noted (P > 0.05). In endodontically treated teeth, CBCT was statistically superior in diagnosing root resorption (P = 0.0138).

Conclusions

CBCT was superior to digital periapical radiography in diagnosing external and internal inflammatory root resorption after dental trauma and can be considered in the differential diagnosis of resorptive lesions in teeth with endodontic treatment.
A transposable element insertion in APOB causes cholesterol deficiency in Holstein cattle
Authors: Menzi F. , Besuchet‐Schmutz N. , Fragnière M. , Hofstetter S. , Jagannathan V. , Mock T. , Raemy A. , Studer E. , Mehinagic K. , Regenscheit N. , Meylan M. , Schmitz‐Hsu F. , Drögemüller C.
Published: January 2016

Cholesterol deficiency, a new autosomal recessive inherited genetic defect in Holstein cattle, has been recently reported to have an influence on the rearing success of calves. The affected animals show unresponsive diarrhea accompanied by hypocholesterolemia and usually die within the first weeks or months of life. Here, we show that whole genome sequencing combined with the knowledge about the pedigree and inbreeding status of a livestock population facilitates the identification of the causative mutation. We resequenced the entire genomes of an affected calf and a healthy partially inbred male carrying one copy of the critical 2.24‐Mb chromosome 11 segment in its ancestral state and one copy of the same segment with the cholesterol deficiency mutation. We detected a single structural variant, homozygous in the affected case and heterozygous in the non‐affected carrier male. The genetic makeup of this key animal provides extremely strong support for the causality of this mutation. The mutation represents a 1.3kb insertion of a transposable LTR element (ERV2‐1) in the coding sequence of the APOB gene, which leads to truncated transcripts and aberrant splicing. This finding was further supported by RNA sequencing of the liver transcriptome of an affected calf. The encoded apolipoprotein B is an essential apolipoprotein on chylomicrons and low‐density lipoproteins, and therefore, the mutation represents a loss of function mutation similar to autosomal recessive inherited familial hypobetalipoproteinemia‐1 (FHBL1) in humans. Our findings provide a direct gene test to improve selection against this deleterious mutation in Holstein cattle.
Trends in sun‐protection behaviour in Australian adults 2007–2012
Authors: Koch Severine , Pettigrew Simone , Minto Carolyn , Slevin Terry , Strickland Mark , Lin Chad , Jalleh Geoffrey
Published: January 2016

Background

Almost all skin cancers are the result of overexposure to UV radiation and could be prevented by adhering to a number of simple behavioural guidelines to minimise exposure to the sun. The present study examined trends in sun‐protection behaviour among adults living in Western Australia, a region with high levels of UV radiation.

Methods

During five summers from 2008 to 2012, 2076 Western Australian adults participated in annual, cross‐sectional telephone surveys that assessed how often they engaged in a range of sun‐protection behaviour (seeking shade, staying inside and wearing a hat, protective clothing, sunscreen or sunglasses).

Results

Apart from an increase in sunscreen use and a consistently high use of sunglasses, most sun‐protection behaviour remained stable at moderate levels during the 5‐year period. Seeking shade, staying inside and wearing a hat were all practised at levels ranging between ‘sometimes’ and ‘usually’ on sunny days in summer during peak UV hours, with little to no variability across the survey years. Wearing protective clothing was the least frequent behaviour across all survey years and was significantly lower in the most recent survey year relative to baseline.

Conclusions

Further efforts are required to encourage greater enactment of sun‐protection behaviour, especially on the use of protective clothing and seeking shade during periods of high UV radiation.
The Uterine Immune Profile May Help Women With Repeated Unexplained Embryo Implantation Failure After In Vitro Fertilization
Authors: Lédée Nathalie , Petitbarat Marie , Chevrier Lucie , Vitoux Dominique , Vezmar Katia , Rahmati Mona , Dubanchet Sylvie , Gahéry Hanne , Bensussan Armand , Chaouat Gerard
Published: January 2016

Labeled problem

Embryo implantation remains the main limiting factor in assisted reproductive medicine (20% success rate).

Methods of study

An endometrial immune profiling was performed among 394 women with the previous history of repeated embryo implantation failures (RIF). The endometrial immune profile documented the ratio of IL‐15/Fn‐14 mRNA as a biomarker of uNK cell activation/maturation (together with the uNK cell count) and the IL‐18/TWEAK mRNA ratio as a biomarker of both angiogenesis and the Th1/Th2 balance. According to their profile, we recommended personalized care to counteract the documented dysregulation and assessed its effects by the live birth rate (LBR) for the next embryo transfer.

Results

Endometrial immune profiles appeared to be dysregulated in 81.7% of the RIF patients compared to control. Overactivation was diagnosed in 56.6% and low activation in 25%. The LBR among these dysregulated/treated patients at the first subsequent embryo transfer was 39.8%.

Conclusion

Endometrial immune profiling may improve our understanding of RIF and subsequent LBR if treated.
Representing the “European refugee crisis” in Germany and beyond: Deservingness and difference, life and death
Authors: HOLMES SETH M. , CASTAÑEDA HEIDE
Published: January 2016

The European refugee crisis has gained worldwide attention with daily media coverage both in and outside Germany. Representations of refugees in media and political discourse in relation to Germany participate in a Gramscian “war of position” over symbols, policies, and, ultimately, social and material resources, with potentially fatal consequences. These representations shift blame from historical, political‐economic structures to the displaced people themselves. They demarcate the “deserving” refugee from the “undeserving” migrant and play into fear of cultural, religious, and ethnic difference in the midst of increasing anxiety and precarity for many in Europe. Comparative perspectives suggest that anthropology can play an important role in analyzing these phenomena, highlighting sites of contestation, imagining alternatives, and working toward them. [refugee, media, immigration, crisis, Germany, Europe]
Immobilizing mobility: Border ethnography, illiberal democracy, and the politics of the “refugee crisis” in Hungary
Authors: KALLIUS ANNASTIINA , MONTERESCU DANIEL , RAJARAM PREM KUMAR
Published: January 2016

In the summer of 2015, more than 350,000 migrants moved through Hungarian territory. Almost immediately there emerged in response a dialectic between, on the one hand, depoliticizing narratives of crisis that sought to immobilize the migrants and, on the other, concrete political mobilization that sought to facilitate their mobility. While state institutions and humanitarian volunteer groups framed mobility in terms that emphasized a vertical form of politics, a horizontal counterpolitics arose by the summer's end, one that challenged hegemonic territorial politics. The state's efforts to immobilize resulted only in more radical forms of mobility. Outlining an ethnography of mobility, immobilization, and cross‐border activism, we follow the dramatic yet momentary presence, and subsequent absence, of migrants in an evanescent rebel city marked by novel political solidarities. [mobility, immobility, transit zones, border politics, refugees, migrants, Hungary]
Audits show that specialist paediatric training programmes are sensitive to medical, staffing and economic changes
Authors: Lohi Olli , Helminen Merja , Korppi Matti
Published: January 2016

Aim

In Finland, specialist paediatrics training is led by university hospitals, but half of it is carried out in regional central hospitals. We audited the training provided by four regional central hospitals in the tertiary care area covered by Tampere University Hospital, in 2003, 2008 and 2015.

Methods

The audits comprised hospital visits and discussions with the chief doctor of the paediatric clinic, the trainees and the specialists who trained them. A modified version of the European Union of Medical Specialists 1997 protocol was used, and the key areas that performed poorly in the audits were followed up.

Results

In 2008 and 2015, most of the key follow‐up issues had improved, but two main areas in need of further development were identified in 2015. These were that educational objectives should be clarified, and their implementation systemically followed up, and that trainees should spend more time working in outpatient settings.

Conclusion

Since 2003, a marked improvement had taken place in the paediatric training provided by regional central hospitals, partly because of the increase in paediatric specialist resources. This study underlines the importance of repeat audits and the need for co‐opera‐tion between the university hospital and regional hospitals, including regular visits.
Desmoplastic nested spindle cell tumours and nested stromal epithelial tumours of the liver
Authors: Misra Sunayana , Bihari Chhagan
Published: January 2016

Desmoplastic nested spindle cell tumour of liver (DNSTL), nested stromal‐epithelial tumour (NSET) and calcifying nested stromal‐epithelial tumour (CNSET) are recently described entities with similar morphology, immunohistochemistry and molecular genetics. These are rare entities with only three large case series described till date. These tumours commonly present in the paediatric age group. NSETs, in addition have been described to be associated with ectopic adrenocorticotropic hormone (ACTH) production and Cushingoid features. It is important to discuss this rare group of tumours with a low malignant potential as the most common radiological differential diagnosis is hepatoblastoma, which has a relatively poorer prognosis. Thus, a pathologist needs to keep this entity in mind, so as to offer a correct histological diagnosis.
Postovipositional development of the sand snake Psammophis sibilans (Serpentes:Lamprophiidae) in comparison with other snake species
Authors: Khannoon Eraqi R. , Zahradnicek Oldrich
Published: January 2016

Characterizing and comparing developmental progress across different species helps to interpret how different or similar body forms evolved. We present an embryonic table for the oviparous African Sand Snake Psammophis sibilans from the Lamprophidae family, describing its postovipositional in ovo development. Psammophis is a good model of a genus that is widely distributed in Africa and Asia and includes 22 species. We describe ten embryonic stages based on the development of externally visible morphological characteristics such as; pharyngeal arches, facial processes, eyes, scales, body pigmentation and body colour pattern development. This study discusses the development of this snake and compares it with that of the closely related brown house snake Lamprophis fulliginosus (Lamprophidae) and the medically important venomous cobras Naja haje haje and Naja kaouthia from the sister lineage Elapidae. The distantly related basal snake Python sebae, which displays different morphology and behaviour, was chosen for deeper insight into the evolution of body structures within the snake clade. We found interspecific differences in the relative stage of development of embryonic structures at the time of oviposition and during postovipositional embryonic development. One of the outcomes of this study is that embryonic structures such as the pharyngeal processes, eye pigmentation and scales are interspecifically conservative in regard to timing of morphodifferentiation, while body pigmentation, colour and colour pattern are interspecifically plastic in their temporospatial development.
Modeling the Cost‐Effectiveness of Doula Care Associated with Reductions in Preterm Birth and Cesarean Delivery
Authors: Kozhimannil Katy B. , Hardeman Rachel R. , Alarid‐Escudero Fernando , Vogelsang Carrie A. , Blauer‐Peterson Cori , Howell Elizabeth A.
Published: January 2016

Background

One in nine US infants is born before 37 weeks' gestation, incurring medical costs 10 times higher than full‐term infants. One in three infants is born by cesarean; cesarean births cost twice as much as vaginal births. We compared rates of preterm and cesarean birth among Medicaid recipients with prenatal access to doula care (nonmedical maternal support) with similar women regionally. We used data on this association to mathematically model the potential cost‐effectiveness of Medicaid coverage of doula services.

Methods

Data came from two sources: all Medicaid‐funded, singleton births at hospitals in the West North Central and East North Central US (n = 65,147) in the 2012 Nationwide Inpatient Sample, and all Medicaid‐funded singleton births (n = 1,935) supported by a community‐based doula organization in the Upper Midwest from 2010 to 2014. We analyzed routinely collected, de‐identified administrative data. Multivariable regression analysis was used to estimate associations between doula care and outcomes. A probabilistic decision‐analytic model was used for cost‐effectiveness estimates.

Results

Women who received doula support had lower preterm and cesarean birth rates than Medicaid beneficiaries regionally (4.7 vs 6.3%, and 20.4 vs 34.2%). After adjustment for covariates, women with doula care had 22 percent lower odds of preterm birth (AOR 0.77 [95% CI 0.61–0.96]). Cost‐effectiveness analyses indicate potential savings associated with doula support reimbursed at an average of $986 (ranging from $929 to $1,047 across states).

Conclusions

Based on associations between doula care and preterm and cesarean birth, coverage reimbursement for doula services would likely be cost saving or cost‐effective for state Medicaid programs.
Induced Labor in Sweden, 1999–2012: A Population‐Based Cohort Study
Authors: Ekéus Cecilia , Lindgren Helena
Published: January 2016

Background

Previous studies show contradictory results about the impact of induced labor on the cesarean delivery rate and few studies have investigated the risk of vacuum extraction subsequent to induced labor. The aims of the present study were to describe the rate of induced labor in Sweden from 1999 to 2012, and to assess the risk of unplanned cesarean delivery and vacuum extraction after induced labor in relation to medical complications and length of gestation.

Methods

A register‐based cohort study was conducted, including 1,078,536 women with spontaneous or induced onset of labor who gave birth by noninstrumental vaginal delivery, unplanned cesarean delivery, or vacuum extraction in gestational week 37 + 0 to 41 + 6. Logistic regression was used to study the association between induced labor and instrumental delivery.

Results

The rate of induced labor increased from 7.7 to 12.9 percent among primiparous and from 7.5 to 11.8 percent among multiparous women. Induced labor was associated with 2–3 times greater risk of unplanned cesarean delivery among all women, except multiparas in gestational week 37–38, and with a 20–50 percent higher risk of vacuum extraction after the adjustment for confounding factors. Among women without a recognized medical complication, induced labor was associated with a threefold increased risk of cesarean delivery in gestational week 39–41 and a 40 percent increase in gestational week 37–38 compared with women with spontaneous onset of labor.

Conclusions

The proportion of induced labors increased substantially during the 14‐year study period and was associated with an increased risk of both cesarean delivery and vacuum extraction, even in women without a documented medical complication. The increased risk of instrumental delivery should be taken into account when counseling about the risks and benefits of induced labor.
Multicentre outcomes of robot‐assisted partial nephrectomy after major open abdominal surgery
Authors: Abdullah Newaj , Rahbar Haider , Barod Ravi , Dalela Deepansh , Larson Jeff , Johnson Michael , Mass Alon , Zargar Homayoun , Allaf Mohamad , Bhayani Sam , Stifelman Michael , Kaouk Jihad , Rogers Craig
Published: January 2016

Objective

To evaluate the outcomes of robot‐assisted partial nephrectomy RAPN after major prior abdominal surgery (PAS) using a large multicentre database.

Patients and methods

We identified 1 686 RAPN from five academic centres between 2006 and 2014. In all, 216 patients had previously undergone major PAS, defined as having an open upper midline/ipsilateral incision. Perioperative outcomes were compared with those 1 470 patients who had had no major PAS. The chi‐squared test and Mann–Whitney U‐test were used for categorical and continuous variables, respectively.

Results

There was no statistically significant difference in Charlson comorbidity index, tumour size, R.E.N.A.L. nephrometry score or preoperative estimated glomerular filtration rate (eGFR) between the groups. Age and body mass index were higher in patients with PAS. The PAS group had a higher estimated blood loss (EBL) but this did not lead to a higher transfusion rate. A retroperitoneal approach was used more often in patients with major PAS (11.2 vs 5.4%), although this group did not have a higher percentage of posterior tumours (38.8 vs 43.3%, P = 0.286). Operative time, warm ischaemia time, length of stay, positive surgical margin, percentage change in eGFR, and perioperative complications were not significantly different between the groups.

Conclusions

RAPN in patients with major PAS is safe and feasible, with increased EBL but no increased rate of transfusion. Patients with major PAS had almost twice the likelihood of having a retroperitoneal approach.
Do stones still kill? An analysis of death from stone disease 1999–2013 in England and Wales
Authors: Kum Francesca , Mahmalji Wasim , Hale Jemma , Thomas Kay , Bultitude Matthew , Glass Jonathan
Published: January 2016

Objectives

To analyse the trends in the number of deaths attributable to urolithiasis in England and Wales over the past 15 years (1999–2013). Urolithiasis has an estimated lifetime risk of 12% in males and 6% in females and is not perceived as a life‐threatening pathology. Admissions with urinary calculi contribute to 0.5% of all inpatient hospital stays, and the number of deaths attributable to stone disease has yet to be identified and presented.

Materials and Methods

Office of National Statistics data relating to causes of death from urolithiasis, coded as International Classification of Diseases (ICD)‐10 N20–N23, was collated and analysed for the 15‐year period from 1999 to 2013 in England and Wales. These data were sub‐categorised into anatomical location of calculi, age, and gender.

Results

In all, 1954 deaths were attributed to urolithiasis from 1999 to 2013 (mean 130.3 deaths/year). Of which, 141 were attributed to ureteric stones (mean 9.4 deaths/year). Calculi of the kidney and ureter accounted for 91% of all deaths secondary to urolithiasis; lower urinary tract (bladder or urethra) calculi contributed to only 7.9% of deaths. The data revealed an overall increasing trend in mortality from urolithiasis over this 15‐year period, with an increase of 3.8 deaths/year based on a linear trend (R2 = 0.65). Overall, the number of deaths in females was significantly higher than in males (ratio 1.5:1, P < 0.001); kidney and ureteric calculi causing death had a female preponderance (1.7:1, female:male); whereas calculi of the lower urinary tract was more common in males (1:2.2, female:male).

Conclusions

Stone disease still causes death in the 21st century in England and Wales. This trend of increasing deaths must be placed in the context of the concurrent rising incidence of urolithiasis in the UK and the number of stone‐related hospital episodes. The primary cause of death relating to complications of stone disease for each individual case should be further investigated to facilitate prevention of complications of urolithiasis.
Endogenous and exogenous testosterone and the risk of prostate cancer and increased prostate‐specific antigen (PSA) level: a meta‐analysis
Authors: Boyle Peter , Koechlin Alice , Bota Maria , d'Onofrio Alberto , Zaridze David G. , Perrin Paul , Fitzpatrick John , Burnett Arthur L. , Boniol Mathieu
Published: January 2016

Objective

To review and quantify the association between endogenous and exogenous testosterone and prostate‐specific antigen (PSA) and prostate cancer.

Methods

Literature searches were performed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Prospective cohort studies that reported data on the associations between endogenous testosterone and prostate cancer, and placebo‐controlled randomized trials of testosterone replacement therapy (TRT) that reported data on PSA and/or prostate cancer cases were retained. Meta‐analyses were performed using random‐effects models, with tests for publication bias and heterogeneity.

Results

Twenty estimates were included in a meta‐analysis, which produced a summary relative risk (SRR) of prostate cancer for an increase of 5 nmol/L of testosterone of 0.99 (95% confidence interval [CI] 0.96, 1.02) without heterogeneity (I² = 0%). Based on 26 trials, the overall difference in PSA levels after onset of use of TRT was 0.10 ng/mL (−0.28, 0.48). Results were similar when conducting heterogeneity analyses by mode of administration, region, age at baseline, baseline testosterone, trial duration, type of patients and type of TRT. The SRR of prostate cancer as an adverse effect from 11 TRT trials was 0.87 (95% CI 0.30; 2.50). Results were consistent across studies.

Conclusions

Prostate cancer appears to be unrelated to endogenous testosterone levels. TRT for symptomatic hypogonadism does not appear to increase PSA levels nor the risk of prostate cancer development. The current data are reassuring, although some caution is essential until multiple studies with longer follow‐up are available.
Percutaneous nephrolithotomy for staghorn stones: a randomised trial comparing high‐power holmium laser versus ultrasonic lithotripsy
Authors: EL‐Nahas Ahmed R. , Elshal Ahmed M. , EL‐Tabey Nasr A. , EL‐Assmy Ahmed M. , Shokeir Ahmed A.
Published: January 2016

Objective

To compare high‐power holmium laser lithotripsy (HP‐HLL) and ultrasonic lithotripsy (US‐L) for disintegration of staghorn stones during percutaneous nephrolithotomy (PCNL).

Patients and Methods

A non‐inferiority randomised controlled trial was conducted between August 2011 and September 2014. Inclusion criteria were patients' aged >18 years who had complete staghorn stones (branching to the three major calyces), without contraindications to PCNL. Eligible patients were randomised between two groups: HP‐HLL and US‐ . A standard PCNL in the prone position was performed for all patients. The only difference between the treatment groups was the method of stone disintegration. In the first group (HP‐HLL), a laser power of 40–60 W (2 J, 20–30 Hz) was used to pulverise the staghorn stone into very small fragments, which could pass through the Amplatz sheath with the irrigation fluid. US‐L,with suction of the fragments, was used in the second group. The primary outcome (stone‐free rate) was evaluated with non‐contrast computed tomography after 3 months. Secondary outcomes of complications, blood transfusion, operative time, and haemoglobin deficit were compared. The outcome assessor was ‘blinded’ to the treatment arm.

Results

The study included 70 patients (35 in each group). The baseline characteristics (age, sex, body mass index, side, stone volume, and density) and operative technique (number, size of tracts, and need for second PCNL session) were comparable for both groups. Operative time was significantly shorter in US‐L group, at a mean (SD) of 130 (34) vs 148.7 (35) min (P = 0.028). The haemoglobin deficit was significantly more with in the US‐L group, at a mean (SD) of 1.7 (0.9) vs 1.3 (0.6) g/dL (P = 0.037). The differences in blood transfusion (17% for US‐L vs 11% for HP‐HLL) and the complication rates (34% for US‐L vs 23% for HP‐HLL) were not significant (P = 0.495 and P = 0.290, respectively). The stone‐free rates at 3 months were comparable (60% for US‐L and 66% for HPL‐L; P = 0.621).

Conclusions

Compared with US‐L for intracorporeal lithotripsy of staghorn stones during PCNL, HP‐HLL showed comparable safety and efficacy with a lower haemoglobin deficit but longer operative time.
Hypospadias repair with onlay preputial graft: a 25‐year experience with long‐term follow‐up
Authors: Cambareri Gina M. , Yap Michael , Kaplan George W.
Published: January 2016

Objective

To evaluate the long‐term outcomes of hypospadias repair using an onlay preputial graft.

Patients and Methods

Patient records from 1989 to 2013 were retrospectively reviewed. One surgeon performed all cases and surgical technique was the same for all patients.

Results

There were 62 patients in the cohort, with a mean (range) follow‐up of 47.4 (1–185) months. The meatal location was separated into distal (one patient), midshaft (19) and proximal (42). In all, 22 (35.5%) patients had complications. There were three main types of complications, including meatal stenosis in three (4.8%), stricture in three (4.8%), and fistula in 21 (33.9%). The mean (range) timing of presentation with a complication after surgery was 24.9 (1–127) months. In all, 54.5% of the patients with complications presented at ≥1 year after the initial surgery and 31.8% presented at ≥3 years. On univariable analysis age at the time of surgery, length of the graft, presence of chordee or meatal location (proximal or midshaft) did not predict a complication. The width of the graft was associated with a complication, with each 1 mm increase in width decreasing the odds of a complication by 56%. On multivariable analysis width remained statistically significant (odds ratio 0.44, 95% confidence interval 0.230–0.840; P = 0.013) for predicting a complication.

Conclusion

Hypospadias repair with onlay preputial graft is an option for single‐stage repair, especially in cases of proximal hypospadias or where the urethral plate width and/or the glanular groove is insufficient for other types of repair. Compared with flaps, the use of grafts may decrease the risk of penile torsion and prevent less bulk around the urethra, improving skin and glans closure.
Old versus New Mechanisms in the Pathogenesis of ALS
Authors: Rossi Simona , Cozzolino Mauro , Carrì Maria Teresa
Published: January 2016

Amyotrophic Lateral Sclerosis (ALS) is recognized as a very complex disease. As we have learned in the past 20 years from studies in patients and in models based on the expression of mutant SOD1, ALS is not a purely motor neuron disease as previously thought. While undoubtedly motor neurons are lost in patients, a number of alterations in those cell‐types that interact functionally with motor neurons (astrocytes, microglia, muscle fibers, oligodendrocytes) take place even long before onset of symptoms. At the same time, disturbance of several, only partly inter‐related physiological functions play some role in the onset and progression of the disease. Traditionally, mitochondrial damage and oxidative stress, excitotoxicity, neuroinflammation, altered axonal transport, ER stress, protein aggregation and defective removal of toxic proteins have been considered as key factors in the pathogenesis of ALS, with the relatively recent addition of disturbances in RNA metabolism. This complexity makes the search for an effective treatment extremely difficult and prompts further studies to reveal other possible, previously unappreciated aspects of the pathogenesis of ALS. In this review, we focus on previous knowledge on ALS mechanisms as well as new facets emerging from studies on genetic ALS patients and models that may both provide precious information for a novel therapeutic approach.
The Conservation Value of Small Fragments For Atlantic Forest Reptiles
Authors: Lion Marília B. , Garda Adrian A. , Santana Diego J. , Fonseca Carlos Roberto
Published: January 2016

Loss and fragmentation of natural habitats are key contributors to the decline of populations and impoverishment of biological communities. The response to these disturbances can vary substantially among taxa and depends on spatial metrics of habitat fragments and the surrounding landscape. Herein we test how fragment area, shape, isolation, and matrix quality affect reptile richness, abundance, and occurrence in Brazilian Atlantic Forest fragments, a biodiversity hotspot with a poorly studied reptile fauna. We used 23 forest fragments, ranging from 2 to 30 hectares, surrounded by different matrix types, including sugarcane crop fields, cattle ranching, subsistence farmlands and rural communities. Species richness, total reptile abundance, population abundance, and occurrence probability of many species decreased with fragment area. Model selection suggested that fragment area is the main predictor of both richness and abundance, but matrix quality as well as fragment shape are also important predictors. For population abundance and occurrence probability, fragment area and proximity were the most important predictors followed by fragment shape and matrix quality, but the strength and even the sign of predictors varied substantially among species. We highlight that the value of small fragments should not be neglected for the conservation of Atlantic Forest reptiles.
White‐sand Ecosystems in Amazonia
Authors: Adeney J. Marion , Christensen Norman L. , Vicentini Alberto , Cohn‐Haft Mario
Published: January 2016

Vegetation on sandy soils, ranging from open grasslands and shrublands to closed‐canopy, thin‐trunked forests, can be found in patches throughout the Amazon. Despite variation in names, appearance, ecological correlates, and suggested origins, these ‘white‐sand ecosystems’ (WSE) share distinctive characteristics and biological communities. Here, in the first Amazon‐wide review of WSE, we review the variation in WSE and the factors underlying this variation. We present the most comprehensive Amazon‐wide map to date of WSE and calculate their total area. We find that WSE are still not completely mapped, and we use biological correlates as a proxy to indicate where white‐sand vegetation patches likely occur. Through our synthesis of the literature, we find that key factors, such as geologic origin, soil characteristics, hydrology, and fire regimes, vary widely and have differing impacts in different regions on vegetation structure and on floral, faunal, and fungal species composition. Although studies of WSE have increased dramatically in recent years, WSE in many parts of the Amazon remain understudied, and there is little synthesis of the interaction of factors across different areas. In response, we suggest priorities for future research. Finally, we find that WSE are inadequately protected and, where accessible, are regularly mined for sand, logged, or burned and cleared for agriculture. We argue that due to their island‐like distribution patterns and resultant complex metapopulation dynamics, their extremely slow recovery after disturbance, and their important contributions to basin‐wide diversity patterns and ecosystem services, WSE should be given special consideration in conservation efforts to ensure their persistence in Amazonia.
Diversity and Distribution of Ectomycorrhizal Fungi from Amazonian Lowland White‐sand Forests in Brazil and French Guiana
Authors: Roy Mélanie , Schimann Heidy , Braga‐Neto Ricardo , Da Silva Rosa A. E. , Duque Jaime , Frame Dawn , Wartchow Felipe , Neves Maria A.
Published: January 2016

White‐sand forests are thought to host many ectomycorrhizal fungi, as demonstrated by the numerous fruiting body collections made by Rolf Singer in the lower Rio Negro in the late 1970s. Despite recognition of the importance of ectomycorrhizal fungi in white‐sand forests, there has not yet been a systematic examination of diversity and taxonomic composition across white‐sand forests, or more widely across lowland Amazonian forests. In an effort to broaden our view of ectomycorrhizal fungal diversity and distribution on white‐sand forests, we collected ectomycorrhizal fruiting bodies in 10 plots of white‐sand forests in Brazil and French Guiana between 2012 and 2014. We collected 221 specimens and 62 morphospecies, from the 10 plots, confirming that all studied white‐sand forests host ectomycorrhizal fungi. Additionally, we searched for taxa associated with white sands among specimens deposited in Brazilian herbaria. We report 1006 unique ectomycorrhizal specimen records in 18 Brazilian herbaria, of which 137 specimens and 64 species are reported from white‐sand forests, mainly in the state of Amazonas, Brazil. Russulaceae and Amanitaceae were frequent in all habitats, and Cortinarius were more frequent on white sands. Our results highlight the high diversity and heterogeneity of ectomycorrhizal communities on white‐sand forests, and the wide distribution of ectomycorrhizal fungi throughout Brazil, irrespective of soil type.
Publishing journal articles in Canadian geography
Authors: Moore Tim R. , Coomes Oliver T.
Published: January 2016

Key Messages

Over the past 30 years, Canadian geographers published in a wide range of journals, but few journals had many articles in each year.

Commercial presses dominate publishing, with a decline in society and university presses; papers published per faculty increased from 0.5 yr−1 in 1981–82 to 1.7 yr−1 in 2011–12.

Canadian geographers are publishing well beyond the field, engaging with much larger audiences, and reaching top journals, to the benefit of the discipline.
Longitudinal changes in developmental defects of enamel
Authors: Wong Hai Ming , Wen Yi Feng , King Nigel Martyn , McGrath Colman Patrick Joseph
Published: January 2016

Objectives

Epidemiological studies on developmental defects of enamel (DDE) have focused on its potential contributory factors and prevalence while there is limited evidence on the longitudinal changes in the epidemiological profile of DDE. Thus, the objective of this longitudinal study was to investigate whether any type of DDE changes with time.

Methods

A total of 668 participants were initially recruited in 2010, and 432 participants were successfully followed up and examined for DDE both at the age of 12 in 2010 and 15 in 2013. The central incisor, lateral incisor and first molar in each quadrant were chosen as index teeth and were examined ‘wet’ by two trained and calibrated examiners using the modified FDI (DDE) Index.

Results

The mouth prevalence and tooth prevalence of ‘any defect’ showed a significant decrease from 2010 to 2013 (P < 0.001). This was predominantly due to the decrease in diffuse opacities (P < 0.001). Significant difference in the distribution of the extent of DDE was also found for diffuse opacities at both the participant and tooth levels irrespective of the types of tooth (P < 0.0001). Median extent score for diffuse opacities in 2013 was lower than those in 2010 at both participant and tooth level irrespective of the types of tooth (P < 0.001).

Conclusions

Diffuse opacities, in terms of prevalence and severity, did fade out over time. The observed overall change in DDE was due to the dominating effect of diffuse opacities over demarcated opacities and hypoplasia.
A proteomics analysis reveals that A2M might be regulated by STAT3 in persistent allergic rhinitis
Authors: Chen X. , Xie Z. H. , Lv Y. X. , Tang Q. P. , Zhang H. , Zhang J. Y. , Wu B. , Jiang W. H.
Published: January 2016

Background

Proteomics tools can be used to identify the differentially expressed proteins related to allergic rhinitis (AR). However, the large numbers of proteins related to AR have not yet been explored using an advanced quantitative proteomics approach, known as isobaric tags for relative and absolute quantitation (iTRAQ).

Objectives

To identify differentially expressed proteins in persistent AR patients and to explore the regulatory signalling pathways involving the identified proteins.

Methods

Forty‐five persistent AR patients and 20 healthy controls were recruited for this study. iTRAQ was used to identify the proteins that were differentially expressed between these two groups, and a bioinformatics analysis was then conducted to identify the signalling pathways associated with the identified proteins. Immunofluorescence labelling was performed to detect alpha‐2‐macroglobulin (A2M), STAT3, p‐STAT3 and IL17 in the nasal mucosa.

Results

A total of 133 differentially expressed proteins were identified. We then determined the top 10 regulatory pathways associated with these proteins and found that the blood coagulation pathway had the most significant association. A2M, a protein involved in the blood coagulation pathway, was found to be differentially expressed in the serum of AR patients. The bioinformatics analysis indicated that STAT3 is an upstream transcription factor that might regulate A2M expression. An immunofluorescence study further confirmed that STAT3 and A2M are co‐localized in nasal mucosa cells. Additionally, A2M, STAT3, p‐STAT3, and IL17 are elevated in AR patients. The expressional level of A2M is positively related to IL17 and the symptom of the congestion in AR subjects.

Conclusions

The blood coagulation pathway may be a key regulatory network pathway contributing to the allergic inflammatory response in AR patients. A2M, which is regulated by STAT3, may be an important protein in the pathogenesis of allergic rhinitis in AR patients.
Retracted: Bone neoformation of a novel porous resorbable Si‐Ca‐P‐based ceramic with osteoconductive properties: physical and mechanical characterization, histological and histomorphometric study
Authors: De Aza Piedad N. , Mate‐Sanchez de Val Jose E. , Baudin Carmen , Perez Albacete‐Martínez Carlos , Armijo Salto Antonio , Calvo‐Guirado Jose L.
Published: January 2016

Objective

The aims of the present work were to study a new porous Nurse's A ceramic (Si‐Ca‐P‐based material) bone substitute and examine its mechanical properties in vitro and the biocompatibility, osteoconductivity and resorption process in vivo.

Materials and method

Porous ceramic scaffolds were prepared by solid‐state reaction and implanted in critical‐sized defect created in 15 NZ rabbits. Strength values were determined by the diametrical compression of disk test. Weibull analyses were performed following the European Standard for technical ceramics EN‐843‐5: 1996, considering 90% of confidence intervals. Results were correlated with scanning microscope observations of fracture surfaces. Implanted scaffolds were characterized by histological and histomorphometric point of view.

Results

The parameters of the Weibull distribution of strength, determined by diametrical compression of disks, were modulus m = 13, and characteristic strength σ0 = 0.60 MPa (90% confidence limit: m = 7.2–17.6, σ0 = 0.570–0.578). Porous calcium silicophosphate scaffolds showed significantly more bone formation in the pores and in the periphery of the implant than the control group. Histomorphometric analysis revealed that the ceramic scaffold (62.23 ± 0.34*) produced higher values of bone‐to‐implant contact (BIC) percentages (higher quality, closer contact); moreover, defect closure was significative in relation with control group.

Conclusions

The porous calcium silicophosphate ceramic is biocompatible, partially resorbable and osteoinductive material. This rabbit study provides radiological and histological evidences confirming the suitablity of this new material for bone tissue regeneration on critical defects.
Role of Donepezil in the Management of Neuropsychiatric Symptoms in Alzheimer's Disease and Dementia with Lewy Bodies
Authors: Cummings Jeffrey , Lai Te‐Jen , Hemrungrojn Solaphat , Mohandas E. , Yun Kim Sang , Nair Girish , Dash Amitabh
Published: January 2016

Alzheimer's disease (AD) is a progressive condition that affects cognition, function, and behavior. Approximately 60–90% of patients with AD develop neuropsychiatric symptoms (NPS) such as hallucinations, delusions, agitation/aggression, dysphoria/depression, anxiety, irritability, disinhibition, euphoria, apathy, aberrant motor behavior, sleep disturbances, appetite and eating changes, or altered sexual behavior. These noncognitive behavior changes are thought to result from anatomical and biochemical changes within the brain, and have been linked, in part, to cholinergic deficiency. Cholinesterase inhibitors may reduce the emergence of NPS and have a role in their treatment. These agents may delay initiation of, or reduce the need for, other drugs such as antipsychotics. This article summarizes the effects of donepezil, a cholinesterase inhibitor, on the NPS of dementia with emphasis on AD and dementia with Lewy bodies.