bluuebunny/crossref_metadata_2025 huggingface dataset:
Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management
Authors: Wilson Alyce N. , Homer Caroline S.E.
Published: February 2020

Background

Third‐ and fourth‐degree tears are associated with significant pain, discomfort and impact on quality of life and intimate relationships. Australian women experience comparatively higher rates of third‐ and fourth‐degree tears relative to countries of similar economic development.

Aims

We aimed to conduct a comprehensive review of the literature, published over the past five years, to identify the best ways to prevent and manage third‐ and fourth‐degree perineal tears in Australian maternity centres.

Materials and Methods

We searched the literature using the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, Maternity and Infant Care Database and Google Scholar for articles published since 2013 using key search terms. A review of reviews was undertaken given the extensive amount of literature on this topic.

Results

Twenty‐six systematic reviews were identified. The most common risk factors reported in the literature for third‐ and fourth‐degree tears included primiparity, mother’s ethnicity, large for gestational age infants and certain interventions used in labour and birth, such as instrumental deliveries. Preventive practices with varying degrees of effectiveness and often dependant on parity included: antenatal perineal massage, different maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for instrumental births.

Conclusions

Third‐ and fourth‐degree perineal tears are associated with immediate and long‐term implications for women and health systems. Evidence‐based approaches can reduce the number of women who sustain a severe perineal tear and alleviate the associated disease burden for those who do.
Comparable outcomes in mini‐midvastus versus mini‐medial parapatellar approach in total knee arthroplasty: a meta‐analysis and systematic review
Authors: Onggo James R. , Onggo Jason D. , Hau Raphael
Published: February 2020

Background

Minimally invasive surgery (MIS) techniques in total knee arthroplasties (TKA) have gained popularity over conventional techniques due to benefits of hastened recovery and reduced complications. There are a variety of MIS techniques available and two most common techniques currently employed are the mini‐midvastus (mMV) and mini‐medial parapatellar (mMPP) approaches. This meta‐analysis aims to compare the clinical outcomes and peri‐operative parameters between mMV and mMPP in TKA in order to determine the presence of a superior technique.

Methods

A multi‐database search was performed according to PRISMA guidelines. Data from studies comparing clinical outcomes and peri‐operative parameters between mMV and mMPP approaches in TKA were extracted and analysed.

Results

A total of five randomized controlled trials were included for analysis, consisting of 190 mMV and 189 mMPP knees. Clinically unimportant differences were noted in blood loss and surgical time between the groups (5 mL less blood loss and 7 min less surgical time in mMV, P < 0.001). There was no statistically significant difference between both groups for Knee Society Score at 1 and 2 years, range of motion at 1 and 2 years, incision length or incidence of lateral retinacular release (all non‐significant, P > 0.05).

Conclusion

The mMV and mMPP MIS TKA approaches have equivalent clinical outcomes. Despite a statistically significant longer operative time and higher mean blood loss in mMV than mMPP approach, clinically significant difference was not demonstrated. Both mMV and mMPP MIS techniques are reliable and safe to perform in TKA.
Breast disease in Timor‐Leste
Authors: Fordyce Andrew , Vorias Blake , Taranto Lucas , Soares Alito , Watters David , Saunders Christobel
Published: February 2020

Background

Surgically treatable conditions are well documented in high‐income countries. There is a gap in epidemiological understanding of breast pathology in many developing countries, Timor‐Leste among them. This study was conducted to determine the burden of breast disease and to inform public health measures to address early detection, diagnosis and management.

Methods

A retrospective quantitative case–control study was conducted at Guido Valadares National Hospital in Dili. Patients were included if they attended surgical outpatients or had a pathology specimen recorded between 1 September 2016 and 1 September 2017.

Results

There were 444 female patients with a clinical diagnosis of breast disease over the 12‐month period. The average age was 33.7 years. There were 188 (42.3% of total sample) cases of fibroadenoma and 122 (27.4% of total sample) diagnoses consistent with non‐specific lumps. Of the 116 female patients presenting to Guido Valadares National Hospital who had a biopsy, 62.6% were malignant or hyperplastic in nature, and 86% of those with a malignant biopsy had clinically locally advanced disease.

Conclusion

Breast conditions including cancer in Timor‐Leste are relatively common and occur in young women in the prime of their lives (37 years of age). Developing a national cancer registry and funding directed towards improving early presentation and good clinical care of breast cancer patients will be critical for reducing early morbidity and mortality and improving other patient outcomes including income loss, gender health inequality and the intergenerational effects of early parental death.
Impact of post‐haemorrhoidectomy pain relief checklists on pain outcomes: a randomized controlled trial
Authors: Huang Johnny , Rickard Matthew J. F. X. , Keshava Anil , Suen Michael K. L.
Published: February 2020

Background

Haemorrhoidectomy is associated with significant post‐operative pain which is primarily managed pharmacologically. Whether a non‐pharmacological adjunct such as a checklist can improve pain outcomes after an open haemorrhoidectomy has yet to be studied. The purpose of this study was to determine if a patient‐completed checklist of prescribed post‐haemorrhoidectomy pain medications would improve pain management after surgery.

Methods

We conducted a dual‐centre randomized controlled trial of patients undergoing a Milligan‐Morgan haemorrhoidectomy for symptomatic third or fourth degree haemorrhoids. Thirty‐five patients were randomized into either a control group which received post‐operative pain medication plus a visual analogue scale (VAS) form, or an intervention group which received a post‐operative medication checklist in addition to the items the control group received. Both groups recorded their pain levels on the VAS forms at 10.00, 14.00 and 20.00 hours each day for 14 days post‐operatively.

Results

Patients in the checklist group reported a significantly greater reduction in mean VAS pain score of 2.51 (95% confidence interval (CI) 1.34–3.68; P < 0.001) between day 1 post‐op and day 14 post‐op compared to 1.86 (95% CI 0.77–2.95; P = 0.001) for the control group. There was no significant difference between mean pain experienced by patients in either group over each of the 14 days individually or overall (P = 0.07).

Conclusion

The pain medication checklist lead to a greater reduction in pain between day 1 and 14 after an open haemorrhoidectomy compared to standard care but did not significantly reduce mean pain across any individual days or overall.
Outcome analysis for prediction of intraaortic balloon pump support failure and long‐term survival in high‐risk patients undergoing mitral valve surgery
Authors: Liang Mengya , Wang Chaoqun , Feng Kangni , Chen Guangxian , Wang Keke , Wu Zhongkai
Published: February 2020

The outcome predictors of intra‐aortic balloon pump (IABP) in patients who undergo mitral valve surgery remain unknown. This study aimed to retrospectively review valvular surgery in patients who received an IABP to identify the predictors of failure of IABP support and anticipate the necessary therapy. This retrospective observational study recruited a total of 157 consecutive patients who underwent open‐heart mitral valve surgery with IABP implantation intraoperatively or postoperatively. Univariate and multivariate logistic regression analyses were performed to identify the risk factors attributed to 30‐day mortality. Follow‐up data of survivors were collected to investigate the effect of IABP support to evaluate long‐term outcomes. The overall 30‐day mortality was 35.7% (56 patients). The following factors that contributed to 30‐day mortality included sepsis (P < .001, OR: 5.627, 95%CI: 2.422‐11.683); IABP implantation postoperatively rather than intraoperatively (P = .001, OR: 6.395, 95%CI: 2.085‐19.511); right heart failure (P = .042, OR: 3.419, 95%CI: 1.225‐12.257); and lack of subvalvular apparatus preservation (P = .033, OR: 3.710, 95%CI: 1.094‐13.167). Furthermore, follow‐up data of these patients showed an estimation of 5‐year and 10‐year survival rates of 58.9% and 35.7%, respectively. Patients with intraoperative IABP demonstrated better long‐term survival outcomes when compared to those with postoperative IABP (χ2 = 4.291, P = .038). In summary, this study distinguished the preoperative predictors of 30‐day mortality of IABP‐support in mitral valve surgery patients. These results indicated that early intervention with IABP should be taken into consideration in case of hemodynamic instability in critically ill patients undergoing mitral valve surgery.
Tablet assessment in primary education: Are there performance differences between TIMSS' paper‐and‐pencil test and tablet test among Dutch grade‐four students?
Authors: Hamhuis Eva , Glas Cees , Meelissen Martina
Published: February 2020

Over the last two decades, the educational use of digital devices, including digital assessments, has become a regular feature of teaching in primary education in the Netherlands. However, researchers have not reached a consensus about the so‐called “mode effect,” which refers to the possible impact of using computer‐based tests (CBT) instead of paper‐and‐pencil‐based tests (PBT) to assess student performance. Some researchers suggest that the occurrence of a mode effect might be related to the type of device used, the subject being assessed and the characteristics of both the test and the students taking the test. The international TIMSS 2019 Equivalence Study offered the opportunity to explore possible performance differences between a PBT and a tablet assessment in mathematics and science among Dutch primary school students. In the spring of 2017, the TIMSS PBT and tablet test were administered to 532 grade‐four Dutch students. Item response theory was used to explore potential mode effects. This exploration revealed no significant differences in the student ability scales between the paper and the tablet tests for mathematics and science. Also, no systematic mode effects were found for the items with high reading demand. A marginal difference was found for girls outperforming boys on the TIMSS tablet test, although no gender differences in achievement were found for the PBT.

Practitioner Notes

Previous knowledge about this topic

Many studies have investigated the test mode differences between CBT and PBT, but their results are divergent and inconclusive.

Factor familiarity with the test device has an important impact on test performance.

The difference between reading on paper or on a tablet is an important factor. Many studies demonstrate that when reading on a screen, text comprehension is perceived to be more difficult.

What this paper contributes

This equivalence study shows that CBT is highly comparable to PBT, indicating that both test modes are suitable for testing the conceptual knowledge of mathematics and science and are comparable for assessing TIMSS in the Netherlands.

When assessed on a tablet, Dutch grade‐four girls slightly outperform boys in mathematics.

Implications for practice and/or policy

Within the Netherlands, the tablet test could be a good alternative to the traditional PBT.

Digital testing enables investigations on the differences between boys and girls in terms of response behaviour, such as response time by analysing the log files of the assessment.
The new biology of PTCL‐NOS and AITL: current status and future clinical impact
Authors: Timmins Matthew A. , Wagner Simon D. , Ahearne Matthew J.
Published: February 2020

Peripheral T‐cell lymphomas (PTCL) comprise a heterogeneous group of aggressive lymphoproliferative disorders almost all of which are associated with poor clinical outcomes. Angioimmunoblastic T‐cell lymphoma (AITL) and some peripheral T‐cell lymphoma, not otherwise specified (PTCL‐NOS) have similarities to normal CD4+ T‐cell subsets in their gene expression profiles. A cell of origin model is, therefore, emerging and is likely to be refined in the future. Follicular helper (Tfh) T cells are now established as the cell of origin of AITL and about 20% of PTCL‐NOS. Sequencing studies have identified recurrent genetic alterations in epigenetic modifiers, T‐cell receptor signalling pathway intermediates or RHOA, most commonly a specific mutation leading to RHOA G17V. While PTCL‐NOS remains a diagnosis of exclusion, advances in genomics have identified subgroups expressing transcription factors TBX 21 (Th1‐like origin) and GATA3 (Th2‐like origin). These findings suggest new biomarkers and new therapeutic avenues including the hypomethylating agent azacytidine, or inhibitors of proximal T‐cell receptor (TCR) signalling and potentially certain monoclonal antibodies. The advances over the past few years, therefore, prompt stratified medicine approaches to test biologically based treatments and determine the clinical utility of the new disease classifications.
Redefining the prognostic likelihood of chronic lymphocytic leukaemia patients with borderline percentage of immunoglobulin variable heavy chain region mutations
Authors: Raponi Sara , Ilari Caterina , Della Starza Irene , Cappelli Luca V. , Cafforio Luciana , Piciocchi Alfonso , Arena Valentina , Mariglia Paola , Mauro Francesca R. , Gentile Massimo , Cutrona Giovanna , Moia Riccardo , Favini Chiara , Morabito Fortunato , Rossi Davide , Gaidano Gianluca , Guarini Anna , Del Giudice Ilaria , Foà Robin
Published: February 2020

In chronic lymphocytic leukaemia (CLL), caution is warranted regarding the clinical implications of immunoglobulin variable heavy chain region (IGHV) rearrangements with a ‘borderline’ (BL) percentage of mutations (i.e. 97–97·9% IGHV identity). We analysed the IGHV mutational status in 759 untreated CLL patients (cohort 1). BL‐CLL (n = 36, 5%) showed a time to first treatment (TFT) similar to that of M‐CLL (n = 338) and significantly longer than that of UM‐CLL (n = 385), despite the enrichment in subset #2 cases. In fact, CLLs belonging to subset #2 (n = 15/759, 2%) were significantly more frequent among BL‐CLLs (n = 5/36, 14%), with a brief TFT. TFT of BL‐CLL remained comparable to that of M‐CLL also considering the 327 CLL patients evaluated at diagnosis. These findings were then validated in an independent cohort 2 of 759 newly diagnosed CLL patients (BL‐CLL: n = 11, 1·4%) and in all newly diagnosed patients from cohorts 1 and 2 (n = 1 086, 84% stage A; BL‐CLL: n = 47, 4·3%). BL‐CLL at diagnosis showed a biological profile comparable to that of M‐CLL with a low frequency of unfavourable prognostic markers, except for a significant enrichment in subset #2. Our data suggest that the prognosis of BL‐CLL is good and similar to that of M‐CLL, with the exception of subset #2 cases.
Trends in the prevalence, incidence and survival of non‐Hodgkin lymphoma subtypes during the 21st century – a Swedish lymphoma register study
Authors: Ekberg Sara , E. Smedby Karin , Glimelius Ingrid , Nilsson‐Ehle Herman , Goldkuhl Christina , Lewerin Catharina , Jerkeman Mats , Eloranta Sandra
Published: February 2020

Non‐Hodgkin lymphoma (NHL) prognosis has improved in recent years, yet the number of patients living with the diagnosis, i.e. the prevalence, has seldom been reported. The prevalence provides a measure of the burden of disease, useful for healthcare planning and to optimise resource allocation. We provide a systematic presentation of temporal trends in absolute numbers of prevalent patients by NHL subtypes, linking them to trends in incidence, survival and mortality. Patients diagnosed 2000–2016 were identified in the national Swedish lymphoma register. Incidence and mortality rates, relative survival and prevalence were estimated for NHL overall and for major clinical and morphological subtypes. Poisson regression was used to test for temporal trends. Increasing incidence and improved survival have led to a 47% increase in the five‐year prevalence of NHL overall in 2016 compared to 2004. An increasing prevalence was observed for all investigated subtypes during the study period, but most notably for diffuse large B cell lymphomas among aggressive subtypes (66%), and marginal zone lymphomas among indolent subtypes (135%). This dramatic increase in NHL prevalence underscores the need to develop and evaluate alternative follow‐up schemes to use resources efficiently and still ensure optimal care of lymphoma survivors.
Analyzing entangled territorialities and Indigenous use of maps: Atikamekw Nehirowisiwok (Quebec, Canada) dynamics of territorial negotiations, frictions, and creativity
Authors: Éthier Benoit
Published: February 2020

This paper highlights the relevance of analyzing entangled territorialities and Indigenous use of maps in order to better understand what Lévy describes in terms of “spatial capital”—the socio‐economic dynamics and power relationships maintained and negotiated between the stakeholders interacting within the Indigenous forestland. More specifically, it discusses the entanglement dynamics of land tenures coexisting today within Nitaskinan, the ancestral territory claimed by the Atikamekw Nehirowisiwok. Within Nitaskinan, members of the First Nation negotiate the continuity of their practices, occupation, and use of ancestral hunting territories with state institutions, logging companies, and non‐Indigenous members of civil society who have interests in the land resources. All these stakeholders implement different territorial regimes that interact and sometimes conflict. Based on concrete ethnographic examples, the analysis presented here focuses on the compromises, frictions, resistance, and creativity that are part of territorial coexistence between Indigenous and non‐Indigenous people.
Fasting plasma glucose variability is an independent risk factor for diabetic retinopathy and diabetic macular oedema in type 2 diabetes: An 8‐year prospective cohort study
Authors: Hsieh Yi‐Ting , Hsieh Ming‐Chia
Published: February 2020

Importance

Long‐term stability in plasma glucose may affect the development of diabetic retinopathy (DR) and diabetic macular oedema (DMO).

Background

To investigate the associations between glycaemic variability and the development of DR and DMO in type 2 diabetes (T2D).

Design

An 8‐year prospective cohort study.

Participants

2005 patients with T2D.

Methods

DR and DMO were detected with non‐mydriatic fundus photography.

Main outcome measures

The visit‐to‐visit variability of fasting glucose or HbA1c was calculated as the standard deviation (SD) or coefficient of variation (CV = SD/mean) of all records during the follow‐up periods or before the onset of the targeted event. Cox regression analysis was used to evaluate the hazard ratios (HRs) for new‐onset DR, proliferative diabetic retinopathy (PDR), and DMO.

Results

After adjusting for the baseline and mean follow‐up values, the SD and CV of fasting glucose during the follow‐up periods were both correlated with the development of PDR (SD: HR = 1.011, P = .005; CV: HR = 6.858, P < .001), and DMO (SD: HR = 1.008, P = .038; CV: HR = 4.027, P = .017). As for HbA1c, neither the SD nor CV was correlated with the development of DR, PDR, or DMO (P > .05 for all).

Conclusions and relevance

High visit‐to‐visit fasting glucose variability was associated with new‐onset PDR and DMO, independent of baseline and mean follow‐up fasting glucose and HbA1c in T2D. Long‐term stability in plasma glucose is important for reducing the risk of the development and progression for DR and DMO.
Simple Threshold Rules Solve Explore/Exploit Trade‐offs in a Resource Accumulation Search Task
Authors: Sang Ke , Todd Peter M. , Goldstone Robert L. , Hills Thomas T.
Published: February 2020

How, and how well, do people switch between exploration and exploitation to search for and accumulate resources? We study the decision processes underlying such exploration/exploitation trade‐offs using a novel card selection task that captures the common situation of searching among multiple resources (e.g., jobs) that can be exploited without depleting. With experience, participants learn to switch appropriately between exploration and exploitation and approach optimal performance. We model participants' behavior on this task with random, threshold, and sampling strategies, and find that a linear decreasing threshold rule best fits participants' results. Further evidence that participants use decreasing threshold‐based strategies comes from reaction time differences between exploration and exploitation; however, participants themselves report non‐decreasing thresholds. Decreasing threshold strategies that “front‐load” exploration and switch quickly to exploitation are particularly effective in resource accumulation tasks, in contrast to optimal stopping problems like the Secretary Problem requiring longer exploration.
The impact of paying for forest conservation on perceived tenure security in Ecuador
Authors: Jones Kelly W , Etchart Nicolle , Holland Margaret , Naughton-Treves Lisa , Arriagada Rodrigo
Published: February 2020

We study the impact of Ecuador's national forest conservation incentives program on reported land conflicts. Data come from a survey of >900 households located within 49 indigenous and Afro‐Ecuadorian communities holding communal conservation contracts. We use quasi‐experimental methods to test for relationships between program participation and changes in land conflicts. Respondents reported that the program reduced land conflicts when households resided in communities with de facto communal tenure arrangements (vs. de facto semiprivate arrangements). We find no evidence that the conservation incentive program increased land conflicts. These results counter concerns that conservation payments undermine land tenure security; in some cases perceived tenure security is improved.
Understanding risk‐based licensing schemes for alcohol outlets: A key informant perspective
Authors: Miller Peter G. , Curtis Ashlee , Graham Kathryn , Kypri Kypros , Hudson Kate , Chikritzhs Tanya
Published: February 2020

Introduction and Aims

Risk‐based alcohol licensing (RBL) has been introduced in several jurisdictions in Australia, New Zealand and Canada with the intention of reducing harm in and around alcohol outlets. RBL involves tailoring licence fees or regulatory agency monitoring levels according to risk criteria such as trading hours, venue size and compliance history. The aim of this study was to document key informant perspectives including their perceptions of the purpose of RBL, how it works and its active ingredients.

Design and Methods

We conducted semi‐structured in‐depth interviews with 28 key informants, including four government policy makers, four liquor licensing representatives, four local council members, eight police officers, six licensees, one academic and one community advocate from Victoria, Queensland, the Australian Capital Territory and Ontario, Canada. We analysed the transcripts using a thematic approach.

Results

Informants varied in their opinions about whether RBL achieved its objective of reducing alcohol‐related harm. They identified difficulties in enforcing the compliance history component of the scheme due to loopholes in legislation as a major shortfall, and the need to apply RBL to packaged liquor (off‐licence) outlets. They also discussed the need to consider outlet density associated with the location of a venue when assessing venue risk.

Discussion and Conclusions

RBL schemes vary by jurisdiction and emphasise different components. In general, informants surmised that RBL as implemented has probably had little or no preventive effect but suggested that it may be effective with greater monitoring and penalties large enough to deter bad practice.
Health‐related quality of life and upper‐limb impairment in children with cerebral palsy: developing a mapping algorithm
Authors: Tonmukayakul Utsana , Imms Christine , Mihalopoulos Cathrine , Reddihough Dinah , Carter Rob , Mulhern Brendan , Chen Gang
Published: February 2020

Aim

To: (1) investigate the relationship between upper‐limb impairment and health‐related quality of life (HRQoL) for children with cerebral palsy and (2) develop a mapping algorithm from the Cerebral Palsy Quality of Life Questionnaire for Children (CPQoL‐Child) onto the Child Health Utility 9D (CHU9D) measure.

Method

The associations between physical and upper‐limb classifications and HRQoL of 76 children (40 females, 36 males) aged 6 to 15 years (mean age 9 years 7 months [SD 3y]) were assessed. Five statistical techniques were developed and tested, which predicted the CHU9D scores from the CPQoL‐Child total/domain scores, age, and sex.

Results

Most participants had mild impairments. The Manual Ability Classification System (MACS) level was significantly negatively correlated with CHU9D and CPQoL‐Child (r=−0.388 and r=−0.464 respectively). There was a negative correlation between the Neurological Hand Deformity Classification (NHDC) and CPQoL‐Child (r=−0.476, p<0.05). The generalized linear model with participation, pain domain, and age had the highest predictive accuracy.

Interpretation

The weak negative correlations between classification levels and HRQoL measures may be explained by the restricted range of impairment levels of the participants. The MACS and NHDC explained the impact of upper‐limb impairment on HRQoL better than the other classifications. The generalized linear model with participation, pain, and age is the suggested mapping algorithm. The suggested mapping algorithm will facilitate the use of CPQoL‐Child for economic evaluation and can be used to conduct cost–utility analyses.

What this paper adds

The Manual Ability Classification System and Neurological Hand Deformity Classification were the best predictors of health‐related quality of life measures.

Age and Cerebral Palsy Quality of Life Questionnaire for Children participation and pain domain scores can predict Child Health Utility 9D scores.
Cortical excitability measured with transcranial magnetic stimulation in children with epilepsy before and after antiepileptic drugs
Authors: Andreasson Ann‐Charlotte , Sigurdsson Gudmundur V , Pegenius Göran , Thordstein Magnus , Hallböök Tove
Published: February 2020

Aim

To evaluate cortical excitability with transcranial magnetic stimulation (TMS) in children with new‐onset epilepsy before and after antiepileptic drugs (AEDs).

Method

Fifty‐five drug‐naïve patients (29 females, 26 males; 3–18y), with new‐onset epilepsy were recruited from 1st May 2014 to 31st October 2017 at the Child Neurology Department, Queen Silvia’s Children’s Hospital, Gothenburg, Sweden. We performed TMS in 48 children (23 females, 25 males; mean [SD] age 10y [3y], range 4–15y) with epilepsy (27 generalized and 21 focal) before and after the introduction of AEDs. We used single‐ and paired‐pulse TMS. We used single‐pulse TMS to record resting motor thresholds (RMTs), stimulus–response curves, and cortical silent periods (CSPs). We used paired‐pulse TMS to record intracortical inhibition and facilitation at short, long, and intermediate intervals.

Results

There were no differences in cortical excitability between children with generalized and focal epilepsy at baseline. After AED treatment, RMTs increased (p=0.001), especially in children receiving sodium valproate (p=0.005). CSPs decreased after sodium valproate was administered (p=0.050). As in previous studies, we noted a negative correlation between RMT and age in our study cohort. Paired‐pulse TMS could not be performed in most children because high RMTs made suprathreshold stimulation impossible.

Interpretation

Cortical excitability as measured with RMT decreased after the introduction of AEDs. This was seen in children with both generalized and focal epilepsy who were treated with sodium valproate, although it was most prominent in children with generalized epilepsy. We suggest that TMS might be used as a prognostic tool to predict AED efficacy.

What this paper adds

Resting motor threshold (RMT) correlated negatively with age in children with epilepsy.

No differences in cortical excitability were noted between patients with generalized and focal epilepsy.

Treatment with antiepileptic drugs decreased cortical excitability as measured with transcranial magnetic stimulation (TMS).

Decreased cortical excitability with increased RMT was recorded, especially after sodium valproate treatment.

Paired‐pulse TMS was difficult to perform because of high RMTs in children.
An autoparasitoid wasp, inferior at resource exploitation, outcompetes primary parasitoids by using competitor females to produce males
Authors: Marrao Rosalina , Frago Enric , Pereira José A. , Tena Alejandro
Published: February 2020

1. Autoparasitoids are intraguild consumers that attack and kill heterospecific and conspecific parasitoids as well as immature stages of hemipteran hosts, such as aphids, whiteflies and soft scales. Field experiments assessing the importance of interspecific competition between autoparasitoids and primary parasitoids, as well as its impact on herbivore suppression, are scarcely found in the ecological literature.

2. Using field data from 40 olive orchards, this study examined the mechanisms that regulate: (i) the interspecific competition between primary parasitoids of the genus Metaphycus and the autoparasitoid Coccophagus lycimnia; and (ii) the density of their shared herbivore host, the soft scale Saissetia oleae.

3. Metaphycus parasitoids used smaller hosts than C. lycimnia, yet did not outcompete C. lycimnia. On the other hand, C. lycimnia preferred to use Metaphycus females as secondary hosts for producing males rather than their own females. This preference might explain why the autoparasitoid negatively affected the density of the primary parasitoids.

4. Parasitism by the autoparasitoid C. lycimnia at the beginning of the season was the sole variable positively related to host mortality throughout the season, showing its greater effect on herbivore suppression.

5. In this study, an autoparasitoid, inferior at resource exploitation, was shown to outcompete a primary parasitoid without disrupting herbivore suppression.
Trade in the shadow of power: Japanese industrial exports in the interwar years
Authors: Ayuso‐Díaz Alejandro , Tena‐Junguito Antonio
Published: February 2020

During the interwar years, Japanese industrialization accelerated alongside the expansion of industrial exports to regional markets. Trade blocs in the interwar years were used as an instrument of imperial power to foster exports and as a substitute for productivity to encourage industrial production. The historiography on Japanese industrialization in the interwar years describes heavy industries’ interests in obtaining access to wider markets to increase economies of scale and reduce unit costs. However, this literature provides no quantitative evidence that proves the success of those mechanisms in expanding exports. In this article we scrutinize how Japan—a relatively poor country—used colonial as well as informal power interventions to expand regional markets for its exports, especially for the most intensive human capital sector of the industrializing economy. Our results show that Japanese exports in 1938 would have been around one‐third smaller had no empire ever existed, which indicates an outstanding effect of empire in the international context.
Efficacy and safety of porcine ALG compared to rabbit ATG as first‐line treatment for children with acquired aplastic anemia
Authors: Zhu Yangmin , Yang Yang , Yang Wenrui , Song Lin , Li Yuan , Fan Huihui , Li Yang , Li Jianping , Ye Lei , Zhao Xin , Zhou Kang , Peng Guangxin , Jing Liping , Zhang Li , Zhang Fengkui
Published: February 2020

Objective

To assess the outcomes of children with acquired aplastic anemia (AA) treated in China with first‐line porcine anti‐lymphocyte immunoglobulin (p‐ALG)/rabbit anti‐thymocyte immunoglobulin (r‐ATG) combined with cyclosporine A (CSA).

Methods

We performed a single‐center, non‐randomized, retrospective cohort study to assess the outcomes of 189 children with AA treated in China with first‐line p‐ALG/r‐ATG combined with CSA between 2014 and 2018.

Results

No significant differences were observed in the overall response rates at 3, 6, 12, or 24 months (3 months: 61.9% vs 67.4%, P = .5; 6 months: 70.9% vs 73.9%, P = .69; 12 months: 77.3% vs 73.3%, P = .58; 24 months: 81.6% vs 78.6%, P = .59) after either p‐ALG‐ or r‐ATG‐based immunosuppressive therapy. No significant differences were observed in overall survival or failure‐free survival between the p‐ALG group and the r‐ATG group.

Conclusion

Our results reveal that the therapeutic efficacy and safety of p‐ALG combined with CSA did not differ significantly from those of r‐ATG combined with CSA as first‐line therapy for pediatric patients with AA. Moreover, p‐ALG has the advantage of significantly lower cost compared with r‐ATG.
Incidence of oral anticoagulant interruption among stroke patients with atrial fibrillation and subsequent stroke
Authors: Kim J.‐M. , Park K.‐Y. , Yu I.‐W. , Song T.‐J. , Kim Y.‐J. , Kim B. J. , Heo S. H. , Jung J.‐M. , Oh K.‐M. , Kim C. K. , Yu S. , Park J.‐H. , Choi J. C. , Park M.‐S. , Kim J.‐T. , Choi K.‐H. , Hwang Y.‐H. , Chung J.‐W. , Bang O. Y. , Kim G.‐M. , Seo W.‐K.
Published: February 2020

Background and purpose

We analyzed the incidence and causes of oral anticoagulant (OAC) cessation and subsequent stroke after OAC withdrawal in a cohort of Korean stroke patients with atrial fibrillation.

Methods

The Korean Atrial Fibrillation Evaluation Registry in Ischemic Stroke patients (K‐ATTENTION) is a multicenter cohort study, merging stroke registries from 11 tertiary centers in Korea. The number of OAC interruption episodes and the reasons were reviewed from hospital records. Stroke after OAC withdrawal was defined when a patient experienced ischaemic stroke within 31 days after OAC withdrawal. Clinical variables were compared between patients who experienced stroke recurrence during OAC interruption and those who did not experience recurrence.

Results

Among 3213 stroke patients with atrial fibrillation, a total of 329 episodes of OAC interruption were detected in 229 patients after index stroke (mean age 72.9 ± 8.3 years, 113 female patients). The most frequent reason for OAC withdrawal was poor compliance [103 episodes (31.3%)] followed by extracranial bleeding [96 episodes (29.2%)]. Stroke after OAC withdrawal was noted in 13 patients. Mean age, vascular risk factor profile and mean CHA2DS2‐VASc score were not significantly different between patients with and without recurrent stroke.

Conclusions

A considerable number of stroke patients with atrial fibrillation experienced temporary interruption of OAC after index stroke, which was associated with stroke recurrence of 4.0 cases per 100 interruption episodes.
Ventilation time and prognosis after stroke thrombectomy: the shorter, the better!
Authors: Fandler‐Höfler S. , Heschl S. , Kneihsl M. , Argüelles‐Delgado P. , Niederkorn K. , Pichler A. , Deutschmann H. , Fazekas F. , Berghold A. , Enzinger C. , Gattringer T.
Published: February 2020

Background and purpose

The aim was to investigate the clinical impact of the duration of artificial ventilation in stroke patients receiving mechanical thrombectomy (MT) under general anaesthesia.

Methods

All consecutive ischaemic stroke patients who had been treated at our centre with MT for anterior circulation large vessel occlusion under general anaesthesia were identified over an 8‐year period. Ventilation time was analysed as a continuous variable and patients were grouped into extubation within 6 h (‘early’), 6–24 h (‘delayed’) and >24 h (‘late’). Favourable outcome was defined as modified Rankin Scale scores of 0–2 at 3 months post‐stroke. Pneumonia rate and reasons for prolonged ventilation were also assessed.

Results

Amongst 447 MT patients (mean age 69.1 ± 13.3 years, 50.1% female), the median ventilation time was 3 h. 188 (42.6%) patients had a favourable 3‐month outcome, which correlated with shorter ventilation time (Spearman’s rho 0.39, P < 0.001). In patients extubated within 24 h, early compared to delayed extubation was associated with improved outcome (odds ratio 2.40, 95% confidence interval 1.53–3.76, P < 0.001). This was confirmed in multivariable analysis (P = 0.01). A longer ventilation time was associated with a higher rate of pneumonia during neurointensive care unit/stroke unit stay (early/delayed/late extubation: 9.6%/20.6%/27.7%, P < 0.01). Whilst stroke‐associated complications represented the most common reasons for late extubation (>24 h), delayed extubation (6–24 h) was associated with admission outside of core working hours (P < 0.001).

Conclusions

Prolonged ventilation time after stroke thrombectomy independently predicts unfavourable outcome at 3 months and is associated with increased pneumonia rates. Therefore, extubation should be performed as early as safely possible.
Early epilepsy in children with Zika‐related microcephaly in a cohort in Recife, Brazil: Characteristics, electroencephalographic findings, and treatment response
Authors: Carvalho Maria Durce C. G. , Ximenes Ricardo A. A. , Montarroyos Ulisses R. , da Silva Paula F. S. , Andrade‐Valença Luciana P. A. , Eickmann Sophie H. , Ramos Regina C. , Rocha Maria Ângela W. , de Araujo Thalia V. B. , de Albuquerque Maria de Fátima P. M. , Martelli Celina M. T. , de Souza Wayner V. , Brickley Elizabeth B. , Miranda‐Filho Demócrito de B. ,   on behalf of the Microcephaly Epidemic Research Group
Published: February 2020

Objective

To estimate the incidence of epilepsy in children with Zika‐related microcephaly in the first 24 months of life; to characterize the associated clinical and electrographic findings; and to summarize the treatment responses.

Methods

We followed a cohort of children, born during the 2015‐2016 Zika virus (ZIKV) epidemic in Brazil, with congenital microcephaly and evidence of congenital ZIKV infection on neuroimaging and/or laboratory testing. Neurological assessments were performed at ≤3, 6, 12, 15, 18, 21, and 24 months of life. Serial electroencephalograms were performed over the first 24 months.

Results

We evaluated 91 children, of whom 48 were female. In this study sample, the cumulative incidence of epilepsy was 71.4% in the first 24 months, and the main type of seizure was infantile spasms (83.1%). The highest incidence of seizures occurred between 3 and 9 months of age, and the risk remained high until 15 months of age. The incidence of infantile spasms peaked between 4 and 7 months and was followed by an increased incidence of focal epilepsy cases after 12 months of age. Neuroimaging results were available for all children, and 100% were abnormal. Cortical abnormalities were identified in 78.4% of the 74 children evaluated by computed tomography and 100% of the 53 children evaluated by magnetic resonance imaging. Overall, only 46.1% of the 65 children with epilepsy responded to treatment. The most commonly used medication was sodium valproate with or without benzodiazepines, levetiracetam, phenobarbital, and vigabatrin.

Significance

Zika‐related microcephaly was associated with high risk of early epilepsy. Seizures typically began after the third month of life, usually as infantile spasms, with atypical electroencephalographic abnormalities. The seizure control rate was low. The onset of seizures in the second year was less frequent and, when it occurred, presented as focal epilepsy.
MRI profiling of focal cortical dysplasia using multi‐compartment diffusion models
Authors: Lorio Sara , Adler Sophie , Gunny Roxana , D’Arco Felice , Kaden Enrico , Wagstyl Konrad , Jacques Thomas S. , Clark Chris A. , Cross Judith Helen , Baldeweg Torsten , Carmichael David W.
Published: February 2020

Objective

Focal cortical dysplasia (FCD) lesion detection and subtyping remain challenging on conventional MRI. New diffusion models such as the spherical mean technique (SMT) and neurite orientation dispersion and density imaging (NODDI) provide measurements that potentially produce more specific maps of abnormal tissue microstructure. This study aims to assess the SMT and NODDI maps for computational and radiological lesion characterization compared to standard fractional anisotropy (FA) and mean diffusivity (MD).

Methods

SMT, NODDI, FA, and MD maps were calculated for 33 pediatric patients with suspected FCD (18 histologically confirmed). Two neuroradiologists scored lesion visibility on clinical images and diffusion maps. Signal profile changes within lesions and homologous regions were quantified using a surface‐based approach. Diffusion parameter changes at multiple cortical depths were statistically compared between FCD type IIa and type IIb.

Results

Compared to fluid‐attenuated inversion recovery (FLAIR) or T1‐weighted imaging, lesions conspicuity on NODDI intracellular volume fraction (ICVF) maps was better/equal/worse in 5/14/14 patients, respectively, while on SMT intra‐neurite volume fraction (INVF) in 3/3/27. Compared to FA or MD, lesion conspicuity on the ICVF was better/equal/worse in 27/4/2, while on the INVF in 20/7/6. Quantitative signal profiling demonstrated significant ICVF and INVF reductions in the lesions, whereas SMT microscopic mean, radial, and axial diffusivities were significantly increased. FCD type IIb exhibited greater changes than FCD type IIa. No changes were detected on FA or MD profiles.

Significance

FCD lesion‐specific signal changes were found in ICVF and INVF but not in FA and MD maps. ICVF and INVF showed greater contrast than FLAIR in some cases and had consistent signal changes specific to FCD, suggesting that they could improve current presurgical pediatric epilepsy imaging protocols and can provide features useful for automated lesion detection.
Drug interactions related to self‐medication: a French pharmacovigilance database study
Authors: Vacher Robin , Lagarce Laurence , Ghamrawi Sarah , Laugier‐Castellan Delphine , Vial Thierry , Bagheri Haleh , Babin Marina , Briet Marie
Published: February 2020

Self‐medication (SM) is a common practice perceived by patients as harmless which can, however, entail health risks. The aim of the study was to identify drug–drug interactions (DDIs) involving SM drugs leading to adverse drug reactions (ADRs) in the National French Pharmacovigilance Database. All ADR reports from 1 January 1985 to 31 July 312018, coded as ‘interaction’ and ‘self‐medication’, were selected and studied. Patient characteristics, the level and type of interaction, and the therapeutic classes of the drugs were examined. Adverse drug reactions were analysed and classified according to the system organ classes of the Medical Dictionary for Regulatory Activities. One hundred and three reports totalling 158 ADRs (71% severe cases) were included; 153 DDIs (59.5% pharmacodynamic) involving 234 drugs were identified. The latter included 119 SM drugs (51% available on prescription), mainly analgaesics, anti‐inflammatory drugs, dietary supplements and antibiotics. Haemostasis disorders and renal failure were the most frequently reported ADRs. The analysis of reference documents raised concerns on the lack of information provided by package leaflets. In conclusion, the present study highlights the risks of medically unapproved re‐use of prescription drugs or the consumption of dietary supplements without monitoring possible interactions and ADRs. Patient awareness could be improved by more regular updates of medication package inserts.
The impact of marine nutrient abundance on early eukaryotic ecosystems
Authors: Reinhard Christopher T. , Planavsky Noah J. , Ward Ben A. , Love Gordon D. , Le Hir Guillaume , Ridgwell Andy
Published: February 2020

The rise of eukaryotes to ecological prominence represents one of the most dramatic shifts in the history of Earth's biosphere. However, there is an enigmatic temporal lag between the emergence of eukaryotic organisms in the fossil record and their much later ecological expansion. In parallel, there is evidence for a secular increase in the availability of the key macronutrient phosphorus (P) in Earth's oceans. Here, we use an Earth system model equipped with a size‐structured marine ecosystem to explore relationships between plankton size, trophic complexity, and the availability of marine nutrients. We find a strong dependence of planktonic ecosystem structure on ocean nutrient abundance, with a larger ocean nutrient inventory leading to greater overall biomass, broader size spectra, and increasing abundance of large Zooplankton. If existing estimates of Proterozoic marine nutrient levels are correct, our results suggest that increases in the ecological impact of eukaryotic algae and trophic complexity in eukaryotic ecosystems were directly linked to restructuring of the global P cycle associated with the protracted rise of surface oxygen levels. Our results thus suggest an indirect but potentially important mechanism by which ocean oxygenation may have acted to shape marine ecological function during late Proterozoic time.
Relationship between heatwave‐induced forest die‐off and climatic suitability in multiple tree species
Authors: Margalef‐Marrase Jordi , Pérez‐Navarro María Ángeles , Lloret Francisco
Published: February 2020

In recent decades, many forest die‐off events have been reported in relation to climate‐change‐induced episodes, such as droughts and heat waves. To understand how these extreme climatic events induce forest die‐off, it is important to find a tool to standardize the climatic conditions experienced by different populations during a specific climatic event, taking into account the historic climatic conditions of the site where these populations live (bioclimatic niche). In this study, we used estimates of climatic suitability calculated from species distribution models (SDMs) for such purpose. We studied forest die‐off across France during the 2003 heatwave that affected Western Europe, using 2,943 forest inventory plots dominated by 14 single tree species. Die‐off severity was estimated by Normalized Difference Vegetation Index (NDVI) loss using Moderate‐resolution Imaging Spectroradiometer remote sensor imagery. Climatic suitability at the local level during the historical 1979–2002 period (HCS), the episode time (2003; ECS) and suitability deviance during the historical period (HCS‐SD) were calculated for each species by means of boosted regression tree models using the CHELSA climate database and occurrences extracted from European forest inventories. Low HCS‐SD and high mean annual temperature explained the overall regional pattern of vulnerability to die‐off across different monospecific forests. The combination of high historical and low episode climatic suitability also contributed significantly to overall forest die‐off. Furthermore, we observed different species‐specific relationships between die‐off vulnerability and climatic suitability: Sub‐Mediterranean and Mediterranean species tended to be vulnerable in historically more suitable localities (high HCS), whereas Euro‐Siberian species presented greater vulnerability when the hot drought episode was more intense. We demonstrated that at regional scale, past climatic legacy plays an important role in explaining NDVI loss during the episode. Moreover, we demonstrated that SDMs‐derived indexes, such as HCS, ECS and HCS‐SD, could constitute a tool for standardizing the ways that populations and species experience climatic variability across time and space.