bluuebunny/crossref_metadata_2025 huggingface dataset:
Interleukin‐33‐nuclear factor‐κB‐CCL2 signaling pathway promotes progression of esophageal squamous cell carcinoma by directing regulatory T cells
Authors: Yue Ying , Lian Jingyao , Wang Tian , Luo Chenghan , Yuan Yiqiang , Qin Guohui , Zhang Bin , Zhang Yi
Published: December 2019

Esophageal cancer is currently one of the most fatal cancers. However, there is no effective treatment. Increasing evidence suggests that interleukin (IL)‐33 has a significant role in tumor progression and metastasis. Currently, the underlying cellular and molecular mechanism of IL‐33 in promoting esophageal squamous cell carcinoma (ESCC) remains unclear. In this study, we investigated whether IL‐33 could induce the epithelial‐mesenchymal transition (EMT) in ESCC. Interleukin‐33 expression was examined in ESCC and corresponding adjacent normal tissues by immunohistochemistry and quantitative real‐time PCR experiments. Elevated IL‐33 levels were observed in ESCC tissues. Further in vitro experiments were undertaken to elucidate the effect of IL‐33 on migration and invasion in KYSE‐450 and Eca‐109 esophageal cancer cells. Knockdown of IL‐33 decreased the metastasis and invasion capacity in esophageal cancer cells, whereas IL‐33 overexpression showed the opposite effect. We then screened CCL2 which is a downstream molecule of IL‐33, and proved that IL‐33 could promote tumor development and metastasis by recruiting regulatory T cells (Tregs) through CCL2, and IL‐33 regulated the expression of CCL2 through transforming growth factor‐β in Treg cells. Knockdown of IL‐33 decreased the development of human ESCC xenografts in BALB/c nude mice. Collectively, we found that the IL‐33/nuclear factor‐κB/CCL2 pathway played an essential role in human ESCC progress. Hence, IL‐33 should be considered as an effective therapy target for ESCC.
Outcomes of cataract surgery in eyes with diabetic macular oedema: Data from the Fight Retinal Blindness! Registry
Authors: Bhandari Sanjeeb , Biechl Anne C. , Nguyen Vuong , Squirrell David , Mehta Hemal , Barthelmes Daniel , Gillies Mark C.
Published: December 2019

Importance

There are limited data on real‐world outcomes of cataract surgery in eyes receiving intravitreal treatments for diabetic macular oedema (DMO).

Background

Cataract surgery may exacerbate oedema in some eyes with DMO resulting in inferior outcomes.

Design

Matched, case‐controlled retrospective study of observational data in routine clinical practice.

Participants

Eyes receiving intravitreal treatments for DMO tracked in the Fight Retinal Blindness! Registry.

Methods

Eyes that underwent cataract surgery were identified and matched 1:1 with phakic controls also receiving intravitreal injections for DMO. We also assessed potential factors that were associated with better visual acuity (VA) outcomes.

Main Outcome Measures

Change in VA 6 months after cataract surgery.

Results

Cataract surgery was identified in 208 eyes of 156 patients of which 147 eyes had 6 months of observations before and after surgery. The mean VA 6 months after surgery improved by 10.6 letters and was similar to their matched phakic controls (68.8 vs 69.2 letters; P = 0.8). Mean CST both 6 months before (341 μm) and after (360 μm) surgery were similar (P = 0.08). However, these eyes had thicker maculae and they received more injections than their matched phakic controls both before and after surgery. Eyes with worse VA before surgery and those that had received intravitreal treatment in the 4 weeks preceding surgery were more likely to gain vision.

Conclusions and Relevance

Visual outcomes of cataract surgery in eyes receiving intravitreal therapy for DMO were reasonably better. Their maculae were thicker and required more injections in the 6 months before and after surgery than their phakic controls.
Best Practices in Family Life Education Program Evaluation
Authors: Hawkins Alan J. , Clyde Tiffany L. , Doty Jennifer L. , Avellar Sarah
Published: December 2019

Program evaluation should be integral to family life education (FLE), but program administrators face common barriers, including expense, lack of evaluation expertise, and fear of no‐effects findings. Thus, the purpose of this article is to provide a primer on feasible best‐practice guidelines for the evaluation of FLE programs. Specifically, we explore four best practices in FLE program evaluation research in real‐world field conditions: (a) clarify upfront the underlying program theory of change or logic model and make research decisions based on this model; (b) adopt a developmental perspective on program evaluation and a mentality of continuous quality improvement; (c) when ready, invest in rigorous impact evaluations with random assignment; and (d) share and synthesize evaluation work to strengthen the field. A theme woven throughout these best practices is for program administrators to collaborate with experienced evaluation researchers to deal with challenging issues. Following these best‐practice guidelines will help program administrators overcome common barriers and conduct evaluation work that strengthens their programs over time and enriches the lives of families.
Denture use and osteoradionecrosis following radiotherapy for head and neck cancer: A systematic review
Authors: Abed Hassan , Burke Mary , Scambler Sasha , Scott Suzanne E.
Published: December 2019

Background

It is strongly recommended to extract teeth with poor prognosis in head and neck cancer (HaNC) patients prior starting treatment with radiotherapy to avoid need for extraction post‐radiotherapy and prevent development of osteoradionecrosis (ORN). Dental extraction means that patients are often left with insufficient teeth leading to psychological problems and reducing their quality of life post‐radiotherapy. Some clinicians do not advocate the use of dentures in HaNC patients claiming that dentures might lead to soft tissue irritation followed by ORN when constructed on irradiated jaws.

Aims

This systematic review aimed to investigate the existing evidence regarding the impact of denture use on the development of ORN in HaNC patients post‐radiotherapy.

Methods

This systematic review followed the Preferred Reporting Item for Systematic Review and Meta‐analyses (PRISMA) guideline. Three database systems were used: Ovid Medline, EMBASE and PsycINFO. PROSPERO was searched for ongoing or recently completed systematic reviews. The https://ClinicalTrials.gov was searched for ongoing or recently completed trials. The Joanna Briggs Institute critical appraisal tools were used to assess quality of studies being reviewed.

Results

Only three retrospective case‐control studies were included. Numbers of participants included in the three studies are limited with incomparable types of mucosal dentures. None of the studies described the method of measurement of the exposure (denture use) in a standard, validated and reliable way.

Conclusion

The three included studies suggested no link between denture use and development of ORN. However, very little evidence exists and the robustness of the studies is questionable. Well‐powered studies are needed.
New Daily Persistent Headache Following Dengue Fever: Report of Three Cases and an Epidemiological Study
Authors: de Abreu Letícia Volpe , Oliveira Cecília Barbosa , Bordini Carlos Alberto , Valença Marcelo Moraes
Published: December 2019

Introduction

Dengue fever is currently a significant public health problem as an emerging pandemic‐prone viral disease in many parts of the world. Up to 100 million individuals, distributed in over 100 countries, are estimated to be infected annually, putting nearly half of the world’s population at risk. The headache associated with dengue fever is considered to be very intense, bilateral, throbbing, frontal, and retro‐orbital. New daily persistent headache (NDPH) is a relatively rare headache entity. It has already been reported that systemic infectious disease may precede the onset of NDPH. We report the data of an epidemiologic study analyzing the cases of NDPH among 450 subjects who had dengue fever.

Method

The study was performed in a medium‐size town in southeastern Brazil (Franca, population 370,000). During the year 2015, 600 cases of dengue fever were reported to the Franca Health Authority. All these patients were contacted by telephone, and 450 of the patients were located and interviewed.

Results

Of these 450 interviews, three possible cases of NDPH were identified.

Conclusion

The observed prevalence of NDPH attributed to dengue fever was 1:150 cases of dengue fever (0.67%).
Higher densities of tumour‐infiltrating lymphocytes and CD4+ T cells predict recurrence and progression of ductal carcinoma in situ of the breast
Authors: Thike Aye Aye , Chen Xiaoyang , Koh Valerie Cui Yun , Binte Md Nasir Nur Diyana , Yeong Joe P S , Bay Boon Huat , Tan Puay Hoon
Published: December 2019

Aims

Host immunity influences cancer progression and therapeutic response. We investigated the potential of tumour‐infiltrating lymphocytes (TILs) around ductal carcinoma in situ (DCIS) in predicting recurrence and progression.

Methods and results

CD4, CD8, programmed cell death 1 (PD‐1) and programmed cell death ligand 1 (PD‐L1) expression in DCIS from 198 patients was determined by immunohistochemistry. We correlated disease‐free survival (DFS), clinicopathological parameters and biomarker expression with TIL density and CD4/CD8 ratio. High TIL density was associated with high nuclear grade (P < 0.001), DCIS PD‐L1 expression (P = 0.008), TIL PD‐L1 expression (P < 0.001), oestrogen (ER) negativity (P < 0.001), progesterone (PR) negativity (P < 0.001), human epidermal growth factor receptor 2 (HER2) positivity (P = 0.002) and triple negativity (P = 0.001). TIL PD‐L1 expression was associated with triple‐negative DCIS (P = 0.028). TIL density was associated with molecular subtypes (P < 0.001). High CD4+ T cell density was associated with high nuclear grade (P = 0.001), microinvasion (P = 0.037), ER negativity (P < 0.001), PR negativity (P = 0.001), HER2 positivity (P = 0.004), triple negativity (P = 0.023) and PD‐L1 expression in TILs (P < 0.011). High CD4/CD8 ratio was associated with PD‐L1 expression in DCIS (P = 0.035) and TILs (P < 0.001). DCIS with higher TIL density disclosed worse DFS (P = 0.012) and was affirmed with multivariate analysis [95% confidence interval (CI) = 1.109–2.554, hazard ratio (HR) = 1.683, P = 0.014]. Poorer DFS for ipsilateral invasive recurrence was found for DCIS with higher CD4+ T cell density (P = 0.006) or CD4/CD8 ratio (P = 0.02), confirmed by multivariate analysis for the former (95% CI = 1.369–10.196, HR = 3.736, P = 0.01) and latter (95% CI = 1.311–7.935, HR = 3.225, P = 0.011).

Conclusion

DCIS with higher TIL density was associated with poorer prognostic parameters and predicted recurrence, while both CD4+ T cell density and CD4/CD8 ratio were associated with both recurrence and ipsilateral invasive recurrence.
Immunohistochemical assessment of HRAS Q61R mutations in breast adenomyoepitheliomas
Authors: Pareja Fresia , Toss Michael S , Geyer Felipe C , da Silva Edaise M , Vahdatinia Mahsa , Sebastiao Ana Paula M , Selenica Pier , Szatrowski Austin , Edelweiss Marcia , Wen Hannah Y , Mihai Raluca , Varga Zsuzsanna , Foschini Maria P , Rubin Brian P , Ellis Ian O , Chandarlapaty Sarat , Jungbluth Achim A , Brogi Edi , Weigelt Britta , Reis‐Filho Jorge S , Rakha Emad A
Published: December 2019

Aims

Breast adenomyoepitheliomas (AMEs) are uncommon tumours. Most oestrogen receptor (ER)‐positive AMEs have mutations in phosphoinositide 3‐kinase (PI3K) pathway genes, whereas ER‐negative AMEs usually harbour concurrent mutations affecting the HRAS Q61 hotspot and PI3K pathway genes. Here, we sought to determine the sensitivity and specificity of RAS Q61R immunohistochemical (IHC) analysis for detection of HRAS Q61R mutations in AMEs.

Methods and results

Twenty‐six AMEs (14 ER‐positive; 12 ER‐negative) previously subjected to massively parallel sequencing (n = 21) or Sanger sequencing (n = 5) of the HRAS Q61 hotspot locus were included in this study. All AMEs were subjected to IHC analysis with a monoclonal (SP174) RAS Q61R‐specific antibody, in addition to detailed histopathological analysis. Nine ER‐negative AMEs harboured HRAS mutations, including Q61R (n = 7) and Q61K (n = 2) mutations. Five of seven (71%) AMEs with HRAS Q61R mutations were immunohistochemically positive, whereas none of the AMEs lacking HRAS Q61R mutations (n = 17) were immunoreactive. RAS Q61R immunoreactivity was restricted to the myoepithelium in 80% (4/5) of cases, whereas one case showed immunoreactivity in both the epithelial component and the myoepithelial component. RAS Q61R immunohistochemically positive AMEs were associated with infiltrative borders (P < 0.001), necrosis (P < 0.01) and mitotic index in the epithelial (P < 0.05) and myoepithelial (P < 0.01) components. RAS Q61R IHC assessment did not reveal Q61K mutations (0/2).

Conclusions

IHC analysis of RAS Q61R shows high specificity (100%) and moderate sensitivity (71%) for detection of HRAS Q61R mutations in breast AMEs, and appears not to detect HRAS Q61K mutations. IHC analysis of RAS Q61R may constitute a useful technique in the diagnostic workup of ER‐negative AMEs.
How helpful are the European AIDS Clinical Society cognitive screening questions in predicting cognitive impairment in an aging, well‐treated HIV‐positive population?
Authors: Metral M , Nadin I , Locatelli I , Tarr PE , Calmy A , Kovari H , Brugger P , Cusini A , Gutbrod K , Schmid P , Schwind M , Kunze U , Di Benedetto C , Pignatti R , Du Pasquier R , Darling KEA , Cavassini M ,   the Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study group, Swiss HIV Cohort Study
Published: December 2019

Objectives

Diagnosing neurocognitive impairment (NCI) in HIV infection requires time‐consuming neuropsychological assessment. Screening tools are needed to identify when neuropsychological referral is indicated. We examined the positive and negative predictive values (PPVs and NPVs, respectively) of the three European AIDS Clinical Society (EACS) screening questions in identifying NCI.

Methods

The Neurocognitive Assessment in the Metabolic and Aging Cohort (NAMACO) study recruited patients aged ≥45 years enrolled in the Swiss HIV Cohort Study between 1 May 2013 and 30 November 2016. NAMACO participants (1) answered EACS screening questions, (2) underwent standardized neuropsychological assessment and (3) completed self‐report forms [Center for Epidemiologic Studies Depression Scale (CES‐D)] rating mood. NCI categories were defined using Frascati criteria. PPVs and NPVs of the EACS screening questions in identifying NCI categories were calculated.

Results

Of 974 NAMACO participants with complete EACS screening question data, 244 (25.1%) expressed cognitive complaints in answer to at least one EACS screening question, of whom 51.3% had NCI (26.1% HIV‐associated and 25.2% related to confounding factors). The PPV and NPV of the EACS screening questions in identifying HIV‐associated NCI were 0.35 and 0.7, respectively. Restricting analysis to NCI with functional impairment or related to confounding factors, notably depression, the NPV was 0.90. Expressing cognitive complaints for all three EACS screening questions was significantly associated with depression (P < 0.001).

Conclusions

The EACS screening questions had an NPV of 0.7 for excluding patients with HIV‐associated NCI as defined by Frascati criteria. The PPV and NPV may improve if NCI diagnoses are based on new criteria.
Preparation, characterization, and physical properties of lightweight ceramics by using sewage sludge ash
Authors: Negm Asmaa A. , Elrasasi Tarek Y. , Khoder Hanem A. , Metawe Fatma M. , El‐Mansy Mabrouk K.
Published: December 2019

In the present study, sewage sludge ash (SSA) was added to clay to prepare lightweight ceramics for sustainable construction materials. The characterization and the effect of different concentrations of SSA on the physical and mechanical properties of the samples were studied. The results showed that the organic matter in SSA facilitated the combustion process. SSA addition reduced the bulk density from (1.94 to 1.32 g/cm3). Otherwise, the water absorption, the apparent porosity and the loss on ignition increased with the increase in SSA concentration. The addition of SSA lowered the compression strength but still within the standard range of the construction materials at concentration up to (30 wt.%). Furthermore, heavy metals are solidified inside the sintered samples, since Cu, Cd, Fe, Zn, Cr, Mn, Ni, and Pb, concentrations in the leachate met the range of Egyptian standard specification.
Investigation on corrosion and wear resistance of MgO‐Al2O3 composite coating prepared by plasma electrolytic oxidation
Authors: Liu Xin‐tong , Wang Dong‐dong , Wu Ye‐kang , Yang Zhong , Li Dalong , Shen Dejiu
Published: December 2019

Ceramic coatings were prepared on 6061 Al alloy in a mixed electrolyte with/without MgO powders at different treatment durations. The results of energy dispersive spectroscopy (EDS) and X‐ray diffraction (XRD) showed that MgO powder was incorporated into the coatings, and Mg species gradually aggregated into coating inside as prolonging the oxidation time. Scanning electron microscopy (SEM) showed that MgO additive had a certain effect on the microstructures and coating thickness. The corrosion behavior tests evaluated by potentiodynamic polarization tests and electrochemical impedance spectroscopy (EIS) in 3.5 wt% NaCl solution suggested that at the same treatment time, the addition of MgO powders can improve the corrosion resistance of the coating, and the Mg‐rich layer can affect the corrosion resistance of the coating. The tests of mechanical properties showed that the addition of MgO powders improved the stability and hardness of the coating.
Permeability behavior of silicon carbide‐based membrane and performance study for oily wastewater treatment
Authors: Das Dulal , Kayal Nijhuma , Marsola Gabriel Antonio , Damasceno Leonardo Augusto , Innocentini Murilo Daniel de Mello
Published: December 2019

Porous SiC ceramic is considered as a suitable material for hot gas filtration, microfiltration, and many others industrial applications. However, full utilizations of porous SiC ceramics have been limited by high‐processing costs. In this study, mullite‐bonded porous SiC ceramics membranes were prepared using commercial SiC powder, alumina, clay, and different sacrificial pore formers. The effect of different pore formers on the microstructure, mechanical strength, porosity and pore size distribution, air, and water permeability of porous SiC ceramics were investigated. The average pore diameter, porosities, and flexural strength of the final ceramics varied in the range 3.7‐6.5 µm, 38‐50 vol. %, and 28‐38 MPa, respectively, depending on the characteristics of pore former. The Darcian (k1) and non‐Darcian (k2) permeability evaluated from air permeation behavior at room temperature was found to vary from 1.48 × 10−13 to 4.64 × 10−13 m2 and 1.46 × 10−8 to 6.51 × 10−8 m, respectively. All membranes showed high oil rejection rate (89%‐93%) from feed wastewater with oil concentration of 1557 mg/L. The membrane with porosity ~48 vol% and mechanical strength 31.5 MPa showed and highest pure water permeability of 13 298 Lm−2h−1bar−1.
Petits‐enfants de Keynes, tâcherons de Marx: pourquoi le travail humain conserve toute son importance
Authors: EKBIA Hamid R. , NARDI Bonnie A.
Published: December 2019

L'inquiétude que suscitent partout dans le monde l'automatisation et son influence sur l'«avenir du travail» découle de certaines idées répandues sur la technologie, l'activité humaine et la valeur économique. Le débat n'est pas nouveau et intéressait déjà des penseurs éminents comme Marx et Keynes. Pour mieux appréhender la situation actuelle, les auteurs réexaminent la question à la lumière de l'histoire du capitalisme. En mettant l'accent sur la place du travail et sur la technologie, ils décrivent des formes cachées de création de valeur dans l'économie contemporaine et abordent certains aspects encore inédits dans le débat historique, avant de présenter plusieurs scénarios possibles pour l'avenir.
Progrès économiques et avancées sociales au sein des chaînes d'approvisionnement mondiales: plusieurs exemples dans les pays du cône Sud
Authors: REINECKE Gerhard , POSTHUMA Anne
Published: December 2019

Les auteurs s'interrogent sur la nature et la diffusion des progrès induits par les chaînes d'approvisionnement mondiales (CAM), en s'appuyant sur les conclusions de neuf études de cas portant sur des filières implantées dans des pays du sud de l'Amérique latine. Des progrès économiques, associés à certaines avancées en matière sociale, sont observés parmi les entreprises têtes de file, mais les fournisseurs en amont n'en tirent pas toujours profit. Après avoir isolé trois types d'évolutions possibles au sein des CAM (développements «antagoniste», «tronqué» et «intégré»), les auteurs formulent des recommandations en ce qui concerne l'action des pouvoirs publics, des entreprises et des acteurs sociaux.
Introduction – Travail, emploi, société: que nous réserve l'avenir?
Authors: Rani Uma , Grimshaw Damian
Published: December 2019

Partant de la matière de ce numéro spécial, les auteurs mettent en évidence les grands thèmes de recherche sur l'avenir du travail. Ils décrivent les mutations accélérées du monde du travail qui offrent des possibilités de croissance génératrice d'égalité, mais avec le risque de mal gérer le changement technique, les inégalités (en insistant sur le caractère intersectionnel et persistant des inégalités entre hommes et femmes), les chaînes d'approvisionnement mondiales et les nouvelles possibilités de dialogue social. Partant, ils formulent des recommandations pour renforcer la protection des travailleurs et les institutions qui les représentent, revoir les cadres réglementaires et les systèmes fiscaux, et enfin assurer des transitions équitables.
Introducción. Trabajo, empleo y sociedad: ¿Qué esperar del futuro?
Authors: RANI Uma , GRIMSHAW Damian
Published: December 2019

En la presente introducción se destacan los principales aspectos extraídos de los artículos de este número especial que cabría considerar en las investigaciones sobre el futuro del trabajo. Se presentan los cambios acelerados que afectan al mundo del trabajo como una oportunidad de orientarse hacia un crecimiento proclive a la igualdad, pero también se advierte de los peligros que plantea una mala gestión del cambio tecnológico, de las desigualdades –haciendo hincapié en el carácter persistente y transversal de la desigualdad de género–, de las cadenas mundiales de suministro y de las oportunidades de diálogo social. En vista de ello, se proponen también recomendaciones de política en las que se presta especial atención al fortalecimiento de la protección de los trabajadores y de las instituciones representativas, el replanteamiento de los marcos normativos y de los sistemas fiscales, y el logro de transiciones justas.
Combining Opinions for Use in Bayesian Networks: A Measurement Error Approach
Authors: Charisse Farr A. , Mengersen Kerrie , Ruggeri Fabrizio , Simpson Daniel , Wu Paul , Yarlagadda Prasad
Published: December 2019

Bayesian networks (BNs) are graphical probabilistic models used for reasoning under uncertainty. These models are becoming increasingly popular in a range of fields including engineering, ecology, computational biology, medical diagnosis and forensics. In most of these cases, the BNs are quantified using information from experts or from users' opinions. While this quantification is straightforward for one expert, there is still debate about how to represent opinions from multiple experts in a BN. This paper proposes the use of a measurement error model to achieve this. The proposed model addresses the issues associated with current methods of combining opinions such as the absence of a coherent probability model, the loss of the conditional independence structure of the BN and the provision of only a point estimate for the consensus. The proposed model is applied to a subnetwork (the three final nodes) of a larger BN about wayfinding in airports. It is shown that the approach performs well than do existing methods of combining opinions.
Finite element modeling of resistive surface layers by micro‐contact impedance spectroscopy
Authors: Veazey Richard A. , Gandy Amy S. , Sinclair Derek C. , Dean Julian S.
Published: December 2019

Micro‐contact impedance spectroscopy (MCIS) is potentially a powerful tool for the exploration of resistive surface layers on top of a conductive bulk or substrate material. MCIS employs micro‐contacts in contrast to conventional IS where macroscopic electrodes are used. To extract the conductivity of each region accurately using MCIS requires the data to be corrected for geometry. Using finite element modeling on a system where the resistivity of the surface layer is at least a factor of ten greater than the bulk/substrate, we show how current flows through the two layers using two typical micro‐contact configurations. This allows us to establish if and what is the most accurate and reliable method for extracting conductivity values for both regions. For a top circular micro‐contact and a full bottom counter electrode, the surface layer conductivity (σs) can be accurately extracted using a spreading resistance equation if the thickness is ~10 times the micro‐contact radius; however, bulk conductivity (σb) values can not be accurately determined. If the contact radius is 10 times the thickness of the resistive surface, a geometrical factor using the micro‐contact area provides accurate σs values. In this case, a spreading resistance equation also provides a good approximation for σb. For two top circular micro‐contacts on thin resistive surface layers, the MCIS response from the surface layer is independent of the contact separation; however, the bulk response is dependent on the contact separation and at small separations contact interference occurs. As a consequence, there is not a single ideal experimental setup that works; to obtain accurate σs and σb values the micro‐contact radius, surface layer thickness and the contact separation must all be considered together. Here we provide scenarios where accurate σs and σb values can be obtained that highlight the importance of experimental design and where appropriate equations can be employed for thin and thick resistive surface layers.
Overexpression of B7H5/CD28H is associated with worse survival in human gastric cancer
Authors: Hu Can , Xu Zhiyuan , Chen Shangqi , Lv Hang , Wang Yiping , Wang Xiaofeng , Mo Shaowei , Shi Chengwei , Wei Shenyu , Hu Liqiang , Chen Wei , Cheng Xiangdong
Published: December 2019

Gastric cancer (GC) is a common malignancy with low 5‐year overall survival (OS). Recently, immune therapy has been used to treat cancer. B7H5 and CD28H are novel immune checkpoint molecules. However, the prognostic value of B7H5/CD28H expression in patients with GC remains unclear. In this study, seventy‐one patients diagnosed with GC were included in this study. Patients' GC tissues and matched adjacent tissue constructed a tissue microarray. The expression levels of B7H5 and CD28H were examined using immunohistochemistry. Correlations between the expression of B7H5 and CD28H and the clinical data were evaluated. We found that the expression of B7H5 and CD28H (both P = .001) were higher in GC tumour tissues than in adjacent noncancerous tissues. B7H5/CD28H expression acted as an independent predictive factor in the OS of patients with GC. High expression of B7H5 and CD28H predicted poor outcome. Patients in the B7H5+CD28H+ group had a lower 5‐year OS compared with patients in the B7H5−CD28− group (4.5% vs 55.6%, P = .001). A significant difference was found in the 5‐year OS between patients in the B7H5+CD28H− and B7H5+CD28H+ groups (33.5% vs 4.5%, P = .006). However, there was no correlation between B7H5 and CD28H expression (P = .844). Therefore, B7H5 and CD28H expression are up‐regulated in GC and are independent prognostic factors for overall survival in patients with GC. Although there was no correlation between B7H5 and CD28H expression, high expression of B7H5 and CD28H predicts poor prognosis, especially when both are highly expressed.
Safety and the effectiveness of a new education program for nurses to assess swallowing function using fiberoptic endoscopic evaluation of swallowing (FEES)
Authors: Yoshida Mikako , Kagaya Hitoshi , Kamakura Yayoi , Miura Yuka , Saitoh Eiichi , Okawa Yohei , Sanada Hiromi
Published: December 2019

Aim

Nurses have the potential to perform fiberoptic endoscopic evaluation of swallowing (FEES) in Japan, which can aid in their provision of swallowing care appropriate to individual patients' swallowing functions. We aimed to confirm the safety and effectiveness of a new nursing education program on FEES by examining its impact on autonomy in performing FEES and accuracy in observing bolus swallowing.

Methods

In this prospective descriptive study, we developed a FEES education program comprising three phases: (a) obtaining knowledge and skills through e‐leaning and a practical workshop; (b) becoming proficient in skills for assessing healthy adults through self‐learning; and (c) obtaining clinical competence through 30 cases of on‐the‐job training (OJT). The trends in autonomy and in accuracy of FEES were evaluated by the data during OJT.

Results

Of the three certified nurses in dysphagia nursing, a trainee completed 30 cases of OJT and the other two trainees experienced 20 cases and 10 cases, respectively without any adverse event. Autonomy in the four major FEES skills gradually increased over the OJT. The correct answer rate, sensitivity, and specificity of the penetration‐aspiration scale and severity of residue in the pyriform sinus and epiglottis valley were above 95% at the first 10 cases of OJT among three trainees and they were 100% after the 11th case of OJT.

Conclusions

Our results suggest that the developed education program helped nurses with experience being present at FEES obtain sufficient knowledge and skills to appropriately and safely perform FEES with 30 cases of OJT.
Prenatal electronic cigarette exposure decreases brain glucose utilization and worsens outcome in offspring hypoxic–ischemic brain injury
Authors: Sifat Ali E. , Nozohouri Saeideh , Villalba Heidi , Al Shoyaib Abdullah , Vaidya Bhuvaneshwar , Karamyan Vardan T. , Abbruscato Thomas
Published: December 2019

It has been shown that prenatal nicotine and tobacco smoke exposure can cause different neurobehavioral disorders in the offspring. We hypothesize that prenatal exposure to nicotine‐containing electronic cigarette (e‐Cig) vapor can predispose newborn to enhanced sensitivity to hypoxic–ischemic (HI) brain injury and impaired motor and cognitive functions. In this study, pregnant CD1 mice were exposed to e‐Cig vapor (2.4% nicotine). Primary cortical neurons isolated from e‐Cig exposed fetus were exposed to oxygen–glucose deprivation followed by reoxygenation (OGD/R) to mimic HI brain injury. Cell viability and glucose utilization were analyzed in these neurons. HI brain injury was induced in 8–9‐day‐old pups. Short‐term brain injury was evaluated by triphenyltetrazolium chloride staining. Long‐term motor and cognitive functions were evaluated by open field, novel object recognition, Morris water maze, and foot fault tests. Western blotting and immunofluorescence were done to characterize glucose transporters in offspring brain. We found that e‐Cig exposed neurons demonstrated decreased cell viability and glucose utilization in OGD/R. Prenatally e‐Cig exposed pups also had increased brain injury and edema 24 hr after HI brain injury. Further, in utero e‐Cig exposed offspring with HI brain injury displayed impaired memory, learning, and motor coordination at adolescence. Additionally, the expression of glucose transporters decreased in e‐Cig exposed offspring brain after HI brain injury. These results indicate that reduced glucose utilization can contribute to prenatal e‐Cig exposure induced worsened HI brain injury in offspring. This study is instrumental in elucidating the possible deleterious effects of e‐Cig use in the general population.

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Early identification of cardiac autonomic neuropathy using complexity analysis in children with type 1 diabetes
Authors: Kane Penny , Larsen Peter , Wiltshire Esko
Published: December 2019

Aim

In children and adolescents, there are significant limitations to detecting cardiac autonomic neuropathy (CAN), an important contributor to morbidity and mortality in adults with type 1 diabetes (T1D). The analysis of heart rate variability (HRV) is one method available to detect CAN. Some evidence shows traditional linear HRV measures detect abnormalities in youth with T1D. In this study, we aimed to assess whether non‐linear complexity analysis of HRV would assist identification of CAN in youth with T1D and to assess contributory factors.

Methods

We studied 19 youth with T1D and 17 healthy controls. Each had an electrocardiogram recorded continuously for 10 min, at a sampling frequency of 1000 Hz. Using Labview software and an algorithm for complexity analysis, along with standard time‐domain and spectral analysis, recordings of the electrocardiogram were analysed to detect differences in HRV between groups.

Results

Youth with T1D had significantly higher sample entropy than controls (P = 0.015) suggesting increased complexity in HRV, but similar detrended fluctuation analysis (P = 0.68). Youth with T1D also had increased % high frequency power (P = 0.017) and reduced mid‐frequency power (P = 0.019) on spectral analysis. There were no differences in heart rate or blood pressure responses to standing, or time‐domain analysis of HRV. Within the T1D group, sample entropy correlated strongly with triglycerides (r = 0.76, P = 0.001) and detrended fluctuation analysis correlated strongly with serum potassium (r = −0.86, P < 0.001).

Conclusions

Complexity analysis of HRV, particularly using sample entropy, may aid detection of CAN in youth with T1D.
Undoing “the vernacular”: Dismantling structures of raciolinguistic supremacy
Authors: Rajendran Shyama
Published: December 2019

This article argues that medieval literary studies must critically reexamine the deployment of the term “vernacular” in its usage concerning late Middle English writing. The term “vernacular” is used to reify and institutionalize the idea of the “standard language,” a concept that emerged in the eighteenth and nineteenth centuries alongside “monolingualism” and “nationalism,” in order to promote cultural homogeneity and a sense of linguistic wholeness for languages such as English; in turn, non‐English (and other non‐European) languages became “vernaculars” within structures of linguistic supremacy designed to discount the languages of the peoples and places that England colonized and enslaved. By historiographically unpacking where our understandings of “vernacular” languages come from, I chart the ways in which defining “vernacular” languages is intrinsic to the making of race in asserting the inferiority of “vernaculars” as inherent to the supposed inferiority of peoples during the nineteenth century through our contemporary moment and reread moments of “language making” in Geoffrey Chaucer's The Man of Law's Tale, drawing from sociolinguistics in order to offer alternative vocabularies to “vernacular.”
Sectarian identity and national identity in the Middle East
Authors: Haddad Fanar
Published: December 2019

This article looks at modern sectarian (here referring to Sunni/Shi'a) identities and their interaction with nationalism in the Middle East. In doing so I make three interrelated claims: 1) the term ‘sectarianism’ is distortive and analytically counterproductive. A better understanding of modern sectarian identity requires us to jettison the term. 2) Once discarded, our focus can then shift to sectarian identity: how it is constructed, perceived, utilized and so forth. A holistic understanding of sectarian identity must recognize the multiple fields upon which it is constructed and contested. The model adopted here frames sectarian identity as simultaneously operating on four fields: doctrinal, subnational, transnational and, crucially for our purposes, the national dimension. 3) Thirdly, this article challenges the assumptions regarding national and sectarian identities in the modern Middle East. Contrary to conventional wisdom, modern sectarian identities are deeply embedded in the prism of the nation‐state and are inextricably linked to nationalism and national identity. The article will rely primarily on the example of modern Iraq but, as will be seen, the Iraqi example is significantly echoed in the cases of Bahrain, Syria and Lebanon.
Identity and state formation in multi‐sectarian societies: Between nationalism and sectarianism in Syria
Authors: Hinnebusch Raymond
Published: December 2019

The relation between state formation and identity in MENA multi‐sectarian societies is examined, taking Syria as a case study. The paper looks at the impact of the mix of sectarianism and nationalism on the formation of state institutions and the impact of the latter on this mix. The flawed export of the Westphalian state system to MENA established the structural context—multiple identities, hybrid states—wherein the two identities compete, overlap, and coexist. Next, the factors that explain varying identity patterns in MENA are surveyed and their likely consequences for state formation; then, reversing the analysis, the impact of state formation and state institutions on the nationalism–sectarianism balance is examined. The Syrian case is briefly discussed in order to illustrate the argument, looking at three periods when the identity balance interacted differently with state formation: pre‐Ba'thist Syria when nationalism eclipsed sectarianism; Ba'thist Syria (1970‐2000) when patrimonial instrumentalization of sectarianism was compensated for by inclusive bureaucratic institutions, populist policies, and nationalist ideology; neo‐liberal Syria under Bashar al‐Asad (2000‐2010) when inclusion shrank, reanimating sectarianism; and civil war Syria (2010‐) when partial state failure fostered exclusionary militant sectarianism at the expense of nationalism.
Soluble iron accumulation induces microglial glutamate release in the spinal cord of sporadic amyotrophic lateral sclerosis
Authors: Niida‐Kawaguchi Motoko , Kakita Akiyoshi , Noguchi Noriko , Kazama Miku , Masui Kenta , Kato Yoichiro , Yamamoto Tomoko , Sawada Tatsuo , Kitagawa Kazuo , Watabe Kazuhiko , Shibata Noriyuki
Published: December 2019

Previous studies on sporadic amyotrophic lateral sclerosis (SALS) demonstrated iron accumulation in the spinal cord and increased glutamate concentration in the cerebrospinal fluid. To clarify the relationship between the two phenomena, we first performed quantitative and morphological analyses of substances related to iron and glutamate metabolism using spinal cords obtained at autopsy from 12 SALS patients and 12 age‐matched control subjects. Soluble iron content determined by the Ferrozine method as well as ferritin (Ft) and glutaminase C (GLS‐C) expression levels on Western blots were significantly higher in the SALS group than in the control group, while ferroportin (FPN) levels on Western blots were significantly reduced in the SALS group as compared to the control group. There was no significant difference in aconitase 1 (ACO1) and tumor necrosis factor‐alpha (TNFα)‐converting enzyme (TACE) levels on Western blots between the two groups. Immunohistochemically, Ft, ACO1, TACE, TNFα, and GLS‐C were proven to be selectively expressed in microglia. Immunoreactivities for FPN and hepcidin were localized in neuronal and glial cells. Based on these observations, it is predicted that soluble iron may stimulate microglial glutamate release. To address this issue, cell culture experiments were carried out on a microglial cell line (BV‐2). Treatment of BV‐2 cells with ferric ammonium citrate (FAC) brought about significant increases in intracellular soluble iron and Ft expression levels and conditioned medium glutamate and TNFα concentrations. Glutamate concentration was also significantly increased in conditioned media of TNFα‐treated BV‐2 cells. While the FAC‐driven increases in glutamate and TNFα release were completely canceled by pretreatment with ACO1 and TACE inhibitors, respectively, the TNFα‐driven increase in glutamate release was completely canceled by GLS‐C inhibitor pretreatment. Moreover, treatment of BV‐2 cells with hepcidin resulted in a significant reduction in FPN expression levels on Western blots of the intracellular total protein extracts. The present results provide in vivo and in vitro evidence that microglial glutamate release in SALS spinal cords is enhanced by intracellular soluble iron accumulation‐induced activation of ACO1 and TACE and by increased extracellular TNFα‐stimulated GLS‐C upregulation, and suggest a positive feedback mechanism to maintain increased intracellular soluble iron levels, involving TNFα, hepcidin, and FPN.
Self‐care as care left undone? The ethics of the self‐care agenda in contemporary healthcare policy
Authors: Greaney Anna‐Marie , Flaherty Sinead
Published: December 2019

Self‐care, or self‐management, is presented in healthcare policy as a precursor to patient empowerment and improved patient outcomes. Alternatively, critiques of the self‐care agenda suggest that it represents an over‐reliance on individual autonomy and responsibility, without adequate support, whereby ‘self‐care’ is potentially unachievable and becomes ‘care left undone’. In this sense, self‐care contributes to a blame culture where ill‐health is attributed to personal behaviours or lack thereof. Furthermore, self‐care may represent a covert form of rationing, as the fiscal means to enable effective self‐care and supplement, or replace, self‐care capacities, is not provided. This paper explores these arguments through a contemporary ethical analysis of the self‐care agenda. The terms self‐care and self‐management are used interchangeably throughout whereby self‐management is understood as a point in the wider self‐care continuum.
Optimal diameter of the pulmonary vein ostium for second‐generation 28‐mm cryoballoon ablation of atrial fibrillation
Authors: Kurokawa Sayaka , Nagashima Koichi , Watanabe Ryuta , Arai Masaru , Wakamatsu Yuji , Otsuka Naoto , Yagyu Seina , Nakai Toshiko , Okumura Yasuo
Published: December 2019

Background

Large pulmonary veins (PVs) have the risk of excessive cooling when the cryoballoon is moved into them, whereas smaller PVs may not be isolated because of insufficient balloon‐tissue contact. We previously reported that the effective nadir balloon temperature (NBT) was <− 44°C for predicting early PV reconnections. However, the ideal PV and left atrial (LA) diameters for cooling temperatures during cryoballoon ablation (CBA) are unknown.

Methods

We measured the PV ostium (PVos) and LA diameters on computed tomography images in 71 atrial fibrillation patients who underwent a 28‐mm CBA. We defined −60°C ≤ NBT <− 44°C as the optimal NBT. The optimal PVos diameters and elliptical area were determined using the receiver operating characteristic curve cutoff values for the optimal NBT.

Results

The maximum PVos diameter (PVmax), minimum PVos diameter (PVmin), and PV elliptical area correlated negatively with the NBT (PVmax: r = −.34, P < .0001; PVmin: r = −.41, P < .0001; PV elliptical area: r = −.41, P < .0001). Based on the NBT‐derived definition, the optimal PVmax, PVmin, and PV elliptical area were 19 < PVmax ≤ 21 mm, 14 < PVmin ≤ 16 mm, and 186.83 < PV elliptical area ≤ 254.34 mm2, respectively. In addition, a positive correlation between the LA longitudinal diameter and NBT was observed in the right superior PV (r = .34, P = .004), and the LA transverse diameter correlated inversely with the NBT in the left inferior PV (r = −.34, P = .004).

Conclusions

We identified the optimal PV diameters and elliptical area to establish the optimal NBT during the second‐generation 28‐mm CBA. These data will help for the preclinical judgment for a successful CBA.
Early experience with erector spinae plane blocks in children
Authors: Holland Erica L. , Bosenberg Adrian T.
Published: December 2019

Background

An erector spinae plane block is a relatively new regional anesthetic technique. Apart from case reports and small series, the literature regarding pediatric use is limited.

Aim

Our objective was to determine the efficacy of the erector spinae plane block in children by measuring the heart rate response to incision. Secondary objectives included feasibility, safety, opioid consumption, and pain scores. Furthermore, we reviewed this block in children published since 2016.

Study design

Case Series; Level of evidence, IV.

Methods

With Institutional Review Board approval, a retrospective chart review was conducted on all patients who received erector spinae plane block for surgery between October 2017 and May 2019 at a single institution. Blocks were performed under anesthesia, using ultrasound guidance prior to surgical incision. Block details and hemodynamic and analgesic data were collected. In addition, a PubMed literature review was conducted to identify all erector spinae plane block related publications in patients ≤18 years of age.

Results

About 164 patients, 2 days‐19.4 years, weighing 2.3‐94.7 kg, received erector spinae plane blocks. For more than 79% of single injection blocks, placement time was ≤10 minutes. Using a heart rate increase of <10% at skin incision as criterion, 70.1% of patients had a successful block. Only 20% required long‐acting opioids intraoperatively. In a subset of infants who underwent gastrostomy surgery using a dose of 0.5 mL/kg, a local anesthetic spread of at least five dermatomes (0.1 mL/kg/dermatome) was achieved. Per the literature review, 33 publications described erector spinae plane block in 128 children. No complications were reported.

Conclusion

Erector spinae plane blocks are relatively easy to perform in children with no complications reported to date. The efficacy of the block for a broad spectrum of surgeries, involving incisions from T1 to L4, is encouraging.
Clinical practice guidelines in pediatric anesthesia: What constitutes high‐quality guidance?
Authors: Olweny Catherine N. , Arnold Philip
Published: December 2019

The explosion of scientific evidence has outstripped the ability of individual clinicians to acquire, process, and apply it within a clinical context. Clinical practice guidelines bridge the gap between this large body of evidence and clinical practice by translating evidence into recommendations. As such, they are an important extension of the evidence‐based medicine paradigm. Guidelines promise to translate evidence into actionable clinical recommendations. However, this promise can only be realized if they are both useful and trustworthy. As the number of guidelines increases users’ question their role, the quality of the scientific evidence behind them and the strength of the recommendations made. In this article, we provide definitions and outline the features of the common forms of clinical guidance. We then describe the essential characteristics of good quality clinical guidance and outline initiatives aimed at improving quality. Specific issues and limitations related to guideline development in perioperative care of children are discussed. Finally, two clinical guidance documents, published recently in Pediatric Anesthesia, are discussed based upon these criteria.