bluuebunny/crossref_metadata_2025 huggingface dataset:
The History of Home Hemodialysis: A View From Seattle
Authors: Blagg Christopher R.
Published: September 2016

Home hemodialysis was first used for the treatment of end‐stage renal disease in the early 1960s, primarily as a means of reducing the cost of treatment. It was soon found to be an effective form of treatment that provided patient independence, greater opportunity for rehabilitation, and better survival. In 1973, when the Medicare End‐Stage Renal Disease Program began, some 40% of all U.S. dialysis patients were on home hemodialysis, but since then the percentage of patients on this treatment has steadily decreased. There are several reasons for this, one in particular being the lack of availability of suitable equipment.

There is now renewed interest in home hemodialysis sparked by the knowledge that new equipment specifically designed for this is being developed, that this is the modality with the best survival rate, greatest opportunity for adequate dialysis and best quality of life, and an interest in the use of daily (or nightly) home hemodialysis. Consequently, more than 30 years later, it appears that home hemodialysis may again become the preferred treatment for many more patients.
Experience With Nocturnal Hemodialysis
Authors: Pierratos Andreas , Ouwendyk Michaelene , Franceur Robert
Published: September 2016

In order to provide a highly efficient, long‐duration form of hemodialysis, we developed nocturnal hemodialysis. Patients were dialyzed nightly at home for 8 – 10 hours, 6 – 7 nights/week. We kept the dialysate flow at 100 mL/min and the blood flow at 250 – 300 mL/min. Patients were monitored remotely from the hospital through a computer connection. An internal jugular line was used as an access. We have trained 12 patients over 30 months and have accumulated 160 patient‐months worth of data. The patients tolerated the dialysis very well and slept through the night. There was a significant improvement in their sense of well‐being. Nightly Kt/V was 0.99. Weekly removal of phosphate was two times as high and β 2 ‐microglobulin four times as high as conventional hemodialysis. All patients have discontinued their phosphate binders and have increased their dietary phosphate and protein intake. Hypertension was controlled with fewer medications, and erythropoietin dosages decreased. Complications were infrequent and included catheter occlusion and infections. Reusing the dialyzers decreased the cost of the treatment to levels similar to continuous ambulatory peritoneal dialysis.

Nocturnal hemodialysis represents a viable dialysis modality that combines high quality, low cost, and excellent tolerance.
Can Diastat Grafts Meet the Challenges of Daily Punctures?
Authors: Chandran Prem K.G. , Messer Diane , Sidwell Richard A. , Stubbs David H. , Nish Andrew D.
Published: September 2016

To determine whether Diastat grafts can meet the challenges of daily needle punctures required for home hemodialysis (HD), a retrospective analysis was performed on the experience with 47 grafts placed in 44 patients receiving HD three times a week. The control group consisted of 17 patients who received 17 stretch polytetrafluoroethylene (s‐PTFE) grafts. Apart from their ability to better contain bleeding after needle withdrawal, in all measures of longevity the Diastat grafts were outperformed by the s‐PTFE grafts. No more direct data exist to address the original challenge.
Home Hemodialysis: A Patient's Perspective
Authors: Harper George
Published: September 2016

This is a personal story of a member of a family with hereditary nephritis. My oldest brother died in 1946 before there was any dialysis or transplantation in the United States. My other brother died at the age of 22 in 1960 after unsuccessful kidney transplantation. I developed renal failure in 1980 and was lucky to survive due to the combination of several factors. The first, and most important, was the choice of home hemodialysis, which offers the longest patient survival of all dialysis modalities. The second was the help of my wife, who is my dialysis partner. The third was my conviction that it is not possible to get too much dialysis. I took control of my treatment and insisted on having the largest available dialyzers and performed long dialysis sessions. I was able to continue to work for the first 15 years on dialysis. As I look to the future, I am excited about the prospect of daily home hemodialysis, because I believe that this therapy will offer more efficient treatment and a nearly normal diet.
Changes in myofibrillar structure of silver carp (Hypophthalmichthys molitrix) as affected by endogenous proteolysis under acidic condition
Authors: Yang Fang , Xia Wenshui , Rustad Turid , Xu Yanshun , Jiang Qixing
Published: September 2016

Effect of endogenous proteolysis on myofibrillar conformational changes under acidic condition was investigated by spectroscopic techniques. The result of intrinsic tryptophan fluorescence showed that tryptophan residues were exposed to polar environment by acid denaturation of protein and participation of endogenous proteolysis. Extrinsic fluorescence indicated that average surface hydrophobicity (ShANS) decreased by reduction of pH but increased by endogenous proteolysis. Second‐derivative UV‐spectroscopy implied that the decrease of ShANS under acidic condition may be due to burying of some aromatic amino acid residues into hydrophobic cores induced by acid‐induced aggregation, such as tyrosine, while ShANS increased by exposure of some hydrophobic amino acids due to the effect of endogenous proteases. Raman spectra verified the changes in microenvironment of tryptophan and tyrosine residues, and showed that aliphatic amino acids were mainly exposed to polar solvent by both acid denaturation and endogenous proteolysis. In addition, new disulphide bonds were less likely to form by acid‐induced aggregation and proteolytic cleavage, while random coils increased and smaller water domains were found.
Infants' Visual Recognition of Pincer Grip Emerges Between 9 and 12 Months of Age
Authors: Senna Irene , Addabbo Margaret , Bolognini Nadia , Longhi Elena , Macchi Cassia Viola , Turati Chiara
Published: September 2016

The development of the ability to recognize the whole human body shape has long been investigated in infants, while less is known about their ability to recognize the shape of single body parts, and in particular their biomechanical constraints. This study aimed to explore whether 9‐ and 12‐month‐old infants have knowledge of a hand‐grasping movement (i.e., pincer grip), being able to recognize violations of the hand's anatomical constraints during the observation of that movement. Using a preferential looking paradigm, we showed that 12‐month‐olds discriminate between biomechanically possible and impossible pincer grips, preferring the former over the latter (Experiment 1). This capacity begins to emerge by 9 months of age, modulated by infants' own sensorimotor experience with pincer grip (Experiment 2). Our findings indicate that the ability to visually discriminate between pincer grasps differing in their biomechanical properties develops between 9 and 12 months of age, and that experience with self‐produced hand movements might help infants in building a representation of the hand that encompasses knowledge of the physical constraints of this body part.
Cross‐sectional survey and surveillance for influenza viruses and MERS‐CoV among Egyptian pilgrims returning from Hajj during 2012‐2015
Authors: Refaey Samir , Amin Marwa Mohamed , Roguski Katherine , Azziz‐Baumgartner Eduardo , Uyeki Timothy M. , Labib Manal , Kandeel Amr
Published: September 2016

Background

Approximately 80 000 Egyptians participate in Hajj pilgrimage annually. The purpose of this study was to estimate influenza virus and MERS‐CoV prevalence among Egyptian pilgrims returning from Hajj.

Study

A cross‐sectional survey among 3 364 returning Egyptian pilgrims from 2012 to 2015 was conducted. Nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected from all participants. Sputum specimens were collected from participants with respiratory symptoms and productive cough at the time of their interview. Specimens were tested for influenza viruses, and a convenience sample of NP/OP specimens was tested for MERS‐CoV. Thirty percent of participants met the case definition for influenza‐like illness (ILI), 14% tested positive for influenza viruses, and none tested positive for MERS‐CoV. Self‐reported influenza vaccination was 20%.

Conclusions

High prevalence of reported ILI during pilgrimage and confirmed influenza virus on return from pilgrimage suggest a continued need for influenza prevention strategies for Egyptian Hajj pilgrims. An evaluation of the Ministry of Health and Population's current risk communication campaigns to increase influenza vaccine use among pilgrims may help identify strategies to improve vaccine coverage.
Feeding problems in infancy and early childhood: evolutionary concept analysis
Authors: Estrem Hayley H. , Pados Britt F. , Park Jinhee , Knafl Kathleen A. , Thoyre Suzanne M.
Published: September 2016

Aim

The aim of this study was to report an analysis of the concept of pediatric feeding problems.

Background

Reviews of the literature on pediatric feeding problems and disorders repeatedly reference the lack of a shared conceptualization of feeding problems. It is difficult to track aetiology, prevalence and incidence of a phenomenon when available definitions and diagnoses lack practical utility.

Design

An evolutionary concept analysis.

Data sources

A search was conducted in October 2014 of Google Scholar, CINAHL, PubMed and Web of Science databases, with MeSH terms and key words including: failure to thrive, feeding disorder/difficulty/problems, infantile anorexia, oral aversion, mealtime behaviour and dysphagia. Inclusion criteria were: subject of feeding problems, index children 0‐10 years of age, English language and full text.

Methods

The articles (n = 266) were sorted into disciplines of authorship, including Psychology, Medicine, Nursing, Nutrition, Occupational Therapy, Speech Language Pathology or Other. The sample was divided into a historical sample (n = 42) for pre‐2000 articles and current for those published post‐2000. The current sample was later reduced to 100 and coded for surrogate terms, related concepts, attributes, antecedents and consequences.

Results

The historical view of pediatric feeding problems shows a tradition of mother blame or parental culpability, both direct and indirect. Currently, there exist many different definitions and typologies, but none have sound validity or generalizability. Areas of attribute consensus across disciplines are problematic feeding behaviours and selective or restrictive intake.

Conclusion

A spectrum conceptualization of feeding problems is suggested for further development, with attributes that would be critical to have a feeding problem.
Assessment of cognitive bias in decision‐making and leadership styles among critical care nurses: a mixed methods study
Authors: Lean Keng Soon , AlQudah Hani Nawaf Ibrahim
Published: September 2016

Aims

To raise awareness of critical care nurses' cognitive bias in decision‐making, its relationship with leadership styles and its impact on care delivery.

Background

The relationship between critical care nurses' decision‐making and leadership styles in hospitals has been widely studied, but the influence of cognitive bias on decision‐making and leadership styles in critical care environments remains poorly understood, particularly in Jordan.

Design

Two‐phase mixed methods sequential explanatory design and grounded theory. Setting: critical care unit, Prince Hamza Hospital, Jordan. Participant sampling: convenience sampling Phase 1 (quantitative,n = 96), purposive sampling Phase 2 (qualitative,n = 20).

Methods

Pilot tested quantitative survey of 96 critical care nurses in 2012. Qualitative in‐depth interviews, informed by quantitative results, with 20 critical care nurses in 2013. Descriptive and simple linear regression quantitative data analyses. Thematic (constant comparative) qualitative data analysis.

Results

Quantitative – correlations found between rationality and cognitive bias, rationality and task‐oriented leadership styles, cognitive bias and democratic communication styles and cognitive bias and task‐oriented leadership styles. Qualitative – ‘being competent’, ‘organizational structures’, ‘feeling self‐confident’ and ‘being supported’ in the work environment identified as key factors influencing critical care nurses’ cognitive bias in decision‐making and leadership styles. Two‐way impact (strengthening and weakening) of cognitive bias in decision‐making and leadership styles on critical care nurses’ practice performance.

Conclusion

There is a need to heighten critical care nurses’ consciousness of cognitive bias in decision‐making and leadership styles and its impact and to develop organization‐level strategies to increase non‐biased decision‐making.
Bullous pemphigoid and its association with neurological diseases: a systematic review and meta‐analysis
Authors: Lai Y.C. , Yew Y.W. , Lambert W.C.
Published: September 2016

Bullous pemphigoid (BP) is a chronic, autoimmune vesiculobullous disease that frequently occurs in the elderly population. Previous epidemiological studies have suggested an association between BP and neurological diseases; some studies, however, showed conflicting results. This study aimed to investigate if patients with BP have significantly higher risks for neurological disorders, compared to controls. A comprehensive search was performed using MEDLINE, EMBASE and Cochrane library databases. Case–control and cohort studies that assessed the relationship between BP and neurological diseases were included. DerSimonian and Laird random‐effects models were utilized to calculate the pooled relative risks (RRs). Publication bias was evaluated qualitatively by constructing a funnel plot and quantitatively by conducting Egger's test. Fourteen studies, with 23 369 BP cases and 128 697 controls were included in this meta‐analysis. Patients with BP were significantly more likely to have stroke (RR 2.68, 95% CI: 2.07–3.46), Parkinson's disease (PD; RR 3.42, 95% CI: 3.01–3.87), dementia (RR 4.46, 95% CI: 3.23–6.16), epilepsy (RR 2.98, 95% CI: 1.42–6.28), multiple sclerosis (RR 12.40, 95% CI: 6.64–23.17) and any aforementioned neurological disease (RR 4.93, 95% CI: 3.62–6.70), compared to controls. Moderate to high heterogeneity were observed for analyses of most neurological diseases, except for PD and multiple sclerosis. This study provided support for a significant association between BP and neurological diseases. Clinicians should be aware of this association and manage modifiable risk factors for neurological diseases accordingly.
Influence of Bleaching Agents on Color and Translucency of Aged Resin Composites
Authors: Lago Maristela , Mozzaquatro Lisandra R. , Rodrigues Camila , Kaizer Marina R. , Mallmann André , Jacques Letícia B.
Published: September 2016

Objectives

Evaluate the influence of two bleaching agents (16% carbamide peroxide—CP and 35% hydrogen peroxide—HP) on color and translucency of one resin composite (Filtek Z350 XT) in two opacities (enamel and dentin) previously aged in deionized water or red wine.

Methods

Sixty specimens of each material were divided in two groups (n = 30): aged in water or red wine for 14 days. Then the specimens were divided in three subgroups (n = 10): control/no treatment, treated with 16% carbamide peroxide (Mix Night), treated with 35% hydrogen peroxide (Mix One). Color readings were performed 24 hours after polishing (baseline); after the 14 days of aging; and after bleaching treatment. Color coordinates CIE L*a*b* were measured using a spectrophotometer (SP60 X‐Rite). Color change (CIEDE2000) and translucency parameter were calculated. Data were analyzed with repeated measures two‐way ANOVA, and Student‐Newman‐Keuls tests (5%).

Results

Bleaching decreased color change in stained resin composites (aged in red wine), whereas increased it in non‐stained enamel resin composites (aged in water). CP had better bleaching results with stained resin composites than HP. Translucency of non‐stained dentin resin composite decreased with aging, but did not change with bleaching. For stained resin composites, aging caused reduced translucency, whereas bleaching increased it.

Clinical Significance

Effective bleaching of discolored resin composites aged in an acidic and alcoholic media rich in staining agents was achieved, improving color and translucency. Carbamide peroxide showed better performance than hydrogen peroxide for the bleaching of stained resin composites. (J Esthet Restor Dent 29:368–377, 2017)
Polymorphism of neuropeptide Y gene rs16147 modifies the response to a hypocaloric diet on cardiovascular risk biomarkers and adipokines
Authors: de Luis D. A. , Izaola O. , de la Fuente B. , Primo D. , Aller R.
Published: September 2016

Background

The main genetic variant described in NPY gene is rs16147 (G‐399A) and it is located within the promoter region upstream of the gene for neropeptide Y (NPY). We evaluate the effects of the rs16147 NPY gene polymorphism on metabolic changes secondary to weight loss after 3 months of a hypocaloric diet in adult obese patients.

Methods

A population of 82 obese patients was analysed in an interventional design of one arm. Before and after 3 months on a hypocaloric diet, an anthropometric evaluation, an assessment of nutritional intake and a biochemical analysis were performed. The statistical analysis was performed for combined GA and AA as a group (minor allele group) and GG as second group (major allele group) (dominant model).

Results

In A allele carriers, the mean (SD) decrease in weight was −2.8 (2.2) kg [decrease in non A allele carriers −2.6 (1.1) kg, P > 0.05), body mass index was −1.2 (0.6) kg m−2 [decrease in non A allele carriers −1.1 (0.8) kg m−2, P > 0.05], fat mass was −1.7 (1.4) kg [decrease in non A allele carriers −1.9 (1.3) kg, P > 0.05], waist circumference was −5.5 (3.4) cm [decrease in non A allele carriers −3.7 (4.1) cm, P = 0.006], C‐reactive protein (CRP) was −0.7 (0.6) mg dL−1 [decrease in non A allele carriers −0.1 (0.3) mg dL−1, P = 0.02], insulin was −1.5 (0.4) mUI L−1 [decrease in non A allele carriers −0.8 (2.0) mUI L−1, P = 0.001] and homeostasis model assessment‐insulin resistance (HOMA‐IR) was −0.4 (0.5) [decrease in non A allele carriers −0.2 (0.1), P = 0.005]. interleukin (IL)‐6 changes were significant in A allele carriers [−0.7 (0.2) pg mL−1] versus non A allele carriers [−0.1 (0.3) pg mL−1] (P = 0.01).

Conclusions

We found that the rs164147 genotype affected the reduction of waist circumference, HOMA‐IR, insulin, CRP and IL‐6 levels in response to weight loss diet in obese subjects.
Waist‐to‐height ratio is independently related to whole and central body fat, regardless of the waist circumference measurement protocol, in non‐alcoholic fatty liver disease patients
Authors: Pimenta N. M. , Cortez‐Pinto H. , Melo X. , Silva‐Nunes J. , Sardinha L. B. , Santa‐Clara H.
Published: September 2016

Background

Waist‐to‐height ratio (WHtR) has been reported as a preferable risk related body fat (BF) marker, although no standardised waist circumference measurement protocol (WCmp) has been proposed. The present study aimed to investigate whether the use of a different WCmp affects the strength of relationship between WHtR and both whole and central BF in non‐alcoholic fatty liver disease (NAFLD) patients.

Methods

BF was assessed with dual energy X‐ray absorptiometry (DXA) in 28 NAFLD patients [19 males, mean (SD) 51 (13) years and nine females, 47 (13) years]. All subjects also underwent anthropometric evaluation including height and waist circumference (WC) measurement using four different WCmp (WC1, minimal waist; WC2, iliac crest; WC3, mid‐distance between iliac crest and lowest rib; WC4, at the umbilicus) and WHtR was calculated using each WC measurements (WHtR1, WHtR2, WHtR3 and WHtR4, respectively). Partial correlations were conducted to assess the relation of WHtR and DXA assessed BF.

Results

All WHtR were particularly correlated with central BF, including abdominal BF (r = 0.80, r = 0.84, r = 0.84 and r = 0.78, respectively, for WHtR1, WHtR2, WHtR3 and WHtR4) and central abdominal BF (r = 0.72, r = 0.77, r = 0.76 and r = 0.71, respectively, for WHtR1, WHtR2, WHtR3 and WHtR4), after controlling for age, sex and body mass index. There were no differences between the correlation coefficients obtained between all studied WHtR and each whole and central BF variable.

Conclusions

Waist‐to‐height ratio was found a suitable BF marker in the present sample of NAFLD patients and the strength of the relationship between WHtR and both whole and central BF was not altered by using different WCmp in the present sample of NAFLD patients.
Unaltered Hypothalamic Metabolic Gene Expression in Kiss1r Knockout Mice Despite Obesity and Reduced Energy Expenditure
Authors: De Bond Julie‐Ann P. , Tolson Kristen P. , Nasamran Chanond , Kauffman Alexander S. , Smith Jeremy T.
Published: September 2016

Kisspeptin controls reproduction by stimulating gonadotrophin‐releasing hormone neurones via its receptor Kiss1r. Kiss1r is also expressed other brain areas and in peripheral tissues, suggesting additional nonreproductive roles. We recently determined that Kiss1r knockout (KO) mice develop an obese and diabetic phenotype. In the present study, we investigated whether Kiss1r KOs develop this metabolic phenotype as a result of alterations in the expression of metabolic genes involved in the appetite regulating system of the hypothalamus, including neuropeptide Y (Npy) and pro‐opiomelanocortin (Pomc), as well as leptin receptor (Lepr), ghrelin receptor (Ghsr), and melanocortin receptors 3 and 4 (Mc3r, Mc4r). Body weights, leptin levels and hypothalamic gene expression were measured in both gonad‐intact and gonadectomised (GNX) mice at 8 and 20 weeks of age that had received either normal chow or a high‐fat diet. We detected significant increases in Pomc expression in gonad‐intact Kiss1r KO mice at 8 and 20 weeks, although there were no alterations in the other metabolic‐related genes. However, the Pomc increases appeared to reflect genotype differences in circulating sex steroids, because GNX wild‐type and Kiss1r KO mice exhibited similar Pomc levels, along with similar Npy levels. The altered Pomc gene expression in gonad‐intact Kiss1r KO mice is consistent with previous reports of reduced food intake in these mice and may serve to increase the anorexigenic drive, perhaps compensating for the obese state. However, the surprising overall lack of changes in any of the hypothalamic metabolic genes in GNX KO mice suggests that the aetiology of obesity in the absence of kisspeptin signalling may reflect peripheral rather than central metabolic impairments.
The feeling of discomfort during vaginal examination, history of abuse and sexual abuse and post‐traumatic stress disorder in women
Authors: Güneş Gizem , Karaçam Zekiye
Published: September 2016

Aims and objectives

To examine the feeling of discomfort during vaginal examinations, history of abuse and sexual abuse and post‐traumatic stress disorder in women to determine the correlation between these variables.

Background

Women who have experienced abuse or sexual abuse may feel more discomfort during vaginal examinations and may perceive a sensation similar to what they experienced during sexual abuse.

Design

Cross‐sectional.

Methods

This study included 320 women receiving a vaginal examination. The data were collected using a questionnaire composed of items related to descriptive characteristics, vaginal examinations and violence, a visual analogue scale of discomfort, and the Post‐Traumatic Stress Disorder Scale‐civilian version.

Results

The mean score for the feeling of discomfort during vaginal examinations was 3·92 ± 3·34; 26·3% of the women described discomfort. Thirty‐eight (12%) of the 320 women had experienced emotional violence, 25 (8%) had experienced physical violence, and 25 (8%) had been forced into sexual intercourse by their spouses. Of the women, 64·7% suffered from post‐traumatic stress disorder, and physical, emotional and sexual violence were found to increase the possibility of this disorder. Exposure to emotional violence increased the possibility of discomfort during vaginal examinations by 4·5 (OR = 4·482; 95% CI = 1·421–14·134). Post‐traumatic stress disorder (OR = 1·038; 95% CI = 1·009–1·066) was found to increase the possibility of discomfort during vaginal examinations; however, as the number of live births increases, women reported a reduction in their discomfort with vaginal examinations.

Conclusion

This study revealed a positive correlation between discomfort during vaginal examinations and emotional violence and post‐traumatic stress disorder but a negative correlation between discomfort during vaginal examinations and the number of live births. In addition, having a history of abuse and sexual abuse was found to increase post‐traumatic stress disorder.

Relevance to clinical practice

Considering these findings during vaginal examinations may help change women's experiences for the positive and reduce the trauma, this procedure may cause.
Unveiling self‐harm behaviour: what can social media site Twitter tell us about self‐harm? A qualitative exploration
Authors: Emma Hilton Charlotte
Published: September 2016

Aims and objectives

To report the findings from a unique analysis of naturally occurring data regarding self‐harm behaviour generated through the global social media site, Twitter.

Background

Self‐harm behaviours are of global concern for health and social care practice. However, little is known about the experiences of those who harm and the attitudes of the general public towards such behaviours. A deeper, richer and more organic understanding of this is vital to informing global approaches to supporting individuals through treatment and recovery.

Design

Exploratory, qualitative design.

Methods

Three hundred and sixty‐two Twitter messages were subject to inductive thematic analysis.

Results

Five themes were identified: (1) celebrity influence, (2) self‐harm is not a joke (with subthemes of you wouldn't laugh if you loved me and you think it's funny, I think it's cruel), (3) support for and from others, (4) eating disorders and self‐harm and (5) videos and personal stories.

Conclusions

The findings indicate that self‐harm behaviour continues to be largely misunderstood by the general public and is often the source of ridicule which may contribute to delays in accessing treatment. Whilst Twitter may also provide a source of valuable support for those who self‐harm, the sense of community, relatedness and understanding generated by such support may contribute to normalising self‐harm and perpetuating the behaviours.

Relevance to clinical practice

Our understanding of the complexity of and aetiology and most effective treatment options for self‐harm behaviours is still unclear. The findings demonstrate that there is a critical opportunity to conduct further qualitative research to better understand self‐harm and to use these valuable and internationally relevant data to support the development of effective public education campaigns and personally tailored treatment options.
Fish consumption and all‐cause mortality in a cohort of Swedish men and women
Authors: Bellavia A. , Larsson S. C. , Wolk A.
Published: September 2016

Background

Epidemiological studies of fish consumption and all‐cause mortality have provided inconsistent results.

Objective

We examined the dose–response association between fish consumption and mortality from all causes in a large population‐based cohort of Swedish men and women.

Methods

The study included 72 522 participants (33 973 women and 38 549 men), aged 45–83 years, from the Swedish Mammography Cohort and the Cohort of Swedish Men. Information on fish consumption was obtained through a self‐administered questionnaire in 1997. Participants were followed for 17 years (1 January 1998 to 31 December 2014), and data on death and causes of death were ascertained through linkage to the Swedish Cause of Death Register. We used Cox proportional hazard regression to estimate hazard ratios (HRs) of death. Fish consumption was evaluated as a continuous predictor, flexibly modelled with restricted cubic splines to assess potential nonlinear associations.

Results

During follow‐up, 16 730 deaths (7168 women and 9562 men) were recorded. The dose–response association between fish consumption and all‐cause mortality was U‐shaped. Compared with the median fish consumption (women: 25.0; men: 30.5 g day−1), lower levels of consumption were progressively associated with higher mortality risk up to 25% for women [HR 1.25; 95% confidence interval (CI): 1.11, 1.40] and 19% for men (HR 1.19; 95% CI: 1.07, 1.32) with no reported consumption. Increasingly higher levels of fish consumption were associated with higher mortality risk only amongst women, with a 39% higher mortality risk amongst women reporting the highest level of fish consumption (80 g day−1; HR 1.39; 95% CI: 1.15, 1.68).

Conclusion

These results indicate a U‐shaped association between fish consumption and all‐cause mortality, particularly amongst women.
Correcting for Frequency Drift in Clinical Brain MR Spectroscopy
Authors: Rowland Benjamin C. , Liao Huijun , Adan Fatah , Mariano Laura , Irvine John , Lin Alexander P.
Published: September 2016

PURPOSE

Averaging multiple repetitions to improve signal‐to‐noise ratio is common practice in magnetic resonance spectroscopy (MRS). However, temporal variations in scanner B0 due to motion or gradient heating may cause spectra to become misaligned, broadening and distorting peaks and impacting on processing and quantification. We present a comparison using in vivo data of different methods for correcting these errors.

METHODS

Three different correction methods were applied to 53 brain scans: residual water peak alignment, creatine fitting, and spectral registration. In 32 of 53 subjects, diffusion tensor imaging (DTI) was acquired prior to the MRS scan. We compared the resulting linewidths to find the most effective technique. In addition, the impact on metabolite concentration estimates was evaluated.

RESULTS

MRS data acquired after DTI imaging exhibited a frequency drift four times higher than data without DTI, resulting in changes to metabolite concentrations, particularly glutamate/glutamine. All three correction methods produced significantly improved linewidths relative to uncorrected data, with spectral registration performing best by a small margin.

CONCLUSION

Frequency correction is an important step in processing MRS data, significantly impacting metabolite quantification, particularly after echo‐planar imaging that often occurs with MRS scans in clinical studies. Spectral registration proved most effective at frequency correction.
Antigastric parietal cell and antithyroid autoantibodies in patients with desquamative gingivitis
Authors: Chang Julia Yu‐Fong , Chiang Chun‐Pin , Wang Yi‐Ping , Wu Yang‐Che , Chen Hsin‐Ming , Sun Andy
Published: September 2016

Background

Desquamative gingivitis (DG) is principally associated with erosive oral lichen planus (EOLP), mucous membrane pemphigoid (MMP), and pemphigus vulgaris (PV).

Methods

Serum autoantibodies including antigastric parietal cell antibody (GPCA), antithyroglobulin antibody (TGA), and antithyroid microsomal antibody (TMA) were measured in 500 patients with DG, 287 EOLP without DG (EOLP/DG−) patients, and 100 healthy control subjects.

Results

The 500 patients with DG were diagnosed as having EOLP in 455 (91%), PV in 40 (8%), and MMP in five (1%) patients. We found that 37.0%, 43.6%, and 42.6% of 500 patients with DG, 39.6%, 46.4%, and 45.1% of 455 EOLP with DG (EOLP/DG) patients, and 18.5%, 27.5%, and 30.3% of 287 EOLP/DG− patients had the presence of GPCA, TGA, and TMA in their sera, respectively. DG, EOLP/DG, and EOLP/DG− patients all had a significantly higher frequency of GPCA, TGA, or TMA positivity than healthy control subjects (all P‐values < 0.001). Moreover, 455 EOLP/DG patients had a significantly higher frequency of GPCA, TGA, or TMA positivity than 287 EOLP/DG− patients (all P‐values < 0.001). Of 210 TGA/TMA‐positive patients with DG whose serum thyroid‐stimulating hormone (TSH) levels were measured, 84.3%, 6.7%, and 9.0% patients had normal, lower, and higher serum TSH levels, respectively.

Conclusion

We conclude that 73.4% DG, 77.1% EOLP/DG, and 47.4% EOLP/DG− patients may have GPCA/TGA/TMA positivity in their sera. Because part of GPCA‐positive patients may develop pernicious anemia, autoimmune atrophic gastritis, and gastric carcinoma, and part of TGA/TMA‐positive patients may have thyroid dysfunction, these patients should be referred to medical department for further management.
Improving the quality of care for children with wheeze: The use of electronic asthma action plans and electronic pre‐school wheeze action plans
Authors: O'Leary Fenton , Pegiazoglou Ioannis , Marshall Tracey , Thosar Deepali , Deck Mitchell , Peat Jennifer , Ging Joanna , Selvadurai Hiran
Published: September 2016

Aim

To measure the long‐term improvement in the documented provision of an asthma action plan (AAP) to children with asthma and wheeze discharged from the Emergency Department following the introduction of the electronic AAP (eAAP) and to determine the need for an electronic pre‐school wheeze action plan in our population.

Methods

A retrospective case note review, from July 2014 to June 2015, of all patients over 12 months old discharged from the Emergency Department or Emergency Medical Unit, with a discharge diagnosis of either asthma or wheeze. The primary outcome was the documentation of an AAP, either recorded electronically as an eAAP or a report of an AAP as part of the patient medical record.

Results

Two thousand three hundred and forty‐two patients were included in the study, 926 with asthma and 1416 with wheeze. The median age was 3.3 years (interquartile range (IQR) 3.5, range 1–15.9 years). The median age of the children with asthma was 5.3 years (IQR 4.6) and of the children with wheeze was 2.5 years (IQR 2.0).Overall, 1683 (71.9%) children had a documented AAP, with a significant difference between those with a discharge diagnosis of asthma (85.9%) compared with wheeze (62.9%), P < 0.001. These results justified the design of the electronic pre‐school wheeze action plan.

Conclusions

The integration of an eAAP into the Emergency Department has resulted in a sustained improvement in the documented provision of an AAP to children with a discharge diagnosis of asthma. Children with a discharge diagnosis of wheeze are significantly less likely to receive an action plan.
Melatonin suppresses TPA‐induced metastasis by downregulating matrix metalloproteinase‐9 expression through JNK/SP‐1 signaling in nasopharyngeal carcinoma
Authors: Ho Hsin‐Yu , Lin Chiao‐Wen , Chien Ming‐Hsien , Reiter Russel J. , Su Shih‐Chi , Hsieh Yi‐Hsien , Yang Shun‐Fa
Published: September 2016

Nasopharyngeal carcinoma (NPC), a disease common in the South‐East Asian population, has high lymph node metastatic ability. Melatonin, an endogenously produced substance present in animals, plants, fungi, and bacteria, has oncostatic activity via several mechanisms. The molecular mechanisms involved in melatonin‐mediated tumor inhibitory potential are not completely defined. Here, we show that melatonin treatment inhibits TPA‐induced cell motility by regulating the matrix metalloproteinase‐9 (MMP‐9) expression in NPC. We also identified the signaling cascade through which melatonin inhibits MMP‐9 expression; this involves melatonin regulating the binding activity of the transcription factor specificity protein‐1 (SP‐1)‐DNA. Our mechanistic analysis further reveals that the c‐Jun N‐terminal kinase/mitogen‐activated protein kinase pathway is involved in the melatonin‐mediated tumor suppressor activity. Furthermore, the findings indicate a functional link between melatonin‐mediated MMP‐9 regulation and tumor suppressing ability and provide new insights into the role of melatonin‐induced molecular and epigenetic regulation of tumor growth. Thus, we conclude that melatonin suppresses the motility of NPC by regulating TPA‐induced MMP‐9 gene expression via inhibiting SP‐1‐DNA binding ability. The results provide a functional link between melatonin‐mediated SP‐1 regulation and the antimetastatic actions of melatonin on nasopharyngeal carcinoma.
Primary deep cutaneous candidiasis caused by Candida duobushaemulonii in a 68‐year‐old man: the first case report and literature review
Authors: Fang Szu‐Yun , Wei Kai‐Che , Chen Wen‐Chieh , Lee Shin‐Jung , Yang Kuo‐Chung , Wu Chieh‐Shan , Sun Pei‐Lun
Published: September 2016

Superficial candida infections of the skin are common, but deep cutaneous candidiasis, including secondary dissemination to the skin from systemic candidiasis, candidaemia or primary invasion due to skin defects such as trauma, is rare. These patients are usually immunosuppressed, but immunocompetent hosts can be affected as well. Candida albicans is the most common pathogen. However, non‐albicans Candida species can cause deep skin invasion in rare circumstances. We report a case of deep cutaneous candidiasis caused by Candida duobushaemulonii in a 68‐year‐old man. Deep tissue invasion was confirmed by skin histopathology examination. The pathogen was initially identified as C. haemulonii using the VITEK® 2 system for microbial identification, but was later determined to be C. duobushaemulonii based on sequencing of the internal transcribed spacer region of ribosomal DNA and D1/D2 region of 26S rDNA. The patient was successfully treated with amphotericin B, followed by fluconazole and surgical intervention. To the best of our knowledge, this is the first case of deep cutaneous infection by C. duobushaemulonii.
‘Rocking the nation’: the popular culture of neo‐nationalism
Authors: Feischmidt Margit , Pulay Gergő
Published: September 2016

The aim of this paper is to understand contemporary forms of nationalism in a socio‐political context in which neo‐nationalism has obtained a dominant role not just in politics but in public discourse and in the cultural field as well. It investigates the emergence of a particular music scene in the beginning of the 21st century, shaped by rock bands and performers and supported by far‐right political actors, which has made the ‘national’ imagination emotionally and ideologically appealing to a considerable part of Hungarian society and first of all to young people.
Oral health and ventilator‐associated pneumonia among critically ill patients: a prospective study
Authors: Saensom D , Merchant AT , Wara‐aswapati N , Ruaisungnoen W , Pitiphat W
Published: September 2016

Objective

To evaluate the association between oral health and ventilator‐associated pneumonia (VAP) among critically ill patients.

Methods

A prospective cohort study was conducted among 162 critically ill patients newly intubated and treated with mechanical ventilator in one tertiary hospital in Thailand. Oral health status was assessed using Oral Health Assessment Tool (OHAT), Plaque Index (PI), and number of teeth. VAP, defined as Clinical Pulmonary Infection Score >6, was assessed on Day 4 after intubation. Hazard ratios and 95% confidence intervals (CIs) were calculated using Cox proportional hazards regression adjusted for confounders.

Results

Critically ill patients had deteriorating oral health status after intubation. Early‐onset VAP developed in 69 patients (42.6%), with VAP incidence of 117 episodes per 1000 ventilator‐days. Moderately unhealthy and unhealthy oral conditions based on OHAT scores were associated with a 2.92‐fold (95% CI: 1.26–6.74) and 3.22‐fold (95% CI: 1.34–7.76) increased risk of VAP. Patients with moderate‐to‐very poor oral hygiene assessed by PI had increased VAP risk of 1.66‐folds (95% CI: 1.001–2.75). The number of teeth was not associated with VAP development.

Conclusions

There is a strong association between poor oral health and increased risk for early‐onset VAP. Routine oral care possibly prevents VAP development among critically ill patients treated with mechanical ventilator.
Lesion Morphology in Multifocal Infantile Hemangiomas
Authors: Reimer Antonia , Hoeger Peter H.
Published: September 2016

Background/Objectives

Multifocal infantile hemangiomas (MIHs; previously called neonatal hemangiomatosis) can be associated with extracutaneous hemangiomas. We observed different morphologic types of hemangiomas in children with MIHs and sought to find out whether they are related to the clinical course.

Methods

This was a retrospective study of 103 infants with MIHs and a control group of 261 age‐matched patients with solitary focal infantile hemangiomas (IHs) seen at an academic pediatric dermatology department between 2004 and 2014.

Results

Two morphologic subtypes of hemangiomas were identified: miliary focal hemangiomas (MFHs; small, lens shaped) in 58 of 103 MIH patients (56.3%), and classical nonmiliary focal IHs (NMIHs; larger, irregularly shaped) in 17 of 103 patients (16.5%). MIHs featuring both types (mixed type) were observed in 28 of 103 patients (27.2%). MFH lesions were significantly smaller (mean 5.3 mm [range 1–20 mm] vs 22.0 mm [range 2–100 mm]), more numerous (23.4 ± 27.3 [range 5–175] vs 7.4 ± 2.8 [range 5–15] p < 0.001), and occurred up to an older age (6.0 ± 5.8 months [range 0–27 months] vs 3.8 ± 2.6 months [range 0–9 months]) than NMIHs. There was a weakly positive correlation between the number and presence of extracutaneous IHs in children with MFHs. Significantly more children with MIHs were delivered preterm than those with solitary IHs.

Conclusions

The number of IHs correlates inversely with their size. MFHs follow a clinical course different from that of classical IHs, are associated with prematurity, and may confer greater risk of extracutaneous hemangiomas. Miliary hemangiomas thus appear to present a separate IH subset requiring special attention.
To Treat Molluscum Contagiosum or Not—Curettage: An Effective, Well‐Accepted Treatment Modality
Authors: Harel Avikam , Kutz Ana Maria , Hadj‐Rabia Smail , Mashiah Jacob
Published: September 2016

Background/Objectives

Molluscum contagiosum (MC) is a common viral disease primarily affecting children. The objective was to compare the effectiveness of curettage as a treatment modality for MC with no treatment.

Methods

We performed a retrospective study of 2,022 children with MC between 2008 and 2012. Epidemiologic, clinical, and treatment data, including effectiveness, safety, and satisfaction, were reviewed.

Results

Fifty‐six percent of the children were 2 to 5 years of age. The duration of the infection was 1 to 2 years for 51%, less than 1 year for 32%, and more than 2 years for 17% of the children. Seventy percent of the children were self‐referrals; 86% had had a previous examination and 76% of those had been advised not to treat the infection. The disease was mild (22%), moderate (64%), or severe (14%). A total of 1,879 patients underwent curettage; 70% were cured after one treatment and 26% after two treatments. Satisfaction was high: 97% of children and parents.

Conclusion

Active treatment should be offered despite the fact that MC is self‐limiting. Curettage in an appropriate setting is very effective, with high patient satisfaction and fast cure rates.
Neonatal Cutis Laxa and Hypertrichosis Lanuginosa in Sotos Syndrome
Authors: Bou‐Assi Elodie , Bonniaud Bertille , Grimaldi Marianne , Faivre Laurence , Vabres Pierre
Published: September 2016

We report a case of transient neonatal cutis laxa and hypertrichosis lanuginosa as an initial presentation in Sotos syndrome. Little is known about skin involvement in Sotos syndrome. Our observation highlights that Sotos syndrome is a rare cause of cutis laxa and suggests that it is a useful neonatal skin clue to the diagnosis of overgrowth syndromes.
Bullous Impetigo Rapid Diagnostic and Therapeutic Quiz: A Model for Assessing Basic Dermatology Knowledge of Primary Care Providers
Authors: Simkin Daren J. , Grossberg Anna L. , Cohen Bernard A.
Published: September 2016

Background/Objectives

Bullous impetigo (BI) is a common dermatologic condition, particularly in children, yet confusion regarding its diagnosis and treatment persists. This study measured pediatricians' ability to diagnose and appropriately treat BI and explored factors that might influence pediatricians' accuracy in managing BI.

Methods

We administered an expert‐validated survey to 64 pediatrics house staff and faculty at three Johns Hopkins Medicine facilities. The survey requested demographic information, diagnoses for five “unknown” cases, and preferred treatments for localized and widespread BI.

Results

Overall, BI was diagnosed correctly 31.9% of the time. There was little difference between house staff and faculty performance, although faculty 50 years of age and older demonstrated better diagnostic acumen. Regarding treatment of localized BI, 92% of faculty members and 84.6% of house staff listed mupirocin as first‐ or second‐line treatment. The second most common medication listed for localized BI was bacitracin. Regarding treatment of widespread BI, faculty listed cephalexin or clindamycin as first‐ or second‐line treatment 56.0% of the time and house staff listed one of these two medications 51.3% of the time. Results for faculty 50 years of age and older were comparable.

Conclusions

Improved pediatrician proficiency in the diagnosis and treatment of BI is needed for safe, cost‐effective management. Physician age and experience appear to have a limited effect on the accuracy of BI diagnosis and management. Future educational efforts must be directed at trainees and their instructors.
Endovascular treatment of pediatric intracranial arteriovenous shunt
Authors: Niimi Yasunari
Published: September 2016

Intracranial arteriovenous shunts (ICAVS) in young children are characterized by frequent high‐flow fistulas. In association with high‐flow fistulas and the physiological condition of the developing brain and heart, each ICAVS type tends to present at a certain age with unique symptoms. Vein of Galen aneurysmal malformation (VGAM) and dural sinus malformation with arteriovenous (AV) shunt tend to present in the neonate with high output cardiac failure. In infancy, VGAM, pial arteriovenous fistula (AVF) and infantile dural AVF (DAVF) tend to present with hydrodynamic disorder such as macrocephaly, ventriculomegaly, prominent facial veins, and developmental delay. Pial AVF, AV malformation, and infantile DAVF can present with focal neurological signs such as seizure or hemorrhage at older ages. Endovascular treatment is currently the first choice of treatment for most pediatric ICAVS. The treatment goal should be defined on a patient‐by‐patient basis, according to the unique physiological condition of the child.