bluuebunny/crossref_metadata_2025 huggingface dataset:
Hints for Reforming Primary and Community Care in Australia
Authors: Swerissen Hal
Published: April 2018

Considerable interest in reform for primary health care and health more generally has emerged recently. There are concerns that primary and community services are fragmented, inequitable and inefficient, particularly for people with chronic and complex conditions. The evidence suggests there will be a significant increase in demand for these services and that stronger primary health care systems lead to better health outcomes. This paper makes a number of suggestions about the development of funding, payment, governance and organisational arrangements that could be part of a National Primary Health Care Strategy for Australia.
Patients’ Experiences of Colorectal Cancer and Oncology Services in North Queensland
Authors: Veitch Craig , Crossland Lisa , Hanks Heather , Ho Yik-Hong , Steeghs Marlous
Published: April 2018

Colorectal cancer (CRC) accounts for 15% of cancer incidence and mortality in Australia. Incidence rates have been rising for two decades. Little is known about the experiences, attitudes and perceptions of people with CRC who live in non-metropolitan areas. The aim of this study was to investigate participants? experiences with and attitudes to CRC. This Cancer Council of Queensland-funded project collected data in three phases - focus groups, individual interviews, postal survey - from patients treated for CRC in north Queensland. Qualitative and quantitative approaches were used to analyse the data. Participants had very little knowledge of CRC signs and symptoms pre-diagnosis, which sometimes led to delays in diagnosis. The speed of diagnosis was dependent on several practitioner-related factors. Treatment-related issues included coming to grips with the diagnosis and preparedness for treatment and side-effects. Personal beliefs and attitudes influenced treatment and follow-up decisions. Rural participants encountered travel-related difficulties, particularly during treatment as outpatients. There was a strong belief in the need for more public education about CRC in general, warning signs and symptoms, and familial risk factors. Good understanding of people?s knowledge of CRC, their attitudes towards screening, diagnosis, treatment and follow-up, will enable health and cancer services provide focused and relevant support to people with CRC, their families and carers. This is especially important in non-metropolitan areas where the full range of specialist services is not locally available.
The Dietary Guideline with Great Therapeutic Potential
Authors: Beard Trevor C.
Published: April 2018

Prescribing 'salt restriction' for patients with salt-related health problems - using diets measuring sodium content and portion sizes - has been notoriously unpopular and unreliable, and the only therapeutic alternative has been to prescribe diuretics. This article reports a new observation that total salt intake is low enough (sodium < 5 0 mmol/day) to be more effective and less troublesome than diuretics in people who follow the Australian dietary guideline to choose foods low in salt while using the definition of low salt foods in the Australia New Zealand Food Standards Code (Na =120 mg/100g). Low salt foods - eaten exclusively during human evolution - can usually abolish the severe vertigo of Meniere?s disorder as the sole treatment, and reverse the universal rise of blood pressure with age, preventing hypertension. This simple prescription for better food (a healthier salt intake) enables health professionals to obtain measurable and permanent clinical improvement in motivated patients. The full public health potential of better food will require a long period of gradual reform in food processing and the evolution of a new cuisine. Shoppers must know what they are buying, and Australia needs Britain?s traffic light labels that identify low salt foods at a glance with green lights for salt.
Molecular structural diversity of mitochondrial cardiolipins
Authors: Oemer Gregor , Lackner Katharina , Muigg Katharina , Krumschnabel Gerhard , Watschinger Katrin , Sailer Sabrina , Lindner Herbert , Gnaiger Erich , Wortmann Saskia B. , Werner Ernst R. , Zschocke Johannes , Keller Markus A.
Published: April 2018

Significance

Cardiolipins are a unique class of phospholipids in mitochondrial membranes that are crucial for cellular bioenergetics as they stabilize respiratory chain complexes. In contrast to most other phospholipids, cardiolipins are substituted with four, rather than only two fatty acyl side chains. Consequently, this opens up a vast number of different theoretically possible molecular lipid species. Experimentally assessing the molecular diversity of cardiolipin species is analytically challenging. In this study we successfully combine tandem mass spectrometry with a mathematical structural modeling approach, to achieve the comprehensive characterization of complex biological cardiolipin compositions.
S-Allyl-L-cysteine sulfoxide, a garlic odor precursor, suppresses elevation in blood ethanol concentration by accelerating ethanol metabolism and preventing ethanol absorption from gut
Authors: Uto-Kondo Harumi , Hase Ayumu , Yamaguchi Yusuke , Sakurai Ayaka , Akao Makoto , Saito Takeshi , Kumagai Hitomi
Published: April 2018

Alcoholic beverages are enjoyed together with meals worldwide, but their excessive intake is associated with an increased risk of various diseases. We investigated whether S-allyl-L-cysteine sulfoxide (ACSO), a sulfuric odor precursor of garlic, suppresses elevation in plasma ethanol concentration by accelerating ethanol metabolism and preventing ethanol absorption from the gut in rats. ACSO and garlic extract with a high ACSO content (Garlic-H) suppressed elevation in concentrations of ethanol and acetaldehyde in plasma and promoted the activities of alcohol dehydrogenase and aldehyde dehydrogenase. However, ACSO and Garlic-H did not affect plasma acetate so much. Furthermore, we examined the change in plasma ethanol concentration by injecting ACSO or Garlic-H into the ligated stomach or jejunum together with ethanol solution. ACSO and Garlic-H suppressed the absorption of ethanol from the stomach and jejunum, but suppression in the jejunum was less than in the stomach. In conclusion, ACSO inhibits ethanol absorption and accelerates ethanol metabolism.
Perfectionism and training distress in junior athletes: The mediating role of coping tendencies
Authors: Madigan Daniel J. , Hill Andrew P. , Anstiss Paul A. , Mallinson‐Howard Sarah H. , Kumar Simon
Published: April 2018

Training distress occurs when athletes fail to cope with physiological and psychological stress and can be an early sign of overtraining syndrome. Recent research has found that perfectionism predicts increases in training distress in junior athletes over time. The current study provides the first empirical test of the possibility that coping tendencies mediate the perfectionism‐training distress relationship. Adopting a cross‐sectional design, 171 junior athletes (mean age = 18.1 years) completed self‐report measures of perfectionistic strivings, perfectionistic concerns, problem‐focused coping, avoidant coping, and training distress. Structural equation modelling revealed that avoidant coping mediated the positive relationship between perfectionistic concerns and training distress, and mediated the negative relationship between perfectionistic strivings and training distress. Problem‐focused coping did not mediate any relationships between dimensions of perfectionism and training distress. The findings suggest that the tendency to use coping strategies aimed at avoiding stress may partly explain the relationship between perfectionism and training distress but the tendency to use, or not use, problem‐focussed coping does not.
Does variability within natural turfgrass sports fields influence ground‐derived injuries?
Authors: Straw Chase M. , Samson Christine O. , Henry Gerald M. , Brown Cathleen N.
Published: April 2018

Natural turfgrass sports fields exhibit within‐field variations due to climatic conditions, field construction, field management, and foot traffic patterns from field usage. Variations within a field could influence the playing surface predictability and require athletes to make abrupt or frequent adjustments that lead to increased ground‐derived injury occurrence. This study introduces a new methodology aimed at evaluating the potential relationship between within‐field variations of turfgrass sports field properties and ground‐derived athlete injuries. Collegiate Club Sport athletes self‐reported ground‐derived injuries over two years. Soil moisture, turfgrass quality, surface hardness, and turfgrass shear strength were quantified from their two home fields. Hot spot analysis identified significantly high (hot spots) and low (cold spots) values within the fields. Injury locations were compared to hot spot maps each month. Binomial proportion tests determined if there were differences between observed injury proportions and expected proportions. Twenty‐three ground‐derived injuries were reported overall. The observed injury proportions occurring in turfgrass quality cold spots [0.52 (95% CI 0.29–0.76)] and soil moisture hot spots [0.43 (95% CI 0.22–0.66)] was significantly higher than expected [0.20 (p < .001) and 0.21 (p < .05), respectively]. Most injuries in significant areas of turfgrass quality, soil moisture, and surface hardness were along edges of hot and cold spots. These results suggest a potential relationship between within‐field variations and ground‐derived injuries, particularly in transition areas between non‐significant and significant high and low values. Future larger‐scale studies can incorporate the reported methodology to validate this relationship and implement strategies that reduce ground‐derived injuries.
DeepSimulator: a deep simulator for Nanopore sequencing
Authors: Li Yu , Han Renmin , Bi Chongwei , Li Mo , Wang Sheng , Gao Xin
Published: April 2018

Motivation

Oxford Nanopore sequencing is a rapidly developed sequencing technology in recent years. To keep pace with the explosion of the downstream data analytical tools, a versatile Nanopore sequencing simulator is needed to complement the experimental data as well as to benchmark those newly developed tools. However, all the currently available simulators are based on simple statistics of the produced reads, which have difficulty in capturing the complex nature of the Nanopore sequencing procedure, the main task of which is the generation of raw electrical current signals.

Results

Here we propose a deep learning based simulator, DeepSimulator, to mimic the entire pipeline of Nanopore sequencing. Starting from a given reference genome or assembled contigs, we simulate the electrical current signals by a context-dependent deep learning model, followed by a base-calling procedure to yield simulated reads. This workflow mimics the sequencing procedure more naturally. The thorough experiments performed across four species show that the signals generated by our context-dependent model are more similar to the experimentally obtained signals than the ones generated by the official context-independent pore model. In terms of the simulated reads, we provide a parameter interface to users so that they can obtain the reads with different accuracies ranging from 83 to 97%. The reads generated by the default parameter have almost the same properties as the real data. Two case studies demonstrate the application of DeepSimulator to benefit the development of tools in de novo assembly and in low coverage SNP detection.

Availability and implementation

The software can be accessed freely at: https://github.com/lykaust15/DeepSimulator.

Supplementary information

Supplementary data are available at Bioinformatics online.
Investigating fish behavioural responses to LED lights in trawls and potential applications for bycatch reduction in the Nephrops-directed fishery
Authors: Melli Valentina , Krag Ludvig A , Herrmann Bent , Karlsen Junita D
Published: April 2018

Light-emitting diodes (LEDs) have been tested in trawl fisheries to reduce the bycatch of unwanted species through behavioural stimulation. Previous studies used LED lights to either highlight escaping routes or increase the contact rate with square-mesh panels. However, phototactic responses (moving towards or away from light sources) to LED lights could also be exploited to separate species during the catching process. We investigated if either positive or negative phototaxis can be used to improve fish vertical separation from Nephrops (Nephrops norvegicus) in the aft section of a horizontally separated trawl codend. The aim was to increase the proportion of fish entering the upper compartment. We conducted two different experiments in front of the separation into compartments, inserting green LED lights in the upper and lower netting panel, respectively. Species vertical separation was analysed and compared in two identical trawls towed in parallel, one equipped with lights and one without. We obtained significant changes in vertical separation, but no clear species-specific phototactic response was identified. Neither of the light positions improved fish separation from Nephrops. However, the potential of LED lights as behavioural stimulators is confirmed, and a more mechanistic understanding of light and fish vision may improve the results of future applications.
Toll-like receptor signaling in macrophages is regulated by extracellular substrate stiffness and Rho-associated coiled-coil kinase (ROCK1/2)
Authors: Gruber Erika , Heyward Christa , Cameron Jody , Leifer Cynthia
Published: April 2018

Macrophages participate in immunity, tissue repair and tissue homeostasis. Activation of Toll-like receptors (TLRs) by conserved exogenous or endogenous structures initiates signaling cascades that result in the release of cytokines such as tumor necrosis factor α (TNFα). Extracellular substrate stiffness is known to regulate functions of non-immune cells through a process called mechanotransduction, yet less is known about how physical cues affect macrophage function or TLR signaling. To investigate this question, we cultured murine primary bone marrow-derived macrophages (BMMs) and RAW264.7 cells on fibronectin-coated polyacrylamide (PA) gels of defined stiffnesses (1, 20 and 150 kPa) that approximate the physical properties of physiologic tissues. BMMs on all gels were smaller and more circular than those on rigid glass. Macrophages on intermediate stiffness 20 kPa PA gels were slightly larger and less circular than those on either 1 or 150 kPa. Secretion of the pro-inflammatory cytokine, TNFα, in response to stimulation of TLR4 and TLR9 was increased in macrophages grown on soft gels versus more rigid gels, particularly for BMMs. Inhibition of the rho-associated coiled-coil kinase 1/2 (ROCK1/2), key mediators in cell contractility and mechanotransduction, enhanced release of TNFα in response to stimulation of TLR4. ROCK1/2 inhibition enhanced phosphorylation of the TLR downstream signaling molecules, p38, ERK1/2 and NFκB. Our data indicate that physical cues from the extracellular environment regulate macrophage morphology and TLR signaling. These findings have important implications in the regulation of macrophage function in diseased tissues and offer a novel pharmacological target for the manipulation of macrophage function in vivo.
The International Relations of East Asia: A New Research Prospectus
Authors: Foot Rosemary , Goh Evelyn
Published: April 2018

East Asia is a region of signal importance for global order because of its economic dynamism and growing heft, China's challenge to the United States as incumbent regional and global hegemon, and other conflict hotspots like the Korean peninsula. This requires academic analysis that both appreciates the subtleties inherent to this region and can relate them to the wider systemic context. Many analysts have begun to allude to the challenging characteristics that are present in the international relations of East Asia, in particular struggling to explain how growing levels of economic interdependence can coexist with heightened security tensions. This article offers a research prospectus that suggests ways of analyzing these apparently contradictory trends. It proposes the development of research questions and approaches that are more suited to studying the international relations of a region with characteristics that we define as dual, hybrid, and contingent. We propose a Conjunctions Analytical Framework that explores what happens at the conjunctions of the regional-global and the unit-regional/global levels of analysis—the “grey areas” where social formations meet and interact. We aim to help shape the future study of the IR of East Asia and to suggest more effective ways of analyzing the complex reality of East Asia's regional and global politics.
The KDM4A/KDM4C/NF-κB and WDR5 epigenetic cascade regulates the activation of B cells
Authors: Hung Kuo-Hsuan , Woo Yong H , Lin I-Ying , Liu Chin-Hsiu , Wang Li-Chieh , Chen Hsin-Yu , Chiang Bor-Luen , Lin Kuo-I
Published: April 2018

T follicular helper (Tfh) cell-derived signals promote activation and proliferation of antigen-primed B cells. It remains unclear whether epigenetic regulation is involved in the B cell responses to Tfh cell-derived signals. Here, we demonstrate that Tfh cell-mimicking signals induce the expression of histone demethylases KDM4A and KDM4C, and the concomitant global down-regulation of their substrates, H3K9me3/me2, in B cells. Depletion of KDM4A and KDM4C potentiates B cell activation and proliferation in response to Tfh cell-derived signals. ChIP-seq and de novo motif analysis reveals NF-κB p65 as a binding partner of KDM4A and KDM4C. Their co-targeting to Wdr5, a MLL complex member promoting H3K4 methylation, up-regulates cell cycle inhibitors Cdkn2c and Cdkn3. Thus, Tfh cell-derived signals trigger KDM4A/KDM4C - WDR5 - Cdkn2c/Cdkn3 cascade in vitro, an epigenetic mechanism regulating proper proliferation of activated B cells. This pathway is dysregulated in B cells from systemic lupus erythematosus patients and may represent a pathological link.
Supermassive black holes with higher Eddington ratios preferentially form in gas-rich galaxies
Authors: Izumi Takuma
Published: April 2018

The Eddington ratio (λEdd) of supermassive black holes (SMBHs) is a fundamental parameter that governs their cosmic growth. Although gas mass accretion onto SMBHs is sustained when they are surrounded by large amounts of gas, little is known about the molecular content of galaxies, particularly those hosting super-Eddington SMBHs (λEdd > 1: the key phase of SMBH growth). Here, we have compiled reported optical and 12CO(1–0) data of local quasars to characterize their hosts. We found that higher-λEdd SMBHs tend to reside in gas-rich (i.e., high gas mass to stellar mass fraction = fgas) galaxies. We used two methods to make this conclusion: one uses black hole mass as a surrogate for stellar mass by assuming a local co-evolutionary relationship, and the other directly uses stellar masses estimated from near-infrared observations. The fgas–λEdd correlation we found concurs with the cosmic decreasing trend in λEdd, as cold molecular gas is primarily consumed by star formation. This correlation qualitatively matches predictions of recent semi-analytic models of the cosmic downsizing of SMBHs as well. As the gas mass surface density would eventually be a key parameter controlling mass accretion, we need high-resolution observations to identify further differences in the molecular properties around super-Eddington and sub-Eddington SMBHs.
I Am an African American: Distinguishing Between African American and African Applicants in Medical School Admissions Matters
Authors: Baugh Reginald F.
Published: April 2018

Ignoring the diverse and rich cultures and histories of Africa and the African diaspora by applying the term African American to anyone of sub-Saharan African ancestry in medical school admissions does a disservice to applicants, medical schools, and the communities they serve. To determine how applicants can contribute to a diverse educational environment, admissions decisions must go beyond racial and ethnic self-reporting and recognize the diversity that applicants bring to their medical school. Using a holistic approach, institutions can fairly evaluate applicants and strategically fill their incoming classes. What each medical school is looking for based on its mission and how each student reflects that mission and enhances the educational environment should be revisited as each application is considered. Medical schools must adopt practices that strategically enroll applicants who help achieve their mission and better the communities they serve. The benefits of diversity are not achieved in a linear fashion but require a critical mass for each diverse group. Different strategies are needed to enhance the educational environment, address underrepresentation in medicine, and eliminate health disparities. If racial justice and health equity are to be realized, diversity policies need to recognize the differences between African and Afro Caribbean immigrants and African Americans.

In this Perspective, the author argues for distinguishing between these groups in medical school admissions. He explores the differences in their history, culture, and experiences and demonstrates their uniqueness. He concludes by discussing diversity in medicine and offering suggestions for considering diversity in medical school admissions.
Trimethoprim-sulfamethoxazole and antineutrophil cytoplasmic antibodies-associated vasculitis
Authors: Cohen Tervaert Jan Willem
Published: April 2018

Purpose of review

In antineutrophil cytoplasmic antibodies-associated vasculitis (AAV), the treatment of choice is either Rituximab or cyclophosphamide in combination with steroids. In less extended forms of AAV, however, less toxic regimens are being used.

In the current review, we will focus on the role of one of these less toxic regimens, that is trimethoprim–sulfamethoxazole monotherapy as induction treatment or as maintenance therapy in AAV.

Recent findings

A substantial portion of patients with active granulomatosis with polyangiitis (GPA) limited to the upper airways can be initially controlled with trimethoprim–sulfamethoxazole (2 × 960 mg/day) monotherapy. In patients with initially a complete response, long-term control of the disease seems possible. In addition, trimethoprim–sulfamethoxazole (2 × 960 mg/day) maintenance therapy is an option for patients with GPA that have been proven to be frequent relapsers. The mechanism by which trimethoprim–sulfamethoxazole works in GPA is at present unknown. Suppression of Staphylococcus aureus carriage and/or anti-inflammatory mechanisms has been postulated.

Trimethoprim–sulfamethoxazole may be considered as a safe initial treatment in GPA patients with disease localized to the ear, nose, and throat region. Furthermore, trimethoprim–sulfamethoxazole in a dose of 2 × 960 mg/day may be used to prevent relapses in GPA.
Long-term treatment strategies for postmenopausal osteoporosis
Authors: Cosman Felicia
Published: April 2018

Purpose of review

Osteoporosis guidelines do not usually provide specific recommendations regarding what medication is most appropriate for individual patients. Generic oral bisphosphonates are often considered first-line treatment for osteoporosis, but treatment duration is limited, based on potential long-term safety concerns, and there is no consensus about what to do after 5 years. There are no recommendations concerning long-term management of osteoporosis over 30 or more years of postmenopausal life.

Recent findings

This review attempts to specify medication choices and provide the best clinical management strategies for women at different stages of life and with different underlying disease severity. Because there is no evidence that considers the entire postmenopausal lifespan, much of the discussion here will be based on expert opinion. The review considers a role for estrogens and selective estrogen receptor modulators, oral and intravenous bisphosphonates, denosumab and the anabolic agents, teriparatide and abaloparatide.

Optimal sequential monotherapy, over an average of 30 postmenopausal years, should be able to minimize exposure to pharmacology while maximizing benefits on bone strength and minimizing imminent and long-term risk of fracture.
Fluoroscopically Guided Lumbar Transforaminal Epidural Steroid Injection
Authors: Stolzenberg David , Ahn Junyoung J. , Kurd Mark
Published: April 2018

Fluoroscopically guided lumbar transforaminal epidural steroid injections are indicated for the treatment of lumbar radicular pain that has failed more conservative options. This article details proper equipment and medications, patient positioning and set-up, step-by-step instructions for multiplanar fluoroscopic visualization, needle advancement and medication instillation, and postoperative management. Pearls and pitfalls are also discussed. In addition, an instructional procedure video accompanies this paper.
Unhas Suture, A Novel Tendon Repair Technique: An In Vitro Experimental Study Comparing Unhas Suture and Bunnell Suture in Tensile Strength and Gap Formation
Authors: Yurianto Henry , Saleh Ruksal , Paturusi Idrus A. , Supriyadi Wilhelmus , Lee Jansen
Published: April 2018

Purpose:

Developing a simple and yet strong repair technique that allows smooth gliding of the tendon within the tendon sheath has remained a challenge to meet the biomechanical needs of early active rehabilitation. Our Objective was to compare Unhas and Bunnell suture technique in terms of strength and gap resistance in tendon repair.

Materials and Methods:

Thirty feet of healthy roosters Gallus domesticus were harvested and assigned randomly into 2 groups of 15 feet each. The tendons were repaired using Unhas suture and Bunnell suture utilizing monofilament nylon 4-0. Every specimens were tested by using repaired tendon gap formation apparatus and then measured when it produced an initial gap and 2-mm gap at the repair site. The measurements were then analyzed for statistical significance.

Results:

Significant difference in initial gap was detected between repaired tendon using Unhas suture and Bunnell suture. Two-millimeter gap forces were tested and Unhas suture group was also significantly higher compared with Bunnell suture group.

Conclusions:

Unhas suture was proven to be able to resist gap forces either in initial gap or 2-mm gap compared with Bunnell suture

Clinical Relevance:

Unhas suture may be a reliable alternative in tendon repair that provides tensile strength, gapping resistance and also provide easiness which can be performed with conventional suture material and less operating time.
Reduction of Donor Cornea Exposure to Repeat Warming Cycles and Evaluation Times After Implementation of a Rapid Warming Protocol
Authors: Clover Jameson , Ansin Amy , Stoeger Christopher G. , Terry Mark A. , Tran Khoa D.
Published: April 2018

Purpose:

To compare tissue evaluation times and specular image quality before and after the implementation of rapid tissue warming at a single eye bank.

Methods:

This retrospective study compares the evaluation of 494 donor corneas. All corneas were stored in Optisol-GS. Group 1 contained 247 corneas evaluated immediately before implementation of a tissue incubator and tissue warming protocol. Group 2 contained 247 corneas evaluated immediately after implementation. Total evaluation times (including specular microscopy, optical coherence tomography for corneal thickness measurements, and 2 slit-lamp examinations) were calculated and compared. Representative specular images of donor corneas were rated and compared using a previously described scale by 2 masked readers.

Results:

Donor tissue characteristics were not significantly different between both groups (age, P = 0.87; sex, P = 0.93; endothelial cell densities, P = 0.47; and death-to-preservation times, P = 0.18). The mean total evaluation time for group 2 corneas was ∼3 hours, with 97% (201/208) of evaluations completed on the same day. In contrast, only 73% (164/225) of corneas from group 1 were completely evaluated in 1 day, and the mean evaluation time for those corneas was ∼4.25 hours (P < 0.01). Specular images of corneas from group 2 were rated 1 grade higher, on average, than those from group 1 (n = 247 in each group, P < 0.01). Furthermore, 71% of specular images from group 2 were categorized as “good” or “excellent” quality, whereas only 30% of corneas from group 1 received those ratings.

Conclusions:

Rapid tissue warming cuts down on tissue evaluation time and reduces the time donor corneas are out of cold storage. Better specular images were obtained after implementation of the rapid warming protocol.
Brodie Abscess in Children
Authors: Foster Catherine E. , Taylor Margaret , Schallert Erica K. , Rosenfeld Scott , King Katherine Y.
Published: April 2018

Brodie abscess is a subacute hematogenous osteomyelitis characterized by intraosseous abscess formation. Treatment recommendations and clinical outcomes for this unusual infection are not well established. We report 15 cases of Brodie abscess in a 10-year retrospective review of pediatric patients at Texas Children’s Hospital and describe their clinical presentation and outcomes.
Preoperative Illnesses in Children Do Not Increase the Risk of Complications After Hypospadias Repair
Authors: Dokter Elisabeth M.J. , Slikboer Karen M.A. , van der Zanden Loes F.M. , Rahamat-Langendoen Janette C. , Henriet Stefanie S.V. , Feitz Wout F.J. , Kortmann Barbara B.M. , Roeleveld Nel , van Rooij Iris A.L.M.
Published: April 2018

Background:

Preoperative illnesses might induce immunosuppression and subsequently increase morbidity after surgery. Several studies have tried to identify risk factors for complications after hypospadias correction, but effects of illnesses in the weeks just before surgery are unknown. We aimed to determine the associations between preoperative illnesses not severe enough to postpone surgery and short-term complications after hypospadias repair in children.

Methods:

In this retrospective cohort study, data were collected from 681 children with anterior or middle type hypospadias that had initial 1-stage repair in the period 1983–2012 in the Radboudumc, The Netherlands. The associations between common illnesses, such as common cold, fever and ear infection, within 2 weeks before repair, and postoperative complications, such as urethrocutaneous fistula, wound dehiscence and stenosis, within 2 months and 1 year after surgery, were analyzed using multivariable logistic regression analyses.

Results:

Of the 681 boys, 22% had preoperative illnesses, most often common cold, and 14% had postoperative complications. Children with preoperative illnesses had fewer postoperative complications within 2 months (n = 13, 9%) than children without preoperative illnesses (n = 79, 16%), resulting in a 50% risk reduction (odds ratio: 0.49; 95% confidence interval: 0.26–0.93). Preoperative infections (common cold, fever and ear infection), in particular, reduced the risk of postoperative infections (wound and urinary tract infections; odds ratio: 0.37; 95% confidence interval: 0.14–0.98). Results were similar for complications within 1 year.

Conclusions:

Common preoperative illnesses not severe enough to postpone surgery did not increase the postoperative complication risk and even seemed to have a protective effect, especially for postoperative infections. Consequently, there is no reason to alter preoperative screening.
Complex Polypharmacy in Patients With Schizophrenia-Spectrum Disorders Before a Psychiatric Hospitalization
Authors: Gaudiano Brandon A. , Guzman Holst Carolina , Morena Alexandra , Reeves Lauren E. , Sydnor Valerie J. , Epstein-Lubow Gary , Weinstock Lauren M.
Published: April 2018

Background

Current evidence-based guidelines provide unclear support for many common polypharmacy practices in schizophrenia. Excessive or complex polypharmacy (≥4 psychotropics) has been studied in patients with bipolar disorder, but not in schizophrenia to date.

Methods

We conducted a digital medical record data extraction of 829 patients consecutively admitted to a psychiatric hospital and diagnosed as having schizophrenia-spectrum disorders.

Results

In those prescribed psychiatric medication preadmission, 28.1% (n = 169) met the criteria for complex polypharmacy. Complex polypharmacy patients were older, female, white, and disabled, and had more comorbidities compared with those without complex polypharmacy. In multivariable analysis, complex polypharmacy was specifically associated with being white and disabled, and having a comorbid anxiety disorder, tobacco use disorder, metabolic condition, and neurological condition compared with noncomplex polypharmacy patients.

Conclusions

Although there is little evidence to support complex polypharmacy in schizophrenia, rates were relatively high in patients requiring hospitalization, especially when they are also diagnosed as having comorbid psychiatric and medical conditions. Future research is needed to study the risk-benefit profile for these patients, especially considering their higher medical burden and related health risks.
Efficacy and Safety of Agomelatine vs Paroxetine Hydrochloride in Chinese Han Patients with Major Depressive Disorder
Authors: Yu Yi-Min , Gao Ke-Run , Yu Hao , Shen Yi-Feng , Li Hua-Fang
Published: April 2018

Purpose

The purpose of this study is to investigate the efficacy, safety, and tolerability of agomelatine and paroxetine in Chinese Han patients with major depressive disorder (MDD).

Methods

A 8-week, double-blind, randomized, parallel study was conducted in 14 medical centers in mainland China from December 2011 to September 2012. A total of 264 subjects with a primary Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD were randomly assigned to receive agomelatine 25–50 mg/d (n = 132) or paroxetine 20–40 mg/d (n = 132). The primary efficacy was evaluated by the decrease of Hamilton Depression Rating Scale (HAM-D17) scores. The secondary measurements of efficacy included Hamilton Anxiety Rating Scale, Montgomery-Asberg Depression Rating Scale, Sheehan Disability Scale, Clinical Global Impressions—Severity, and Clinical Global Impressions—Improvement. The laboratory test abnormity, and observed and self-reported adverse events were all assessed as the measurements of safety and tolerability.

Results

Both the agomelatine and paroxetine groups showed significant improvement from baseline to the end point (P < 0.05) without between-group differences (P > 0.05). The mean decrease of HAM-D17 of agomelatine group was not inferior to the paroxetine group over the 8-week treatment (agomelatine 15.26 ± 6.44 vs paroxetine 14.87 ± 5.89, δ = 2.0; μA–μB 95% confidence interval, −1.13 to 1.91). The percentage of responders at the last postbaseline assessment was similar in the 2 groups on both HAM-D17 (agomelatine 66.15% vs paroxetine 63.49%) and Clinical Global Impressions—Improvement (agomelatine 79.09% vs paroxetine 80.36%). The anxiety (Hamilton Anxiety Rating Scale) and sleep symptoms (sleep items of HAM-D17) of the patients were improved significantly in the 2 groups at week 8 without between-group differences (P > 0.05). The incidence of overall adverse events was similar in the 2 groups (agomelatine 49.62% vs paroxetine 56.15%, P > 0.05). The incidence of adverse events in skin and subcutaneous tissue was higher in the paroxetine group than in the agomelatine group (none in agomelatine and 4.62% in paroxetine, P = 0.0144).

Conclusions

Agomelatine showed equivalent antidepressant efficacy to paroxetine in treating MDD patients after 8 weeks of treatment with an acceptable safety.
Do Initial Symptom Factor Scores Predict Subsequent Impairment Following Concussion?
Authors: Cohen Paul E. , Sufrinko Alicia , Elbin Robert J. , Collins Michael W. , Sinnott Aaron M. , Kontos Anthony P.
Published: April 2018

Objective:

Symptom factors present during the first week following concussion may predict subsequent concussion outcomes and recovery duration. We hypothesized that a high loading on cognitive-fatigue-migraine and somatic factors would be predictive of neurocognitive impairment following concussion. We also hypothesized that the affective factor would be related to vestibular symptoms and impairment.

Design:

Prospective repeated measures.

Setting:

Concussion specialty clinic.

Participants:

Athletes aged 13 to 20 years diagnosed with a concussion within the past 7 days.

Independent Variable:

Symptom factors at the initial visit 1 to 7 days after injury.

Main Outcome Measure:

Symptom factor score, neurocognitive testing, and vestibular/ocular motor assessment at the second visit (2-4 weeks after injury).

Results:

The somatic symptom factor from the initial visit was significant (P< 0.05) in all vestibular/ocular screening components (P< 0.05) but not neurocognitive test performance (P> 0.05) at the second visit. The cognitive-migraine-fatigue and affective symptom factors predicted symptom burden at the second visit (P< 0.001) but did not predict recovery time (P= 0.200).

Conclusions:

The somatic symptom factor during the first week after injury predicted symptom provocation during vestibular/ocular screening at 2 to 4 weeks after injury. Specifically, higher scores on somatic symptom factor at the initial visit predicted worse symptom reporting for all vestibular/ocular screening components at the second visit. Patients with higher scores on the cognitive-migraine-fatigue and affective symptom factors at the initial visit predicted total symptom burden at the second visit.
Neutropenia and Increased Mean Corpuscular Volume (MCV) With Abnormal Neurologic Findings: A Case of Cobalamin D Deficiency
Authors: Soylu Ustkoyuncu Pembe , Kendirci Mustafa , Kardas Fatih , Gokay Songul , Per Huseyin , Kacar Bayram Ayse
Published: April 2018

Background:

Disorders of intracellular cobalamin (Cbl) metabolism are classified from A to J according to biochemical phenotype, and genetic and complementation analyses. CblD-deficient patients present with developmental, hematologic, neurologic, and metabolic findings.

Clinical Observation:

An 11-year-old boy presented with neutropenia, increased mean corpuscular volume, psychomotor retardation, and seizures. His plasma total homocysteine and urinary methylmalonic acid levels were elevated, and a homozygous nonsense mutation [p. R250X (c.748C>T] leading to premature termination of translation was identified in the MMADHC gene, which was compatible with CblD defect.

Conclusion:

In the presence of increased mean corpuscular volume and other hematologic manifestations, such as leukopenia, thrombocytopenia, and megaloblastic anemia, with severe nonspecific or mild neurologic symptoms, Cbl synthesis defects should be considered.
Spontaneous Regression of Diffuse Periosteal Melanotic Neuroectodermal Tumor of Infancy in the Tibia, With 13-Year Follow-up
Authors: Lei Li , Ellsworth Brandon D. , Young Lionel W. , Kheradpour Albert , Zuppan Craig W.
Published: April 2018

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare entity primarily affecting the craniofacial bones during the first year of life, with only 5 reported cases involving peripheral long bones. We herein present a case of MNTI in the tibia of an infant, with a somewhat atypical presentation, and a noteworthy clinical course characterized by progressive spontaneous resolution without therapy, thus sparing the child the trauma of amputation. There is no evidence of active residual or recurrent disease with 13-year follow-up. To the best of our knowledge, essentially all reported cases of MNTI have received empirical treatment, some at the price of mutilating surgery or fatal chemotherapy. We propose that the necessity of aggressive treatment be evaluated on a case-by-case basis, especially in patients with diffuse periosteal involvement, as in this patient. A trial of watchful waiting can be considered when treatment would involve substantial morbidity or risk of complications.
Diagnostic Accuracy of 18F-FDG PET/CT in the Staging and Assessment of Response to Chemotherapy in Children With Ewing Sarcoma
Authors: Ruggiero Antonio , Lanni Valerio , Librizzi Alberto , Maurizi Palma , Attinà Giorgio , Mastrangelo Stefano , Giordano Alessandro , Riccardi Riccardo
Published: April 2018

Introduction:

The purpose of this study was to evaluate the potential role of fluorine-18 fluorodeoxyglucose (18F-FDG) positron-emission tomography/computed tomography (PET-CT) in the staging and assessment of chemotherapy response in Ewing sarcoma.

Materials and Methods:

For 13 patients with Ewing sarcoma, whole-body FDG PET-CT was assessed for site of primary disease, disease extent, and response to therapy. Chest CT, localized magnetic resonance imaging or CT of primary site, and bone scintigrams were evaluated for imaging features of the primary lesion and presence or absence of metastatic disease. Response to therapy was also assessed. Descriptive statistics are reported.

Results:

Nine patients (69%) presented metastatic disease. All metastatic lung lesions were detected by spiral CT, but some failed to be detected using FDG PET-CT. As regards bone lesions, both FDG PET-CT and bone scans were able to identify bone metastasis, but FDG PET-CT identified more lesions than bone scans. All PET-CT scans at the end of the neoadjuvant chemotherapy showed a decreased FDG uptake.

Conclusions:

FDG PET-CT seems to be superior to bone scan in the detection of bone metastasis in all districts except skull bones. For pulmonary metastasis smaller than 7 mm, FDG PET-CT is less sensitive than CT. FDG PET-CT may have an important role in initial staging of Ewing sarcoma and subsequent evaluation of response to therapy.
Sexual Problems of Patients With Breast Cancer After Treatment
Authors: Chang Yun-Chen , Chang Shiow-Ru , Chiu Shih-Che
Published: April 2018

Background

Sexual health is a crucial part of quality of life in breast cancer survivors, regardless of their relationship status. However, previous studies have rarely used qualitative methods to explore the postoperative experiences and feelings of patients with breast cancer.

Objective

The aim of this study was to examine the causes of changes in sexual relationships of breast cancer survivors, methods for adaptation to these changes, and healthcare interventions to facilitate the patients’ return to a normal life.

Interventions/Study Methods

A survey was performed by using five electronic databases and electronic journals accessed through the Internet. The following keywords were used: “breast cancer,” “sexual problem,” “sexual dysfunction,” and “qualitative.”

Results

Seven articles were included in the literature review. Three main domains were explored, namely, reasons for sexual relationship changes; the way patients used to adapt to sexual life after the diagnosis of breast cancer; and intervention by healthcare workers.

Conclusions

The results of this study can facilitate and encourage health professionals to identify, examine, and solve most of the patient’s sexual problems by using the functional and medical framework of the healthcare system.

Implications for Practice

One practical recommendation of this study is the incorporation of sexual counseling units into the national healthcare system. Counselors in these units can help breast cancer survivors solve problems and improve sexual satisfaction between couples.
Endometrial Carcinoma With an Unusual Morphology in a Patient With Cornelia de Lange Syndrome: A Case Study
Authors: Tate Keisei , Yoshida Hiroshi , Ishikawa Mitsuya , Shimizu Hanako , Uehara Takashi , Kato Tomoyasu
Published: April 2018

Cornelia de Lange syndrome (CdLS) is a cohesinopathy, which is characterized by multiple structural anomalies as well as mental and growth retardation. A 36-yr-old nulliparous woman with oligomenorrhea was referred to us due to a mass in the uterine corpus. She had been clinically diagnosed with CdLS during infancy based on her specific facial features as well as growth and intellectual retardation. Imaging examinations and an endometrial biopsy revealed endometrial endometrioid carcinoma and polycystic ovary syndrome (PCOS). She underwent a hysterectomy and bilateral salpingo-oophorectomy. The tumor was mainly located at the uterine isthmus and exhibited diffuse exophytic growth. Microscopically, the grade 1 endometrioid carcinoma consisted of extremely well-differentiated glands and showed myometrial invasion. Both swollen ovaries had a thick fibrous cortex and multiple follicles. To the best of our knowledge, this is the first case report of a gynecologic malignancy in an adult patient with CdLS. Several gene mutations have been reported to be causative of CdLS; however, a potential role of these mutations in the pathogenesis of PCOS and subsequent endometrial cancer remains controversial. In this case, PCOS seemed to underlie the endometrial carcinogenesis and then concurrent loss of PTEN and PAX2 expression, confirmed by immunohistochemistry, can facilitate tumor progression. Our case suggests that adult female patients with CdLS can have PCOS and subsequent endometrial carcinoma. As patients with CdLS often have difficulties recognizing and/or reporting menstrual disorder, their care providers should pay particular attention to menstrual cycle irregularities due to the risk of endometrial cancer.
Success of sky-polarimetric Viking navigation: revealing the chance Viking sailors could reach Greenland from Norway
Authors: Száz Dénes , Horváth Gábor
Published: April 2018

According to a famous hypothesis, Viking sailors could navigate along the latitude between Norway and Greenland by means of sky polarization in cloudy weather using a sun compass and sunstone crystals. Using data measured in earlier atmospheric optical and psychophysical experiments, here we determine the success rate of this sky-polarimetric Viking navigation. Simulating 1000 voyages between Norway and Greenland with varying cloudiness at summer solstice and spring equinox, we revealed the chance with which Viking sailors could reach Greenland under the varying weather conditions of a 3-week-long journey as a function of the navigation periodicity Δtif they analysed sky polarization with calcite, cordierite or tourmaline sunstones. Examples of voyage routes are also presented. Our results show that the sky-polarimetric navigation is surprisingly successful on both days of the spring equinox and summer solstice even under cloudy conditions if the navigator determined the north direction periodically at least once in every 3 h, independently of the type of sunstone used for the analysis of sky polarization. This explains why the Vikings could rule the Atlantic Ocean for 300 years and could reach North America without a magnetic compass. Our findings suggest that it is not only the navigation periodicity in itself that is important for higher navigation success rates, but also the distribution of times when the navigation procedure carried out is as symmetrical as possible with respect to the time point of real noon.