bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of nodal classification for non‐small cell lung cancer by merging current N categories with the number of involved lymph node stations
Authors: Chen Wei , Zhang Chenlei , Wang Gebang , Yu Zhanwu , Liu Hongxu
Published: June 2019

Introduction

The aim of this study was to assess the prognoses of patients with non‐small cell lung cancer (NSCLC) according to the current nodal (N) categories of the tumor, node and metastasis (TNM) classification and the number of involved lymph node stations.

Methods

Five hundred and seventy patients with NSCLC underwent surgery from 1 January 2005 to 31 December 2009 and were analysed retrospectively. Postoperative overall survival was analysed according to two nodal classifications: the current N0, N1, N2 and N3 categories and those based on the number of involved nodal stations: N0, N1a (single N1), N1b (multiple N1), N2a1 (single N2 without N1), N2a2 (single N2 with N1), N2b1 (multiple N2 without N1) and N2b2 (multiple N2 with N1).

Results

Five‐year survival rates were 76.1%, 53.4% and 26.3% for N0, N1 and N2, respectively (P < 0.001). When survival was analysed by the number of involved nodal stations, the groups with significant differences were maintained; otherwise, they were merged, and new codes were assigned as follows for exploratory analyses: NA (N0), NB (N1a), NC (N1b, N2a (i.e., N2a1 and N2a2) and N2b1) and ND (N2b2). Five‐year survival rates were 76.1%, 60.0%, 39.1%, and 11.4% for NA, NB, NC and ND, respectively, and there were significant differences among them. This N classification was an independent prognostic factor in multivariate analyses.

Conclusion

Pending prospective and international validation, it is practical to merge the current N categories with the number of involved lymph node stations when evaluating the postoperative prognosis of NSCLC patients.
Transcriptome analysis reveals differentially expressed genes and pathways for oviduct development and defense in prelaying and laying hens
Authors: Yin Lingqian , Yu Lintian , Zhang Long , Ran Jinshan , Li Jingjing , Yang Chaowu , Jiang Xiaosong , Du Huarui , Hu Xiaofang , Liu Yiping
Published: June 2019

Problem

The oviduct plays an indispensable role in the formation of eggs, especially the magnum and uterus. The identification of oviduct development in different stages will help to target candidate genes and pathways in regulation of albumen and eggshell formation, as well as defense mechanism in oviduct and egg.

Methods

To identify the function differences and the molecular defense mechanism of the oviduct and egg, we performed transcriptome sequencing analysis of the magnum and uterus in 120‐d‐old and 300‐d‐old Lohmann layers, three birds in each group.

Results

With fold changes (log2 ratio) ≥ 2 and false discovery rate (FDR) < 0.01, RNA‐Seq revealed 1,040 genes expressed differentially in the magnum and 595 genes in the uterus. By combining GO enrichment and KEGG pathway analysis, it served to show that gene activities of the magnum and uterus in prelaying chickens were more likely to concentrate on growth and development, and after egg‐laying, they were mainly inclined to enhance the substances transmembrane transport and secretion activities. We further characterized 1579 new genes, while only 803 of them were functionally annotated. A complex mixture of proteins related to defense was measured in this study. A subset of avian β‐defensins (AvBDs) and ovodefensins (OvoDs), that is, AvBD12, AvBD11, AvBD10, OvoDA1, OvoDB1, OvoDA2, OvoDA3, and OvoDBβ, was detected to express in the magnum of laying hens at high levels.

Conclusion

Collectively, the identification and functional analysis of these differentially expressed genes (DEGs), as well as specific expression of avian defensins, may contribute to understand the development and defense mechanisms of oviduct and eggs.
Risk assessment for antenatal depression among women who have undergone female genital mutilation or cutting: Are we missing the mark?
Authors: Boghossian Araz S. , Freebody John , Moses Rebecca , Jenkins Gregory
Published: June 2019

Background

Although prohibited by specific legislation in Australia, patterns of global migration underscore the importance for local clinicians to recognise and manage potential complications associated with female genital mutilation/cutting (FGM/C). The incidence of antenatal depression in Australia is 10% and may be higher among those with a history of FGM/C (RANZCOG 2 statement: Perinatal Anxiety and Depression, 2012). The phenomenon of cultural embedding could represent a protective factor against an increase in mental health problems among these women.

Aim

To determine whether women who have undergone FGM/C are at greater risk of depression in the antenatal period as defined by the Edinburgh Postnatal Depression Scale (EPDS).

Materials and Methods

A multicentre retrospective case‐control study was performed. Participants who had delivered at either of two hospitals, had migrated from FGM/C‐prevalent countries and who had undergone FGM/C were assessed and compared with the control group, case‐matched by language and religion.

Results

Eighty‐nine cases were included with an equal number of matched controls. No significant difference in the EPDS score was demonstrated when analysed as a continuous variable (P = 0.41) or as a categorical variable with a cut‐off score of 12 (P = 0.12). There was no difference in the number of women who identified as having thoughts of self‐harm between the two groups.

Conclusion

There was no identified increase in the risk of antenatal depression among women who have undergone FGM/C from high‐prevalence countries. Consideration must be given to the utility of the EPDS in this population, as well as factors such as cultural embedding.
Reading Nearby: Literary Ethnography in a Postsocialist City
Authors: Rosen Matthew
Published: June 2019

The solitary reader, sitting quietly surrounded by her thoughts, is a powerful image. But reading is also a deeply social practice. From learning to read to deciding what to read next, a significant amount of literate activity takes place within specific social relationships. Drawing from ethnographic research I conducted between 2015 and 2018, this essay shows how the act of co‐reading has contributed to the emergence of a new literary community based in Tirana, Albania. The broader intention of the essay is to demonstrate the application of the general approach to literary anthropology I call reading nearby.
A Ghost Map of Kigali
Authors: Bolin Annalisa
Published: June 2019

This piece stems from the effort to understand how to move about the Rwandan capital, which has its own navigational logic. This attempt to establish a ghost map of the city in order to move through it dovetails with my research into how the visible materiality of the past holds the invisible: meaning, memory, significance. In Rwanda, this history, particularly of violence, lies underneath the everyday, demanding to be encountered both in daily life and in attempts to write the city. The essay circumvents the question of to what extent Rwanda’s past determines its future—an oppositional structure—in favor of an interpretation of the past as always present, whether visible or invisible.
An exploration and proposed taxonomy of leisure–befriending for adults with learning disabilities
Authors: Southby Kris
Published: June 2019

Accessible summary

Taking part in leisure activities is beneficial, yet many adults with learning disabilities are unable to participate in their preferred activities because of cost, because not having anyone to go with or because they do not feel welcome.

Befriending is where someone volunteers to act as a friend. Befriending may be a way for adults with learning disabilities to participate in leisure activities with someone who is not a paid carer or family.

The author spent time with four people with learning disabilities and their befrienders to find out what things they do together and what they both get from it. Friends and family members were also interviewed.

Participants enjoyed the time they spent together. However, they often did the same activities they would do with paid carers or family and the relationship was sometimes quite professional.

Befriending could be a way for adults with learning disabilities to have new, beneficial experiences, but we need to know more about how relationships work.

Background

Leisure time for adults with learning disabilities is often diversionary and spent doing passive, solitary or family‐orientated activities. Befriending, as a hybrid “natural” support, may help adults with learning disabilities overcome the barriers to participation in nonsegregated leisure.

Materials and methods

Four case studies of pairs of “befrienders” and “befriendees” were recruited purposively. Participant observation was carried out with each case, followed by semi‐structured interviews with participants and relevant stakeholders. Data were analysed using thematic analysis.

Results

Befriending activities were mostly limited to enjoyable yet “casual” leisure activities that adults with learning disabilities might already participate in with family and paid service providers. Negotiating the befriender role between friend and professional was an ongoing challenge.

Conclusions

Outcomes of leisure–befriending relationships for adults with learning disabilities are linked to both the nature of relationships and the types of activities undertaken. There are four proposed ideal types of leisure–befriending relationship, yet repeating familiar “casual” leisure activities means adults with learning disabilities risk missing out on novel leisure and social experiences.
Rational design of peptides with enhanced antimicrobial and anti‐biofilm activities against cariogenic bacterium Streptococcus mutans
Authors: Liang Dongsheng , Li Huanying , Xu Xiaohu , Liang Jingheng , Dai Xingzhu , Zhao Wanghong
Published: June 2019

Streptococcus mutans (S. mutans) is known to be a leading cariogenic pathogen in the oral cavity. Antimicrobial peptides possess excellent properties to combat such pathogens. In this study, we compared the antimicrobial activity of novel linear reutericin 6‐ and/or gassericin A‐inspired peptides and identified LR‐10 as the leading peptide. Antibacterial assays demonstrate that LR‐10 is more active against S. mutans (3.3 μM) than many peptide‐based agents without resistance selection, capable of killing many oral pathogens, and tolerant of physiological conditions. LR‐10 also presented a faster killing rate than chlorhexidine and erythromycin, and appeared to display selective activity against S. mutans within 10 s. S. mutans is usually encased in plaque biofilms. Biofilm inhibitory assays indicated that LR‐10 had excellent inhibitory effect on the biofilm formation of S. mutans and biofilm‐encased cells in vitro at low concentrations (6.5 μM). Consistent with most peptides, LR‐10 kills S. mutans mainly by disrupting the cell membranes. Notably, both hemolytic activity assays and cytotoxicity tests indicated that LR‐10 could keep biocompatible at the effective concentrations. Hence, LR‐10 could be a good candidate for clinical treatment of dental caries.
Matrix metalloproteinases: Expression, regulation and role in the immunopathology of tuberculosis
Authors: Sabir Naveed , Hussain Tariq , Mangi Mazhar Hussain , Zhao Deming , Zhou Xiangmei
Published: June 2019

Mycobacterium tuberculosis (Mtb) leads to approximately 1.5 million human deaths every year. In pulmonary tuberculosis (TB), Mtb must drive host tissue destruction to cause pulmonary cavitation and dissemination in the tissues. Matrix metalloproteinases (MMPs) are endopeptidases capable of degrading all components of pulmonary extracellular matrix (ECM). It is well established that Mtb infection leads to upregulation of MMPs and also causes disturbance in the balance between MMPs and tissue inhibitors of metalloproteinases (TIMPs), thus altering the extracellular matrix deposition. In TB, secretion of MMPs is mainly regulated by NF‐κB, p38 and MAPK signalling pathways. In addition, recent studies have demonstrated the immunomodulatory roles of MMPs in Mtb pathogenesis. Researchers have proposed a new regimen of improved TB treatment by inhibition of MMP activity to hinder matrix destruction and to minimize the TB‐associated morbidity and mortality. The proposed regimen involves adjunctive use of MMP inhibitors such as doxycycline, marimastat and other related drugs along with front‐line anti‐TB drugs to reduce granuloma formation and bacterial load. These findings implicate the possible addition of economical and well‐tolerated MMP inhibitors to current multidrug regimens as an attractive mean to increase the drug potency. Here, we will summarize the recent advancements regarding expression of MMPs in TB, their immunomodulatory role, as well as their potential as therapeutic targets to control the deadly disease.
Cerebrospinal Fluid and Brain Tissue Penetration of Tenofovir, Lamivudine, and Efavirenz in Postmortem Tissues with Cryptococcal Meningitis
Authors: Nicol Melanie R. , Pastick Katelyn A. , Taylor Joneé , Namuju Olivie C. , Rhein Joshua , Williams Darlisha A. , Meya David B. , Boulware David R. , Lukande Robert
Published: June 2019

The central nervous system (CNS) is a known HIV reservoir, yet little is known about drug exposure in the brain. Our primary objective was to quantify exposure of three common antiretrovirals in brain tissue and compare exposures to plasma and cerebrospinal fluid (CSF). We also sought to identify pockets of brain most vulnerable to inadequate drug exposures and examine the role of meningitis in drug penetration into the CNS. Tenofovir, lamivudine, and efavirenz concentrations were measured using liquid chromatography and tandem mass spectrometry in plasma and CSF from 14 individuals with HIV, 7 with cryptococcal meningitis. In four individuals (three with meningitis) drug concentrations were also measured in 13 distinct brain tissue regions. In subjects with meningitis, geometric mean ratio (95% confidence interval) of tenofovir CSF to plasma was 66% (7–598%) and 14% (6–31%) in subjects without meningitis. Lamivudine CSF penetration was 100% (25–409%) in subjects with meningitis and 30% (24–37%) in subjects without meningitis. Tenofovir brain tissue concentrations were 36% (14–124%) of plasma and 49% (1–572%) of CSF. Lamivudine brain concentrations were 37% (23–64%) of plasma and 27% (1–104%) of CSF. Efavirenz brain tissue concentrations were 128% (108–179%) of plasma. Tissues collected postmortem provide a unique opportunity to assess drug distribution in tissues difficult to sample in living subjects. CSF is a poor surrogate for drug exposure throughout the CNS. Antiretrovirals differentially penetrate into the CNS and penetration may be enhanced by meningitis.
Cutaneous aneurysmal bone cyst—First report of a case and literature review
Authors: Chung Ivy Ah‐Yu , Petelin Kristina , Pižem Jože , Luzar Boštjan
Published: June 2019

Aneurysmal bone cyst (ABC) is a benign, expansile, multiloculated and blood‐filled cystic lesion most commonly involving bones. We report herein the case of a 78‐year‐old woman with a dermal ABC located in the skin of the right foot. Histologically, the lesion displayed characteristic features of ABC, including blood‐filled cystic spaces lined by loose connective tissue, admixed with solid areas composed of spindle cells and osteoclast‐like giant cells, associated with foci of woven bone formation and matrix calcification (“blue bone” formation). Fewer than 30 cases of extraosseous ABCs have been described in soft tissues and, to the best of our knowledge, ABC primarily occurring in the skin, not associated with an underlying lesion in the bone, has not so far been reported in the literature.
The utility of TTF‐1, napsin A, CK5 and p63 staining in the sub‐classification of non‐small cell carcinoma of the lung
Authors: van Zyl Adri , Schubert Pawel T. , Koegelenberg Coenraad F. N.
Published: June 2019

Background

The potentially curative and/or palliative therapy for non‐resectable lung cancer has evolved significantly over the past 2 decades. With the availability of targeted therapies, the need for precise sub‐typing of non‐small cell lung carcinoma (NCSLC) has become paramount.

Objectives

As there are few data from South Africa, we aimed to determine utility of TTF‐1, napsin A, p63 and CK5 immunostaining on fine needle aspiration (FNA) cell block and formalin‐fixed paraffin‐embedded tissue biopsy specimens in subtyping NSCLC as adenocarcinoma and squamous cell carcinomas.

Methods

All cases of NSCLC diagnosed during a 3‐year period were retrospectively identified. All FNA biopsy and formalin‐fixed paraffin‐embedded cases that were stained with TTF‐1, napsin A, CK5 and p63 were collected. A lung cancer registry was used to access and correlate clinical and radiological data.

Results

We included 271 cases with diagnoses of adenocarcinoma of the lung (n = 201), squamous cell carcinoma of the lung (n = 53), unspecified NSCLC (n = 8) and other carcinomas (n = 9). TTF‐1 and napsin A had sensitivities of 99.0% and 91.9%, respectively, positive predictive values (PPVs) of 90.8% and 90.3%, respectively, and accuracies of 91.0% for adenocarcinoma of the lung. Napsin A had a higher specificity than TTF‐1 (90.2% vs 62.8%). Both CK5 and P63 had high sensitivities (95.4% and 97.9%, respectively) and negative predictive values of 96.4% and 96.8%, respectively, for squamous cell carcinoma of the lung. CK5 had a higher specificity than p63 (84.4% and 61.2%, respectively), PPV (80.4% and 70.8%, respectively) and accuracy (88.8% and 79.2%, respectively) for squamous cell carcinoma.

Conclusion

All four immunostaining methods had high sensitivities. TTF‐1 and napsin A both had high PPV and diagnostic accuracy for adenocarcinoma of the lung, whereas CK5 had an equally high PPV and accuracy for squamous cell carcinoma of the lung. The specificity of napsin A for adenocarcinoma was higher than that of TTF‐1. The specificity of CK5 for squamous cell carcinoma was higher than p63.
Preoperative indicators of misdiagnosis in invasion depth staging of esophageal cancer: Pitfalls of magnifying endoscopy with narrow‐band imaging
Authors: Kimura Hidenori , Yoshida Masao , Tanaka Masaki , Kawata Noboru , Kakushima Naomi , Takizawa Kohei , Kishida Yoshihiro , Imai Kenichiro , Ito Sayo , Hotta Kinichi , Ishiwatari Hirotoshi , Matsubayashi Hiroyuki , Ono Hiroyuki
Published: June 2019

Objectives

The Japan Esophageal Society classification has been widely applied for predicting the invasion depth of superficial esophageal squamous cell carcinomas (SESCCs). Although Type B2 of the classification clinically corresponds to SESCCs with muscularis mucosa or slight submucosal invasion (MM/SM1), diagnostic yield based on Type B2 is insufficient. This study aimed to investigate risk factors for misdiagnosis in preoperative invasion depth staging.

Methods

We included a total of 104 SESCCs in which Type B2 was observed by magnifying endoscopy. SESCCs were classified as either correct diagnosis (pMM/SM1, 39 lesions), overdiagnosis (epithelium or the lamina propria [pEP/LPM], 34 lesions), or underdiagnosis (deep invasion into the submucosa [pSM2‐3], 31 lesions) based on pathological depth of invasion. The association between misdiagnosis and endoscopic features, including distinct features, was evaluated using logistic regression analysis. Distinct features were defined as nodular protrusion, thickness, and/or clearly depressed area. The diameter of type B2 area was endoscopically measured, and the cut‐off value was determined using a receiver operating characteristic curve.

Results

Type B2 area <6 mm (area under the curve, 0.776) and Type B2 vessels around erosion were significantly associated with overdiagnosis (odds ratio, 16.6 and 11.0, respectively), while distinct features were significantly associated with underdiagnosis (odds ratio, 8.7). Adjusted by these misdiagnosis factors, positive predictive value of Type B2 significantly improved from 38% to 65% (P < 0.01).

Conclusions

Lesions with a small Type B2 area (<6 mm) and/or Type B2 vessels around erosion should be diagnosed as EP/LPM and lesions with distinct features as SM2‐3.
Universal drug coverage and income‐related disparities in glycaemic control
Authors: Branfield Day L. , Austin P. C. , Shah B. R.
Published: June 2019

Aims

To examine whether income‐related disparities in glycaemic control decline after the age of 65 years, when publicly funded universal drug insurance is acquired in Ontario, Canada.

Methods

We conducted a population‐based cross‐sectional study using linked administrative healthcare databases. Adults with diabetes, aged 40–89 years, with available HbA1c data were included (N = 716 297). Income was based on median neighbourhood household income. Multiple linear regression was used to test for effect modification of age ≥65 years on the relationship between income and HbA1c.

Results

There was a significant inverse association between income and HbA1c level. After adjusting for baseline factors, the effect of income on HbA1c level was significantly greater for individuals aged <65 years (mean difference HbA1c for lowest vs highest income group +2.5 mmol/mol, 95% CI +2.3 to +2.7 [+0.23%, 95% CI 0.21 to 0.24]) than for those aged ≥65 years (+1.2 mmol/mol, 95% CI +1.0 to +1.3 [+0.11%, 95% CI 0.10 to 0.12]; P < 0.0001 for interaction).

Conclusions

Despite universal access to healthcare, people with diabetes with lower incomes had significantly worse glycaemic control compared with their counterparts on higher incomes. However, income gradients in glycaemic control were markedly reduced after the age of 65 years, possibly as a result of access to prescription drug coverage.
Paying Politicians: Not Too Little, Not Too Much
Authors: Fedele Alessandro , Giannoccolo Pierpaolo
Published: June 2019

How does pay affect the quality of politicians? This paper addresses the question by considering a three‐period citizen candidate model where potential candidates vary in skills and in public service motivation. First, potential candidates observe the level of pay in politics and simultaneously decide whether or not to run for office. Second, an election takes place and only one candidate is elected. Finally, the successful candidate provides a public good, while the others work in the market sector. In a benchmark model where potential candidates differ only in skills, the quality of the elected politician is shown to increase with pay. If public service motivation is also considered, then an inverted U‐shaped relationship is found.
Extracellular matrix protein anosmin‐1 modulates olfactory ensheathing cell maturation in chick olfactory bulb development
Authors: Hu Youli , Butts Thomas , Poopalasundaram Subathra , Graham Anthony , Bouloux Pierre‐Marc
Published: June 2019

Olfactory ensheathing cells (OECs) are a specialized class of glia, wrapping around olfactory sensory axons that target the olfactory bulb (OB) and cross the peripheral nervous system/central nervous system boundary during development and continue to do so post‐natally. OEC subpopulations perform distinct subtype‐specific functions dependent on their maturity status. Disrupted OEC development is thought to be associated with abnormal OB morphogenesis, leading to anosmia, a defining characteristic of Kallmann syndrome. Hence, anosmin‐1 encoded by Kallmann syndrome gene (KAL‐1) might modulate OEC differentiation/maturation in the OB. We performed in ovo electroporation of shRNA in the olfactory placode to knock‐down kal in chick embryos, resulting in abnormal OB morphogenesis and loss of olfactory sensory axonal innervation into OB. BLBP‐expressing OECs appeared to form a thinner and poorly organized outmost OB layer where SOX10 expressing OECs were completely absent with emergence of GFAP‐expressing OECs. Furthermore, in embryonic day 10 chick OB explant cultures, GFAP expression in OECs accumulating along the OB nerve layers was dramatically reduced by recombinant anosmin‐1. We then purified immature OECs from embryonic day 10 chick OB. These cells express GFAP after 7 days in vitro, exhibiting a multipolar morphology. Overexpression of chick anosmin, exogenous anosmin‐1 or FGF2 could inhibit GFAP expression with cells presenting elongated morphology, which was blocked by the FGF receptor inhibitor Su5402. These data demonstrate that anosmin‐1 functions via FGF signalling in regulating OEC maturation, thereby providing a permissive glial environment for axonal innervation into the OB during development.
Size‐abundance rules? Evolution changes scaling relationships between size, metabolism and demography
Authors: Malerba Martino E. , Marshall Dustin J.
Published: June 2019

Body size often strongly covaries with demography across species. Metabolism has long been invoked as the driver of these patterns, but tests of causal links between size, metabolism and demography within a species are exceedingly rare. We used 400 generations of artificial selection to evolve a 2427% size difference in the microalga Dunaliella tertiolecta. We repeatedly measured size, energy fluxes and demography across the evolved lineages. Then, we used standard metabolic theory to generate predictions of how size and demography should covary based on the scaling of energy fluxes that we measured. The size dependency of energy remained relatively consistent in time, but metabolic theory failed to predict demographic rates, which varied unpredictably in strength and even sign across generations. Classic theory holds that size affects demography via metabolism – our results suggest that both metabolism and size act separately to drive demography and that among‐species patterns may not predict within‐species processes.
Hyperkinetic movement disorders: expanding the phenotype of congenital disorders of glycosylation
Authors: Pandey S. , Chouksey A.
Published: June 2019

Click here to view the accompanying paper in this volume.
First record of Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae) in Burundi
Authors: Ndayizeye L. , Manirakiza O. , Ntashavu D. , Ndayikeza L. , Mbarushimana D.
Published: June 2019

This study to detect Tuta absoluta was carried out at four sites in western Burundi from March to July 2018. Delta traps containing Tutrack pheromone and sticky paper were installed in tomato fields at 40 cm from the ground. Sample collection was carried out twice a week. The results confirmed the presence of T. absoluta in Burundi. Effective pest control is required to avoid heavy losses on tomato production.
Southern Lapwing Vanellus chilensis cooperative helpers at nests are older siblings
Authors: Cerboncini Ricardo A. S. , Braga Talita V. , Roper James J. , Passos Fernando C.
Published: June 2019

Cooperative breeding is rare in shorebirds, and when found it is thought to be due to polygamous mating (cooperative polygamy). Here we describe the social structure of cooperatively breeding groups in Southern Lapwing Vanellus chilensis and test the prediction that offspring sex ratio is skewed towards the sex that helps. The social groups consisted of a breeding pair with one or two young (mostly males, 68%) from the previous breeding season, and offspring sex ratio was not skewed. Cooperative breeding in the Southern Lapwing is not the consequence of cooperative polygamy, but rather groups were formed by a mated pair and some of their offspring from previous nests as helpers.
Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center
Authors: Seth Jai , Kiosoglous Anthony , Pakzad Mahreen , Hamid Rizwan , Shah Julian , Ockrim Jeremy , Greenwell Tamsin
Published: June 2019

Objectives

To report a large series of vesicovaginal fistula, and to assess the incidence of ureteric injury in association with vesicovaginal fistula.

Methods

We retrospectively reviewed a prospective database of patients with vesicovaginal fistula referred to our center between 2004 and 2016. Data on patient demographics, fistula etiology, mode of repair, and any associated ureteric injury and its treatment were noted.

Results

Overall, 116 patients (median age 49 years, range 23–88 years) were referred for management of vesicovaginal fistula during the study period. Four of these patients (3.4%) had associated ureteric injury, one of whom had bilateral injury. Ureteric obstruction alone was noted in two patients, ureterovaginal fistula alone in one patient, and bilateral ureteric obstruction and ureterovaginal fistula in one patient. All ureteric injuries were managed with simultaneous reimplantation into the bladder at the time of vesicovaginal fistula repair. Five patients had post‐radiotherapy vesicovaginal fistula, and the remainder were post‐surgical. Three patients with post‐radiotherapy vesicovaginal fistula proceeded to primary diversion.

Conclusions

Ureteric injury is far less common than previously reported, occurring in <5% of patients presenting with vesicovaginal fistula. It can be successfully managed, and it remains the major indication for abdominal repair of vesicovaginal fistula.
Do guidelines help us to deviate from their recommendations when appropriate for the individual patient? A systematic survey of clinical practice guidelines
Authors: Morgott Marc , Heinmüller Stefan , Hueber Susann , Schedlbauer Angela , Kühlein Thomas
Published: June 2019

Rationale, aims, and objectives

Clinical practice guidelines (CPG) were introduced to summarize the best scientific evidence available. Thereby, CPG were meant to support evidence‐based medicine (EBM). However, besides evidence, EBM also asks for patients' preferences and physicians' experiences to be considered when coming to therapeutic decisions. Thus, deviations from CPG recommendations are sometimes necessary when practicing EBM. We wanted to examine whether CPG support deviations from their recommendations when appropriate. For operationalization, we asked whether absolute effect sizes (AES) for benefit and/or harm of suggested therapies were provided along with the respective CPG recommendation.

Methods

This systematic survey comprised the most common CPG on chronic coronary heart disease (CCHD) and type 2 diabetes mellitus (T2DM) from English‐ and German‐speaking countries. Only CPG recommendations on pharmacotherapy were evaluated. If AES of a recommended therapy were reported, we rated how easily findable they were within the CPG. Moreover, we assessed whether the CPG provided patient information material and whether this material supplied AES allowing patients to determine the effects to be expected.

Results

In the 13 CPG surveyed, 144 recommendations on pharmacotherapy were identified. For 108 recommendations (75%), no AES for benefit and/or harm were reported. Thirty‐one recommendations (22%) were accompanied by one or more AES for either benefit or harm. Along with five recommendations (3%), one or more AES for both benefit and harm were given. AES were considered easy to find for three of these 36 recommendations (8%). Patient information material was provided in three of the 13 CPG (23%) accounting for AES in one occasion only.

Conclusion

Current CPG on T2DM and CCHD do not sufficiently offer AES for benefits and harms of recommended therapies. Thus, they lack satisfactory information to support deviations from CPG recommendations. Consequently, CPG in their present form do not adequately facilitate EBM.
Value‐based health care in obstetrics
Authors: Van Den Berg Kim , Dijksman Lea Magdalena , Keus Samyra Hermione Jessica , Scheele Fedde , Van Pampus Maria Gabriel
Published: June 2019

Rationale, Aims, and Objectives

We strive to maximize outcomes that are relevant to the women who deliver in our hospital. We demonstrate a practical method of using value‐based health care (VBHC) concepts to analyse how care can be improved.

Method

Using International Consortium of Health Outcome Measurements (ICHOM) set, a practical outcome set was constructed for women who go into spontaneous labour at term of a singleton in cephalic presentation and used for benchmarking. We included data on interventions that are major drivers of outcomes. Data from two hospitals in Amsterdam and for The Netherlands for 2011 to 2015 were collected.

Results

Benchmarking of readily available data helped identify a number of statistically significant and clinically relevant differences in obstetric outcomes. Caesarean section rate was significantly different at 13.7% in hospital 2 compared with 11.5% in hospital 1 with similar neonatal outcomes. Third and fourth degree tearing rates were significantly higher for hospital 1 at 5.5% compared with 3.6% for hospital 2 and the national average of 3.5%. On the basis of the guidelines, literature, and discussion, initiatives on how to improve these outcomes were then identified. These include caesarean section audit and guidelines regarding caesarean section decision making. In order to reduce the rate of third and fourth degree tearing, routine episiotomy on vaginal operative deliveries was introduced, and a training programme was set up to make care providers more aware of risk factors and potential preventive measures.

Conclusion

Defining, measuring, and comparing relevant outcomes enable care providers to identify improvements. Collection and comparison of readily available data can provide insights in where care can be improved. Insights from literature and comparison of care practices and processes can lead to how care can be improved. Continuous monitoring of outcomes and expanding the set of outcomes that is readily available are key in the process towards value‐based care provision.
Numerical study of the thermolysis of catechins in green tea
Authors: Carmona‐Jasso Jaime G. , Gallegos‐Infante José A. , Díaz‐Ovalle Christian O. , González‐Laredo Rubén , Valle‐Cervantes Sergio , Cruz‐Fierro Francisco , Lesso‐Arroyo Raúl
Published: June 2019

Tea contains health benefits due to its compounds such as catechins, which undergo thermolysis during heating. These complex reactions have been proposed as first order kinetic models at controlled conditions, and this work proposes a non‐first‐order kinetic model to cover a wide range of conditions. Afterward, these reactions were simulated via computational fluid dynamics in order to determine the concentration at different operative conditions. The system was a continuous heating reactor, where mesh and iteration tests were developed. The results indicated that the reactions presented a high thermal dependency, and a short residence time with low conversion due to the low values of the Damköhler number. Thus, the kinetic model proposed herein reached a well representation of the thermolysis of catechins, which suggests the applicability of this model and strategy in other thermal treatments of tea.

Practical Application

The high comsumption of green tea demands better process treatments in order to reduce the perishable compounds. Thermal processing of tea requires a thorough understanding of thermolysis in catechins. The basis of this paper can be extended into evaporation and drying of green tea under CFD simulation.
Evaluation of immersion‐contact type heat transfer for continuous pharmaceutical spin freeze‐drying process
Authors: Srinivasan Ganeshmurthy , Raja Balakrishnan
Published: June 2019

Spin freeze‐drying process is a recently proposed method to achieve continuous processing of unit doses in freeze‐drying application. An experimental study is carried out to investigate the heat transfer and drying characteristics of a spin‐frozen liquid product. To enhance heat transfer, unlike freeze drying performed in shelves, the shell is immersed into a temperature‐controlled bath. The influence of different ramping condition of bath temperature on drying rate, time and variation of moisture content in spin‐frozen products (deionized water and skimmed milk) are analyzed and reported in this paper. Among different ramping conditions, ramping of bath temperature to 10°C resulted in higher drying rate (1.8 kg hr−1 m−2) and lesser drying time (44%). The overall heat transfer coefficient (Kv) between the bath and product is evaluated for the above condition in both the test liquids. This direct contact type heat transfer helps in reducing air gap resistance and radiation effect, which primarily helps in minimizing thermal resistances. The effect of dry layer resistance is minimal in the spin‐frozen product due to lower product thickness and larger ice‐vapor surface area.

Practical Applications

The spin‐frozen sample is dried either by using an infrared (IR) heater or by placing on a shelf. Limitations using IR heater include positioning of the vials (the distance between the vials and IR source) and selecting suitable IR window material and thickness. In the case of the shelf, conduction resistance between shelf and vial, radiation resistance inside the chamber and air gap resistance present between vial and shelf plays a major role. The thermal resistance is minimal in the immersion method due to the absence of air gap resistance and radiation effect. Hence, an alternative approach is discussed using immersion drying method to achieve continuous vial processing and uniformity among vials. Hence, freeze‐drying process can also be shifted to continuous production mode like prefilling and packaging.
Deficient allo‐centric visuospatial processing contributes to apraxic deficits in sub‐acute right hemisphere stroke
Authors: Ubben Simon D. , Fink Gereon R. , Kaesberg Stephanie , Kalbe Elke , Kessler Josef , Vossel Simone , Weiss Peter H.
Published: June 2019

While visuospatial deficits are well‐characterized cognitive sequelae of right hemisphere (RH) stroke, apraxic deficits in RH stroke remain poorly understood. Likewise, very little is known about the association between apraxic and visuospatial deficits in RH stroke or about the putative common or differential pathophysiology underlying these deficits. Therefore, we examined the behavioural and lesion patterns of apraxic deficits (pantomime of object use and bucco‐facial imitation) and visuospatial deficits (line bisection and letter cancellation tasks) in 50 sub‐acute RH stroke patients. Using principal component analysis (PCA), we characterized the relationship between the two deficits. We hypothesized that any interaction of these neuropsychological measures may be influenced by the demands of ego‐centric/space‐based and/or allo‐centric/object‐based processing. Contralesional visuospatial deficits were common in our clinically representative patient sample, affecting more than half of RH stroke patients. Furthermore, about one‐third of all patients demonstrated apraxic deficits. PCA revealed that pantomiming and the imitation of bucco‐facial gestures loaded clearly on a first component (PCA1), while letter cancellation loaded heavily on a second component (PCA2). For line bisection, overall mean deviation loaded on PCA1, while the difference between the mean deviations in contra‐ versus ipsilesional space loaded on PCA2. These results suggest that PCA1 represents allo‐centric/object‐based processing and PCA2 ego‐centric/space‐based processing. This interpretation was corroborated by the statistical lesion analyses with the component scores. Data suggest that disturbed allo‐centric/object‐based processing contributes to apraxic pantomime and imitation deficits in (sub‐acute) RH stroke.
Oro‐dental characteristics in patients with hypermobile Ehlers‐Danlos Syndrome compared to a healthy control group
Authors: Honoré Michelle Bornemann , Lauridsen Eva Fejerskov , Sonnesen Liselotte
Published: June 2019

Background

Ehlers‐Danlos syndrome (EDS) is a hereditary disorder that affects the connective tissue and collagen structures in the body characterised by joint hypermobility, skin hyperextensibility and tissue fragility.

Objective

The aim of the study was to investigate the oro‐dental characteristics including measurements of tooth size of 26 patients with hypermobile EDS (hEDS), differentiated by a genetic test, compared to 39 healthy controls.

Methods

Interview, clinical and radiological examination on panoramic radiograph and cone‐beam computed tomographic (CBCT) scan were performed. Statistical analyses included Fisher's exact test, paired t test and multiple logistic and linear models adjusted for age and gender.

Results

The experience of xerostomia (P = 0.039), local anaesthetic insufficiency (P < 0.001) and tooth extraction complications (P < 0.003) were significantly higher in hEDS compared to controls. The debris index was significantly higher in hEDS (P < 0.001), and the distance between the cement‐enamel junction (CEJ) and the bone level on the upper left first incisor and molar and the lower right first molar was significantly larger in hEDS compared to controls (P = 0.021, P = 0.024, P = 0.021, respectively). The crown heights of the upper and lower first incisors were significantly smaller (P = 0.001, P = 0.003, P = 0.002, P < 0.001, respectively) in hEDS compared to controls. When adjusting for debris index, only the distance between CEJ and the marginal bone level on the upper left and lower right molar was associated with hEDS.

Conclusion

The results indicate that xerostomia, resistance to local anaesthesia, tooth extraction complications, poor oral hygiene, larger distance between CEJ and marginal bone level and small crown heights can be found in patients with hEDS.
Impact of immunodeficiency on lingual carcinogenesis and lymph node metastasis in mice
Authors: Wang Shan , Li Fang , Qiang Dongxia , Hu Zheng , Meng Yan , Shi Lei , Zhao Eryang , Niu Yumei
Published: June 2019

Purpose

Carcinogenesis is mostly accompanied by inflammation and is shaped by immune responses, where the host immune system does not always appear to be a powerful active tool. Some studies have identified that T lymphocytes in the tumor microenvironment are indispensable for the process of distant metastasis. This study aimed to investigate the contradictory role of the immune system and to examine the impact of immunodeficiency on carcinogenesis and lymph node metastasis in mouse models.

Methods

BALB/c mice, BALB/c nude mice, and CB‐17SCID mice were treated with 50 mg/L 4‐nitroquinoline‐1‐oxide (4NQO) in drinking water for 16 weeks followed by distilled water until 38 weeks. Three mice per group were sacrificed biweekly or every four weeks from week 4, and tongue lesions and regional lymph node metastases were evaluated.

Results

There were no significant differences in the histological examination of carcinogenesis in immunocompetent and immunodeficient mice exposed to 4NQO. However, development of cancer in immunodeficient mice (12 weeks) was earlier than that in immunocompetent mice (28 weeks). Local lymph metastases were observed after 36 weeks in immunocompetent BALB/c mice as opposed to after 18 weeks in immunodeficient mice.

Conclusion

Immunodeficiency could remarkably advance carcinogenic progression and lymph node metastasis but might not accelerate lymph node metastasis progression.
How Is Religiousness Associated With Adolescent Risk‐Taking? The Roles of Emotion Regulation and Executive Function
Authors: Holmes Christopher , Brieant Alexis , King‐Casas Brooks , Kim‐Spoon Jungmeen
Published: June 2019

Existing literature has demonstrated an association between higher adolescent religiousness and lower risk‐taking via higher self‐regulation. This study sought to elucidate the roles of emotion regulation and executive function as parallel mediators in the link between religiousness and risk‐taking in a sample of 167 adolescents (mean age = 14.13 years, 52% male, 82% White at Time 1). Longitudinal results across three waves utilizing structural equation modeling indicated higher religiousness was associated with higher emotion regulation, whereas religiousness was not associated with executive function. Subsequently, higher emotion regulation and executive function were associated with lower risk‐taking. Emotion regulation mediated the association between religiousness and risk‐taking. The findings highlight religiousness as a contextual protective factor for adolescents.
The Varieties of Religious Significance: An Idiographic Approach to Study Religion's Role in Adolescent Development
Authors: Schachter Elli , Ben Hur Avital
Published: June 2019

We present a rationale and method for taking an idiographic approach to study the role religion plays in adolescent development. We theorize that adolescents harness qualitatively different aspects of religion to address idiosyncratic developmental needs. Therefore, analyzing religion's role in adolescent development necessitates a case‐by‐case holistic analysis. We introduce a systematic method using narratives to identify the personal ways that individuals attribute meaning in general and regarding religion in particular. We present three detailed case studies from a sample of 20 religious Israeli Jewish Orthodox emerging‐adult women who provided retrospective narrative accounts of their general and religious development through adolescence. Systematic analysis reveals that religion was significant to these women in diverse and personal ways, addressing markedly different adolescent developmental needs.
Parent Psychological Distress: A Moderator of Behavioral Health Intervention Outcomes among Justice‐Involved Adolescents
Authors: Ng Mei Yi , Tolou‐Shams Marina , Galbraith Katharine , Brown Larry K.
Published: June 2019

We examined whether pre‐existing parent psychological distress moderated juvenile offenders’ substance use, sexual risk, and mental health outcomes in a randomized trial. Forty‐seven parent–adolescent dyads received either Family‐based Affect Management Intervention (FAMI) for adolescent substance use and HIV prevention or adolescent‐only Health Promotion Intervention (HPI). Parents’ self‐reported distress at baseline significantly moderated adolescents’ self‐reported marijuana use and alcohol use but not other outcomes at 3 months postintervention, producing crossover interactions. FAMI outperformed HPI when parents reported high‐level distress, whereas HPI outperformed FAMI when parents reported low‐level distress. This finding that the relative efficacy of interventions depends on the severity of parent psychological distress could inform efforts to match substance‐using, justice‐involved adolescents with the intervention most likely to benefit them.
Social Inclusion of Refugee and Native Peers Among Adolescents: It is the Language that Matters!
Authors: Beißert Hanna , Gönültaş Seçil , Mulvey Kelly Lynn
Published: June 2019

This study investigated the role of refugee status and language skills for adolescents’ inclusion or exclusion decisions in hypothetical intergroup scenarios. 100 German adolescents (Mage = 13.65 years,SD = 1.93) were presented three scenarios in which groups of adolescents are planning leisure time activities, and peers from their own country (Germany) versus another country (Syrian refugees) with either good or bad German skills want to join them. Whereas adolescents’ inclusion decisions did not differ between the German protagonist and the Syrian one with good German skills, the Syrian protagonist with bad German skills was less likely to be included than either of the other two. These findings have implications for understanding the role of language in adolescents’ inclusion decisions.