bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic accuracy of point‐of‐care ultrasound for evaluation of early blood‐induced joint changes: Comparison with MRI
Authors: Foppen W. , van der Schaaf I. C. , Beek F. J. A. , Mali W. P. T. M. , Fischer K.
Published: May 2018

Introduction

Recurrent joint bleeding is the hallmark of haemophilia. Synovial hypertrophy observed with Magnetic Resonance Imaging (MRI) is associated with an increased risk of future joint bleeding.

Aim

The aim of this study was to investigate whether point‐of‐care ultrasound (POC‐US) is an accurate alternative for MRI for the detection of early joint changes.

Methods

In this single centre diagnostic accuracy study, bilateral knees and ankles of haemophilia patients with no or minimal arthropathy on X‐rays were scanned using POC‐US and 3 Tesla MRI. POC‐US was performed by 1 medical doctor, blinded for MRI, according to the “Haemophilia Early Arthropathy Detection with Ultrasound” (HEAD‐US) protocol. MRIs were independently scored by 2 radiologists, blinded for clinical data and ultrasound results. Diagnostic accuracy parameters were calculated with 95% confidence intervals (CI).

Results

Knees and ankles of 24 haemophilia patients (96 joints), aged 18‐34, were studied. Synovial hypertrophy on MRI was observed in 20% of joints. POC‐US for synovial tissue was correct (overall accuracy) in 97% (CI: 91‐99) with a positive predictive value of 94% (CI: 73‐100) and a negative predictive value of 97% (CI: 91‐100). The overall accuracy of POC‐US for cartilage abnormalities was 91% (CI: 83‐96) and for bone surface irregularities 97% (CI: 91‐99).

Conclusion

POC‐US could accurately assess synovial hypertrophy, bone surface irregularities and cartilage abnormalities in haemophilia patients with limited joint disease. As POC‐US is an accurate and available alternative for MRI, it can be used for routine evaluation of early joint changes.
High expression of CD10 in anaplastic thyroid carcinomas
Authors: Nakazawa Tadao , Kondo Tetsuo , Vuong Huy Gia , Odate Toru , Kawai Masataka , Tahara Ippei , Kasai Kazunari , Inoue Tomohiro , Oishi Naoki , Mochizuki Kunio , Ito Koichi , Katoh Ryohei
Published: May 2018

Aims

CD10 is an endopeptidase that degrades various bioactive peptides in the extracellular matrix. In addition to enzymatic degradation, it affects multiple intracellular signal transduction pathways. CD10 expression has been extensively studied in human epithelial cancers of numerous organs and sites. However, its presence in thyroid carcinomas, especially in anaplastic thyroid carcinoma (ATC), has not been fully determined. An actual CD10 expression in thyroid lesions including a large series of ATC was evaluated.

Methods and results

We examined CD10 by immunohistochemistry (IHC) in 152 thyroid lesions: nine adenomatous goitres (AGs) and 143 tumours, including 47 anaplastic carcinomas. IHC showed diffuse and strong positivity for CD10 in the epithelial components of almost all ATCs. However, epithelia with squamous metaplasia and oncocytic change from AGs, follicular adenomas and differentiated carcinomas had focal CD10 reactivity. Some papillary thyroid carcinomas (PTCs), along with the PTC components of some ATCs, showed CD10 positivity in fibroblast‐like stromal cells and fibrous material.

Conclusion

Our results imply that the CD10 expression pattern depended on the histotypes of thyroid lesions. When possible metastatic tumours and non‐epithelial tumours are excluded, high CD10 expression may be useful in determining whether a primary thyroid carcinoma includes an anaplastic component.
Phenotypic and molecular changes in nodule‐in‐nodule hepatocellular carcinoma with pathogenetic implications
Authors: Rudini Noemi , Novello Chiara , Destro Annarita , Riboldi Elena , Donadon Matteo , Viganò Luca , Morenghi Emanuela , Roncalli Massimo , Di Tommaso Luca
Published: May 2018

Aims

Nodule‐in‐nodule (N/N) hepatocellular carcinoma (HCC) is a convincing proof of multistep hepatocarcinogenesis. In this lesion, an inner HCC develops within an outer, more differentiated, tumour, which can be rapidly taken over by the former so that N/N HCC is rarely detected.

Methods and results

Ten resected N/N HCCs arising in cirrhotic background and characterized: (i) as outer lesions by early (n = 3) and G1 (n = 7) HCC; (ii) as inner lesions by G1 (n = 3) and G2 (n = 7) HCC. The largest/smallest diameters of outer and inner nodules were, respectively, 20/6 mm and 16/4 mm. We investigated vascular (CD34 and endocan), hepatocellular VEGF, GS, GPC3, HSP70 and CHC) and molecular (TERT promoter and β‐catenin) changes taking place from the outer neoplastic compartment to the inner neoplastic compartment (INC). A diffuse pattern of CD34+ capillarized vessels and focal endocan immunoreactivity were major distinctive features acquired in the INC; VEGF immunoreactivity was inversely related to CD34 staining. A gain in the number of cells immunoreactive for GPC3, HSP70, and CHC, but not of GS‐immunoreactive cells, also occurred in the INC. TERT promoter mutations were seen in half of the cases in both compartments, whereas β‐catenin mutations were more rarely detectable.

Conclusions

Major phenotypic changes take place in the INC of N/N HCC. TERT promoter mutations take place frequently and very early, and, in contrast to β‐catenin mutations, do not appear to be acquired during N/N growth. These findings suggest that inner nodules represent a step further along the pathway of tumour progression, in contrast to earlier, simply initiated, lesions, and that complete neovascularisation predicts a change in HCC biology.
Chemsex and new HIV diagnosis in gay, bisexual and other men who have sex with men attending sexual health clinics
Authors: Pakianathan M , Whittaker W , Lee MJ , Avery J , Green S , Nathan B , Hegazi A
Published: May 2018

Objectives

The aim of the study was to analyse associations between chemsex and new HIV and sexually transmitted infection (STI) diagnoses among gay, bisexual and other men who have sex with men (GBMSM) accessing sexual health clinics.

Methods

A retrospective case note review was carried out for all GBMSM attending two London sexual health clinics between 1 June 2014 and 31 July 2015.

Results

Chemsex status was documented for 1734 of 1840 patients. Overall, 27.1% (n = 463) disclosed current recreational drug use, of whom 286 (16.5%) disclosed chemsex participation and 74 of 409 (18.1%) injected drugs. GBMSM who were already HIV positive were more likely to disclose chemsex participation [adjusted odds ratio (AOR) 2.55; 95% confidence interval (CI) 1.89–3.44; P < 0.001]. Those disclosing chemsex participation had higher odds of being newly diagnosed with HIV infection (AOR 5.06; 95% CI 2.56–10.02; P < 0.001), acute bacterial STIs (AOR 3.94; 95% CI 3.00–5.17; P < 0.001), rectal STIs (AOR 4.45; 95% CI 3.37–6.06; P < 0.001) and hepatitis C (AOR 9.16; 95% CI 2.31–36.27; P = 0.002). HIV‐negative chemsex participants were also more likely to have accessed post‐exposure prophylaxis for HIV in the study period and to report sex with a discordant HIV‐ or hepatitis C virus‐infected partner (P < 0.001).

Conclusions

Chemsex disclosure in sexual health settings is associated with higher rates of STI diagnoses, including HIV infection and hepatitis C. GBMSM attending sexual health services should therefore be assessed for chemsex participation and disclosure should prompt health promotion, harm minimization and wellbeing interventions.
A proficiency‐based analysis of EFL learners' humorous language play
Authors: Heidari‐Shahreza Mohammad Ali
Published: May 2018

Besides having significant pedagogical functions, learner‐initiated humorous language play may shed light on learners' linguistic knowledge and development. Hence, through a mixed methods design, this study explored the humorous language play instigated by 86 Iranian EFL learners at elementary, intermediate and advanced level. The quantitative analysis of the learners' humorous interaction revealed several proficiency‐based variations (e.g., higher relevance and wider linguistic coverage of their humor in advanced proficiency). Also, the participants' ‘multicompetence’ and ‘strategic attitude’ emerged as two major themes in the qualitative analysis. Building on linguistic and pedagogical perspective, the findings provide insights into an expanded conceptualization of L2 proficiency and a view of L2 learners as multicompetent communicators. Within the purview of the study's limitations, the paper also suggests directions for further research.
Sensitivity and specificity of ex vivo dermatoscopy: a case series
Authors: Dobrosavljevic Danijela , Brasanac Dimitrije , Glumac Sofija , Radojevic Sanja , Matija Lidija , Stanisavljevic Dejana
Published: May 2018

Background

Sensitivity and specificity of ex vivo dermatoscopy (EVD) for malignancy detection of skin tumors is unknown. We sought to assess whether the use of EVD could be a useful adjunct to histopathological diagnosis of pigmented skin tumors, including cases where complete clinical information is inadequate or missing.

Materials and methods

EVD was performed on 195 excised, formalin‐fixed pigmented skin tumors.

Results

Of 183 eligible lesions, 104 (56.8%) were melanocytic and 79 (43.2%) nonmelanocytic. Overall, 54 (29.5%) were malignant: 10 melanomas, 39 basal cell carcinomas, and five squamous cell carcinomas. Ex vivo images were devoid of red color. The following colors were seen: light and dark brown, grey, blue, black, and white. All structures typical for pigmented melanocytic and nonmelanocytic lesions were observed. In malignant nonmelanocytic lesions, diagnostic accuracy and sensitivity for malignant/benign decision was not better when combining visual assessment and EVD but diagnostic specificity improved by 3.0%. For melanoma, combined diagnostics improved diagnostic accuracy, sensitivity, and specificity for 9.6, 30.0, and 7.5%, respectively.

Conclusion

For dermatopathologists, EVD offers increased specificity for all categories of tumors and increased diagnostic accuracy, sensitivity, and specificity for melanoma. With EVD view, the dermatopathologist can instantly find areas of interest, thus minimizing the possibility for missing a malignant lesion.
Maximising yield of peripheral blood flow cytometry for chronic lymphoproliferative disorders
Authors: Lim H. Y. , Hong F. S.
Published: May 2018

Introduction

Flow cytometry is used in the diagnosis of haematological diseases including chronic lymphoproliferative disorders. This audit aims to ascertain the real‐world indications for peripheral blood (PB) flow cytometry and which of these are associated with higher diagnostic yields.

Methods

All PB flow cytometry requests for chronic lymphoproliferative disorders from 1 January 2014 to 31 December 2014 were identified using the laboratory information system. Data including patient demographics, specialty of requestor, lymphocyte count and blood film report (if available), indications for tests and subsequent diagnosis were collected.

Results

A total of 185 requests with median patient age of 60 years were analysed. The main requestor was the Haematology Unit (n = 109; 58.9%) although the diagnostic yield of their requests was not significantly better than other units combined (16.5% vs 13.2%, P = .49). Factors that significantly improved the diagnostic yield of testing were older age, the presence of atypical lymphocytes on the blood film and lymphocytosis (P < .01). Constitutional symptoms and cytopenias were not found to influence the diagnostic yield.

Conclusion

PB flow cytometry is a useful tool when used in the appropriate clinical setting. Rationalisation of testing is important to reduce the futility of testing and unnecessary health costs.
Cooperative cation substitution facilitated construction of garnet oxynitride MgY2Al3Si2O11N:Ce3+ for white LEDs
Authors: Pan Zaifa , Wang Ruiping , Li Weiqiang , Wu Haiqin , Chen Jiacheng , Zheng Yifan
Published: May 2018

Structural modification is an important means to induce redshift of Ce3+ emission in garnet phosphor. We intend to design and synthesize garnet oxynitride compounds which combine attributes of rigidity inherited from garnet structure and of high covalence characteristic of oxynitride compounds. However, impurity phase usually occurs in the nitridation of garnet phosphor, due to the low solubility of nitrogen in oxides. We herein exploit the cooperative cation substitution strategy to facilitate the incorporation of nitrogen in Y3Al5O12. It is found that partial substitution of Y3+‐Altet3+ pairs by Mg2+‐Si4+ pairs can diminish the phase instability caused by the replacement of Altet3+‐O2− by Si4+‐N3−. A novel pure garnet phase oxynitride phosphor MgY2Al3Si2O11N:Ce3+ with a higher substitution content of N has been obtained and the successful incorporation of N in the garnet phosphor is confirmed by the Rietveld refinements of XRD, XPS, and TEM. The emission and excitation spectra indicate that the blue‐light‐excitable MgY2Al3Si2O11N:Ce3+ phosphor exhibited a bright yellow‐orange emission peaking at 570 nm, which is redshifted by 28 nm when compared to YAG:Ce3+. The garnet oxynitride phosphor exhibit excellent thermal stability with high quantum efficiency and is a promising candidate for warm white LED.
Posttraumatic stress symptomatology following exposure to perceived traumatic perinatal events within the midwifery profession: The impact of trait emotional intelligence
Authors: Nightingale Suzanne , Spiby Helen , Sheen Kayleigh , Slade Pauline
Published: May 2018

Aims

To explore factors associated with, and predictors of, posttraumatic stress symptoms in midwives. To explore factors associated with, and potential moderating effects of, trait emotional intelligence. Secondary analysis explored predictors of resilience.

Background

Midwives may experience vicarious trauma responses due to exposure to certain perinatal events in their professional lives. This may have adverse psychological outcomes for midwives, and women and children in their care.

Design

A cross‐sectional, online and paper survey of midwives in the United Kingdom was conducted.

Methods

Between February and October 2016, 113 midwives who met inclusion criteria provided demographic information, and completed scales measuring posttraumatic stress symptoms, trait emotional intelligence, empathy, resilience, social support, and attitudes towards emotional expression.

Results

Higher resilience and trait emotional intelligence scores were associated with reduced posttraumatic stress symptoms. Higher empathy, perceived social support, and resilience were associated with higher trait emotional intelligence. Lower resilience significantly predicted posttraumatic stress symptoms. Trait emotional intelligence did not moderate relationships between resilience and posttraumatic stress symptoms, but may protect against posttraumatic stress symptoms in midwives with higher empathy. Higher trait emotional intelligence, and lower empathy and need for support, significantly predicted resilience. Notably, when trait emotional intelligence was higher, the negative relationship between empathy and resilience was reduced.

Conclusion

Approximately one‐fifth of midwives were experiencing posttraumatic stress symptoms at clinically significant levels. Trait emotional intelligence may protect against posttraumatic stress symptoms by supporting resilience, while enabling midwives to remain empathic. The negative correlation between resilience and empathy needs careful consideration by policy makers.
Factors associated with quality of life of dementia caregivers: Direct and indirect effects
Authors: Oba Hikaru , Matsuoka Teruyuki , Kato Yuka , Narumoto Jin
Published: May 2018

Aims

To examine the direct and indirect relationships between the characteristics of people with dementia and caregivers associated with caregivers' quality of life.

Background

Complex relationships exist among the factors associated with caregivers' quality of life.

Design

This study was a retrospective cross‐sectional design.

Methods

The data were retrospectively extracted from participants who had visited the Center for Diagnosis of Dementia at Kyoto Prefectural University of Medicine from April 2013–March 2016. The data search was conducted on 21 April 2017. In total, 110 people with dementia and their caregivers participated. The characteristics of people with dementia were evaluated in terms of cognitive function, basic and instrumental activities of daily living and neuropsychiatric symptoms. We also evaluated caregivers' quality of life, depressive symptoms and care burden. Path analysis was used to investigate direct and indirect relationships.

Results

The path analysis revealed that care burden and depressive symptoms directly affected caregivers' quality of life. Furthermore, declines in instrumental activities of daily living among people with dementia indirectly affected caregivers' quality of life, while declines in cognitive function of people with dementia also indirectly affected caregivers' care burden and depressive symptoms.

Conclusion

Caregiver quality of life was directly and indirectly affected by the characteristics of caregivers and people with dementia. The present findings provided evidence that factors related to both people with dementia and caregivers should be considered when nursing interventions are conducted.
Customer and Supplier Portfolios: Can Credit Risks be Managed Through Supply Chain Relationships?
Authors: Schwieterman Matthew A. , Goldsby Thomas J. , Croxton Keely L.
Published: May 2018

While supply chain risk has been the subject of an ever‐increasing amount of research attention, the importance of credit risk has been less studied, at least by supply chain researchers. Yet, there may be risks inherent within a firm's portfolios of supply chain relationships that are manifested in the credit risk of a firm. Moreover, portfolio characteristics may serve as a signal to the external market regarding these risks. While customer and supplier portfolio characteristics may impact the firm's exposure to risks, the specific issue of how portfolio characteristics relate to credit risk has rarely been examined by supply chain scholars. This research bridges extant works in supply chain management and finance to relate supply chain characteristics to a critical reputational outcome, namely credit ratings. In this research, we utilize a sample of firms that recently underwent an initial public offering to empirically examine the theoretical predictions of Resource Dependence Theory regarding the relationships between different supply chain portfolio characteristics and credit risk.
Effects of endurance training on hippocampus DJ‐1, cannabinoid receptor type 2 and blood glucose concentration in diabetic rats
Authors: Kurd Mohammad , Valipour Dehnou Vahid , Tavakoli Seyed A , Gahreman Daniel E
Published: May 2018

Aims/Introduction

To investigate the effect of endurance training on hippocampus DJ‐1 and cannabinoid receptor type 2 (CB2) protein and blood glucose concentration in diabetic rats.

Materials and Methods

A total of 32 rats were randomly divided into diabetic (D), diabetic and exercise (DE), exercise (E) and control (C) groups. The endurance training was carried out five times per week for 6 weeks. The hippocampus DJ‐1 and CB2 were measured using an enzyme‐linked immunosorbent assay method.

Results

The level of DJ‐1 in the D group was significantly higher than the other groups (P ≤ 0.01). However, the level of DJ‐1 was not significantly different between the C, E and DE groups. In addition, the level of CB2 was significantly lower in the D group compared with the other groups (P ≤ 0.01). Blood glucose was significantly higher in the D group compared with the DE group (P ≤ 0.05). Furthermore, a significant positive correlation between the level of DJ‐1 and blood glucose was observed (r = 0.67, P ≤ 0.001). There was also a significant inverse correlation between the level of CB2 and blood glucose (r = −0.77, P ≤ 0.001).

Conclusions

The results of this study suggest that the level of DJ‐1 and CB2 might change in response to diabetes, and regular aerobic exercise could mediate the effect of DJ‐1 and CB2 on diabetes‐induced neurodegenerative diseases.
What happens to offspring when parents are inbred, old or had a poor start in life? Evidence for sex‐specific parental effects
Authors: Vega‐Trejo Regina , Kruuk Loeske E. B. , Jennions Michael D. , Head Megan L.
Published: May 2018

Parental effects on offspring performance have been attributed to many factors such as parental age, size and condition. However, we know little about how these different parental characteristics interact to determine parental effects, or the extent to which their effect on offspring depends on either the sex of the parent or that of the offspring. Here we experimentally tested for effects of variation in parents’ early diet and inbreeding levels, as well as effects of parental age, and for potential interactive effects of these three factors on key aspects of offspring development in the mosquitofish (Gambusia holbrooki). Older mothers produced offspring that were significantly smaller at birth. This negative effect of maternal age on offspring size was still evident at maturation as older mothers had smaller daughters, but not smaller sons. The daughters of older mothers did, however, reach maturity sooner. Paternal age did not affect offspring body size, but it had a complex effect on their sons’ relative genital size. When initially raised on a food‐restricted diet, older fathers sired sons with relatively smaller genitalia, but when fathers were initially raised on a control diet their sons had relatively larger genitalia. The inbreeding status of mothers and fathers had no significant effects on any of the measured offspring traits. Our results indicate that the manifestation of parental effects can be complex. It can vary with both parent and offspring sex; can change over an offspring's life; and is sometimes evident as an interaction between different parental traits. Understanding this complexity will be important to predict the role of parental effects in adaptation.
Looking for trouble? Diagnostics expanding disease and producing patients
Authors: Hofmann Bjørn
Published: May 2018

Novel tests give great opportunities for earlier and more precise diagnostics. At the same time, new tests expand disease, produce patients, and cause unnecessary harm in overdiagnosis and overtreatment. How can we evaluate diagnostics to obtain the benefits and avoid harm? One way is to pay close attention to the diagnostic process and its core concepts. Doing so reveals 3 errors that expand disease and increase overdiagnosis. The first error is to decouple diagnostics from harm, eg, by diagnosing insignificant conditions. The second error is to bypass proper validation of the relationship between test indicator and disease, eg, by introducing biomarkers for Alzheimer's disease before the tests are properly validated. The third error is to couple the name of disease to insignificant or indecisive indicators, eg, by lending the cancer name to preconditions, such as ductal carcinoma in situ. We need to avoid these errors to promote beneficial testing, bar harmful diagnostics, and evade unwarranted expansion of disease. Accordingly, we must stop identifying and testing for conditions that are only remotely associated with harm. We need more stringent verification of tests, and we must avoid naming indicators and indicative conditions after diseases. If not, we will end like ancient tragic heroes, succumbing because of our very best abilities.
Dactylomonas gen. nov., a Novel Lineage of Heterolobosean Flagellates with Unique Ultrastructure, Closely Related to the Amoeba Selenaion koniopes Park, De Jonckheere & Simpson, 2012
Authors: Hanousková Pavla , Táborský Petr , Čepička Ivan
Published: May 2018

We report the discovery of a new genus of heterolobosean flagellates, Dactylomonas gen. nov., with two species, D. venusta sp. nov. and D. crassa sp. nov. Phylogenetic analysis of the SSU rRNA gene showed that Dactylomonas is closely related to the amoeba Selenaion, the deepest‐branching lineage of Tetramitia. Dactylomonads possess two flagella, and ultrastructural studies revealed an unexpected organization of the flagellar apparatus, which resembled Pharyngomonada (the second lineage of Heterolobosea) instead of Tetramitia: basal bodies were orthogonal to each other and a putative root R1 was present in the mastigont. On the other hand, Dactylomonas displayed several features uncommon in Heterolobosea: a microtubular corset, a distinctive rostrum supported by the main part of the right microtubular root, a finger‐like projection on the proximal part of the recurrent flagellum, and absence of a ventral groove. In addition, Dactylomonas is anaerobic and seems to have lost mitochondrial cristae. Dactylomonas and Selenaion are accommodated in the family Selenaionidae fam. nov. and order Selenionida ord. nov. The taxonomy of Tetramitia is partially revised, and the family Neovahlkampfiidae fam. nov. is established.
Time after seawater transfer influences immune cell abundance and responses to SAV3 infection in Atlantic salmon
Authors: Jarungsriapisit J , Moore L J , Fiksdal I U , Bjørgen H , Tangerås A , Köllner B , Koppang E O , Patel S
Published: May 2018

Pancreas disease (PD) caused by salmonid alphavirus (SAV) severely affects salmonid aquaculture during the seawater phase. To characterize immune cells in target tissues for SAV infection, heart, pancreas and pyloric caeca were analysed from two groups of fish adapted to seawater for 2 and 9 weeks. The sections were scored for the relative abundance of cells expressing MHC class II, IgM, CD3, CD8 or neutrophil/granulocyte markers using immuno‐histochemical techniques. In general, necrosis of tissue was more severe in fish infected at 2 weeks post‐seawater transfer (wpt) compared with those infected at 9 wpt. At 9 wpt, there were higher numbers of MHC II+ cells in heart, pancreas and pyloric caeca, IgM+ cells in heart and pancreas, and CD3+ cells in pancreas compared to those infected at 2 wpt. The majority of the immune cells infiltrating PD‐affected tissues were MHC II+ and CD3+ cells suggesting that antigen‐presenting cells and T lymphocytes are the main types of immune cells responding to SAV infection. All the investigated cell types were also observed in pyloric caeca of infected fish, suggesting that this tissue may play a role in the immune response to SAV.
Centenarians' End‐of‐Life Thoughts and Plans: Is Their Social Network on the Same Page?
Authors: Boerner Kathrin , Kim Kyungmin , Kim Yijung , Rott Christoph , Jopp Daniela S.
Published: May 2018

Objectives

To explore how centenarians think about and plan for the end of life (EOL) and to what extent their primary contacts (proxy informants) are aware of these thoughts.

Design

Population‐based study with semistructured in‐person interviews.

Setting

Defined geographical region approximately 60 km around Heidelberg, Germany.

Participants

Subsample drawn from the larger study of centenarians (N = 78) with data on centenarians' EOL thoughts from the centenarian and the proxy informant.

Measurements

Centenarians reported on their thoughts about the EOL, perception of the EOL as threatening, longing for death, engagement in any EOL planning, and type of EOL plan (will, living will, healthcare surrogate) in place. Proxy respondents answered the same set of questions based on what they thought the centenarians' perspective was.

Results

In nearly half of cases, proxies misjudged whether the centenarian thought about EOL. Although only few centenarians perceived the EOL as threatening, and approximately one‐quarter reported longing for death, proxies overestimated centenarians' reports on the former and underestimated the latter. Proxies reported more centenarian EOL planning than centenarians themselves.

Conclusion

Even though enrolled proxies were mostly persons very close to the centenarian, many of them did not seem to be well informed about the centenarians' thoughts and plans regarding the EOL, suggesting a lack of communication between centenarians and social network members in this respect. Healthcare professionals should be aware that, even for very old adults approaching the end of their lives, discussions about EOL and EOL planning may need to be actively encouraged and supported.
Systematic review of platelet‐rich plasma (PRP) preparation and composition for the treatment of androgenetic alopecia
Authors: Kramer MaryJo E , Keaney Terrence C
Published: May 2018

Background

Platelet‐rich plasma (PRP) injections have gained popularity in dermatology practice as a treatment for hair loss. As an autologous blood product, PRP is categorized as a minimally manipulated tissue by the U.S. Food and Drug Administration (FDA) and thus evades extensive regulation. As a result, there is a lack of standardization of its preparation and final composition.

Objective

This study aims to provide a systematic review of the various PRP preparation protocols and PRP compositions utilized in clinical trials for the treatment of hair loss.

Methods & Materials

A review of the literature was performed using PubMed and Ovid/Medline in November 2017 using the search terms “Platelet‐Rich Plasma” and (“Alopecia” or “Hair Loss”), including all publication dates. Human clinical trials in the English language were included.

Results

Nineteen studies (in 15 articles) met the inclusion criteria for analysis. Only 21% of these studies reported all PRP preparation factors analyzed, and only 32% of the protocols reported the platelet count for both the initial whole blood and final PRP product.

Conclusion

The current reporting of PRP preparation methodology and final composition is inconsistent and insufficient to enable comparison between studies and determination of efficacy for particular treatment applications.
Ethical dilemmas in nursing: An integrative review
Authors: Rainer Jennifer , Schneider Joanne Kraenzle , Lorenz Rebecca A.
Published: May 2018

Aims

To identify themes and gaps in the literature to stimulate researchers to develop strategies to guide decision‐making among clinical nurses faced with ethical dilemmas.

Background

The concept of ethical dilemmas has been well explored in nursing because of the frequency of ethical dilemmas in practice and the toll these dilemmas can take on nurses. Although ethical dilemmas are prevalent in nursing practice, frequently leading to moral distress, there is little guidance in the literature to help nurses resolve them.

Design

This study is an integrative review of published research from 2000 to 2017.

Methods

The keywords ethics, ethical dilemmas and nurs* were searched in CINAHL, PubMed, OVID and SCOPUS. Exclusion criteria were sources not available in English, not in acute care, and without an available abstract. Seventy‐two studies were screened; 35 were retained. Garrard's matrix was utilised to analyse and synthesise the studies.

Results

Ethical dilemmas arose from end‐of‐life issues, conflict with physicians or families, patient privacy concerns and organisational constraints. Differences were found in study location, and yet international research confirms that ethical dilemmas are universally prevalent and must be addressed globally to protect patients and nurses.

Conclusions

This review offers an analysis of the available evidence regarding ethical dilemmas in acute care, identifying themes, limitations and gaps in the literature. The gaps in quantitative intervention work, US paucity of research, and lack of comparisons across practice settings/nursing roles must be addressed. Further exploration is warranted in the relationship between ethical dilemmas and moral distress, the significance patient physical appearance plays on nurse determination of futility, and strategies for pain management and honesty.

Relevance to Nursing Practice

Understanding and addressing gaps in research is essential to develop strategies to help nurses resolve ethical dilemmas and to avoid moral distress and burnout.
CD44 and ALDH1 immunoexpression as prognostic indicators of invasion and metastasis in oral squamous cell carcinoma
Authors: Ortiz Rafael C. , Lopes Nathália M. , Amôr Nádia G. , Ponce José B. , Schmerling Cláudia K. , Lara Vanessa S. , Moyses Raquel A. , Rodini Camila O.
Published: May 2018

Background

Tumour metastasis has been associated with cancer stem cells, a small population with stem‐like cells properties, higher rate of migration and metastatic potential compared to cells from the tumour bulk. Our aim was to evaluate the immunoexpression of the putative cancer stem cell biomarkers ALDH1 and CD44 in primary tumour and corresponding metastatic lymph nodes.

Methods

Tumour tissue specimens (n = 50) and corresponding metastatic lymph nodes (n = 25) were surgically obtained from 50 patients with oral squamous cell carcinoma and submitted to immunohistochemistry. CD44 and ALDH1 were semi‐quantitatively scored according to the proportion and intensity of positive cells within the invasive front and metastatic lymph nodes as a whole. A combined score was obtained by multiplying both parameters and later dichotomized into a final score classified as low (≤2) or high (>2) immunoexpression.

Results

ALDH1 immunoexpression and CD44 immunoexpression were detected in both tumour sites, although the means of ALDH1 (P = .0985) and CD44 (P = .4220) cells were higher in metastasis compared to primary tumours. ALDH1high was positively associated (P = .0184) with angiolymphatic invasion, while CD44high was positively associated (P = .0181) with metastasis (N+). At multivariate analysis, CD44 significantly increased the odds of lymph node metastasis, regardless of T stage (OR = 8.24; 1.64‐65.64, P = .0088).

Conclusions

CD44 immunoexpression was a significant predictor of lymph node metastasis, while ALDH1high immunostaining was associated with angiolymphatic invasion. Altogether, it suggests that immunoexpression of CD44 and ALDH1 links the cancer stem cell phenotype with oral squamous cell carcinoma invasion and metastasis.
Diagnosis and management of conductive hearing loss in children with trisomy 21
Authors: Stewart Robbie , Gallagher Donna , Leyden Peter
Published: May 2018

Aim

The objective of this study is to review the prevalence and degree of hearing loss in children with trisomy 21, their response to intervention and the presence of concomitant pathologies. The project will also highlight the experiences of the children from their parents’ and guardians’ perspective and the link between perceived service quality and an objective improvement in their hearing after rehabilitation.

Methods

All patients with trisomy 21 who were referred to district general otolaryngology outpatient clinics between 2014 and 2016 were included. A retrospective analysis of the medical notes and audiograms along with a qualitative questionnaire to the children's parents was utilised to gather the information.

Results

The study showed that 77% (17/22) of children suffered from hearing loss, with a moderate degree being most prevalent. The majority of patients (14/17, 82%) were managed conservatively, undergoing a period of watchful waiting (9/17, 53%) or receiving hearing aids (5/17, 30%) and 3 of 17 (17%) were managed with grommet insertion. The improvement in hearing with hearing aids was comparable with grommet insertion and hearing aids scored highest in the post‐intervention qualitative assessment with grommet insertion scoring the lowest.

Conclusions

Functional hearing has been shown to be key in developing speech and language skills. In children with trisomy 21, behavioural and anatomical abnormalities make the diagnosis and intervention technically more challenging. This study demonstrates that in the absence of other otological symptoms, hearing loss can be managed effectively and with the least distress to the children with hearing aids.
Ocean acidification stimulates particulate organic carbon accumulation in two Antarctic diatom species under moderate and high natural solar radiation
Authors: Heiden Jasmin P. , Thoms Silke , Bischof Kai , Trimborn Scarlett
Published: May 2018

Impacts of rising atmospheric CO2 concentrations and increased daily irradiances from enhanced surface water stratification on phytoplankton physiology in the coastal Southern Ocean remain still unclear. Therefore, in the two Antarctic diatoms Fragilariopsis curta and Odontella weissflogii, the effects of moderate and high natural solar radiation combined with either ambient or future pCO2 on cellular particulate organic carbon (POC) contents and photophysiology were investigated. Results showed that increasing CO2 concentrations had greater impacts on diatom physiology than exposure to increasing solar radiation. Irrespective of the applied solar radiation regime, cellular POC quotas increased with future pCO2 in both diatoms. Lowered maximum quantum yields of photochemistry in PSII (Fv/Fm) indicated a higher photosensitivity under these conditions, being counteracted by increased cellular concentrations of functional photosynthetic reaction centers. Overall, our results suggest that both bloom‐forming Antarctic coastal diatoms might increase carbon contents under future pCO2 conditions despite reduced physiological fitness. This indicates a higher potential for primary productivity by the two diatom species with important implications for the CO2 sequestration potential of diatom communities in the future coastal Southern Ocean.
Immune responses against tumour‐associated antigen‐derived cytotoxic T lymphocyte epitopes in cholangiocarcinoma patients
Authors: Kida Akihiko , Mizukoshi Eishiro , Tamai Toshikatsu , Terashima Takeshi , Kitahara Masaaki , Arai Kuniaki , Yamashita Tatsuya , Fushimi Kazumi , Honda Masao , Kaneko Shuichi
Published: May 2018

Background & Aims

Immunotherapy is a promising treatment option for cholangiocarcinoma. We compared cytotoxic T lymphocyte (CTL) responses against several tumour‐associated antigen (TAA)‐derived epitopes in cholangiocarcinoma patients to identify candidate epitopes for immunotherapy.

Methods

Twenty‐six TAAs were selected, and the expression of TAAs in 6 cholangiocarcinoma cell lines and 9 specimens were measured using real‐time polymerase chain reaction (PCR). CTL responses against 38 TAA‐derived epitopes were measured using samples from 26 cholangiocarcinoma patients by interferon‐γ enzyme linked immunospot (ELISPOT)‐assay.

Results

Most TAAs were expressed in cholangiocarcinoma cell lines and specimens in PCR. Epitopes that stimulated a specific immune response were defined as those that elicited a CTL response in more than 3 patients and little response in healthy volunteers, as measured by ELISPOT‐assay. Based on these criteria, there were 18 epitopes that stimulated specific immune responses: squamous cell carcinoma antigen recognized by T cells (SART)1690, P53161, multidrug resistance‐associated protein (MRP)3503, Survivin2B80, melanoma‐associated antigen (MAGE)‐A4143, receptor tyrosine kinase ErbB‐2/neu (Her2/neu)63, Wilms tumour (WT1)235, WT1417, β‐catenin29, carcinoembryonic antigen (CEA)268, CEA652, epithelial cell adhesion molecule (EpCAM)173, enhancer of zeste homolog (EZH)2291, mucin 5AC (MUC5AC)716, glypican‐3 (GPC3)298 and kinesin family member 20A (KIF20A)66. Furthermore, the absolute number of lymphocytes in peripheral blood was significantly correlated with the TAA‐specific response. Lastly, the overall survival was significantly prolonged in patients with 2 or more TAA‐specific CTL responses compared with none to one.

Conclusions

These results demonstrated several TAAs may be promising for immunotherapy for cholangiocarcinoma, and patients with high lymphocyte counts may benefit more from immunotherapy.
Investigations on VELVET regulatory mutants confirm the role of host tissue acidification and secretion of proteins in the pathogenesis of Botrytis cinerea
Authors: Müller Nathalie , Leroch Michaela , Schumacher Julia , Zimmer David , Könnel Anne , Klug Klaus , Leisen Thomas , Scheuring David , Sommer Frederik , Mühlhaus Timo , Schroda Michael , Hahn Matthias
Published: May 2018

The Botrytis cinerea VELVET complex regulates light‐dependent development and virulence. The goal of this study was to identify common virulence defects of several VELVET mutants and to reveal their molecular basis.

Growth, differentiation, physiology, gene expression and infection of fungal strains were analyzed, and quantitative comparisons of in planta transcriptomes and secretomes were performed.

VELVET mutants showed reduced release of citric acid, the major acid secreted by the wild‐type, whereas no significant role for oxalic acid was observed. Furthermore, a common set of infection‐related and secreted proteins was strongly underexpressed in the mutants. Quantitative secretome analysis with 15N metabolic labeling revealed a correlation of changes in protein and mRNA levels between wild‐type and mutants, indicating that transcript levels determine the abundance of secreted proteins. Infection sites kept at low pH partially restored lesion expansion and expression of virulence genes by the mutants. Drastic downregulation of proteases in the mutants was correlated with incomplete degradation of cellular host proteins at the infection site, but no evidence was obtained that aspartyl proteases are required for lesion formation.

The B. cinerea VELVET complex controls pathogenic differentiation by regulating organic acid secretion, host tissue acidification, gene expression and protein secretion.
Mycorrhizal fungi affect orchid distribution and population dynamics
Authors: McCormick Melissa K. , Whigham Dennis F. , Canchani‐Viruet Armando
Published: May 2018

Symbioses are ubiquitous in nature and influence individual plants and populations. Orchids have life history stages that depend fully or partially on fungi for carbon and other essential resources. As a result, orchid populations depend on the distribution of orchid mycorrhizal fungi (OMFs). We focused on evidence that local‐scale distribution and population dynamics of orchids can be limited by the patchy distribution and abundance of OMFs, after an update of an earlier review confirmed that orchids are rarely limited by OMF distribution at geographic scales. Recent evidence points to a relationship between OMF abundance and orchid density and dormancy, which results in apparent density differences. Orchids were more abundant, less likely to enter dormancy, and more likely to re‐emerge when OMF were abundant. We highlight the need for additional studies on OMF quantity, more emphasis on tropical species, and development and application of next‐generation sequencing techniques to quantify OMF abundance in substrates and determine their function in association with orchids. Research is also needed to distinguish between OMFs and endophytic fungi and to determine the function of nonmycorrhizal endophytes in orchid roots. These studies will be especially important if we are to link orchids and OMFs in efforts to inform conservation.
Integration of parenting and nutrition interventions in a community health program in Pakistan: an implementation evaluation
Authors: Yousafzai Aisha K. , Rasheed Muneera A. , Siyal Saima
Published: May 2018

Policy and program implementers require evidence on whether integrated psychosocial stimulation and nutrition interventions can be effectively delivered at‐scale, how, and at what cost? To address some of these issues, a comprehensive evaluation of implementation was designed for a trial in Pakistan that integrated psychosocial stimulation and nutrition interventions in a community health service. The first objective was to describe, analyze, and assess the quality and accuracy of the implementation of the interventions. The second objective was to identify barriers and facilitators for uptake of interventions. A mixed‐methods evaluation of implementation processes was conducted. Interventions were accepted by the community and health providers and there was evidence for behavior change uptake of the care for early childhood care recommendations. The new interventions did not dilute delivery of routine services. However, fidelity and quality required supportive supervision and active use of monitoring data, which would require attention in scale‐up.
Implementing aeioTU: quality improvement alongside an efficacy study—learning while growing
Authors: Nores Milagros , Figueras‐Daniel Alexandra , Lopez Maria Adelaida , Bernal Raquel
Published: May 2018

Effectiveness trials of increasing childhood development interventions across low‐ and middle‐income countries have shown significant variability. The strength and consistency of benefits for children are dependent on program quality, and this requires paying attention to program implementation. In this paper, we summarize findings on program quality and teacher practices and perceptions for the aeioTU program, a center‐based Reggio‐inspired program in Colombia, now serving more than 13,000 children. The research found engaged, committed staff who valued the emergent approach and understood the children as requiring opportunities to express themselves, being the source for the curriculum, and having relationships with the materials around them. Although the average classroom quality was low in 2011, it increased significantly by 2014, particularly in the language and reasoning and interactions items. Indicator‐level analyses showed that higher‐order interactions and language processes were observed in a large proportion of classrooms by 2014. Teachers' self‐reports on the environment and their teaching and learning showed high levels of quality by 2013. These findings illustrate the significance of process data for program improvement, especially when a program is young. Program quality can be raised after teachers improve their skills, have experience enacting a curriculum, and after training has been strengthened in response to information, while simultaneously scaling up the program.
Designing, testing, and implementing a sustainable nurse home visiting program: right@home
Authors: Goldfeld Sharon , Price Anna , Kemp Lynn
Published: May 2018

Nurse home visiting (NHV) offers a potential platform to both address the factors that limit access to services for families experiencing adversity and provide effective interventions. Currently, the ability to examine program implementation is hampered by a lack of detailed description of actual, rather than expected, program development and delivery in published studies. Home visiting implementation remains a black box in relation to quality and sustainability. However, previous literature would suggest that efforts to both report and improve program implementation are vital for NHV to have population impact and policy sustainability. In this paper, we provide a case study of the design, testing, and implementation of the right@home program, an Australian NHV program and randomized controlled trial. We address existing gaps related to implementation of NHV programs by describing the processes used to develop the program to be trialed, summarizing its effectiveness, and detailing the quality processes and implementation evaluation. The weight of our evidence suggests that NHV can be a powerful and sustainable platform for addressing inequitable outcomes, particularly when the program focuses on parent engagement and partnership, delivers evidence‐based strategies shown to improve outcomes, includes fidelity monitoring, and is adapted to and embedded within existing service delivery systems.