bluuebunny/crossref_metadata_2025 huggingface dataset:
Duodenal tubular resection using laparoscopic‐endoscopic cooperative surgery: A new technique for the treatment of duodenal lesions
Authors: Kitasato Amane , Kuroki Tamotsu , Adachi Tomohiko , Tanaka Takayuki , Mine Yuka , Soyama Akihiko , Hidaka Masaaki , Takatsuki Mitsuhisa , Yamaguchi Naoyuki , Eguchi Susumu
Published: January 2016

Introduction

Laparoscopic‐endoscopic cooperative surgery (LECS) is a minimally invasive surgical technique that combines the advantages of laparoscopic surgery and endoscopic treatment. LECS has been developed for treatment of gastric submucosal tumors and can be applied to superficial non‐ampullary duodenal tumors. Here we describe the use of LECS for duodenal mucosal cancer.

Materials and Surgical Technique

After the placement of five ports, an endoscopic procedure was performed to confirm the tumor location and to place marks around the tumor. The jejunum was then resected 10 cm from the ligament of Treitz, and the connective tissue between the pancreas and duodenum was dissected to close to Vater's papilla. Duodenal resection was performed with a stapling device 2 cm to the oral side of the tumor, with endoscopic confirmation of the duodenal papilla, and duodenal tubular resection was then accomplished. Duodeno‐jejunostomy was carried out using the same stapling device. There were no postoperative complications.

Discussion

This case shows that duodenal tubular resection using LECS enables curability through a minimally invasive procedure that offers the advantages of laparoscopic surgery and endoscopic treatment. This technique is applicable to duodenal lesions such as those due to duodenal mucosal cancers.
Postoperative discal cyst: An unusual complication after microendoscopic discectomy in teenagers
Authors: Jha Subash C , Tonogai Ichiro , Higashino Kosaku , Sakai Toshinori , Takata Yoichiro , Goda Yuichiro , Abe Mitsunobu , Nagamachi Akihiro , Fukuta Shoji , Sairyo Koichi
Published: January 2016

Various complications after microendoscopic discectomy (MED) are well known, but postoperative discal cyst is a unique and relatively unknown complication. Here, we report on two teenage patients who presented with postoperative discal cyst after MED for herniated nucleus pulposus (HNP), which resolved after conservative treatment. The patients were diagnosed with HNP at L4‐5 and L5‐S1 based on MRI and then treated by MED. Postoperative discal cyst was diagnosed on MRI after recurrence of symptoms. Both patients were managed conservatively. T2‐weighted MRI demonstrated hyperintense collections adjacent to the operated intervertebral disc level, which were communicating with the corresponding disc annulus. Because the clinical symptoms were relatively mild, the patients were managed conservatively; both made a complete clinical recovery with radiological evidence of improvement. Postoperative discal cyst is a relatively unknown complication after MED for HNP. Surgeons should be aware of this postoperative complication when operating on young individuals with HNP.
Laparoscopic distal pancreatectomy without needle aspiration before resection for giant mucinous cell neoplasms
Authors: Nagakawa Yuichi , Hosokawa Yuichi , Sahara Yatsuka , Takishita Chie , Nakajima Tetsushi , Hijikata Yousuke , Tsuchida Akihiko
Published: January 2016

Laparoscopic resection of large mucinous cystic neoplasms (MCN) has recently been reported. However, in most reports, needle aspiration of the cyst contents was performed before resection and can cause dissemination. Here, we report two patients with giant MCN: a 26‐year‐old woman with a 23‐cm MCN and a 41‐year‐old woman with an 18‐cm MCN. The MCN were successfully resected without aspiration by laparoscopic surgery. CT revealed no tumor involvement of the origins of the splenic artery and vein in either case. In case 1, we performed hand‐assisted laparoscopic surgery while dissecting around the spleen, whereas case 2 underwent pure laparoscopic surgery. No postoperative complications occurred in either case, indicating that laparoscopic distal pancreatectomy for giant MCN is feasible without aspiration in patients without splenic artery and vein origin involvement.
Right lateral decubitus approach to a laparoscopic modified Hassab's operation
Authors: Tanaka Motomu , Ikeda Yoshifumi , Matsui Shimpei , Kato Ayu , Nitori Nobuhiro , Kadomura Tomohisa , Hatori Takashi , Kitajima Masaki
Published: January 2016

Introduction

The lateral approach is the standard for laparoscopic splenectomy. However, when the modified Hassab's operation is performed laparoscopically, the patient is placed in the supine position and then the right semi‐lateral or lateral decubitus position. Based on our experience with laparoscopic adrenalectomy and splenectomy, we laparoscopically performed the modified Hassab's operation with the patient in the right lateral decubitus position.

Materials and Surgical Technique

Indications for the modified Hassab's operation for patients with portal hypertension in our institute include both gastric varices and hypersplenism resistant to endoscopic or radiologic procedures. We performed splenectomy and devascularization of the greater curvature and then dissected adhesions between the stomach, pancreas, and gastrohepatic ligament. With the patient in the right lateral decubitus position, the lesser curvature could be identified from both the ventral and dorsal sides.

Discussion

For the modified Hassab's operation, as in laparoscopic gastrectomy, many operators select the supine position for lesser curvature devascularization and gastric vessel ligation. However, after sufficient adhesion dissection around the stomach, anatomical structures can be identified in the right lateral decubitus position. For this approach, gravity is not an issue on the dorsal side, and the lesser curvature can be observed from both the ventral and dorsal sides with the patient in the right lateral decubitus position. Laparoscopically performing the modified Hassab's operation with the patient in the right lateral decubitus position is a feasible method.
Cardiovascular Alterations during the Interictal Period in Awake and Pithed Amygdala‐Kindled Rats
Authors: Ruiz‐Salinas Inna , Rocha Luisa , Marichal‐Cancino Bruno A. , Villalón Carlos M.
Published: January 2016

Epileptic seizures are often accompanied by increased sympathetic cardiovascular activity (even interictally), but it remains unknown whether this increased activity is of central and/or peripheral origin. Hence, this study investigated the cardiovascular alterations produced by amygdala kindling in awake and pithed Wistar rats. Blood pressure (BP) and heart rate (HR) were initially recorded by tail cuff plethysmography in awake control, sham‐operated and amygdala‐kindled rats before and 24 hr after the kindling process. The after‐discharge threshold (ADT) was measured under different conditions to correlate brain excitability with BP and HR in kindled rats. Twenty‐four hours after the last kindling seizure, (i) HR, systolic and diastolic BP were increased and (ii) only higher HR values correlated with lower ADT values. Forty‐eight hr after the last kindled seizure, all rats were pithed and prepared for analysing the tachycardic, vasopressor and vasodepressor responses by (i) stimulation of the sympathetic or sensory vasodepressor CGRPergic out‐flows (stimulus–response curves, S‐R curves) and (ii) intravenous injections of noradrenaline or α‐CGRP (dose–response curves, D‐R curves). Interestingly, (i) the tachycardic S‐R and D‐R curves were attenuated, whilst the CGRPergic S‐R and D‐R curves were potentiated in kindled rats, and (ii) the vasopressor noradrenergic S‐R and D‐R curves were not significantly different in all groups. Therefore, the kindling process may be associated with overstimulation in the central sympathetic and sensory out‐flows interictally, producing (i) peripheral attenuation of cardiac sympathetic out‐flow and β‐adrenoceptor activity and (ii) peripheral potentiation of vasodepressor sensory CGRPergic out‐flow and CGRP receptor activity.
Concurrently examining unrealistic absolute and comparative optimism: Temporal shifts, individual‐difference and event‐specific correlates, and behavioural outcomes
Authors: Ruthig Joelle C. , Gamblin Bradlee W. , Jones Kelly , Vanderzanden Karen , Kehn Andre
Published: January 2016

Researchers have spent considerable effort examining unrealistic absolute optimism and unrealistic comparative optimism, yet there is a lack of research exploring them concurrently. This longitudinal study repeatedly assessed unrealistic absolute and comparative optimism within a performance context over several months to identify the degree to which they shift as a function of proximity to performance and performance feedback, their associations with global individual difference and event‐specific factors, and their link to subsequent behavioural outcomes. Results showed similar shifts in unrealistic absolute and comparative optimism based on proximity to performance and performance feedback. Moreover, increases in both types of unrealistic optimism were associated with better subsequent performance beyond the effect of prior performance. However, several differences were found between the two forms of unrealistic optimism in their associations with global individual difference factors and event‐specific factors, highlighting the distinctiveness of the two constructs.
Pharmacological characterization of the first in class clinical candidate PF‐05190457: a selective ghrelin receptor competitive antagonist with inverse agonism that increases vagal afferent firing and glucose‐dependent insulin secretion ex vivo
Authors: Kong J , Chuddy J , Stock I A , Loria P M , Straub S V , Vage C , Cameron K O , Bhattacharya S K , Lapham K , McClure K F , Zhang Y , Jackson V M
Published: January 2016

Background and Purpose

Ghrelin increases growth hormone secretion, gastric acid secretion, gastric motility and hunger but decreases glucose‐dependent insulin secretion and insulin sensitivity in humans. Antagonizing the ghrelin receptor has potential as a therapeutic approach in the treatment of obesity and type 2 diabetes. Therefore, the aim was to pharmacologically characterize the novel small‐molecule antagonist PF‐05190457 and assess translational pharmacology ex vivo.

Experimental Approach

Radioligand binding in filter and scintillation proximity assay formats were used to evaluate affinity, and europium‐labelled GTP to assess functional activity. Rat vagal afferent firing and calcium imaging in dispersed islets were used as native tissues underlying food intake and insulin secretion respectively.

Key Results

PF‐05190457 was a potent and selective inverse agonist on constitutively active ghrelin receptors and acted as a competitive antagonist of ghrelin action, with a human Kd of 3 nM requiring 4 h to achieve equilibrium. Potency of PF‐05190457 was similar across different species. PF‐05190457 increased intracellular calcium within dispersed islets and increased vagal afferent firing in a concentration‐dependent manner with similar potency but was threefold less potent as compared with the in vitro Ki in recombinant overexpressing cells. The effect of PF‐05190457 on rodent islets was comparable with glibenclamide, but glucose‐dependent and additive with the insulin secretagogue glucagon‐like peptide‐1.

Conclusions and Implications

Together, these data provide the pharmacological in vitro and ex vivo characterization of the first ghrelin receptor inverse agonist, which has advanced into clinical trials to evaluate the therapeutic potential of blocking ghrelin receptors in obesity and type 2 diabetes.
Mini Gastric Bypass: first report of 125 consecutive cases from United Kingdom
Authors: Parmar C. D. , Mahawar K. K. , Boyle M. , Carr W. R. J. , Jennings N. , Schroeder N. , Balupuri S. , Small P. K.
Published: January 2016

Mini Gastric Bypass is a promising bariatric procedure with multiple apparent benefits. Ours is the first unit within the National Health Service of the United Kingdom to be routinely performing this procedure. This retrospective cohort study reports our experience with first 125 procedures. Data were retrospectively analysed from a prospective database. Information was further supplemented by interviewing team members, contacting patients' general practitioners and telephonic follow‐up. The mean follow‐up was 11.4 months. There were 86 (68.8%) females and the mean age was 45 (range 20–70) years. Mean weight and body mass index was 135.8 (range 85–244) kilograms and 48.1 (range 34.5–73.8) kg m−2, respectively. The mean operating time was 92.4 (range 45–150) minutes and the mean post‐operative hospital stay was 2.2 (range 2–17) days. There was no leak, one 30‐day reoperation and no mortality in this study. Three patients required late reoperations and four patients developed marginal ulcers. At 6 months follow‐up (n = 114), 27.5 (range 11.4–47.4) % total body weight loss and 60.1 (range 23.2–117.5) % excess body weight loss was seen. The figures at 12 months follow‐up (n = 65) were 36.8 (range 23.7–55.4) % and 79.5 (range 44.9–138.3) %, respectively. This study demonstrates early safety and efficacy of Mini Gastric Bypass in a carefully selected British obese population in a high‐volume centre.
A rare pattern of lung metastasis of rectum adenocarcinoma
Authors: Basara Isil , Altay Canan , Obuz Funda , Balci Pinar
Published: January 2016

Lung is primary capillary filter of venous drainage for many organs. As a result of this, it is the most common metastasis site of extrapulmonary organ tumours. Cystic and cavitary forms of lung metastases are unusual. In evaluation of patients with these lesions benign and malignant lesions should be distinguished from each other. In this case report, we aimed to present computed tomography findings of an unusual cystic form of lung metastasis that is originated from rectum adenocarcinoma.
Kidney transplant referral practices in southeastern dialysis units
Authors: Browne Teri , Patzer Rachel E. , Gander Jennifer , Amamoo M. Ahinee , Krisher Jenna , Sauls Leighann , Pastan Stephen
Published: January 2016

Background

The Southeastern Kidney Transplant Coalition was created in 2010 to improve kidney transplant (KTx) rates in Georgia, North Carolina, and South Carolina. To identify dialysis staff‐reported barriers to transplant, the Coalition developed a survey of dialysis providers in the region.

Methods

All dialysis units in the ESRD Network (n = 586) were sent a survey to be completed by the professional responsible for helping patients get transplants.

Results

One staff member at almost all (n = 546) of the dialysis units in Network 6 completed the survey (93% response rate). Almost all respondents reported being very comfortable (51.47%) or comfortable (46.89%) discussing the KTx process with patients. Just over half (56%) of facilities reported discussing KTx as a treatment option with patients on an annual basis. Fewer than one quarter of respondents (19%) perceived that more than 50% of their patients were interested in kidney transplant, and most of the staff surveyed (68%) reported that <25% of their dialysis patients completed the evaluation process and been wait‐listed for a kidney transplant.

Conclusion

The survey results provide insight into KTx referral practices in southeastern dialysis units that may be contributing to low KTx rates in this region.
Current principles and practice in autologous intraportal islet transplantation: a meta‐analysis of the technical considerations
Authors: Kumar Rohan , Chung Wen Yuan , Dennison Ashley Robert , Garcea Giuseppe
Published: January 2016

Objectives

Autologous islet transplantation (IAT) following pancreatectomy is now a recognized, albeit highly specialized procedure carried out in a small number of centers worldwide. Current clinical principles and best practice with emphasis on examining the technical aspects of surgery in centers with significant IAT experience are reviewed.

Methods

Literature search for studies discussing any technical aspect of pancreatectomy with intraportal IAT was included.

Results

Thirty‐five papers were included; all were single‐center case series. The indications, surgical approach to pancreatectomy with IAT, islet yield, static pancreas preservation prior to islet digestion, portal vein access, absolute islet infusion volumes, and portal venous pressure changes during transfusion evaluated.

Conclusions

IAT is considered a “last resort” when alternative approaches have been exhausted. Pre‐morbid histology and prior surgical drainage adversely influence islet yields and may influence the clinical decision to perform pancreatectomy and IAT. Following pancreas digestion, absolute numbers of islets recovered and smaller islet size predict rates of insulin independence following IAT. Islet volumes and portal venous pressure changes are important factors for the development of complications. Surgical access for IAT includes intra‐operative, immediate or delayed infusion via an “exteriorized” vein, and radiological percutaneous approaches. Delayed infusion can be combined with pancreas preservation techniques prior to islet isolation.
Increased gene expression of TGF‐β in peripheral blood mononuclear cells from renal transplant patients with polyomavirus BK viremia
Authors: Yin Wen‐Yao , Lee Ming‐Che , Huang Hsien‐Bin , Lu Ming‐Chi
Published: January 2016

We aimed to investigate the roles of cytokines during polyomavirus BK (BKV) reactivation in renal transplant patients. Forty‐eight renal allograft recipients were enrolled, and their sera BKV viral load and mRNA expression levels of cytokines in peripheral blood mononuclear cells were measured by real‐time polymerase chain reaction. Patient's age and gene expression levels of interleukin (IL)‐2 (10.04 ± 2.63 vs. 8.70 ± 2.40, p = 0.049) and transforming growth factor (TGF)‐β (12.58 ± 2.59 vs. 10.89 ± 1.91, p = 0.015) were significantly higher in BKV viremia (+) renal transplant patients. Multivariate logistic regression analysis revealed that age and mRNA expression levels of TGF‐β, but not IL‐2, significantly correlated with the presence of BKV viremia. Sera BKV viral loads showed a positive correlation with patient age and the levels of TGF‐β and IL‐6 mRNA. After adjusting for age and sex in the regression model, both age and TGF‐β mRNA levels maintained a significant positive association with sera BKV viral loads. Serum TGF‐β concentration tended to be higher in BKV viremia (+) patients (p = 0.079). In conclusion, expression levels of TGF‐β were found to correlate with both BKV viremia positivity and sera BKV viral loads in renal transplant patients.
Comparative study of laparoscopic and mini‐incision open donor nephrectomy: have we heard the last word in the debate?
Authors: Yadav Kunal , Aggarwal Sandeep , Guleria Sandeep , Kumar Rajeev
Published: January 2016

Objective

Laparoscopic donor nephrectomy (LDN) is generally considered a better option than open donor nephrectomy (ODN) as it is associated with better cosmesis, less post‐operative pain and faster recovery. Mini‐incision donor nephrectomy (MDN) has proven to be an effective and less invasive modification of classic ODN. Our aim was to compare the peri‐operative outcomes and quality of life of donors following laparoscopic and mini‐incision ODN.

Methods

One hundred patients, underwent donor nephrectomy using laparoscopic approach (n = 50) or open mini‐incision approach (n = 50) over a period of 18 months. Data were entered into a prospective database and analyzed retrospectively.

Results

The mean operative (skin to skin) time for MDN, 53.9 min (range, 40–75 min), was significantly shorter than the 93.7 min (range, 75–140 min) for LDN. The laparoscopic donors had a longer hospital stay, warm ischemia time and higher operative and post‐operative cost. There was no significant difference in the pain scores, graft function, or quality of life between the two groups.

Conclusions

MDN compares well with the laparoscopic approach in terms of post‐operative pain, graft function and quality of life of donors. Significantly less operative time along with the reduced cost makes it a better option in our predominantly lower BMI patient population.
Differential effects of hunger and satiety on insular cortex and hypothalamic functional connectivity
Authors: Wright Hazel , Li Xiaoyun , Fallon Nicholas B. , Crookall Rebecca , Giesbrecht Timo , Thomas Anna , Halford Jason C.G. , Harrold Joanne , Stancak Andrej
Published: January 2016

The insula cortex and hypothalamus are implicated in eating behaviour, and contain receptor sites for peptides and hormones controlling energy balance. The insula encompasses multi‐functional subregions, which display differential anatomical and functional connectivities with the rest of the brain. This study aimed to analyse the effect of fasting and satiation on the functional connectivity profiles of left and right anterior, middle, and posterior insula, and left and right hypothalamus. It was hypothesized that the profiles would be altered alongside changes in homeostatic energy balance. Nineteen healthy participants underwent two 7‐min resting state functional magnetic resonance imaging scans, one when fasted and one when satiated. Functional connectivity between the left posterior insula and cerebellum/superior frontal gyrus, and between left hypothalamus and inferior frontal gyrus was stronger during fasting. Functional connectivity between the right middle insula and default mode structures (left and right posterior parietal cortex, cingulate cortex), and between right hypothalamus and superior parietal cortex was stronger during satiation. Differences in blood glucose levels between the scans accounted for several of the altered functional connectivities. The insula and hypothalamus appear to form a homeostatic energy balance network related to cognitive control of eating; prompting eating and preventing overeating when energy is depleted, and ending feeding or transferring attention away from food upon satiation. This study provides evidence of a lateralized dissociation of neural responses to energy modulations.
Biomarkers and personalized medicine: current status and further perspectives with special focus on dermatology
Authors: Landeck Lilla , Kneip Christoph , Reischl Joachim , Asadullah Khusru
Published: January 2016

Biomarkers are of increasingly high importance in medicine, particularly in the realm of ‘personalized medicine’. They are valuable for predicting prognosis and dose selection. Moreover, they may be helpful in detecting therapeutic and adverse responses and in patient stratification based on efficacy or safety prediction. Thus, biomarkers are essential tools for the selection of appropriate patients for treatment with certain drugs to and enable personalized medicine, that is ‘providing the right treatment to the right patient, at the right dose at the right time’. Currently, there are six drugs approved for dermatological indications with recommended or mandatory biomarker testing. Most of them are used to treat melanoma and human immunodeficiency virus infection. In contrast to the few fully validated biomarkers, many exploratory biomarkers and biomarker candidates have potential applications. Prognostic biomarkers are of particular significance for malignant conditions. Similarly, diagnostic biomarkers are important in autoimmune diseases. Disease severity biomarkers are helpful tools in the treatment for inflammatory skin diseases. Identification, qualification and implementation of the different kinds of biomarkers are challenging and frequently necessitate collaborative efforts. This is particularly true for stratification biomarkers that require a companion diagnostic marker that is co‐developed with a certain drug. In this article general definitions and requirements for biomarkers as well as for the impact of biomarkers in dermatology are reviewed and opportunities and challenges are discussed.
Lichen striatus versus linear lichen planus: a comparison of clinicopathological features, immunoprofile of infiltrated cells, and epidermal proliferation and differentiation
Authors: Zhou Ying , Yu Zuo‐Zhong , Peng Jing , Yang Pei‐Pei , Li Shi‐Jie , Fan Yi‐Ming
Published: January 2016

Background

Lichen striatus (LS) and linear lichen planus (LLP) are separate uncommon disorders belonging to linear inflammatory dermatoses. The immunotyping of inflammatory cells has been investigated in LS and lichen planus (LP), but epidermal proliferation and differentiation have little been described in LS and LLP.

Methods

The clinical and pathological data of eight patients with LS and seven with LLP were retrospectively collected. Immunotyping of infiltrated cells and expression of Ki‐67, K16, involucrin, and filaggrin were stained by immunohistochemistry in skin lesions of these patients and normal skin of eight healthy controls.

Results

Dermal infiltrates contained primarily CD3+ and CD68+ cells in three groups. CD4+ cells were predominantly located in the perivascular area, while CD8+ cells were frequently close to the junctional zone. Compared with control skin, epidermal and dermal CD1a+ cells, and dermal CD3+, CD4+, CD8+, and CD68+ cells were increased in LS and LLP (P < 0.05), while Ki‐67+ cells were significantly high in LLP (P < 0.05) but not in LS. K16 and involucrin expression in LLP were more extensive than in LS, and filaggrin expression was similar between both entities.

Conclusions

Our results indicate that the predominance of CD8+ cells and increased epidermal proliferation and abnormal keratinization are present in both dermatoses, although the levels of the above indexes are mild in LS as compared to LLP. These two entities might be due to the interaction of infiltrated cells and keratinocytes, and CD8+ cells could play a pivotal role in their pathogenesis.
Development of a global hospital self-assessment tool and prioritization tier system based on FIP's Basel Statements
Authors: Lyons Kayley , Blalock Susan J , Brock Tina Penick , Manasse Henri R , Eckel Stephen F
Published: January 2016

Objectives

The objective of this study was to develop and pilot a hospital self-assessment tool and prioritization system for hospitals to evaluate their pharmacy practice performance against the International Pharmaceutical Federation (FIP)'s Basel Statements.

Methods

To develop the self-assessment tool, we reviewed the Basel statements to identify characteristics that could be measured at the individual hospital level and finalized these based on feedback from five cognitive interviews. The survey instrument was pilot tested in four countries; two high-, one lower middle- and one low-income country. Participants were electronically sent the survey tool and enrolled through the snowball sampling method. Tiers were developed by investigators to assist hospitals in prioritizing the achievement of Basel Statement practices. Tiers were validated by the Hospital Section chairs of FIP through a card sorting exercise. Simple agreement and Cohen's kappa was used to characterize inter-rater reliability. Descriptive statistics were used to characterize the responses.

Key findings

Forty-four survey responses were collected from 36 hospitals in four countries. The survey response rate was 29% and took an average of 26 minutes to complete. The overall average agreement of constructs was 83%. The survey characterized how far a hospital was to achieving the Basel Statement practices with an average achievement rate of 57% (ranging from 30% to 90%). The survey highlighted medication safety challenges facing the pharmacy profession. The results produced a benchmarking report for each respondent.

Conclusions

The results support the validity and reliability of the survey tool. This comprehensive survey tool can be used by institutions to track their progress towards achieving the Basel Statement practices.
Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele
Authors: Shiraishi Koji , Oka Shintaro , Matsuyama Hideyasu
Published: January 2016

Objective

To compare the surgical outcomes of subinguinal and high inguinal approaches for microsurgical varicocelectomy.

Methods

A total of 81 patients with left varicocele were randomly assigned to undergo microsurgical left varicocelectomy by the subinguinal (n = 41) or high inguinal (n = 40) approach. These two techniques were compared with regard to the operative parameters, complications and testicular growth. Anatomical parameters, including the numbers and diameters of internal spermatic arteries, veins and lymphatic vessels, were recorded.

Results

The microsurgical step was significantly shorter for the high inguinal approach compared with the subinguinal approach (25.5 vs 33.3 min, respectively, P < 0.01). The numbers of preserved arteries and ligated veins were significantly greater and the artery size was significantly smaller for the subinguinal (1.6 arteries, 11.5 veins and 1.1 mm, respectively) compared with the high inguinal approach (1.2 arteries, 7.3 veins and 1.3 mm; P < 0.001, <0.0001 and <0.01, respectively). There was one patient with postoperative hydrocele, and three with persistent scrotal pain after treatment with the subinguinal approach. The postoperative catch‐up growth rates at 24 months were 70% and 78% for the subinguinal and high inguinal approaches, respectively.

Conclusions

The microsurgical subinguinal and high inguinal approaches seem to yield similar success rates in terms of testicular growth. However, the high inguinal approach is easier to carry out, as it requires fewer divisions of veins and is associated with a larger diameter of the spermatic artery.
Homeland (Dis)Integrations: Educational Experience, Children and Return Migration to Albania
Authors: Vathi Zana , Duci Veronika , Dhembo Elona
Published: January 2016

Based on empirical research conducted in Albania, this article reports that educational experience and performance, and hence, integration of the children of (returned) migrants in their parents' homeland is obstructed by structural factors linked to the educational system. A finding such as this challenges the centrality of an essentialized notion of ethnicity in models of “second generation” integration and evidences the centrality of the nation‐state, and the education system as one of its pillars, in the integration of migrants and their children. Comparative integration context theory appears to apply to the integration of children of returned migrants; yet it needs to take into account the mobile lives of migrants and their children, the transnational disjuncture between different educational systems, and the role of locality within the nation‐state. Moreover, including children in analyses of integration, in the context of education, calls for the inclusion of life‐course and scale in integration theories.
Clinical nursing and midwifery research: grey literature in African countries
Authors: Sun C. , Dohrn J. , Omoni G. , Malata A. , Klopper H. , Larson E.
Published: January 2016

Aim

This study reviewed grey literature to assess clinical nursing and midwifery research conducted in southern and eastern African countries over the past decade.

Background

The shortage of published nursing research from African countries severely limits the ability of practicing nurses and midwives to base clinical decisions on solid evidence. However, little is known regarding unpublished or unindexed clinical research (‘grey literature’), a potentially rich source of information. Identifying these sources may reveal resources to assist nurses in providing evidence‐based care.

Introduction

This scoping review of grey literature on clinical nursing and midwifery research in southern and eastern African countries helped to identify gaps in research and assess whether these gaps differ from published research.

Methods

Systematic searches of grey literature were performed. Research was included if it was conducted by nurses in 1 of 25 southern or eastern African countries, between 2004 and 2014 and included patient outcomes. Data were extracted on location, institution, research topic, institutional connections and author information. Chi‐square tests were performed to compare differences between indexed and non‐indexed literature.

Results

We found 262 studies by 287 authors from 17 southern and eastern African countries covering 13 topics. Although all topics were also found in indexed literature and there were statistically significant differences between the number of times, fewer topics were covered in grey literature vs. indexed.

Discussion

Patient satisfaction and experience and traditional health practices were more likely to be published, whereas chronic disease, assault and paediatric‐related research were less often published.

Conclusions and Implications for Nursing and Health Policy

Generally, there is a paucity of clinical nursing research in this region. This could reflect the shortage of nurses prepared to conduct research in this region. Nurses may find additional resources for evidence in the grey literature. A complete understanding of the state of nursing science in southern and eastern African countries will help nurses and midwives to understand gaps in clinical research knowledge, potentially direct their research to more critical topics, and inform funding bodies and policy‐makers of the situation of nursing science in southern and eastern African countries.
Transformation of Brushite (CaHPO4·2H2O) to Whitlockite (Ca9Mg(HPO4)(PO4)6) or Other CaPs in Physiologically Relevant Solutions
Authors: Tas A. Cuneyt
Published: January 2016

Brushite (dicalcium phosphate dihydrate, DCPD, CaHPO4·2H2O) and whitlockite [WH, Ca9Mg(HPO4)(PO4)6] are usually found in the mammalian metabolism in the form of diverse pathological calcifications, dental calculi, urinary tract stones, salivary gland deposits, cardiovascular or pulmonary calcified deposits, and even as prostate or cartilage calcifications. The hydrothermal transformation of synthetic brushite crystals into single‐phase whitlockite, octacalcium phosphate, or apatitic calcium phosphate was observed over the time period of 1 to 21 d and at 37°C, 70°C, and 115°C in nonstirred physiologically relevant solutions developed for this work. The strong influence of the physiologically relevant ions such as Mg2+ and HCO3− on hydrothermal transformations is exposed. The formation of the nanoglobules and nanofibrils of X‐ray amorphous calcium phosphate or Mg‐doped calcium phosphate on the surfaces of brushite crystals are observed for the first time in biomimetic solutions containing 10 mm Mg2+ and/or 27 mm HCO3−. The experimental conditions leading to the formation of such nanofibrils on brushite crystal surfaces are also found to stop the further transformation of brushite into any other calcium phosphate (CaP) phases even at high solution temperatures. Samples were characterized by scanning electron microscopy and powder X‐ray diffraction.
High‐Temperature Compression Deformation Behavior of Fine‐Grained Carbon‐Bonded Alumina
Authors: Solarek Johannes , Bachmann Christina , Klemm Yvonne , Aneziris Christos G. , Biermann Horst
Published: January 2016

Carbon‐bonded alumina with 33 wt% residual carbon was tested in compression at room temperature and at temperatures between 700°C and 1500°C in quasi‐static tests, creep tests, and stress relaxation tests. Therefore, a new high‐temperature test set up with inert gas chamber and inductive heating was used. The tests were accomplished by investigations of microstructure and Young's modulus. At room temperature, the results exhibit a pronounced hysteresis for the first loading cycle, which almost completely disappeared in subsequent cycles. The creep tests showed characteristic curves for compression whereas primary and secondary (stationary) creep occurred. Above 1000°C, a strong increase in creep rate was detected, whereas almost no creep was observed below this temperature. All creep curves were approximated with the models of logarithmic and Andrade creep. The activation energy for creep was found to be 263 kJ/mol above 1150°C. The resistance against stress relaxation showed an anomaly with a minimum between 1000°C to 1200°C and a maximum between 1300°C and 1400°C.
The Accelerating Effect of CaSO4 Within CMAS (CaO–MgO–Al2O3–SiO2) and Its Effect on the Infiltration Behavior in EB‐PVD 7YSZ
Authors: Naraparaju Ravisankar , Mechnich Peter , Schulz Uwe , Mondragon Rodriguez Guillermo Cesar
Published: January 2016

Infiltration and deposition of CaSO4 in thermal barrier coatings (TBC) in addition to the CMAS deposits was found in many occasions on real aviation engines. The source and role of CaSO4 on the degradation of TBC is not well understood. CaSO4 containing CMAS was synthesized and a systematic study of its role on the CMAS infiltration behavior in EB‐PVD 7YSZ is presented in this work. Its influence on the melting and crystallization behavior of CMAS was studied with the help of differential scanning calorimetry. The decomposition of CaSO4 into CaO and SO3 was observed at 1050°C in laboratory air under the presence of CMAS using mass spectroscopy and in situ high‐temperature XRD. The same amount of CaO is brought into the CMAS system by means of adding CaCO3, which will eventually decompose into CaO and CO2 at 700°C. CMAS infiltration tests were carried out at different temperatures with and without CaSO4/CaCO3 and the results demonstrate that the sulfur has no direct effect on the aggressiveness of the anhydrite containing CMAS with regard to its infiltration behavior in EB‐PVD 7YSZ at high temperatures. The extra amount of calcia added to CMAS that is introduced by the evaporating species is responsible for enhanced infiltration of the deposits into the TBC.
Stress Effects on Stabilizing Antiferroelectric Phase in Multilayer Ceramics
Authors: Sharifzadeh Mirshekarloo Meysam , Tan Chee Kiang Ivan , Li Yang , Lai Szu Cheng , Zhang Lei , Wong Ten It , Rahimabadi Mojtaba , Yao Kui , Shankar Samudra Ganesh
Published: January 2016

Controllable phase transformation between antiferroelectric (AFE) and ferroelectric (FE) states suggests multifunctional properties valuable for many device applications. Compared to AFE bulk ceramics with large voltage required for driving electric field‐induced phase transition, implementation of structures comprising multiple thin AFE ceramic layers can realize applications by reducing the switching operation voltage in the feasible range. Here, it is found that a compressive residual stress is developed in multilayer (Pb0.97,La0.02)(Zr0.66,Snx,Ti0.34−x)O3 (PLZST) ceramic co‐fired with multiple Pd/Ag electrode layers, and the compressive residual stress can stabilize AFE phase. AFE phase forms in the PLZST multilayer ceramic with composition corresponding to FE in the bulk materials. Thermodynamic analysis based on free energy of FE and AFE phases well explains the FE to AFE phase transformation observed in the multilayer ceramic under the compressive stress. The findings exhibit a new strategy to tune structure and functional properties of multilayer ceramics through stress engineering for achieving device applications.
Metastable Ferroelectric Phase Induced by Electric Field in xPb(Zn1/3Nb2/3)O3–(1–x)Pb(Zr0.95Ti0.05)O3 Ceramics
Authors: Zheng Mupeng , Hou Yudong , Zhu Mankang , Yan Hui
Published: January 2016

A xPb(Zn1/3Nb2/3)O3–(1–x)Pb(Zr0.95Ti0.05)O3 (xPZN–(1–x) PZT) system close to antiferroelectric–ferroelectric (AFE–FE) morphotropic phase boundary has been prepared and investigated. The XRD results reveal PZN addition induces a phase transition from the orthorhombic (AFE) to rhombohedral (FE) phase through a phase coexistence region (AFE+FE). The polarization–electric field (P–E) measurements indicate that the AFE phase can be induced into a metastable FE (FEm) phase. And the FEm can recover to AFE around a critical temperature indicated by temperature‐dependent P–E loops. A composition‐temperature phase diagram was generalized within a certain range of PZN content in which an AFE–FE phase boundary connecting orthorhombic antiferroelectric to rhombohedral ferroelectric phase zones is formed near room temperature.
Effect of TeO2 on Near‐Infrared Emission from Bismuth Centers in Borogermanate Glasses
Authors: Xu Zhou‐Su , Xu Cheng , guo Qiang‐Bing , Liu Xiao‐Feng , Qiu Jian‐Rong
Published: January 2016

Bi‐doped xTeO2–(60−x)GeO2–15B2O3–20MgO–5Al2O3 glasses were prepared by the conventional melt‐quenching method and their absorption and fluorescence spectra were characterized. Broadband near‐infrared (NIR) emission from Bi centers centered around 1240 nm with a full width at half maximum (FWHM) of 250 nm was observed, and the position of the emission peak strongly depends on the excitation wavelength. Increasing TeO2 concentration results in the strong coloration of the glass, leading to the reduction and finally, complete quenching of the NIR emission. Based on Raman, X‐ray photoelectron spectroscopy and transmission microscopy observation, the coloration of the glass at high TeO2 concentration can be ascribed to the precipitation of elemental Te nanoparticles of around 3–8 nm, which effectively suppresses the NIR emission by reabsorption. The precipitation of Te nanoparticles in an oxide glass may find novel applications in photonics and relevant fields.
Survival Prognosis in Very Old Adults
Authors: Thinggaard Mikael , McGue Matt , Jeune Bernard , Osler Merete , Vaupel James W. , Christensen Kaare
Published: January 2016

Objectives

To determine whether simple functional indicators are predictors of survival prognosis in very old adults.

Design

In‐person survey conducted over a 3‐month period in 1998; assessment of survival over a 15‐year follow‐up period.

Setting

Denmark.

Participants

All 3,600 Danes born in 1905 and living in Denmark in 1998, were invited to participate regardless of residence and health; 2,262 (63%) participated in the survey: 1,814 (80.2%) in person and 448 (19.8%) through a proxy.

Measurements

Socioeconomic factors, medications and diseases, activities of daily living, physical performance, cognition, depression symptomatology, self‐rated health, and all‐cause mortality, evaluated as average remaining lifespan and chance of surviving to 100 years.

Results

Men aged 92 to 93 had an overall 6.0% chance of surviving to 100 years, whereas the chance for women was 11.4%. Being able to rise without use of hands increased the chance for men to 11.2% (95% confidence interval (CI) = 7.7–14.7) and for women to 22.0% (95% CI = 18.9–25.1). When combining this with a Mini‐Mental State Examination (MMSE) scores from 28 to 30, the chances were 21.7% (95% CI = 11.5–31.9) for men and 34.2% (95% CI = 24.8–43.5) for women.

Conclusion

Chair stand score combined with MMSE score is a quick and easy way to estimate overall chance of survival in very old adults, which is particularly relevant when treatment with potential side effects for nonacute diseases is considered.
Association Between Random Measured Glucose Levels in Middle and Old Age and Risk of Dementia‐Related Death
Authors: Rosness Tor Atle , Engedal Knut , Bjertness Espen , Strand Bjørn Heine
Published: January 2016

Objectives

To investigate the association between random measured glucose levels in middle and old age and dementia‐related death.

Design

Population‐based cohort study.

Setting

Norwegian Counties Study (middle‐aged individuals; 35–49) and Cohort of Norway participants (older individuals; 65–80).

Participants

Individuals without (n = 74,630) and with (n = 3,095) known diabetes mellitus (N = 77,725); 67,865 without and 2,341 with diabetes mellitus were included in the complete case analyses (nonmissing for all included covariates), of whom 1,580 without and 131 with diabetes mellitus died from dementia‐related causes.

Measurements

Dementia‐related death was ascertained according to the Norwegian Cause of Death Registry. Cox regression was used to assess the relationship between random glucose levels (nonfasting) in individuals without and with diabetes mellitus and dementia‐related death. Education, smoking, cardiovascular disease, body mass index, cholesterol, blood pressure, and physical activity were adjusted for.

Results

Individuals without diabetes mellitus at midlife with glucose levels between 6.5 and 11.0 mmol/L had a significantly greater risk of dementia‐related death than those with levels less than 5.1 mmol/L (hazard ratio = 1.32, 95% confidence interval = 1.04–1.67) in a fully adjusted model. A dose‐response relationship (P = .02) was observed. No significant association between high glucose levels in individuals aged 65 to 80 and dementia‐related death was detected.

Conclusion

High random glucose levels measured in middle‐aged but not older age persons without known diabetes mellitus were associated with greater risk of dementia‐related death up to four decades later.
Falls and Parkinson's Disease: Evidence from Video Recordings of Actual Fall Events
Authors: Weaver Tyler B. , Robinovitch Stephen N. , Laing Andrew C. , Yang Yijian
Published: January 2016

Objectives

To compare the fall characteristics of individuals with and without Parkinson's disease (PD) through the analysis of real‐life falls captured on video.

Design

Observational cohort study.

Setting

Two long‐term care facilities in British Columbia, Canada.

Participants

Individuals living in long‐term care (N = 306; 16 with PD).

Measurements

Falls captured on video and analyzed (N = 906; 71 in participants with PD). Generalized estimating equation models were used to examine differences in fall characteristics between participants with and without PD.

Results

Individuals with PD were 1.3 times as likely as those without PD to fall because of incorrect weight shifting (95% confidence interval (CI) = 1.03–1.65). Secondary steps during the fall event were 1.5 times as likely to be short in individuals with PD as in those without (95% CI = 1.23–1.78). Individuals with PD were also 1.6 times as likely to attempt to recover balance by reaching to grasp an external object (95% CI = 1.13–2.15) and 5.0 times as likely to secure grasp of the object (95% CI = 1.23–20.0).

Conclusion

Along with greater likelihood for individuals with PD to fall because of incorrect weight shifting, differences between groups were found in reactive stepping responses. This first detailed evidence of the characteristics of falls in PD should help to inform fall and injury prevention approaches for clinicians and rehabilitation professionals working with individuals with PD.
A cross‐sectional study exploring the different roles of individual and group assessment methods in assessing public health nutrition competence
Authors: Palermo C. , Davidson Z. E. , Hay M.
Published: January 2016

Background

Competency in the practice of public health is essential for dietitians, yet little is known about credible and dependable assessment in this field. The present study aimed to investigate the role of individual and group assessment tasks as elements of a public health nutrition competency‐based assessment system.

Methods

Assessment performance data from 158 dietetics students (three group tasks and one individual task) who had completed a practical placement learning experience in a public health nutrition setting were examined using nonparametric techniques. All 158 students were deemed individually ‘competent’ on completion of the placement.

Results

The median mark was significantly lower for the individual compared to the group task, with a greater range of marks achieved in the individual assessment. There was a weak relationship between individual and group marks for the whole cohort (n = 158) (Spearman's rho correlation coefficient = 0.193, P = 0.015). Bland–Altman analysis showed that the mean (SD) agreement between the two assessment tasks was −5.9 (17.7) marks. Systematic bias between the two tasks was also demonstrated, indicating that students with the lowest average mark of the two assessments scored lower on the individual assessment task compared to their group task and those who had a higher average mark scored higher on the individual group assessment compared to their group task.

Conclusions

Student performance in public health differs between individual and group assessment. Individual assessment appears to differentiate between students, yet group work is essential for the development of teamwork skills. Both should be considered in the judgement of public health nutrition competency.