bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical hemodialysis experience with percutaneous arteriovenous fistulas created using the Ellipsys® vascular access system
Authors: Hebibi Hedia , Achiche Jedjiga , Franco Gilbert , Rottembourg Jacques
Published: March 2019

Introduction: The aim of this study is to report our clinical hemodialysis experience using a percutaneous arteriovenous fistula (pAVF) created with the Ellipsys® vascular access system. This pAVF device creates a permanent AVF anastomosis between the proximal radial artery (PRA) and the deep communicating vein (DCV) in the proximal forearm.

Methods: The medical records of all patients with a pAVF were retrospectively reviewed. The clinical data analyzed included reliability of pAVF use, quality of dialysis, rate and success of puncture, and pAVF related complications, along with incidence of subsequent interventions.

Findings: Between May 2017 and November 2018, 34 patients had a pAVF created with technical success in 33 patients (97%). Twenty‐eight out of 34 (82%) patients had successful two‐needle cannulation within 10 days to 6 weeks after pAVF creation. The mean Kt/v was 1.6 (1.2‐2) and the average recirculation was 10%. Fifteen patients (44%) needed no further access intervention. Twelve patients (35%) required an additional procedure to assist maturation of the pAVF in order to facilitate puncture. The average blood flow measured at the brachial artery, before the first cannulation, was 850 ml/min. From causes unrelated to the procedure, four patients died during the follow‐up study. Two patients required revision to a surgical AVF. None of the pAVFs developed aneurysmal degeneration steal syndrome, or high access flow related issues.

Discussion: The Ellipsys® pAVF offers a safe and functional vascular access for hemodialysis. Advantages included prompt access maturation, avoidance of high flow AVFs, and a simple nonsurgical procedure with high patient satisfaction. Functional outcomes are equivalent and likely better than surgical fistulas. There appears to be less aneurysmal degeneration and need for future re‐intervention. Objective dialysis parameters indicate excellent quality of hemodialysis for the patient.
Gastric juice‐based PCR assay: An alternative testing method to aid in the management of previously treated Helicobacter pylori infection
Authors: Hsieh Meng‐Shu , Liu Chung‐Jung , Hsu Wen‐Hung , Li Chia‐Jung , Tsai Pei‐Yun , Hu Huang‐Ming , Shih Hsiang‐Yao , Lu Chien‐Yu , Yu Fang‐Jung , Kuo Fu‐Chen , Wu Deng‐Chyang , Kuo Chao‐Hung
Published: March 2019

Background

Culture of Helicobacter pylori with previous eradication failure has been emphasized in clinical guidelines. The current unmet need to manage previously treated H pylori is one tool with diagnostic accuracy and ability for antibiotics susceptibility. Gastric juice PCR can provide diagnosis and antibiotics susceptibility; however, whether treatment failure affects its accuracy remains uninvestigated. Our study aimed to investigate diagnostic accuracy and antibiotics susceptibility of juice PCR in previously treated H pylori and to compare with the current standard of culture.

Methods

We categorized all 547 patients into treatment‐naïve, post‐1st treatment, post‐2nd treatment, and post‐3rd treatment. Helicobacter pylori infection was confirmed using gold standards. Sensitivity, specificity, positive predictive value, negative predictive value, receiver operating characteristic (ROC) curve and area under ROC curve (AUC) of juice PCR and culture were calculated. Intra‐gastric H pylori density was evaluated. Lastly, the antibiotics susceptibility results of gastric juice and culture were compared.

Results

Our findings demonstrated AUC was higher in juice PCR than culture in all patients (96.7% vs 91.3%, P < 0.0001). The superiority of juice PCR was statistically significant in previously treated patients (P < 0.0001) but not in treatment‐naïve patients (P = 0.13). Antral H pylori density was less marked in previously treated patients (P = 0.014). The comparisons of PCR‐RFLP and E‐test for Clarithromycin resistance showed reliable AUC = 89.8%.

Conclusion

Compared with the current standard of culture, the gastric juice PCR contains the strengths of performing the antibiotics susceptibility and overcomes the shortcomings of low accuracy. Consequently, gastric juice PCR suits the unmet need to manage previously treated H pylori.
Host genetic factors and clinical parameters influencing the occult hepatitis C virus infection in patients on chronic hemodialysis: Is it still a controversial infection?
Authors: Ayadi Ahmad , Nafari Amir Hossein , Sakhaee Fatemeh , Rajabi Kimia , Ghaderi Yaser , Rahimi Jamnani Fatemeh , Vaziri Farzam , Siadat Seyed Davar , Fateh Abolfazl
Published: March 2019

Aim

The presence of occult hepatitis C virus (HCV) infection (OCI) is still controversial, however, this infection cannot be ignored. Therefore, the current study aimed at assessing the OCI frequency in patients on chronic hemodialysis (CHD) and also evaluating the association between OCI incidence with clinical parameters and interferon lambda 3/4 (IFNL3/4) gene polymorphisms.

Methods

A total of 515 patients on CHD and HCV negative markers were selected. Plus‐ and minus‐stranded HCV‐RNA was tested in peripheral blood mononuclear cell samples by reverse transcription–polymerase chain reaction and then genotyped using the restriction fragment length polymorphism method.

Results

The frequency of OCI was 11.3% in patients on CHD. Among 58 patients with OCI, 25.8%, 62.1%, and 12.1% were infected with HCV‐1a, HCV‐1b, and HCV‐3a, respectively. The mean alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels were 31.9 ± 24.8, 32.3 ± 19.1, and 171.6 ± 88.9, respectively. None of the patients with OCI had a history of liver disease. Multivariate logistic regression analysis indicated that cholesterol, triglyceride, low‐density lipoprotein, 25‐hydroxyvitamin D, platelets, duration of hemodialysis, HCV subtypes, IFNL3 rs12979860 TT, IFNL3 rs8099917 GG, IFNL3 rs12980275 GG, and IFNL4 ss469415590 ΔG/ΔG genotypes were associated with OCI.

Conclusion

There was a moderate prevalence of OCI in Iranian patients on CHD. The current study findings indicated that this infection was associated with clinical parameters and unfavorable genotypes of IFNL3 single nucleotide polymorphisms and IFNL4 ss469415590. Further studies are required to determine the correlation between OCI incidence with clinical parameters and host genetic factors.
Assessment of renal function in living kidney donors before and after nephrectomy: A Japanese prospective, observational cohort study
Authors: Kakuta Yoichi , Imamura Ryoichi , Okumi Masayoshi , Horio Masaru , Isaka Yoshitaka , Ichimaru Naotsugu , Takahara Shiro , Nonomura Norio , Tanabe Kazunari
Published: March 2019

Objective

To investigate the utility of estimated glomerular filtration rate for assessing kidney function in living kidney donors before and after nephrectomy.

Methods

A total of 101 donors underwent inulin clearance measurements before and 1 year after nephrectomy. The mean of three inulin clearance values was used as the measured glomerular filtration rate. Estimated glomerular filtration rate based on serum creatinine and cystatin C levels was calculated using the Japanese estimated glomerular filtration rate equation, Chronic Kidney Disease Epidemiology Collaboration formula and new full age spectrum equation. Age‐adjusted chronic kidney disease was defined as glomerular filtration rate <75 mL/min/1.73m2 for donors aged <40 years, <60 mL/min/1.73m2 for donors aged 40–65 years and <45 mL/min/1.73m2 for donors aged >65 years.

Results

The postoperative measured glomerular filtration rate <60 mL/min/1.73m2 and age‐adjusted chronic kidney disease rate were 36.0% and 27.0%, respectively. In younger donors (aged <50 years), postoperative measured glomerular filtration rate <60 mL/min/1.73m2 and age‐adjusted chronic kidney disease rates were 5.3% and 26.3%, respectively. In older donors (aged >70 years), postoperative measured glomerular filtration rate <60 mL/min/1.73m2 and age‐adjusted chronic kidney disease rates were 75.0% and 33.3%, respectively. Donor age and measured glomerular filtration rate were significant predictors of postoperative measured glomerular filtration rate. The Japanese estimated glomerular filtration rate equation based on creatinine and cystatin C showed the strongest correlation with measured glomerular filtration rate. However, the Japanese estimated glomerular filtration rate equation based on creatinine overestimated the prevalence of measured glomerular filtration rate <60 mL/min/1.73m2, whereas the Japanese estimated glomerular filtration rate based on cystatin C underestimated it.

Conclusions

Aged donors might have an increased risk of lower glomerular filtration rate after donor nephrectomy; post‐surgery, long‐term monitoring of renal function is recommended. Measurement of glomerular filtration rate should be carried out for donors, especially pre‐surgery. A more precise glomerular filtration rate equation is required in the future.
The Social Inclusion and Inequality Nexus: EU versus non‐EU migrants
Authors: Wang Cong , Naveed Amjad
Published: March 2019

This study examines the relationship between social inclusions of migrant and income inequality. Both positive and negative impacts of social inclusion on income inequality have been observed in the previous literature. This study specifically considers two types of migration flow: migration flow from EU and migration flow from non‐EU. The aim of this article is twofold: 1) is there a strong association between social inclusion of migrants and income inequality, 2) is there any different impact of social inclusion of two types of migrants (EU vs non‐EU)? Using data from 33 mainly European countries over the period 2003‐2015 and controlling for savings rate, arable land rate and age‐dependency ratio, our results indicate that there is a significant negative relationship between social inclusion and income inequality. In particular, we find that social inclusion from non‐EU migrants significantly reduces income inequality compare with EU migrants.
A Dynamic Growth Model with Equity for Guarantee Swap and Asymmetric Information*
Authors: Liu Qi , Song Dandan , Tang Xiaolin
Published: March 2019

We develop an endogenous dynamic growth model in which a financially constrained firm optimizes the entrance timing and financing structure in different information exposure scenes. An innovation financing tool called equity‐for‐guarantee swap is introduced to solve the dilemma of financing constraints. The productivity of the firm is a random variable following a two‐point distribution and its value can be observed in advance by the entrepreneur but not by the insurer. Our main goal is to fix the fair guarantee cost with asymmetry information and examine how the cost differs from the one under the same situation except with symmetric information. We solve a Nash equilibrium of the game between the entrepreneur and the insurer and specify the condition to determine whether a separating equilibrium or pooling one will be achieved. We find that at the separating equilibrium, the high‐profit firm will sacrifice a profit to send a signal for the purpose of separating itself from the low‐profit one by increasing the latter's mimicking cost. The pooling equilibrium occurs when the insurer can not distinguish the firm's type and therefore, the insurer demands the same guarantee cost for all firms.
Prospective validation of a deep learning electrocardiogram algorithm for the detection of left ventricular systolic dysfunction
Authors: Attia Zachi I. , Kapa Suraj , Yao Xiaoxi , Lopez‐Jimenez Francisco , Mohan Tarun L. , Pellikka Patricia A. , Carter Rickey E. , Shah Nilay D. , Friedman Paul A. , Noseworthy Peter A.
Published: March 2019

Objectives

We sought to validate a deep learning algorithm designed to predict an ejection fraction (EF) less than or equal to 35% based on the 12‐lead electrocardiogram (ECG) in a large prospective cohort.

Background

Patients undergoing routine ECG may have undetected left ventricular (LV) dysfunction that warrants further echocardiographic assessment. However, identification of these patients can be challenging.

Methods

We applied the algorithm to all ECGs interpreted by the Mayo Clinic ECG laboratory in September 2018. The performance of the algorithm was tested among patients with recent echocardiographic assessments of LV function. We also applied the algorithm in patients with no recent echocardiographic assessments of LV function to determine the rate of new “positive screens.”

Results

Among 16 056 adult patients who underwent routine ECG, 8600 (age 67.1 ± 15.2 years, 45.6% male), had a transthoracic echocardiogram (TTE) and 3874 patients had a TTE and ECG less than 1 month apart. Among these patients, the algorithm was able to detect an EF less than or equal to 35% with 86.8% specificity, 82.5% sensitivity, and 86.5% accuracy, (area under the curve, 0.918). Among 474 “false‐positives screens,” 189 (39.8%) had an EF of 36% to 50%. Among patients with no prior TTE, the algorithm identified 3.5% of the patients with suspected EF less than or equal to 35%. Exploratory analysis suggests false positives could be reduced by assessing NT‐pro‐BNP after the initial “positive screen.”

Conclusions

A deep learning algorithm detected depressed LV function with good accuracy in routine practice. Further studies are needed to validate the algorithm in patients with no prior echocardiogram and to assess the impact on echocardiography utilization, cost, and clinical outcomes.
Transmission of Bursaphelenchus xylophilus between Monochamus alternatus and Monochamus saltuarius through interspecific mating behaviour
Authors: Togashi Katsumi , Akbulut Süleyman , Matsunaga Koji , Sugimoto Hiroyuki , Yanagisawa Kenichi
Published: March 2019

Cerambycid adults of the genus Monochamus transmit the pine wood nematode (Bursaphelenchus xylophilus [Steiner et Buhrer] Nickle), the causative agent of pine wilt disease. To confirm the transmission of B. xylophilus between vector species, nematode‐infected Monochamus alternatus Hope and nematode‐free Monochamus saltuarius (Gebler) adults were paired and their behaviour was observed for 107–220 min. In three pairs that exhibited mounting without copulation, nematode transmission occurred, whereas it was not found in another pair without mountings. The effect of nematode transmission between different vector species on the invasion biology of B. xylophilus is discussed.
Systematic reviews in restorative dentistry: discussing relevant aspects
Authors: Sarkis‐Onofre Rafael , Pereira‐Cenci Tatiana , Tricco Andrea C. , Demarco Flávio Fernando , Moher David , Cenci Maximiliano Sérgio
Published: March 2019

Objective

This article aims to discuss key aspects of systematic reviews (SR) focusing on the improvement of the conduct and reporting.

Methods

Important aspects of SRs, such as prospective registration of the review protocol, basic structure, inclusion criteria, use of the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Statement, confidence in the results and future directions are discussed. To determine relevant aspects, a search was conducted without date limitations in PubMed (October 15th, 2017) to identify SRs written in English evaluating clinical performance of direct composite resin restoration in permanent posterior teeth or comparing direct composite resin with other material/techniques. The quality of SRs included was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 tool.

Results

Fifteen SRs were included. The overall confidence in the results of SRs was classified as critically low. Some aspects should be highlighted: SRs of in vitro studies are an important tool in restorative dentistry, and initiatives such as the PRISMA Statement and PROSPERO should be considered a standard code of practice.

Conclusions

The compliance with and awareness of the discussed aspects may be a significant feature of the improvement of SR quality in the dentistry.

Clinical significance

Initiatives such as the PRISMA Statement and PROSPERO should be taken in account by systematic reviewers in dentistry to improve the conduct and reporting of SRs, and to make their reviews are more clinically helpful.
First‐Year Impacts on Savings and Economic Well‐Being from the Assets for Independence Program Randomized Evaluation
Authors: Mills Gregory , McKernan Signe‐Mary , Ratcliffe Caroline , Edelstein Sara , Pergamit Michael , Braga Breno
Published: March 2019

Individual development accounts (IDAs) help low‐income families save by providing a savings account and a potential match toward personal savings for specific investments, such as a first home, business capitalization, or postsecondary education and training. The Assets for Independence (AFI) program uses AFI IDAs—commonly coupled with financial education—with the goal of helping low‐income households achieve greater self‐sufficiency. Using a randomized controlled trial, we evaluate the impact of AFI after one year and find that the median level of liquid assets was $657 higher for the treatment group than the control group (before matching funds). We also find that the treatment (vs control) group experienced less material hardship (by 34%) and was less likely to use nonbank check‐cashing services (by 39%).
Twin anemia‐polycythemia sequence with blood chimerism in monochorionic dizygotic opposite‐sex twins
Authors: Suzuki Takuma , Kagami Kyosuke , Mitani Yusuke , Yamazaki Rena , Ono Masanori , Fujiwara Hiroshi
Published: March 2019

We report a case of twin anemia‐polycythemia sequence with blood chimerism in monochorionic dizygotic twins born to a 30‐year‐old woman who conceived via ovulation induction. The neonates developed twin anemia‐polycythemia sequence; the female twin had anemia and the male had polycythemia. We detected blood chimerism using fluorescence in situ hybridization (FISH). Twin anemia‐polycythemia sequence carries not only perinatal risks, but also genetic and immunological implications due to blood chimerism. Although previous reports have described twin‐to‐twin transfusion syndrome in monochorionic dizygotic twins, we report the first case of twin anemia‐polycythemia sequence in monochorionic dizygotic twins.
Maintaining the Flow: Medical Challenges to Breastfeeding and “Risky” Bodies in Mexico
Authors: de López Jenna Murray
Published: March 2019

In this article, I discuss a case study from southeast Mexico that highlights conflicting ideas regarding what constitutes risk and illness in the context of breastfeeding and postpartum practices. On the one hand, doctors’ indeterminate and conflicting diagnoses about mother's milk as a source of pollution is revealed as an act of moral pathology that frames young mothers as high risk. On the other hand, milk pollution is understood by women as an unwelcome yet temporary interruption that can be remedied through non‐allopathic intervention. As such, women can exert collective agency to overcome medicalized barriers to early breastfeeding and maintain established nurturing practices.
Three Hfq‐dependent small RNAs regulate flagellar motility in the fire blight pathogen Erwinia amylovora
Authors: Schachterle Jeffrey K. , Zeng Quan , Sundin George W.
Published: March 2019

Erwinia amylovora, the causative agent of fire blight disease of apple and pear trees, causes disease on flowers by invading natural openings at the base of the floral cup. To reach these openings, the bacteria use flagellar motility to swim from stigma tips to the hypanthium and through nectar. We have previously shown that the Hfq‐dependent sRNAs ArcZ, OmrAB and RmaA regulate swimming motility in E. amylovora. Here, we tested these three sRNAs to determine at what regulatory level they exert their effects and to what extent they can complement each other. We found that ArcZ and OmrAB repress the flagellar master regulator flhD post‐transcriptionally. We also found that ArcZ and RmaA positively regulate flhD at the transcriptional level. The role of ArcZ as an activator of flagellar motility appears to be unique to E. amylovora and may have recently evolved. Our results suggest that the Hfq‐dependent sRNAs ArcZ, OmrAB and RmaA play an integral role in regulation of flagellar motility by acting primarily on the master regulator, FlhD, but also through additional factors.
Reflections on an ethnographic project with elementary educators on the Wind River Reservation: A cautionary tale
Authors: BIALOSTOK STEVEN
Published: March 2019

In this article, I analyze the successes and challenges of the first year of a four‐year applied anthropology project conducted on Wyoming's Wind River Reservation intended to help mostly white educators of Arapaho children who develop culturally relevant classroom pedagogy. Educators of Arapaho children have expressed concerns that student achievement is low, but also that the curriculum is largely disconnected from student backgrounds and experiences. Following deficit models, non‐Indian educators have historically cast American Indian schooling to reflect the norms and expectations constructed by the white dominant group. In contrast, in this study teachers were taught anthropological methods to conduct fieldwork in the households of children they taught. Teachers successfully documented historically accumulated and culturally developed bodies of knowledge and skills essential for household or individual functioning and well‐being. Teacher's ethnographic research fostered trust between school and families, and bridged communities to classrooms. On the other hand, pedagogical paradigms remained largely aligned with preexisting schooled programs, culturally relevant pedagogy existing as an add‐on but not inextricably embedded within the curriculum.
A case of MuSK myasthenia gravis associated with solitary lymphadenopathy and insidious autoimmune‐like diffuse encephalopathy
Authors: Konishi Tetsuro , Kohsaka Masayuki , Daifu Masako
Published: March 2019

We report an 81‐year‐old woman with anti‐muscle‐specific kinase (MuSK) antibody‐positive myasthenia gravis (MG) associated with solitary lymphadenopathy and insidious encephalopathy. At the age of 74, her myasthenic symptoms were remitted by immunosuppressive therapy and solitary abdominal lymphadenopathy was removed from the mesentery. Histopathological examinations showed follicular hyperplasia with marked IgG4‐positive plasma cell infiltration in the interfollicular connective tissues. Simultaneous head MRI examinations revealed diffuse brain lesions predominantly in the white matter without any neurological symptoms. The biopsied brain specimen showed scattered lymphocyte infiltration around vessels and reactive gliosis without IgG4‐positive plasma cells suggesting an autoimmune‐like encephalopathy. At the age of 81, MuSK‐MG was remittent, but the head MRI abnormalities sustained.
Invisible but sensible aesthetic aspects of excellence in nursing
Authors: Herholdt‐Lomholdt Sine Maria
Published: March 2019

Based on a Lived Experience Description written by an experienced nurse in Denmark, this article offers an ontological and existential‐phenomenological exploration of aesthetic dimensions of excellence in nursing. In the research of Patricia Benner and colleagues, excellence in nursing is described as a matter of intuitive pattern recognition based on clinical experience and narrative understanding. In this article, and based on phenomenological reflections and philosophical inspirations from the Danish philosopher Dorthe Jørgensen and the French philosopher Maurice Merleau‐Ponty, I suggest an extended understanding of excellence in nursing, and I argue that the work and research of Benner seem to overlook ontological and aesthetic aspects of excellence in nursing. This article argues that aesthetic aspects of excellence in nursing can be comprehended as moments where nurses sense a surplus of meaning and moments where the nurse and the patient share and are subjected to communal and unfolding life phenomena. Aesthetic dimensions of being in nursing can, from an ontological approach, best be described as similar to the way human beings listen to a piece of music or to how artists try to give a voice to the world: as a resonant way of being and becoming within the moment.
Risk for a second primary hypopharyngeal and esophageal cancer after an initial primary oral cancer
Authors: Su William Wang‐Yu , Chuang Shu‐Lin , Yen Amy Ming‐Fang , Chen Sam Li‐Sheng , Fann Jean Ching‐Yuan , Chiu Sherry Yueh‐Hsia , Chiu Han‐Mo , Su Chiu‐Wen , Hsu Chen‐Yang , Chen Mu‐Kuan , Chen Hsiu‐Hsi , Wang Cheng‐Ping , Lee Yi‐Chia
Published: March 2019

Objective

To investigate the risk for second primary cancer in the hypopharynx and esophagus (SPC‐HE) among individuals with an initial oral/oropharyngeal cancer.

Materials and Methods

Mass screening data from Taiwan (2004–2009) included individuals who were ≥18 years old and smoked cigarettes and/or chewed betel quid. Occurrence of SPC‐HE was monitored until December 31, 2014. Results were expressed as adjusted relative risk (aRR) and 95% confidence interval (CI).

Results

One hundred and fifty‐eight out of 4,494 subjects with oral cancer developed SPC‐HE (incidence rate: 6.47 per 1,000 person‐years). Relative to patients with primary cancers in the lip, the risk of an SPC‐HE was higher in patients with primary cancers in oropharynx (aRR: 19.98, 95% CI: 4.72–84.55), floor of mouth (aRR: 12.13, 95% CI: 2.67–55.15), and hard palate (aRR: 7.31, 95% CI: 1.65–32.37), but not in patients with cancers in tongue (aRR: 3.67, 95% CI: 0.89–15.17) or gum (aRR: 3.99, 95% CI: 0.92–17.35). Regression analyses also showed the risk of an SPC‐HE was greater in alcohol drinkers than those who did not (aRR: 1.65, 95% CI: 1.10–2.48).

Conclusions

Compared with the initial cancer in the lip, patients with a cancer in the oropharynx, floor of mouth, and hard palate had a higher risk for the SPC‐HE.
Influence of bisphosphonates on clinical features of osteoradionecrosis of the maxilla and mandible
Authors: Miniello Thaís Gimenez , Araújo Juliane Pirágine , Silva Maria Letícia Gobo , Paulo Kowalski Luiz , Rocha André Caroli , Jaguar Graziella Chagas , Abreu Alves Fábio
Published: March 2019

Background and purpose

Osteoradionecrosis (ORN) is one of the most severe adverse effects of radiotherapy (RT) to the head and neck region. Medication‐induced osteonecrosis of the jaw has been reported among patients using bisphosphonates. However, the impact of RT on osteonecrosis in patients using bisphosphonates has not yet been described. Therefore, the aim of this study was to compare ORN characteristics between patients who use and do not use bisphosphonates.

Materials and methods

This retrospective study evaluated 96 patients with ORN of the jaw. Patients were divided into group I (patients who did not receive bisphosphonates, n = 83) and group II (patients who did receive bisphosphonates, n = 13). Clinical data were obtained from medical charts.

Results

Osteoradionecrosis more often involved the mandibular jaw than the maxillary jaw for both patient groups. However, maxillary involvement was more common among patients who received bisphosphonates than those who did not (p = 0.014). There was also a trend toward earlier development of ORN in the group that received bisphosphonates (p = 0.21).

Conclusions

Bisphosphonate use appears to contribute to earlier development of ORN. Long‐term prospective studies are needed to understand the pathogenesis of ORN in patients treated with combined radiation and bisphosphonate therapy.
What is known about the spirituality in older adults living in residential care facilities? An Integrative review
Authors: Gautam Sital , Neville Stephen , Montayre Jed
Published: March 2019

Aim

To synthesize evidence regarding the spiritual needs and care of older adults living in residential care facilities from the perspectives of older adults and nurses or caregivers.

Design

Integrative review of literature.

Data sources

Literature search was conducted using CINAHL Plus with Full Text via EBSCO, Scopus, PubMed, PsychInfo, Web of Science, and ProQuest Social Science Databases from March to December 2017.

Review methods

This integrative review utilised the Whittemore and Knafl framework and PRISMA in the selection of eligible articles. Quality of the articles was evaluated using the Mixed Method Appraisal Tool.

Results

Seven articles were reviewed and analysed. There is limited evidence \and no agreed definition of spiritual needs and care of older adults living in residential care facilities. Spiritual needs of older adults in residential care facilities is a psycho‐social, religious and existential construct. Spiritual care in residential care facilities is linked to information gathering, religious guidance, maintaining family connections, providing companionship, discussing end of life issues, and providing counseling. Older adults highly value the role of nurses and caregivers in fulfilling their spiritual needs and providing spiritual care. However, nurses and caregivers perceived arranging a referral to a religious advisor as the main aspect of spiritual care. Therefore, nurses’, caregivers’, and older adults’ views on spiritual care differed to some extent.

Conclusion

The practical aspects of spiritual needs assessment and spiritual care provision requires further investigation, which is essential to improve the effectiveness of service delivery in residential care facilities.
A wheat NAC interacts with an orphan protein and enhances resistance to Fusarium head blight disease
Authors: Perochon Alexandre , Kahla Amal , Vranić Monika , Jia Jianguang , Malla Keshav B. , Craze Melanie , Wallington Emma , Doohan Fiona M.
Published: March 2019

Taxonomically‐restricted orphan genes play an important role in environmental adaptation, as recently demonstrated by the fact that the Pooideae‐specific orphan TaFROG (Triticum aestivum Fusarium Resistance Orphan Gene) enhanced wheat resistance to the economically devastating Fusarium head blight (FHB) disease. Like most orphan genes, little is known about the cellular function of the encoded protein TaFROG, other than it interacts with the central stress regulator TaSnRK1α. Here, we functionally characterized a wheat (T. aestivum) NAC–like transcription factor TaNACL‐D1 that interacts with TaFROG and investigated its’ role in FHB using studies to assess motif analyses, yeast transactivation, protein‐protein interaction, gene expression and the disease response of wheat lines overexpressing TaNACL‐D1. TaNACL‐D1 is a Poaceae‐divergent NAC transcription factor that encodes a Triticeae‐specific protein C‐terminal region with transcriptional activity and a nuclear localisation signal. The TaNACL‐D1/TaFROG interaction was detected in yeast and confirmed in planta, within the nucleus. Analysis of multi‐protein interactions indicated that TaFROG could form simultaneously distinct protein complexes with TaNACL‐D1 and TaSnRK1α in planta. TaNACL‐D1 and TaFROG are co‐expressed as an early response to both the causal fungal agent of FHB, Fusarium graminearum and its virulence factor deoxynivalenol (DON). Wheat lines overexpressing TaNACL‐D1 were more resistant to FHB disease than wild type plants. Thus, we conclude that the orphan protein TaFROG interacts with TaNACL‐D1, a NAC transcription factor that forms part of the disease response evolved within the Triticeae.
Cyber bullying among children with neurodevelopmental disorders: A systematic review
Authors: Beckman Linda , Hellström Lisa , von Kobyletzki Laura
Published: March 2019

Children and young adults with neurodevelopmental disorders (ND) are at increased risk of bullying compared to typically developing peers. It is still unclear to what extent they are involved in cyber bullying. This systematic review aimed at studying the prevalence of cyber bullying as perpetrators, victims, or both (“bully‐victims”) among students with ND in a school setting and in need of special education. The Web of Science, Scopus, ERIC, PsycINFO, PubMED, and Cochrane databases were searched including a manual search of reference lists, until February 24, 2018. Eight studies conducted in Europe, North America, the Middle East, and Australia were included reporting a prevalence of cyber‐victimization among students with ND of 0%–41%, a prevalence of cyber‐perpetration of 0%–16.7%, and a prevalence of bully‐victims of 6.7%. Three out of five studies using control groups showed that students with ND might be more involved in cyber bullying overall compared to typically developing students. Students in segregated school settings report slightly higher prevalence rates of cyber bullying compared to students with ND in inclusive school settings, especially among girls. When comparing prevalence rates among studies using the same definition, we found similar prevalence rates. There was a tendency towards students with ND being more involved in cyber bullying compared to typically developing students, but this needs to be confirmed in future studies that should include control groups with typically developing students as well as validated and standardized measurements of cyber bullying and ND diagnoses.
Identification of the novel HLA‐DRB5*02:21 allele in a Saudi individual
Authors: Aloufi Faisal , Gattan Manal , Alanazi Hanan , Alqasem Afnan , Hajeer Ali H.
Published: March 2019

HLA‐DRB5*02:21 differs from HLA‐DRB5*02:02 by a single‐nucleotide substitution (A → G) at position 3785.
TypeLoader2: Automated submission of novel HLA and killer‐cell immunoglobulin‐like receptor alleles in full length
Authors: Schöne Bianca , Fuhrmann Markus , Surendranath Vineeth , Schmidt Alexander H. , Lange Vinzenz , Schöfl Gerhard
Published: March 2019

The Immuno Polymorphism Database (IPD) databases provide global, curated repositories for information regarding polymorphisms of genes of the immune system, thereby generating immense value for the research and clinical communities. The advent of high‐throughput genotyping in immunogenetics has led to dramatically growing numbers of heretofore unknown HLA and lately also killer‐cell immunoglobulin‐like receptor (KIR) alleles, which are to be curated and deposited in the IPD‐IMGT/HLA and IPD‐KIR databases, respectively. It is highly desirable that these novel alleles are characterised and submitted in full length, and that known alleles are extended to cover the complete gene sequence.

However, the manual annotation and submission of sequences to European Molecular Biology Laboratory's European Nucleotide Archive and the IPD‐IMGT/HLA and IPD‐KIR databases is time‐consuming and error‐prone. Here, we report the substantial extension of the HLA allele submission tool TypeLoader, which now also supports the annotation and submission of KIR alleles. To enable a more widespread use of this tool, we have made it available as a stand‐alone application that can easily be installed on standard Windows or Linux computers. Furthermore, an internal SQLite database was added to store a wide range of metadata about each allele. This allows TypeLoader2 to be used as a lab's central information platform for the annotation, curation and submission of full‐length HLA and KIR allele sequences. The software is freely available from GitHub (https://github.com/DKMS-LSL/typeloader).

We hope that the increased convenience and scope of TypeLoader2 will foster the submission of more full‐length sequences to the IPD‐IMGT/HLA and IPD‐KIR databases, ultimately promoting the use of full‐length sequencing for genotyping both HLA and KIR.
Clinical performance among recent graduates in nine low‐ and middle‐income countries
Authors: Lewis Todd P. , Roder‐DeWan Sanam , Malata Address , Ndiaye Youssoupha , Kruk Margaret E.
Published: March 2019

Objectives

Recent studies have identified large and systematic deficits in clinical care in low‐income countries that are likely to limit health gains. This has focused attention on effectiveness of pre‐service education. One approach to assessing this is observation of clinical performance among recent graduates providing care. However, no studies have assessed performance in a standard manner across countries. We analysed clinical performance among recently graduated providers in nine low‐ or middle‐income countries.

Methods

Service Provision Assessments from Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda were used. We constructed a Good Medical Practice Index that assesses completion of essential clinical actions using direct observations of care (range 0–1), calculated index scores by country and clinical cadre, and assessed the role of facility and clinical characteristics using regression analysis.

Results

Our sample consisted of 2223 clinicians with at least one observation of care. The Good Medical Practice score for the sample was 0.50 (SD = 0.20). Nurses and midwives had the highest score at 0.57 (SD = 0.20), followed by associate clinicians at 0.43 (SD = 0.18), and physicians at 0.42 (SD = 0.16). The average national performance varied from 0.63 (SD = 0.18) in Uganda to 0.39 (SD = 0.17) in Nepal, persisting after adjustment for facility and clinician characteristics.

Conclusions

These results show substantial gaps in clinical performance among recently graduated clinicians, raising concerns about models of clinical education. Competency‐based education should be considered to improve quality of care in LMICs. Observations of care offer important insight into the quality of clinical education.
Genetic screen for factors mediating PIN polarization in gravistimulated Arabidopsis thaliana hypocotyls
Authors: Rakusová Hana , Han Huibin , Valošek Petr , Friml Jiří
Published: March 2019

Gravitropism is an adaptive response that orients plant growth parallel to the gravity vector. Asymmetric distribution of the phytohormone auxin is a necessary prerequisite to the tropic bending both in roots and shoots. During hypocotyl gravitropic response, the PIN3 auxin transporter polarizes within gravity‐sensing cells to redirect intercellular auxin fluxes. First gravity‐induced PIN3 polarization to the bottom cell membranes leads to the auxin accumulation at the lower side of the organ, initiating bending and, later, auxin feedback‐mediated repolarization restores symmetric auxin distribution to terminate bending. Here, we performed a forward genetic screen to identify regulators of both PIN3 polarization events during gravitropic response. We searched for mutants with defective PIN3 polarizations based on easy‐to‐score morphological outputs of decreased or increased gravity‐induced hypocotyl bending. We identified the number of hypocotyl reduced bending (hrb) and hypocotyl hyperbending (hhb) mutants, revealing that reduced bending correlated typically with defective gravity‐induced PIN3 relocation whereas all analyzed hhb mutants showed defects in the second, auxin‐mediated PIN3 relocation. Next‐generation sequencing‐aided mutation mapping identified several candidate genes, including SCARECROW and ACTIN2, revealing roles of endodermis specification and actin cytoskeleton in the respective gravity‐ and auxin‐induced PIN polarization events. The hypocotyl gravitropism screen thus promises to provide novel insights into mechanisms underlying cell polarity and plant adaptive development.
Adverse transfusion reactions in patients with aplastic anaemia or myelodysplastic syndromes
Authors: Moncharmont Pierre , Quittançon Elodie , Barday Grégory , Benamara Abdelhalim ,   les Correspondants d'Hémovigilance et de sécurité transfusionnelle Auvergne Rhône Alpes
Published: March 2019

Background and Objectives

Patients with aplastic anaemia or myelodysplastic syndromes frequently receive transfusions in an attempt to correct anaemia and/or thrombocytopenia, putting them at risk of adverse transfusion reactions. The aim of this study is to evaluate the incidence and the types of adverse transfusion reactions in these patients.

Materials and Methods

Adverse transfusion reaction reported in transfused patients with aplastic anaemia or myelodysplastic syndromes from all the hospitals in the Auvergne‐Rhône‐Alpes region of France were extracted from the national haemovigilance database system and analysed. The types of adverse transfusion reactions, their incidence, their severity, the blood component involved and its imputability were evaluated.

Results

From 1 January 2010 to 30 June 2016, 7174 adverse transfusion reactions were reported. Seventy adverse transfusion reactions (0·9%) were reported in patients with aplastic anaemia and 193 (2·7%) in patients with myelodysplastic syndromes. Febrile non‐haemolytic transfusion reaction was the most common reaction both aplastic anaemia (23 cases, 33·0%) and myelodysplastic syndrome (56 cases, 29·0%). Post‐transfusion red blood cell alloimmunization was also high in both these groups (17·1% in patients with aplastic anaemia and 22·3% in patients with myelodysplastic syndrome) frequently involving anti‐JK1 (Jka) specificity.

Conclusion

Febrile non‐haemolytic transfusion reaction was the most common adverse transfusion reaction in patients with aplastic anaemia or myelodysplastic syndromes who received transfusions. Post‐transfusion red blood cell alloimmunization was also observed frequently, but the use of RH‐KEL 1 (Rhesus‐Kell)‐matched red blood cell concentrates reduces this risk.
Radial torsion in dogs with medial compartment disease
Authors: Petkov Emanouil P. , Lesser Arnold S. , Lozier Scott M. , Maguire Patrick J. , Fischetti Anthony J. , Ahn Jaeil
Published: March 2019

Objective

To evaluate the magnitude and direction of radial torsion (RT) in dogs with medial compartment disease (MCD).

Study design

Case‐control study.

Sample population

Twenty‐eight healthy dogs and 28 dogs with confirmed MCD.

Methods

Computed tomography images of each dog's antebrachium were evaluated. Radial torsion was measured by using previously described landmarks on the proximal and distal radius. Differences between groups were tested with Student's t tests and Wilcoxon rank‐sum tests.

Results

Healthy dogs had a mean RT angle of 3.44° (range, 1.28°‐5.44°). Dogs with MCD had a mean RT angle of 11.84° (range, 2.31°‐26.55°). Both groups included similar proportions of dogs with external (76% vs 77%) and internal (24% vs 23%) torsion. The direction of torsion (P = .21 and P = .69) did not appear to affect the magnitude of the RT angle.

Conclusion

Dogs with MCD had an increased RT angle compared with healthy controls. The direction of torsion varied similarly between groups regardless of the disease status of dogs in this study.

Clinical significance

The fourfold increase in the RT seen in dogs with MCD may contribute to the rotational overload proposed recently, potentially modifying the orientation of the elliptical radial head and the ligaments crossing the elbow joint.
Quantitative assessment of nocturnal neural respiratory drive in children with and without obstructive sleep apnoea using surface EMG
Authors: Chuang Sandra Y. , Teng Arthur , Butler Jane , Gandevia Simon , Narang Indra , Briggs Nancy , Selvadurai Hiran , Jaffe Adam
Published: March 2019

New Findings

What is the central question of this study?

Recent studies have suggested potential utility of non‐normalized respiratory muscle EMG as an index of neural respiratory drive (NRD). Whether NRD measured using non‐normalized surface EMG of the lateral chest wall overlying the diaphragm (sEMGcw) recorded during nocturnal clinical polysomnography can differentiate children with and without obstructive sleep apnoea (OSA) is not known.

What is the main finding and its importance?

Non‐normalized sEMGcw was increased in children with OSA and an additional group of snoring children without OSA but subjectively increased respiratory effort compared with primary snorers. The sEMGcw has potential clinical utility in evaluation of children with sleep‐disordered breathing as an objective, non‐invasive, non‐volitional marker of NRD.

Our aim was to investigate whether neural respiratory drive measured by non‐normalized surface EMG recorded from the chest wall overlying the diaphragm (sEMGcw) differentiates children with and without obstructive sleep apnoea (OSA). Polysomnography data of children aged 0–18 years were divided into the following three groups: (i) primary snorers (PS); (ii) snoring children without OSA but with increased work of breathing (incWOB; subjective physician report of increased respiratory effort during sleep); and (iii) children with OSA [obstructive apnoea–hypopnoea index (OAHI) >1 h−1]. Excerpts of sEMGcw obtained during tidal unobstructed breathing from light, deep and rapid eye movement sleep were exported for quantitative analysis. Overnight polysomnography data from 45 PS [median age 4.4 years (interquartile range 3.0–7.7 years), OAHI 0 h−1 (0.0–0.2 h−1)], 19 children with incWOB [age 2.8 years (2.4–5.7 years), OAHI 0.1 h−1 (0.0–0.4 h−1)] and 27 children with OSA [age 3.6 years (2.6–6.2 years), OAHI 3.7 h−1 (2.3–6.9 h−1)] were analysed. The sEMGcw was higher in those with OSA [8.47 μV (5.98–13.07 μV); P < 0.0001] and incWOB [8.97 μV (5.94–13.43 μV); P < 0.001] compared with PS [4.633 μV (2.98–6.76 μV)]. There was no significant difference in the sEMGcw between children with incWOB and OSA (P = 0.78). Log sEMGcw remained greater in children with OSA and incWOB compared with PS after age, body mass index centiles, sleep stages and sleep positions were included in the mixed linear models (P < 0.0001). The correlation between sEMGcw and OAHI in children without OSA was small (rs = 0.254, P = 0.04). The sEMGcw is increased in children with OSA and incWOB compared with PS.
Performance Evaluation of an SOFC-GT Hybrid System With Ejectors for the Anode and Cathode Recirculations
Authors: Chen Jinwei , Gao Kuanying , Liang Maozong , Zhang Huisheng
Published: March 2019

The ejectors used for the fuel cell recirculation are more reliable and low cost in maintenance than high-temperature blowers. In this paper, an anode and cathode recirculation scheme, equipped with ejectors, was designed in a solid oxide fuel cell-gas turbine (SOFC-GT) hybrid system. The ejector model, SOFC model, and other component models and the validation were conducted to investigate the performance of the hybrid system with anode and cathode ejectors. The geometric parameters of the ejectors were designed to perform the anode and cathode recirculation loops according to the design conditions of the hybrid system with a blower-based recirculation loop. The cathode ejector geometries are much larger than the anode ejector. In addition, the sensitivity analysis of the primary fluid for the standalone anode and cathode ejectors is investigated. The results show that the ejector can recirculate more secondary fluid by reducing the ejector outlet pressure. Then, the anode and cathode ejectors were integrated into the SOFC-GT hybrid system. A blower gets involved downstream, and the compressor is necessary to avoid high expensive cost of redesigning compressor. The off-design and dynamic performance were characterized after integrating the anode and cathode ejectors into the hybrid system. The dynamic and off-design performances show that the designed ejectors are effectively integrated into the anode and cathode recirculation loops to replace the blower-based recirculation loops. The safety range of relative fuel flow rate is 0.62–1.22 in the fixed rotational speed strategy, and it is 0.53–1.1 in the variable rotational speed strategy. The variable rotational speed strategy can ensure higher system efficiency, which is more than 61% at a part-load condition.