bluuebunny/crossref_metadata_2025 huggingface dataset:
A casein kinase 1 prevents expulsion of the oocyte meiotic spindle into a polar body by regulating cortical contractility
Authors: Flynn Jonathan R. , McNally Francis J.
Published: July 2017

During female meiosis, haploid eggs are generated from diploid oocytes. This reduction in chromosome number occurs through two highly asymmetric cell divisions, resulting in one large egg and two small polar bodies. Unlike mitosis, where an actomyosin contractile ring forms between the sets of segregating chromosomes, the meiotic contractile ring forms on the cortex adjacent to one spindle pole, then ingresses down the length of the spindle to position itself at the exact midpoint between the two sets of segregating chromosomes. Depletion of casein kinase 1 gamma (CSNK-1) in Caenorhabditis elegans led to the formation of large polar bodies that contain all maternal DNA, because the contractile ring ingressed past the spindle midpoint. Depletion of CSNK-1 also resulted in the formation of deep membrane invaginations during meiosis, suggesting an effect on cortical myosin. Both myosin and anillin assemble into dynamic rho-dependent cortical patches that rapidly disassemble in wild-type embryos. CSNK-1 was required for disassembly of both myosin patches and anillin patches. Disassembly of anillin patches was myosin independent, suggesting that CSNK-1 prevents expulsion of the entire meiotic spindle into a polar body by negatively regulating the rho pathway rather than through direct inhibition of myosin.
Migraine and pregnancy-related hypertension
Authors: Benedetto Chiara , Gabellari Ilaria Castagnoli , Allais Gianni
Published: July 2017

Migraine is one of the most common, disabling neurological disorders in women of reproductive age. It is a disabling condition that can lead to a compromised health-related quality of life. Often `migraineurs' are unable to carry out everyday tasks due to a reduction in functioning and productivity. This burden impacts not only at work, but also on social and family life. Migraine affects not only the physical but also mental and social health. Chapter 5 discusses the available evidence of a correlation between migraine and pre-eclampsia. Pre-eclampsia complicates 3-5% of all pregnancies and remains a leading cause of maternal and perinatal morbidity, and mortality. Although the primary mechanisms of both migraine and pre-eclampsia are not yet well understood, they do share some common pathogenetic aspects. However, studies investigating the clinical association between migraine and pre-eclampsia are sparse. The majority suggest a close association between headaches and hypertensive disorders of pregnancy: gestational hypertension, pre-eclampsia, and eclampsia. There also appears to be a significant increase in the incidence of severe pre-eclampsia in women suffering from migraine. Clinical manifestations of both migraine and pre-eclampsia appear to result from an interaction of the mind and body. A relation with stress has been identified. Further robust research is needed to elucidate the psychosomatic contributions to the pathogenesis of migraine and pre-eclampsia, and the clinical application of their relationship in improving materno-fetal health.
Disease severity, pain, and patient perception: themes in clinical practice and research
Authors: Lal Mira , Bitzer Johannes
Published: July 2017

Chapter 6 begins with a discussion of how to assess disease severity. It then moves on to the concepts of physical and emotional pain, which are particularly useful for understanding pelvic floor problems, infertility, pregnancy loss, and chronic pelvic pain. All of these have biological, psychological, and social features associated with their aetiopathogenesis, and presentations. To manage these conditions effectively, it is crucial to understand the patient's perception. First, pelvic/perineal dysfunction is addressed. This includes the loss of urinary and bowel continence, with deleterious effects on biopsychosocial health. The condition is common, and can cause severe morbidity following any delivery mode, including a planned caesarean. This is illustrated by an evaluation of biopsychosocial morbidity, quantified by categorising patient perceptions of severity of incontinence, and related sexual problems. The psychosomatic repercussions of infertility, miscarriage, stillbirth, and chronic pelvic pain are then appraised. Since physical and emotional pain can affect these conditions, timely recognition and biopsychosocial management helps promote positive physical, mental and social health. A special focus is given to endometrial implants outside the uterine cavity (endometriosis). These can cause chronic pelvic pain, infertility, and pregnancy loss, but may be symptomless. Their aetiology remains unclear. Ovulation suppression relieves pain and treatment is tentative, with removal of the affected pelvic organs being an extreme option. Even after this, however, symptoms may persist. A pathway using the tailored psychosomatic approach is advocated to provide patient-centred care where indicated.
Vulval pain
Authors: MacLean Allan B
Published: July 2017

Vulval pain or pain involving the vulval tissue is discussed in Chapter 9. It becomes chronic when lasting for at least three months. Vulvodynia is a subset of chronic vulval pain, once known causes (infective, inflammatory, neoplastic, neurological, traumatic, iatrogenic and hormone deficiencies) are excluded. It reportedly affects one in six women at some stage of their lives. Uncertain terminology has hampered understanding. Even the latest classification from the International Society for the Study of Vulvovaginal Disease has deficiencies but it allows the discarding of previously used unhelpful terms. Differentiating features between provoked (entry dyspareunia), and unprovoked, localised and generalised, overlap, both in diagnosis and management. Older theories on causation included infection, irritation and inflammation but laboratory-based research has not supported these. Hormonal and neural mechanisms seem more likely to cause the pain, while the interplay of biological, psychological, and social factors has recently gained credence. Publications on successful management demonstrate a powerful placebo effect. The role of specially designated vulval pain clinics, multidisciplinary approaches, and team working is emphasised. General measures in vulval care, such as wearing clothes made of natural fibre, using emollients or carrying out pelvic floor exercises besides reducing stress, can minimise the pain. Topical anaesthetic creams or systemic treatments with antidepressants or anti-epileptics have advocates. Treatment is most effective when careful selection, adequate counselling, and ongoing psychosomatic evaluation address all the interactive factors that initiate, and maintain vulval pain besides modulating patient response. Case scenarios illustrate the complexities of diagnosis and management.
Psycho-oncology: the sexuality of women and cancer
Authors: Ohkawa Reiko
Published: July 2017

Female patients undergoing treatment for cancer often experience significant changes in their sexuality due to the disease and its treatment. Sexuality relates to the sexual habits and desires of each individual. It varies according to age-related sexual needs. Many women with cancer consider their sexuality an important aspect of their lives. Yet, they may refrain from sex or enjoy it less following treatment, whether it be surgical or by irradiation, and accompanied by adjunctive chemotherapy or hormonal therapy. Chapter 11 discusses these issues, with a vignette illustrating the impact of an unexpected diagnosis of cancer. Multiple studies have examined sexual dysfunction following treatment of gynaecological cancers, including breast cancer, and several proposed solutions are available. However, the information has not been implemented by many health providers, and patients often experience anxiety and embarrassment when planning to discuss sexuality. The patients may be concerned that their sexual habits might interfere with the treatment outcome, and cause a recurrence of cancer. Reproductive dysfunction is only one of the manifold problems in the female undergoing cancer therapy. It can lead to infertility but certain treatment methods could help retain fertility. Ethical concerns pertaining to the preservation, and use of germ cells, need to be addressed. Ideally, a team of healthcare providers should handle sexual rehabilitation of the cancer survivor based on the patient's history. Unfamiliarity with such matters makes many medical professionals hesitant in discussing their patients' sexuality. The PLISSIT model can help initiate the assessment of sexual dysfunction in these patients.
The Utility of Preoperative Magnetic Resonance Imaging for Determining the Flexibility of Sagittal Imbalance
Authors: Sharma Akshay , Pourtaheri Sina , Savage Jason , Kalfas Iain , Mroz Thomas E , Benzel Edward C , Steinmetz Michael P
Published: July 2017

BACKGROUND

Scoliosis X-rays are the gold standard for assessing preoperative lumbar lordosis; however, particularly for flexible lumbar deformities, it is difficult to predict from these images the extent of correction required, as standing radiographs cannot predict the thoracolumbar alignment after intraoperative positioning.

OBJECTIVE

To determine the utility of preoperative MRI in surgical planning for patients with flexible sagittal imbalance.

METHODS

We identified 138 patients with sagittal imbalance. Radiographic parameters including pelvic incidence and lumbar lordosis were obtained from images preoperatively.

RESULTS

The mean difference was 2.9° between the lumbar lordosis measured on supine MRI as compared to the intraoperative X-rays, as opposed to 5.53° between standing X-rays and intraoperative X-ray. In patients with flexible deformities (n = 24), the lumbar lordosis on MRI measured a discrepancy of 3.08°, as compared to a discrepancy of 11.46° when measured with standing X-ray.

CONCLUSION

MRI adequately determined which sagittal deformities were flexible. Furthermore, with flexible sagittal deformities, lumbar lordosis measured on MRI more accurately predicted the intraoperative lumbar lordosis than that measured on standing X-ray. The ability to preoperatively predict intraoperative lumbar lordosis with positioning helps with surgical planning and patient counseling regarding expectations and risks of surgery.
Development of a Predictive Score for Discharge Disposition After Lumbar Fusion Using the Quality Outcomes Database
Authors: Guan Jian , Knightly John J , Bisson Erica F
Published: July 2017

BACKGROUND

Lumbar fusion remains the treatment of choice for many degenerative pathologies. Healthcare costs related to the procedure are a concern, and postdischarge needs often contribute to greater expenditure. The Quality Outcomes Database (QOD) is a prospective, multicenter clinical registry designed to analyze outcomes after neurosurgical procedures.

OBJECTIVE

To create a simple scoring system to predict discharge needs after lumbar fusion.

METHODS

Institutional QOD data from 2 high-volume neurosurgical centers were collected retrospectively. Univariate and multivariable logistic regression analyses were used to identify factors for our model. A receiver operating characteristic curve was used to set cutoff scores for patients likely to discharge home without ongoing services and those likely to require additional services/alternative placement after discharge.

RESULTS

Two hundred seventeen patients were included. Five variables—osteoporosis, predominant preoperative symptom, need for assistive ambulation device, American Society of Anesthesiologist grade, and age—were included in our final scoring system. Patients with higher scores are less likely to need additional services. In patients with high scores (8-10), our scale correctly predicted discharge needs in 88.7% of cases. In patients with low scores (0-5), our scale predicted discharge needs (additional home services/alternative placement) in 75% of cases. For our final instrument, the area under the receiver operating characteristic curve was 0.809 (95% confidence interval 0.720-0.897).

CONCLUSION

We present a simple scoring system to assist in predicting postdischarge needs for patients undergoing lumbar fusion for degenerative disease. Further validation studies are needed to assess the generalizability of our scale.
Primary Neuroleptospirosis
Authors: Chiappe-Gonzalez Alfredo , Ticona-Huaroto César , Hoerster Valerie , Coral-Gonzales Carlos , Sihuincha-Maldonado Moisés
Published: July 2017

Leptospirosis is a highly prevalent, globally distributed zoonosis with an incidence 10 times higher in tropical regions, where the proportion of new cases correlates with rainy seasons. Secondary effects to the central nervous system in the immune phase of the illness typically manifest as aseptic meningitis. However, neurologic sequelae can be diverse and, although rare, other central and peripheral neurologic presentations have been described including the Guillain-Barré syndrome. Neuroleptospirosis as a primary disease manifestation is even more unusual. Below, we present the case of a 27-year-old woman with a Guillain-Barré–like syndrome as a primary manifestation of neuroleptospirosis as confirmed by positive IgM serology test result in paired samples and microscopic agglutination test reactive for Leptospira icterohaemorrhagiae in the convalescent phase. The patient had a favorable clinical outcome after treatment with antibiotics, corticosteroids, ventilator support, and physical therapy.
Experience of Treating Patients With Multidrug-Resistant Tuberculosis at a Public Health Hospital in Boston
Authors: Nagami Ellen H. , Gardner Adrian , McGowan Katherine , Woo-Roderick Myung S. , Turner Marie T.
Published: July 2017

Background

Management of patients with multidrug-resistant tuberculosis (MDR-TB) is challenging and resource intensive. We describe demographic/clinical characteristics, management, and outcomes of patients with MDR-TB in a designated TB unit in a public health hospital located in Boston, Massachusetts.

Methods

Records of 42 patients treated for MDR-TB between 1993 and 2014 were reviewed. Data were extracted from paper/electronic medical records.

Results

Forty-two patients were treated for MDR-TB between 1993 and 2014. The mean age was 41.9 years (17–78 years); 35 patients (83%) were foreign born. Thirty-three patients (78%) were diagnosed as having pulmonary TB, 5 (12%) as having extrapulmonary disease, and 4 (10%) as having both pulmonary and extrapulmonary TB. Thirty-six patients (86%) received an injectable agent; half received injectable therapy for 4 months or less. Fourteen (33%) received inhaled aminoglycosides. Mean time to culture conversion was 3.4 months. Thirty-three patients (79%) required admission to the inpatient unit for respiratory isolation, psychosocial reasons, or management of acute toxicities. Duration of treatment ranged from 10 to 29 months. All patients successfully completed therapy. There were no deaths.

Conclusions

All patients demonstrated clinical improvement and culture conversion, where appropriate, without relapse. Despite variations in treatment regimens, a significant number of individuals were cured with less than the recommended 6 months of injectable therapy. Given the complexity of second-line drugs and associated toxicities, the treatment of MDR-TB should be reserved for those with experience in this area with the support of a strong public health infrastructure to aid in this endeavor.
Relationship of Nonseptal Late Gadolinium Enhancement to Ventricular Tachyarrhythmia in Hypertrophic Cardiomyopathy
Authors: Amano Yasuo , Yanagisawa Fumi , Kitamura Mitsunobu , Tachi Masaki , Kumita Shinichiro
Published: July 2017

Objective

This study aimed to determine the relationship between the extent and the location of late gadolinium enhancement (LGE) and ventricular tachyarrhythmia or implantable cardioverter defibrillator (ICD) in hypertrophic cardiomyopathy (HCM).

Methods

We enrolled 115 patients with HCM and LGE. The location of LGE was divided into septal and nonseptal segments. Clinical backgrounds and LGE were compared in patients between with and without the arrhythmia or consequent ICD installation.

Results

There were significant differences in the number of risk markers, left ventricular ejection fraction, extent of global LGE, and extent of nonseptal LGE between the groups (P < 0.01). Multivariate analysis revealed that the number of risk markers and extent of nonseptal LGE contributed to ventricular tachyarrhythmia or ICD installation (P < 0.01).

Conclusions

The nonseptal LGE is related to ventricular tachyarrhythmia or ICD installation. We should be vigilant for nonseptal LGE when applying LGE to risk stratification for HCM.
Investigating the Robustness Neighborhood Gray Tone Difference Matrix and Gray Level Co-occurrence Matrix Radiomic Features on Clinical Computed Tomography Systems Using Anthropomorphic Phantoms: Evidence From a Multivendor Study
Authors: Mahmood Usman , Apte Aditya P. , Deasy Joseph O. , Schmidtlein C. Ross , Shukla-Dave Amita
Published: July 2017

Objective

The aim of this study was to determine if optimized imaging protocols across multiple computed tomography (CT) vendors could result in reproducible radiomic features calculated from an anthropomorphic phantom.

Methods

Materials with varying degrees of heterogeneity were placed throughout the lungs of the phantom. Twenty scans of the phantom were acquired on 3 CT manufacturers with chest CT protocols that had optimized protocol parameters. Scans were reconstructed using vendor-specific standards and lung kernels. The concordance correlation coefficient (CCC) was used to calculate reproducibility between features. For features with high CCC values, Bland-Altman analysis was also used to quantify agreement.

Results

The mean Hounsfield unit (HU) was 32.93 HU (141.7 to −26.5 HU) for the rubber insert and 347.2 HU (−320.9 to −347.7 HU) for the wood insert. Low CCC values of less than 0.9 were calculated for all features across all scans.

Conclusions

Radiomic features that are derived from the spatial distribution of voxel intensities should be particularly scrutinized for reproducibility in a multivendor environment.
Development of Correction for Signal-to-Noise Ratio Using a T2* With Improved Phase Method
Authors: Ikemitsu Natsuki , Kanazawa Yuki , Matsumoto Yuki , Sasaki Toshiaki , Hayashi Hiroaki , Miyoshi Mitsuharu , Harada Masafumi
Published: July 2017

Objective

This study aims to improve the signal-to-noise ratio (SNR) of the phase image focusing T
2
* and to develop an improved phase (iPhase) image acquired high SNR.

Methods

The iPhase images of phantom and brain were acquired with multi-echo spoiled gradient-echo. The phantom component was a gadopentetate dimeglumine (Gd-DTPA) solution made of different concentrations (0.1, 0.5, and 1 wt%) and Gd-DTPA (0.1, 0.5, and 1 wt%) with agar (1.0 wt%). We applied the iPhase image to susceptibility weighed image (SWI) and evaluated SNR of SWI.

Results

In phantom study, SNRs of conventional SWI at each sample were 19.8, 15.7, 7.4, 20.0, 17.4, and 27.3, respectively. Signal-to-noise ratios of SWI derived from iPhase method were 29.5, 33.7, 21.7, 28.5, 24.3, and 14.7, respectively. Then, the SNR showed an improvement of 196% at maximum (for the Gd-DTPA 1 wt% sample). In healthy volunteer study, SWI derived from iPhase method had the good contrast between white matter and gray matter.

Conclusions

The iPhase image was able to improve the phase SNR. Moreover, iPhase method makes it possible to obtain a high SNR image when applying to SWI.
Determinants of financial performance of real estate brokerage industry in Iran
Authors: Gholipour Hassan F. , Razali Muhammad Najib
Published: July 2017

Purpose

The aim of this study is to investigate the factors influencing the financial performance of the real estate brokerage (REB) industry in Iran.

Design/methodology/approach

The authors use two surveys concerning REB firms from provinces of Iran which were collected by the Statistical Centre of Iran in 2003 and 2011. The authors apply the pooled ordinary least squares and panel fixed-effects regressions to estimate the relationships between the explanatory variables and performance of REB industry.

Findings

The results indicate that in provinces where REB firms invest more in residential properties, vehicles, computers and business software, REB firms are more active in residential and non-residential property sales, and rent transactions have higher levels of financial performance. In addition, the results show that in provinces where REB firms invest more in non-residential properties and office furniture, REB industry has lower levels of financial performance. The authors also find that Iranian REB industry has significantly benefited from international economic and financial sanctions.

Practical implications

In terms of managerial implications, the authors findings potentially serve as guidance for Iranian REB firms to allocate resources and adjust their strategy to enhance their financial performance.

Originality value

Previous studies have typically been conducted in countries where REB firms mainly operate as intermediaries in transactions between property buyers and sellers, whereas in Iran, REB firms not only provide services to their clients but also are very active speculators in the property market. Furthermore, while there have been many studies that have investigated the various determinants of performance and efficiency of REB industry in developed economies, there is scant literature around this topic for Middle Eastern countries.
Spiritual development – a missing and powerful leverage when building learning organizations
Authors: Rupčić Nataša
Published: July 2017

Purpose

The purpose of this paper is to examine and discuss the role that spiritual development plays in the development of learning individuals and organizations. Spiritual development has been examined though the lens of various meditative practices (such as transcendental meditation, mindfulness and flow) and religious indoctrinations (such as Hinduism and Islam).

Design/methodology/approach

Possibilities of developing learning individuals and learning organizations have been examined by reviewing the benefits of meditative practices and core beliefs of several religious indoctrinations. The findings have been discussed and put into context of the desired learning organizations characteristics, especially from the perspective offered by Peter Senge.

Findings

The presented discussion points to the conclusion that spiritual development, either by practicing certain meditation practices or by implementing core values of different religious indoctrinations, can be considered as a missing and a powerful leverage when developing learning organizations. Spiritual development of individuals might be the missing link or the Holy Grail which could make the learning organizations, as defined by Senge, not only logical and desirable but also attainable.

Research limitations/implications

In this paper, other religious indoctrinations and their correspondence with the learning organization philosophy, besides Hinduism and Islam, have not been considered.

Practical implications

Implications for practitioners, especially managers, have been identified regarding recommendations for designing working environments that would enable space and time for practicing meditative practices. Implications for raising the level of consciousness have been identified for individuals striving to enliven their state of being and hence improve their creativity and motivation, as well as the inner sense of serenity and well-being. Suggestions have been provided for practitioners in the academic environment regarding the need to introduce the benefits of raising the level of consciousness to their students.

Social implications

Raising the level of consciousness and developing spirituality can have tremendous positive social implications in terms of improved health, ethical and moral conduct, social relations, creativity, productivity and general welfare.

Originality/value

By comparing the benefits of raising the level of consciousness by practicing meditation and reflecting on religious core values and beliefs with the desired learning organization characteristics, it becomes clear that individual spiritual development is the missing link when building learning organizations.
Devotion to Legalism: On the Brexit Case
Authors: Poole Thomas
Published: July 2017

This note examines the UK Supreme Court's judgment in the Brexit case, Miller v Secretary of State for Exiting the European Union. The case upheld the decision of the High Court, which rejected the claim that the foreign affairs prerogative provided a legal basis for giving notice to EU institutions of the UK's intention to withdraw from the EU. But the Supreme Court's preferred basis for dismissing that claim rested on the more general proposition that significant constitutional change can only be effected by statute. This position offers the germs of a jurisprudence of constitutional change and was substantiated by means of an analysis of Parliament's dual capacity as legislator and constituent agent. Miller also includes important and potentially innovative dicta on the relationship between international and domestic sources of law.
A genome‐wide association study reveals candidate genes for the supernumerary nipple phenotype in sheep (Ovis aries)
Authors: Peng W.‐F. , Xu S.‐S. , Ren X. , Lv F.‐H. , Xie X.‐L. , Zhao Y.‐X. , Zhang M. , Shen Z.‐Q. , Ren Y.‐L. , Gao L. , Shen M. , Kantanen J. , Li M.‐H.
Published: July 2017

Genome‐wide association studies (GWASs) have been widely applied in livestock to identify genes associated with traits of economic interest. Here, we conducted the first GWAS of the supernumerary nipple phenotype in Wadi sheep, a native Chinese sheep breed, based on Ovine Infinium HD SNP BeadChip genotypes in a total of 144 ewes (75 cases with four teats, including two normal and two supernumerary teats, and 69 control cases with two teats). We detected 63 significant SNPs at the chromosome‐wise threshold. Additionally, one candidate region (chr1: 170.723–170.734 Mb) was identified by haplotype‐based association tests, with one SNP (rs413490006) surrounding functional genes BBX and CD47 on chromosome 1 being commonly identified as significant by the two mentioned analyses. Moreover, Gene Ontology enrichment for the significant SNPs identified by the GWAS analysis was functionally clustered into the categories of receptor activity and synaptic membrane. In addition, pathway mapping revealed four promising pathways (Wnt, oxytocin, MAPK and axon guidance) involved in the development of the supernumerary nipple phenotype. Our results provide novel and important insights into the genetic mechanisms underlying the phenotype of supernumerary nipples in mammals, including humans. These findings may be useful for future breeding and genetics in sheep and other livestock.
Laparoscopic surgery to remove a cage that migrated to the retroperitoneal space during posterior lumbar interbody fusion: A case report
Authors: Okuyama Takashi , Tagaya Nobumi , Sugamata Yoshitake , Hirano Kousuke , Saito Kazuyuki , Yamagata Yukinori , Sameshima Shinichi , Noie Tamaki , Oya Masatoshi
Published: July 2017

Introduction

Cage migration into the retroperitoneal space during posterior lumbar interbody fusion rarely occurs. Here, we report a patient who underwent laparoscopic surgery to remove a migrated cage from the retroperitoneal space.

Case Presentation

A 76‐year‐old woman had a cage that had migrated into the retroperitoneal space during posterior lumbar interbody fusion. On abdominal CT, the migrated cage appeared at the front of the promontorium, just below the aortic and vena caval bifurcations. One day later, the patient underwent laparoscopic surgery using intraoperative fluoroscopy to extract the migrated cage. The patient's postoperative course was uneventful, and she was discharged on the fifth postoperative day.

Discussion

A cage that migrates during posterior lumbar interbody fusion can have serious consequences. In cases where the patient remains in stable condition, laparoscopic surgery is a useful and suitable method for removing the cage from the retroperitoneal space.
Using indocyanine green fluorescent imaging to successfully resect metachronous regional lymph node recurrence of rectosigmoid cancer
Authors: Tamura Koichi , Hotta Tsukasa , Yokoyama Shozo , Matsuda Kenji , Iwamoto Hiromitsu , Yamaue Hiroki
Published: July 2017

A 39‐year‐old female patient underwent anterior resection with locoregional lymph node dissection for rectosigmoid cancer at another hospital. The procedure involved transection of the superior rectal artery just below the origin of the left colic artery. Postoperative diagnosis was stage III B. The patient received adjuvant chemotherapy with oxaliplatin plus capecitabine for 6 months. Sixteen months after the operation, PET‐CT scans revealed regional lymph node metastases around the root of the inferior mesenteric artery. The patient was referred to our hospital with a recurrence of rectosigmoid cancer. We performed laparoscopic lymph node dissection with real‐time indocyanine green fluorescent images superimposed on color images to prevent intraoperative vascular insufficiency. We were able to successfully observe the sufficient blood flow in the descending colon. Postoperative pathological findings showed lymph node recurrence after initial surgery. She was discharged 7 days after the operation. In the 8 months since the second operation, the patient has not had any indication of further recurrence.
A cost analysis of a long‐term prospective study of patients treated with immediately loaded implant‐supported mandibular overdentures
Authors: Alfadda Sara A. , Attard Nikolai J.
Published: July 2017

Background

The economic burden for patients seeking treatment with implant‐supported prostheses has not been given adequate attention.

Purpose

To document long‐term costs from a prospective trial on edentulous patients treated with mandibular implant‐supported overdentures and 2 loading protocols.

Materials and methods

The direct clinical and time costs for 35 patients receiving an immediate‐loading protocol (ILP) and 40 patients with a conventional‐loading protocol, over 14 years of observation, were analyzed in 2016 Canadian dollars as a base year. Quality of life (QoL) for the ILP was measured using the OHIP‐20 questionnaire.

Results

The ILP was associated with higher complication costs ($870.77 ± 692.24 vs $85.73 ± 133.14) with resultant higher maintenance costs ($1746.37 ± 892.68 vs $853.04 ± 276.21) (P < .05). OHIP results showed a sustained improvement in QoL through the first 5 year of follow‐up. A worsening of QoL, specifically the functional‐related OHIP scores, was noted at 14 years. Incremental cost‐effectiveness ratios indicated that the accrued maintenance costs for the ILP made the treatment less cost‐effective over time.

Conclusions

This long‐term study confirmed that ILP is associated with higher maintenance costs and varying subjective QoL measurements. Clinical treatment protocols should be evaluated over a long period and address different perspectives.
Producing the Middle Class: Domestic Tourism, Ethnic Roots, and Class Routes in Brazil
Authors: Ricke Audrey
Published: July 2017

Este artigo analisa o papel que o turismo étnico tem na construção da classe média e a interação entre as classes médias rurais e urbanas neste processo. Baseando‐se em dados etnográficos da Festa Pomerana, uma festa alemã em Pomerode, Brasil, este artigo mostra que a manutenção da etnicidade é parte de um amplo processo de construção da classe média no Brasil. Este artigo usa a metáfora roots/routes para analisar a formação e manutenção de certos segmentos da classe média na América Latina. Este artigo ilustra que a classe média no Brasil ajuda a perpetuar tradições étnicas alemães no Brasil e ao mesmo tempo este turismo étnico contribui para a formação da classe média no país. O artigo salienta o papel que turismo doméstico tem na construção da identidade de classe média nas regiões rurais da América Latina e a interação com a classe média urbana. [Brasil, classe media, etnicidade, identidade, turismo]
Chronic kidney disease in Australian Human Immunodeficiency Virus‐infected patients: Analysis of the Australian HIV Observational Database
Authors: Cheung Jason , Puhr Rainer , Petoumenos Kathy , Cooper David A , Woolley Ian , Gunathilake Manoji , Raymond Nigel , Varma Rick , O'Connor Catherine C , Gracey David M
Published: July 2017

Aim

The aim of the present study was to examine data from the Australian HIV Observational Database (AHOD), and firstly, to describe the incidence of chronic kidney disease (CKD) and the rate of loss of renal function in HIV‐infected individuals living in Australia, and then to examine the risk factors contributing to CKD in this population.

Methods

AHOD patients over 18 years of age were eligible if they had at least two serum creatinine measurements from 1 April 2008 until 31 March 2016 and an initial estimated glomerular filtration rate (eGFR) greater than 60 mL/min per 1.73 m3. Cox proportional hazards models were used to assess risk factors for CKD, which included key patient demographic data and antiretroviral therapy (ART) exposure.

Results

Of 1924 patients included in the analysis between April 2008 and March 2016, 81 (4.2%) developed CKD (confirmed eGFR of less than 60 mL/min per 1.73 m3 through two consecutive eGFR measurements at least 3 months apart). Of the examined risk factors, baseline age, baseline eGFR, and the route of HIV acquisition were statistically significant predictors of development of CKD. ART exposure, viral hepatitis co‐infection, high viral load and low CD4 lymphocyte count were not found to be significant risk factors for CKD.

Conclusion

This is the first study to investigate the risk factors for development of CKD among Australian HIV‐infected patients using cohort data. It highlights the need for awareness of renal risk factors, particularly among older patients or in those with pre‐existing renal dysfunction. Further research is required to explore the discrepancy between patients who have acquired HIV through different means of exposure.
Duration of action of mepivacaine and lidocaine in equine palmar digital perineural blocks in an experimental lameness model
Authors: Hoerdemann Mona , Smith Rachael L. , Hosgood Giselle
Published: July 2017

Objective

To establish and compare the onset and duration of action of 2 local anesthetics based on objective lameness and skin sensitivity assessment.

Study design

Interventional crossover experimental trial with balanced randomization.

Animals

Eight horses.

Methods

Reversible forelimb lameness was induced in 8 horses. A palmar digital nerve block (PDNB) was applied with mepivacaine or lidocaine (both 2%). Quantitative lameness and skin sensitivity data were collected with an inertial sensor system and a force gauge, respectively. The times to lameness resolution/skin desensitization (T1), consistent lameness detection/partial return of skin sensitivity (T2), and complete return of lameness/skin sensitivity (T3) were determined and compared between treatments and assessment methods.

Results

Mepivacaine blocks resolved lameness in 8/8 horses, compared to 3/8 horses with lidocaine blocks. Both agents led to skin desensitization in 8/8 horses. Skin desensitization occurred sooner than lameness resolution after mepivacaine (P = .047). Duration of action was longer with mepivacaine than lidocaine (mean T3_lameness mepivacaine 366 minutes, lidocaine 113 minutes (P = .038); T3_skin mepivacaine 195 minutes, lidocaine 63 minutes [P ≤ .001]). Skin sensitivity returned sooner than lameness after lidocaine block at T3 (P = .015).

Conclusion

The use of lidocaine in PDNBs for the purpose of lameness diagnosis should be reassessed, as it may not resolve lameness despite loss of skin sensation. Mepivacaine is superior, with a reliable onset and longer duration of action. Skin desensitization as an indicator for the onset of action or effectiveness of PDNBs for mepivacaine and lidocaine, or as a measure of the duration of action of lidocaine PDNBs should be interpreted with caution.
Experiences of compassion fatigue in direct care nurses: a qualitative systematic review protocol
Authors: Salmond Erin , Ames Margaret , Kamienski Mary , Watkins Ann V. , Holly Cheryl
Published: July 2017

Review question/objectives:

: The objective of this qualitative systematic review is to examine available evidence on the experiences of direct care nurses of compassion fatigue (CF) within any nursing specialty or care setting. Specifically, this review will identify evidence on the following:

Direct care nurses’ perceptions of factors that contribute to or mediate CF.

Direct care nurses’ ability to recognize CF and care for themselves when experiencing the phenomenon.

Direct care nurses’ experiences of strategies that have assisted them to cope with CF.
Prenatal diagnosis of the fetal common arterial trunk. A case series
Authors: Marginean Claudiu , Gozar Liliana , Mărginean Cristina Oana , Suciu Horațiu , Togănel Rodica , Muntean Iolanda , Mureșan Maria Cezara
Published: July 2017

Fetal common arterial trunk is an anomaly represented by a unique arterial trunk that arouses from the base of the heart, and gives birth to systemic branches, both pulmonary and coronary, frequently associated with a ventricular septal defect (VSD) and has a poor prognosis. We present a series of 17 cases diagnosed in our tertiary center with different types of fetal common arterial trunk, its associated disorders, the evolution of the pregnancies, and of the neonates. We concluded that our cases support the fact that a complete intrauterine evaluation of each case of the common arterial trunk is impossible. The postnatal prognosis of the cases from our center was fatal, similar to most reports of the literature.
Effects of the NEDD8-Activating Enzyme Inhibitor MLN4924 on Lytic Reactivation of Kaposi's Sarcoma-Associated Herpesvirus
Authors: Chang Pey-Jium , Chen Lee-Wen , Chen Li-Yu , Hung Chien-Hui , Shih Ying-Ju , Wang Shie-Shan
Published: July 2017

The switch of Kaposi's sarcoma-associated herpesvirus (KSHV) from latency to lytic replication is a key event for viral dissemination and pathogenesis. MLN4924, a novel neddylation inhibitor, reportedly causes the onset of KSHV reactivation but impairs later phases of the viral lytic program in infected cells. Thus far, the molecular mechanism involved in the modulation of the KSHV lytic cycle by MLN4924 is not yet fully understood. Here, we confirmed that treatment of different KSHV-infected primary effusion lymphoma (PEL) cell lines with MLN4924 substantially induces viral lytic protein expression. Due to the key role of the virally encoded ORF50 protein in the latent-to-lytic switch, we investigated its transcriptional regulation by MLN4924. We found that MLN4924 activates the ORF50 promoter (ORF50p) in KSHV-positive cells (but not in KSHV-negative cells), and the RBP-Jκ-binding elements within the promoter are critically required for MLN4924 responsiveness. In KSHV-negative cells, reactivation of the ORF50 promoter by MLN4924 requires the presence of the latency-associated nuclear antigen (LANA). Under such a condition, LANA acts as a repressor to block the ORF50p activity, whereas MLN4924 treatment relieves LANA-mediated repression. Importantly, we showed that LANA is a neddylated protein and can be deneddylated by MLN4924. On the other hand, we revealed that MLN4924 exhibits concentration-dependent biphasic effects on 12-
O
-tetradecanoylphorbol-13-acetate (TPA)- or sodium butyrate (SB)-induced viral reactivation in PEL cell lines. In other words, low concentrations of MLN4924 promote activation of TPA- or SB-mediated viral reactivation, whereas high concentrations of MLN4924, conversely, inhibit the progression of TPA- or SB-mediated viral lytic program.

IMPORTANCE
MLN4924 is a neddylation (NEDD8 modification) inhibitor, which currently acts as an anti-cancer drug in clinical trials. Although MLN4924 has been reported to trigger KSHV reactivation, many aspects regarding the action of MLN4924 in regulating the KSHV lytic cycle are not fully understood. Since the KSHV ORF50 protein is the key regulator of viral lytic reactivation, we focus on its transcriptional regulation by MLN4924. We here show that activation of the ORF50 gene by MLN4924 involves the relief of LANA-mediated transcriptional repression. Importantly, we find that LANA is a neddylated protein. To our knowledge, this is the first report showing that neddylation occurs in viral proteins. Additionally, we provide evidence that different concentrations of MLN4924 have opposite effects on TPA-mediated or SB-mediated KSHV lytic cycle activation. Therefore, in clinical application, we propose that MLN4924 needs to be used with caution in combination therapy to treat KSHV-positive subjects.
Protection against HIV Acquisition in the RV144 Trial
Authors: Desrosiers Ronald C.
Published: July 2017

Differences of opinion regarding whether there may, or may not, have been protective efficacy in the RV144 vaccine trial have important societal implications.
Congenital kinking of aorta
Authors: Thodi Ramamurthy Muralidharan , Balakrishnan Vinod Kumar , David Sunny Anand Nesan , Korrapati Hema Sundar
Published: July 2017

Pseudocoarctation is an unusual anomaly mirroring true coarctation. Congenital kinking or pseudocoarctation of aorta was never a benign condition. Although surgical repair should be suggested for all symptomatic individuals. Regular follow-up is obligatory for all asymptomatic patients deprived of linked anomalies. We suggest CT-aortogram as a non-invasive imaging modality for the definitive diagnosis of pseudocoarctation.
What determines treatment satisfaction of patients with type 2 diabetes on insulin therapy? An observational study in eight European countries
Authors: Boels Anne Meike , Vos Rimke C , Hermans Tom G T , Zuithoff Nicolaas P A , Müller Nicolle , Khunti Kamlesh , Rutten Guy E H M
Published: July 2017

Objective

Patients with type 2 diabetes (T2DM) on insulin therapy are less satisfied with their diabetes treatment than those on oral hypoglycaemic therapies or lifestyle advice only. Determinants of satisfaction in patients with T2DM on insulin therapy are not clearly known. The aim of this study was to determine the association of treatment satisfaction with demographic and clinical characteristics of patients with T2DM.

Design

For this study we used data from the GUIDANCE (Guideline Adherence to Enhance Care) study, a cross-sectional study among 7597 patients with T2DM patients from Belgium, France, Germany, Ireland, Italy, Sweden, the Netherlands and the UK. The majority of patients were recruited from primary care. Treatment satisfaction was assessed by the Diabetes Treatment Satisfaction Questionnaire (DTSQ, score 0–36; higher scores reflecting higher satisfaction). To determine which patient characteristics and laboratory values were independently associated with treatment satisfaction, a linear mixed model analysis was used.

Participants

In total, 1984 patients on insulin were analysed; the number of included patients per country ranged from 166 (the Netherlands) to 384 (Italy).

Results

The mean DTSQ score was 28.50±7.52 and ranged from 25.93±6.57 (France) to 30.11±5.09 (the Netherlands). Higher DTSQ scores were associated with having received diabetes education (β 1.64, 95% CI 0.95 to 2.32), presence of macrovascular complications (β 0.76, 95% CI 0.21 to 1.31) and better health status (β 0.08 for every one unit increase on a 0–100 scale, 95% CI 0.07 to 0.10). Lower DTSQ scores were associated with more frequently perceived hyperglycaemia (β −0.32 for every 1 unit increase on a seven-point Likert scale, 95% CI −0.50 to −0.13), and higher glycated haemoglobin (β −0.52 for every percentage increase, 95% CI −0.75 to −0.29).

Conclusions

A number of factors including diabetes education, perceived and actual hyperglycaemia and macrovascular complications are associated with treatment satisfaction. Self-management education programmes should incorporate these factors for ongoing support in patients with T2DM.
Protecting study participants in emergency research: is community consultation before trial commencement enough?
Authors: Henry Blair , Perez Adic , Trpcic Sandy , Rizoli Sandro , Nascimento Barto
Published: July 2017

Background

This article presents the results of a community consultation (CC) process completed in Toronto, Ontario, using a random digit dialling technique, on the attitudes and perceptions of the public toward the use of exception from informed consent when conducting emergency research involving the use of massive blood transfusions.

Methods

In 2012, our hospital conducted a CC, using a random digit dialling technique, to elicit the attitudes and perceptions of the public toward the use of an exemption from informed consent for an upcoming clinical trial. A total of 500 participants from high violent crime areas were interviewed as part of this consultation.

Results

The response rate for the telephone survey was 54%. Participants indicated a personal acceptance rate of 76%, acceptance of the justification for the exception to consent at 81%, thatthe study would meet the best interest of patients and the community at 81% and that youth (between 15 and 18 years) could be enrolled at 71%. When offered, no participant requested an opt-out wrist band to avoid being enrolled in this study.

Discussion

The use of violent crime neighborhoods to locate at risk communities was not effective in identifying the appropriate community of interest for this study. Though only representing a small subpopulation from a large Canadian city, the attitudes noted here is suggestive that Canadians may have a similar level of acceptance as the US based on published studies. However, given the resources needed to undertake this process and that in the end it did not elicit any useful feedback or recommendations for enhancing the safety of participants, the future use of phone surveys as a means of engaging communities should be reconsidered.

Level of evidence (Level V)

This is a retrospective subanalysis of a CC using a randomized phone dialling technique from a site prior to the start of the Pragmatic Randomized Optimal Platelet and Plasma Ratios Trial. The CC was not designed specifically for research purposes and as such reflect only a case study from a single center.

Trial registration number

Pre-result,NCT01545232.
AI amusements
Authors: Williams Tom
Published: July 2017

Solve this acrostic puzzle by filling answers to the clues on the left into the dashed spaces to the right. Copying the letter above each numbered space into the same-numbered space in the grid above will yield a quotation from a work whose title and author will be spelled out in the first letter of each of your answers. Words are separated in the quotation grid by black squares, and as such may wrap between grid rows.