bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital Unilateral Renal Aplasia in a Cynomolgus Monkey (Macaca fascicularis) With Investigation Into Potential Pathogenesis
Authors: Obert Leslie A , Suttie Andrew , Abdi Mohamoud , Gales Tracy , Dwyer David , Fritz Wayne , Robertson Nicola , Weir Lucinda , Frazier Kendall
Published: August 2020

We describe and characterize unilateral renal aplasia in a cynomolgus monkey ( Macaca fascicularis) from a chronic toxicology study adding to the limited histopathology reports of congenital renal anomalies in macaques. In the current case, the affected kidney was macroscopically small and characterized microscopically by a thin cortex with an underdeveloped medulla and an absent papilla. The remnant medulla lacked a corticomedullary junction and contained only a few irregular collecting duct-like structures. The cortex had extensive interstitial mature collagen deposition with fibromuscular collar formation around Bowman’s capsules. Due to parenchymal collapse, mature glomeruli were condensed together with occasional atrophic and sclerotic glomeruli. The majority of the cortical tubules were poorly differentiated with only small islands of fully developed cortical tubules present. Histochemical and immunohistochemical stains were utilized to demonstrate key diagnostic features of this congenital defect, to assist with differentiating it from renal dysplasia, and to provide potential mechanistic pathways. Immunostaining (S100, paired box gene 2 [PAX2], aquaporins) of the medulla was compatible with incomplete maturation associated with aplasia, while the immunostaining profile for the cortex (vimentin, calbindin, PAX2-positive cortical tubules, and smooth muscle actin–positive fibromuscular collars) was most compatible with dedifferentiation secondary to degenerative changes.
Examining the Bidirectional Relations Between Language and Behavior in Head Start Children
Authors: Gigi An Zhe , Zeng Songtian , Chen Ching-I , Zhao Hongxia
Published: August 2020

The purpose of this study is to examine the bidirectional relationship between children’s language development and challenging behaviors as well as the moderating roles of gender and race/ethnicity. We conducted a number of structural equation modeling analyses with a national representative sample ( N = 2,462) of Head Start children from the 2014 Head Start Family and Child Experiences Survey. Results suggest that there is no bidirectional relationship between vocabulary development and challenging behavior in the full sample. However, gender, race/ethnicity, and the interaction between the two moderate associations between language and behavior.
Age-related features in vestibular migraine onset: A multiparametric analysis
Authors: Ori Michele , Arra Gabriele , Caricato Michela , Freccia Rocco , Frati Francesco , De Bonis Teodosio , Ricci Giampietro , Faralli Mario
Published: August 2020

Background

Clinical heterogeneity is a peculiarity of vestibular migraine, in contrast to other vestibular disorders that have a more stereotypical expression. Migraine presents a range of variability in symptoms depending on the age of the patient. Supposing that migraine headache and vestibular migraine share the same pathogenetic mechanisms, a multiparametric analysis was performed to verify the hypotheses of an age-related influence on the clinical features of vestibular migraine at the onset.

Methods

In this retrospective study, we analysed the clinical records of 72 consecutive patients affected by vestibular migraine from June 2012 to November 2018: 64 females and eight males; mean age 38.2 ± 9.6. We considered only patients that reported onset of vestibular symptoms within 12 months preceding inclusion into the study.

Results

Statistical analysis shows a significant increase in the diagnosis of probable vestibular migraine with increasing age and a decrease in vestibular migraine diagnosis ( p = 0.034). The incidence of spontaneous dizziness increases with age ( p = 0.012); by contrast, external spontaneous vertigo, and visually induced vertigo decrease after 40 years of age ( p = 0.018), clinically characterising the onset of juvenile forms. Spontaneous vertigo, head motion-induced vertigo/dizziness, and positional vertigo did not show significant variations with age.

Conclusion

Our data show that the type of vestibular symptoms in vestibular migraine varies according to the age of onset.
Microstructure evolution based particle chain model for shear yield stress of magnetorheological fluids
Authors: Peng Yongbo , Pei Pei
Published: August 2020

To predict the shear stress of magnetorheological fluids (MRFs) under magnetic field and shear flows, a meso-microscale shear model is proposed based on the entire course of particle aggregates and chains. For this purpose, a systematic study on the microstructure evolution and rheological properties of MRFs is conducted by using molecular dynamics simulations. An efficient chain identification technique is introduced to count the number of particle chains within the suspension system. From the perspective of particle-level simulations, the microstructured behavior of MRFs involving particle aggregation and internal structure evolution of magnetorheological suspensions are addressed. Shear properties of MRFs derived by the proposed model are studied, and model verification by comparison with previous experimental data and predictions of the existing structural viscosity model is included as well. It is revealed that the proposed meso-microscale shear model exhibits satisfactory accuracy and efficiency for describing the rheological properties of MRFs. Besides, the critical factors linked with rheological properties of MRFs such as magnetic field strength, particle volume fraction and shear rate, are analyzed, further demonstrating the applicability of the proposed model in design and optimization of MRFs.
Violence at the Intersections of Women’s Lives in an Urban Context: Indigenous Women’s Experiences of Leaving and/or Staying With an Abusive Partner
Authors: Smye Victoria , Varcoe Colleen , Browne Annette J. , Dion Stout Madeleine , Josewski Viviane , Ford-Gilboe Marilyn , Keith Barbara
Published: August 2020

This article is based on an ethnographic study exploring Indigenous women’s experiences of leaving intimate partner violence. Analysis draws attention to the contextual features of Indigenous women’s lives that differentially shaped women’s experiences of “leaving and/or staying” with an abusive partner. Our findings are identified and described across four intersecting thematic areas: (a) the context of state-Indigenous relations; (b) complex trauma, stigma, and discrimination; (c) kinship and ties to communities and the land; and (d) health, healing, and resistance. These findings offer valuable insights into what constitutes appropriate, safe services, and support for the Indigenous women whose lives are shaped by multiple forms of violence.
Synergistic effect of surface texturing and coating on the friction between piston ring and cylinder liner contact
Authors: Mishra Parul , Penchaliah Ramkumar
Published: August 2020

It is well-established that the piston ring/cylinder liner (PRCL) contact is the major contributor to friction losses in the internal combustion engine. While numerous studies have evaluated the individual effect of surface engineering techniques like surface texturing, coating, on the PRCL system, however, its combined effect has not been thoroughly explored. In this work, the combined effect of surface coating and texturing on the frictional properties of piston ring/cylinder liner (PRCL) contact in different lubrication regimes has been simulated using a reciprocating tribometer rig. A cylinder liner of cast iron material and three different types of piston ring coatings, namely Diamond-like-carbon (DLC), chrome, and moly-chrome-ceramic (MCC) were used as samples. Under all lubrication regimes, the coated samples with texturing had better frictional performance compared to non-textured coated samples. The maximum friction reduction was observed for textured DLC coated samples under boundary lubrication regime. This behaviour was proposed to be a result of the synergistic effect of graphitisation and texturing.
Self in the mirror: Uniting occidental and oriental views
Authors: Røgild-Müller Laura
Published: August 2020

The self is a complex system that no human being can ignore and yet it is still incredibly abstract. The present paper will apply occidental as well as oriental perspectives in its study of the dynamic of the dialogical self. Inspired by the work of David. Y. F. Ho I take on the task of looking at myself in the mirror to study the aspects of inner dialogue. The analysis is done with integration of Dialogical Self Theory and Dialectic perspectives. Leading into an illustration of the dialogical nature of spirituality.
The multi-level governance imperative
Authors: Allain-Dupré Dorothée
Published: August 2020

Governments are facing increasingly complex policy challenges, ranging from climate change, demographic pressures, rising inequalities and discontent, to the global health crisis that countries are presently confronting. Successful responses require more integrated approaches to policy making at all levels of government, so that economic, social and environmental actions reinforce each other rather than compete. They also require effective coordination across levels of government to manage shared responsibilities, mutual dependence and common challenges. This commentary highlights the progress in the multi-level governance concept since its first use, and focuses on some current dynamics driving multi-level governance, in particular the trend towards differentiated subnational governance. It then highlights that the way multi-level governance systems are designed has a direct impact on policy outcomes, hence the imperative to strengthen multi-level governance systems. The commentary offers insight into how the Organisation for Economic Co-operation and Development is tacking this imperative to best support countries in their development processes.
Third place theory and social work: Considering collapsed places
Authors: Littman Danielle Maude
Published: August 2020

While social work as a field predicates itself upon a person-in-environment approach, limited work has explored the nuanced relationship between a person and their environment. Exploring place, which can briefly be described as “meaningful location,” is one means of looking at the person-in-environment paradigm. This conceptual article builds upon Oldenberg and Brisset’s sociological theory of Third Places (which conceptualizes non-home/non-work places that provide a particular sense of well-being and belonging for participants) to consider an alternative theory of “collapsed places,” which recognizes the ways in which socially marginalized communities uniquely build meaning within their respective place contexts.

Findings

In a traditional first, second, and third places, Oldenburg and Brissett imagine that individuals can move freely throughout and between all three spaces. However, individuals whose lives are constrained for any number of reasons do not have this same freedom. Their places are thus “collapsed”—perhaps geographically so, or perhaps their mobility limitations constrain free movement. This article includes case examples from three “collapsed place” contexts—older adults, incarcerated communities, and individuals experiencing homelessness or housing instability.

Applications

Little has been done to operationalize social work theories of place towards practice. This article offers implications for social workers to better support clients and communities in operationalizing place-based social work research and practice. Considering how individuals and groups make meaning in “collapsed place” contexts can serve as a tool for social workers to engage with socially marginalized groups at micro, meso and macro levels.
Acute and short-term efficacy of sauna treatment on cardiovascular function: Ameta-analysis
Authors: Li Zhongyou , Jiang Wentao , Chen Yu , Wang Guanshi , Yan Fei , Zeng Tao , Fan Haidong
Published: August 2020

Objective

The role of sauna bathing in cardiovascular function treatment has been increasingly explored, but insufficient attention has been paid to its efficacy. We performed a meta-analysis to provide more evidence for the efficacy of sauna treatment in cardiovascular nursing.

Methods

Sixteen peer-reviewed journal articles were screened to summarize the efficacy of the sauna on cardiovascular function. Both acute (0–30 min after the sauna) and short-term (2–4 weeks following the sauna treatment) efficacies were investigated.

Results

For pooled acute efficacy, body temperature and heart rate significantly (p < 0.001) grew by 0.94°C and 17.86 beats/min, respectively; reductions of 5.55 mmHg (p < 0.001) and 6.50 mmHg (p < 0.001) were also observed in systolic blood pressure and diastole blood pressure, respectively. For combined short-term efficacy, left ventricular ejection fraction (LVEF), 6-min walk distance, and flow-mediated dilation (p < 0.001) increased by 3.27%, 48.11 m, and 1.71%, respectively; greater amelioration in LVEF was observed in participants with lower LVEF. The proportion of patients with New York Heart Association class III and IV decreased by 10.9% and 12.2%, respectively. Systolic blood pressure, diastolic blood pressure, brain natriuretic peptide concentration, left ventricular end-diastolic dimension, cardiothoracic ratio, and left atrial dimension reduced by 5.26 mmHg (p < 0.001), 4.14 mmHg (p < 0.001), 116.66 pg/mL (p < 0.001), 2.79 mm (p < 0.001), 2.628% (p < 0.05), and 1.88 mm (p < 0.05), respectively, while the concentration of norepinephrine in the plasma remained unchanged.

Conclusion

Sauna treatment was found to play a positive role in improving cardiovascular function and physical activity levels, especially in patients with low cardiovascular function. These findings reveal that thermal intervention may be a promising means for cardiovascular nursing.
HMGB1 Promotes the Proliferation and Metastasis of Lung Cancer by Activating the Wnt/β-Catenin Pathway
Authors: Wang Xiao-hui , Zhang Shu-ying , Shi Mei , Xu Xiao-peng
Published: August 2020

The aim of this study was to investigate the role of high mobility group protein-1 (HMGB1) in the proliferation and migration of lung cancer cells. CCK-8 assays and colony formation assays were used to evaluate the effect of HMGB1 regulation on cancer cell viability and colony formation. Trans-well assays and wound healing assays were also performed. Our data showed that HMGB1 is upregulated in clinical lung cancer tissues compared with non-cancer tissues, and it is differentially expressed in lung cancer cell lines. The knockdown of HMGB1 in A549 lung cancer cells significantly reduced cell proliferation, viability and motility. In contrast, overexpression of HMGB1 in lung cancer H1299 cells significantly increased cell viability and motility. Western blotting showed that HMGB1 could promote epithelial-mesenchymal transition. The Wnt/β-catenin pathway was activated after overexpression of HMGB1 in H1299 cells, while it was inactivated by knocking down HMGB1 in A549 cells. These data suggest that HMGB1 promotes the proliferation and migration of lung cancer cells in vitro. The carcinogenic behavior of HMGB1 can be achieved by activating the Wnt/β-catenin pathway.
Inhibition of oxidative stress and NLRP3 inflammasome by Saikosaponin-d alleviates acute liver injury in carbon tetrachloride-induced hepatitis in mice
Authors: Chen Yirong , Que Renye , Lin Liubing , Shen Yanting , Liu Jinkai , Li Yong
Published: August 2020

NLRP3 inflammasome activation results in severe liver inflammation and injury. Saikosaponin-d (SSd) possesses anti-inflammatory and hepatoprotective effects. This study aimed to determine the protective effects of SSd on carbon tetrachloride (CCl4)-induced acute liver injury in mice, and whether oxidative stress and NLRP3 inflammasome activation participate in the process.

The CCl4 mice model and controls were induced. The mice were treated with SSd at 1, 1.5, or 2.0 mg/kg in a total volume of 100 µl/25 g of body weight. Liver injury was assessed by histopathology. Oxidative stress was determined using mitochondrial superoxide production (MSP), malondialdehyde (MDA) content, and superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) activities. NLRP3, ASC, and Caspase 1 were determined by real-time PCR and western blot. IL-1β and IL-18 levels were determined by ELISA.

Significantly elevated oxidative stress was induced in the liver by CCl4, as demonstrated by histopathology and increases of MDA and MSP levels and decreases of SOD, GPx, and CAT activities (all P < 0.01). SSd significantly decreased the MDA and MSP levels and increased the activities of SOD, GPx, and CAT (all P < 0.05). The mRNA expression of NLRP3, ASC, and Caspase 1, and the protein expression of Caspase 1-p10, NLRP3, ASC, IL-1β, and IL-18 were significantly increased after CCl4 induction (all P < 0.01). These changes were reversed by SSd (all P < 0.05).

Suppression of the oxidative stress and NLRP3 inflammasome activation were involved in SSd-alleviated acute liver injury in CCl4-induced hepatitis.
Distal Biceps Tendon Repair Using a Modified Double-Incision Technique: Patient-Reported Outcomes With 10-Year Follow-up
Authors: Razaeian Sam , Zhang Dafang , Harb Afif , Meller Rupert , Krettek Christian , Hawi Nael
Published: August 2020

Background:

In the setting of complete distal biceps tendon rupture, surgical repair has become the standard of care to restore optimal elbow function, but the optimal approach and method of tendon fixation are still subjects of debate and have remained controversial for more than half a century.

Purpose:

To evaluate patient-reported long-term outcomes after distal biceps tendon repair using a modified double-incision technique.

Study Design:

Case series; Level of evidence, 4.

Methods:

We reviewed primary distal biceps tendon repairs after isolated tendon rupture using the modified muscle-splitting double-incision approach and transosseous suture fixation technique described by Morrey et al (1985), which had been performed at our level 1 trauma center between January 2000 and December 2013. Outcome measures included the subjective elbow value (SEV), the Oxford Elbow Score (OES) with its 3 domains (function, pain, and social-psychological), a self-performed hook test, and the 3-level version of the EuroQoL 5-dimensional instrument (EQ-5D-3L) as a measure of health status. Levels of overall satisfaction were determined by asking whether the patient would consent to the operation again. In addition, patients were asked to report any complications.

Results:

A total of 30 patients met the inclusion criteria, and 25 patients were available for the survey. Mean age at the time of rupture was 47 years. All patients were male. Mean follow-up was 120 months (range, 57-207 months). The follow-up rate was 83.34%. The following outcome results were obtained: SEV, 88.16% ± 25.18%; OES, 43.80 ± 10.56 out of 48 points; OES Pain, 92.50% ± 23.03%; OES Function, 92.25% ± 22.19%; OES Social-Psychological, 89% ± 23.68%; EQ-5D-3L, 0.93 ± 0.21. All patients described a negative hook test. Patient-reported complications included painless limitation in forearm rotation in 8% of patients (n = 2); reduced flexion and forearm rotation strength with and without pain in 8% (n = 2) and 4% (n = 1), respectively; synostosis after 1 year requiring revision surgery in 4% (n = 1); and transient wrist drop in 4% (n = 1). The overall complication rate was 28% (7/25), and 96% (n = 24) would consent to the operation again.

Conclusion:

Despite the cited approach-related morbidity, we report an excellent patient-reported long-term outcome for the double-incision distal biceps repair technique.
p53 activation during ribosome biogenesis regulates normal erythroid differentiation
Authors: Le Goff Salomé , Boussaid Ismael , Floquet Celia , Raimbault Anna , Hatin Isabelle , Andrieu-Soler Charlotte , Salma Mohammad , Leduc Marjorie , Gautier Emilie-Fleur , Guyot Boris , d’Allard Diane , Montel-Lehry Nathalie , Ducamp Sarah , Houvert Amandine , Guillonneau François , Giraudier Stéphane , Cramer-Bordé Elisabeth , Morlé François , Diaz Jean-Jacques , Hermine Olivier , Taylor Naomi , Kinet Sandrina , Verdier Frédérique , Padua Rose-Ann , Mohandas Narla , Gleizes Pierre-Emmanuel , Soler Eric , Mayeux Patrick , Fontenay Michaela
Published: August 2020

The role of ribosome biogenesis in erythroid development is supported by the recognition of erythroid defects in ribosomopathies in both Diamond-Blackfan anemia and 5q− syndrome. Whether ribosome biogenesis exerts a regulatory function on normal erythroid development is still unknown. In the present study, a detailed characterization of ribosome biogenesis dynamics during human and murine erythropoiesis showed that ribosome biogenesis is abruptly interrupted by the decline in ribosomal DNA transcription and the collapse of ribosomal protein neosynthesis. Its premature arrest by the RNA Pol I inhibitor CX-5461 targeted the proliferation of immature erythroblasts. p53 was activated spontaneously or in response to CX-5461, concomitant to ribosome biogenesis arrest, and drove a transcriptional program in which genes involved in cell cycle–arrested, negative regulation of apoptosis, and DNA damage response were upregulated. RNA Pol I transcriptional stress resulted in nucleolar disruption and activation of the ATR-CHK1-p53 pathway. Our results imply that the timing of ribosome biogenesis extinction and p53 activation is crucial for erythroid development. In ribosomopathies in which ribosome availability is altered by unbalanced production of ribosomal proteins, the threshold downregulation of ribosome biogenesis could be prematurely reached and, together with pathological p53 activation, prevents a normal expansion of erythroid progenitors.
Trunk-to-peripheral fat ratio predicts a subsequent blood pressure in normal-weight pubertal boys: a 3-year follow-up of the Kitakata Kids Health Study
Authors: Kouda Katsuyasu , Iki Masayuki , Fujita Yuki , Nakamura Harunobu , Hamada Masami , Uenishi Kazuhiro , Miyake Mari , Nishiyama Toshimasa
Published: August 2020

Background

Limited evidence exists regarding the relationship between central-to-peripheral fat ratio measured by dual-energy X-ray absorptiometry (DXA) and subsequent cardiometabolic risk in both pediatric and adult populations.

Methods

The present cohort study investigated the relationship between DXA-measured body fat distribution and cardiometabolic parameters. The source population was 275 4th–6th graders (aged 9.6–12.6 years) in the northeast region of Japan (Shiokawa area in Kitakata). A 3-year follow-up was conducted to obtain complete information from 155 normal-weight children (87 boys and 68 girls). Normal-weight children were identified using sex- and age-specific international cut-offs for body mass index (BMI) based on adult BMI values of 25 kg/m2and 18.5 kg/m2, respectively. Body fat distribution was assessed using the trunk-to-appendicular fat ratio (TAR) and trunk-to-leg fat ratio (TLR) measured by DXA.

Results

In boys, systolic blood pressure (SBP) at follow-up showed a significant relationship with TAR at baseline after adjusting for age, height, pubic hair appearance, SBP, and whole body fat at baseline (β= 0.24,P< 0.05), and SBP also showed a significant relationship with TLR after adjusting for confounding factors including whole body fat (β= 0.25,P< 0.05). In girls, there were no significant relationships between blood pressure and TAR/TLR.

Conclusion

Body fat distribution in normal-weight boys predicted subsequent blood pressure levels in adolescence. The relationship between fat distribution and blood pressure was independent of fat volume.
Candidate stress biomarkers for queen failure diagnostics
Authors: McAfee Alison , Milone Joseph , Chapman Abigail , Foster Leonard J. , Pettis Jeffery S. , Tarpy David R.
Published: August 2020

Background

Queen failure is a persistent problem in beekeeping operations, but in the absence of overt symptoms it is often difficult, if not impossible, to ascertain the root cause. Stressors like heat-shock, cold-shock, and sublethal pesticide exposure can reduce stored sperm viability and lead to cryptic queen failure. Previously, we suggested candidate protein markers indicating heat-shock in queens. Here, we further investigate these heat-shock markers and test new stressors to identify additional candidate protein markers.

Results

We found that heat-shocking queens for upwards of 1 h at 40 °C was necessary to induce significant changes in the two strongest candidate heat-shock markers, and that relative humidity significantly influenced the degree of activation. In blind heat-shock experiments, we tested the efficiency of these markers at assigning queens to their respective treatment groups and found that one marker was sufficient to correctly assign queens 75% of the time. Finally, we compared cold-shocked queens at 4 °C and pesticide-exposed queens to controls to identify candidate markers for these additional stressors, and compared relative abundances of all markers to queens designated as ‘healthy’ and ‘failing’ by beekeepers. Queens that failed in the field had higher expression of both heat-shock and pesticide protein markers, but not cold-shock markers.

Conclusions

This work offers some of the first steps towards developing molecular diagnostic tools to aid in determining cryptic causes of queen failure. Further work will be necessary to determine how long after the stress event a marker’s expression remains elevated, and how accurate these markers will be for field diagnoses.
Blood management in a patient with anti-Oka antibody who underwent cardiac surgery using cardiopulmonary bypass: a case report
Authors: Watanabe Yasuhiro , Suzuki Tomofumi , Kaneda Toru
Published: August 2020

Background

Cardiac surgery under cardiopulmonary bypass (CPB) is often associated with massive bleeding and blood transfusion. For patients requiring specific blood products, meticulous blood management is critical to reduce blood loss, as well as the need for transfusion. Here, we have described the intraoperative blood management in a patient with anti-Okaantibody, who underwent cardiac surgery with CPB.

Case presentation

A 79-year-old woman was scheduled for open aortic valve replacement and tricuspid valve annuloplasty under hypothermic CPB. Her blood type was A RhD(+) Ok(a−), and anti-Oka, an extremely rare antibody against erythrocyte antigen, was detected. Eight units of Ok(a−) frozen thawed red cells (FTRCs), and six units of red blood cells donated by three Ok(a−) individuals were collected just prior to surgery. Although she was anemic, acute normovolemic hemodilution was conducted after anesthesia induction to preserve the autologous whole blood. Four units of FTRCs were loaded in the CPB priming solution, and modified ultrafiltration was adopted during CPB to prevent further hemodilution. After CPB termination, two units of FTRCs, four units of fresh frozen plasma, and ten units of platelet concentrate were intensively transfused, facilitating surgical hemostasis and stable hemodynamics. The autologous whole blood was returned to the patient in the intensive care unit. Since the hemoglobin and hematocrit levels were maintained postoperatively, no additional transfusion was required throughout her hospital stay.

Conclusions

Multidisciplinary intraoperative blood management in a patient with anti-Okaantibody facilitated successful cardiac surgery using CPB, along with effective use of limited blood products.
Hydroxyethyl starch for perioperative goal-directed fluid therapy in 2020: a narrative review
Authors: Joosten Alexandre , Coeckelenbergh Sean , Alexander Brenton , Delaporte Amélie , Cannesson Maxime , Duranteau Jacques , Saugel Bernd , Vincent Jean-Louis , Van der Linden Philippe
Published: August 2020

Background

Perioperative fluid management – including the type, dose, and timing of administration –directly affects patient outcome after major surgery. The objective of fluid administration is to optimize intravascular fluid status to maintain adequate tissue perfusion. There is continuing controversy around the perioperative use of crystalloid versus colloid fluids. Unfortunately, the importance of fluid volume, which significantly influences the benefit-to-risk ratio of each chosen solution, has often been overlooked in this debate.

Main text

The volume of fluid administered during the perioperative period can influence the incidence and severity of postoperative complications. Regrettably, there is still huge variability in fluid administration practices, both intra-and inter-individual, among clinicians. Goal-directed fluid therapy (GDFT), aimed at optimizing flow-related variables, has been demonstrated to have some clinical benefit and has been recommended by multiple professional societies. However, this approach has failed to achieve widespread adoption. A closed-loop fluid administration system designed to assist anesthesia providers in consistently applying GDFT strategies has recently been developed and tested. Such an approach may change the crystalloid versus colloid debate. Because colloid solutions have a more profound effect on intravascular volume and longer plasma persistence, their use in this more “controlled” context could be associated with a lower fluid balance, and potentially improved patient outcome. Additionally, most studies that have assessed the impact of a GDFT strategy on the outcome of high-risk surgical patients have used hydroxyethyl starch (HES) solutions in their protocols. Some of these studies have demonstrated beneficial effects, while none of them has reported severe complications.

Conclusions

The type and volume of fluid used for perioperative management need to be individualized according to the patient’s hemodynamic status and clinical condition. The amount of fluid given should be guided by well-defined physiologic targets. Compliance with a predefined hemodynamic protocol may be optimized by using a computerized system. The type of fluid should also be individualized, as should any drug therapy, with careful consideration of timing and dose. It is our perspective that HES solutions remain a valid option for fluid therapy in the perioperative context because of their effects on blood volume and their reasonable benefit/risk profile.
Evaluation of β-blocker therapy for long-term outcomes in patients with low ejection fraction after cardiac surgery
Authors: Fan Fu-Dong , Zhang Hai-Tao , Pan Tuo , Tang Xin-Long , Wang Dong-Jin
Published: August 2020

Background

Preoperative low left ventricular ejection fraction (LVEF) has been reported as an independent risk factor for in-hospital mortality. However, there were few studies evaluating the long-term mortality in these patients. We, therefore, conducted this study to investigate long-term outcomes of surgery on patients with LVEF≤35% undergoing a broad range of cardiac procedures.

Methods

We performed a retrospective cohort study in 510 patients from January 1, 2007 to September 1, 2019. These patients were divided into survival group (n = 386) and non-survival group (n = 124). The multivariate Cox analysis was used to estimate the risk factors for survival. In Cox analysis, β-blockers were indicated to be associated with long-term mortality. To further address bias, we derived a propensity score predicting the function of β-blockers on survival, and matched 52 cases to 52 controls with similar risk profiles.

Results

Patients were followed for a median period of 24 months (interquartile range: 11–44 months). Multivariate Cox regression analysis indicated that the non-survival group had higher weight, higher EuroSCORE, more smoking patients, longer time of cardiopulmonary bypass (CPB), more intra-aortic balloon pump (IABP) use, and more patients who always used β-blocker (HR: 2.056, 95%CI:1.236–3.420, P = 0.005) compared with survival group. After propensity matching, the group which always used β-blocker showed higher rate of all-cause death compare with the control group (61.54% vs 80.77%, P = 0.030).

Conclusions

The risk factors for long-term survival were weight, EuroSCORE, smoking, CPB, IABP, always used β-blockers in patients with LVEF≤35%. The discharge prescription of β-blocker should be cautiously administrated in those patients.
The relationship between serum uric acid and cognitive function in patients with chronic heart failure
Authors: Niu Weihua , Yang Huifeng , Lu Chengzhi
Published: August 2020

Background

Evidence has shown that serum uric acid (UA) is associated with cognitive function, but this finding remains debatable. Serum UA is commonly elevated in patients with chronic heart failure (CHF), especially in men. However, the relationship between serum UA and cognitive function in CHF populations and stratified by sex are unclear. We aimed to examine whether serum UA was independently associated with cognitive function in CHF populations after controlling for demographic, medical and psychological variables and whether there was a sex difference in the association between serum UA and cognitive function among male and female CHF patients.

Methods

One hundred ninety-two hospitalized patients with CHF underwent an assessment of cognitive function using the Montreal Cognitive Assessment (MoCA) and the determination of serum UA. Hyperuricemia was defined as serum UA ≥7 mg/dl in men and ≥ 6 mg/dl in women. Multiple linear hierarchical regression analyses were conducted to examine the independent association between serum UA and cognitive function in CHF populations and stratified by sex.

Results

The mean serum UA concentration of participants was 7.3 ± 2.6 mg/dL. The prevalence of hyperuricemia was 54.7% (105 of 192) in CHF patients, 52.9% (64 of 121) in men, and 57.7% (41 of 71) in women. In the total sample, higher serum UA was associated with poorer cognitive function independent of demographic, medical and psychological variables (β = − 0.130, ΔR2 = 0.014, p = 0.015). In sex-stratified groups, elevated serum UA was independently associated with worse cognitive function in men (β = − 0.247, ΔR2 = 0.049, p = 0.001) but not in women (β = − 0.005, ΔR2 = 0.000, p = 0.955).

Conclusions

Higher serum UA is independently associated with poorer cognitive function in CHF populations after adjusting for confounding variables. Furthermore, elevated serum UA is independently related to worse performance on cognitive function in men but not in women. More longitudinal studies are needed to examine the association between serum UA and cognitive function in CHF populations and stratified by sex.
Recruiting people with severe mental illness through community pharmacies: real-world experiences from a UK study
Authors: Macfarlane Hannah , Maidment Ian
Published: August 2020

Background

Proxy recruitment of patient participants through community pharmacies may be a valuable strategy to maximise participation. This paper focuses on the feasibility of such a recruitment strategy for research involving people who experience severe mental illness.

Methods

Fifty-three community pharmacies, including 50 ‘Research Ready’ pharmacies, were asked to recruit people with severe mental illness for participation in research. Pharmacists were asked to provide participant information to anyone presenting a prescription meeting specific criteria.

Results

Thirteen recruitment sites (25%) (from 4 distinct organisations) were approved to recruit patient participants. Eighty-five percent (n = 11) failed to recruit any potential participants.

Conclusions

Proxy recruitment of people with severe mental illness through community pharmacies was challenging with challenges in both pharmacy- and participant-recruitment. Further investigation into supporting community pharmacists’ engagement with recruiting patients with SMI as research participants is required.
Retroperitoneal laparoscopic hepatectomy of recurrent hepatocellular carcinoma: case report and literature review
Authors: Li Baifeng , Liu Tao , Zhang Yijie , Zhang Jialin
Published: August 2020

Background

Almost all liver tumours can be removed laparoscopically, but some difficult tumour locations complicate laparoscopic surgery. Recurrent liver tumours often pose great difficulties to laparoscopic surgery due to adhesions caused by previous operations. Referring to laparoscopic adrenalectomy, a retroperitoneal approach is proposed to remove liver tumours near the adrenal gland, which will provide a new method for liver surgery.

Case presentation

Our case involves a patient with recurrent hepatocellular carcinoma (HCC) whose last operation was laparoscopic hepatectomy in our department, with a recurrence of HCC 2 years after the first surgery. In this case, based on preoperative CT and MRI, through a retroperitoneal approach, combined with intraoperative ultrasound (IOUS) localization and indocyanine green (ICG) fluorescence navigation, laparoscopic hepatectomy was successfully performed to precisely resect recurrent hepatocellular carcinoma in segment VII. The patient was discharged on the third day after the operation. The AFP decreased to normal levels on the 28th postoperative day.

Conclusions

Retroperitoneal hepatectomy has the advantages of less trauma, shorter operation times, fewer complications and faster recovery for hepatic tumours near the adrenal gland. Accurate localization of tumours is needed to ensure accurate resection; therefore, IOUS and ICG fluorescence are very important. Liver parenchyma was severed strictly according to fluorescent labelling during hepatectomy, which prevented the deviation of liver parenchyma from the plane and ensured that the margin of hepatectomy was tumour-free. In order to ensure a radical resection of the tumour, it may be necessary to enter the abdominal cavity.
Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: a systematic review and meta-analysis
Authors: Lyu Yunxiao , Wang Bin , Cheng Yunxiao , Xu Yueming , Du Wei Bing
Published: August 2020

Background

We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy.

Methods

We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.

Results

Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that reoperation rates following isolated pancreaticojejunostomy were lower reoperation than with conventional pancreaticojejunostomy (OR = 0.36, 95% CI: 0.15–0.86, p = 0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD = 43.61, 95% CI: 21.64–65.58, P = 0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage, reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy.

Conclusions

This study showed that isolated pancreaticojejunostomy was associated with a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.
Eosinophilic gastroenteritis as a cause of non-Helicobacter pylori, non-gastrotoxic drug ulcers in children
Authors: Joo Jung Yeon , Cho Jin Min , Yoo In Hyuk , Yang Hye Ran
Published: August 2020

Background

While Helicobacter pylori (H. pylori) ulcers has declined recently, H. pylori-negative and/or gastrotoxic drug-negative peptic ulcers (HNGN-PU) has increased. This study aimed to analyze the etiology of peptic ulcers in children and the differences in clinical, laboratory, endoscopic, and histopathologic findings of peptic ulcers according to etiology, including eosinophilic gastroenteritis (EoGE).

Methods

In total, 255 children (157 boys and 98 girls) with peptic ulcers were recruited. The subjects were categorized into 5 groups according to the etiology of the ulcer: 1) H. pylori infection (n = 51); 2) gastrotoxic drugs (n = 18); 3) idiopathic (n = 144); 4) systemic disease (n = 23); 5) EoGE (n = 19). Clinical data were reviewed and analyzed retrospectively.

Results

Age at diagnosis, ulcer recurrence, atopic dermatitis history, white blood cell count, blood eosinophil count, platelet count, serum albumin level, iron level, erythrocyte sedimentation rate, and C-reactive protein level differed significantly among the 5 groups (all p < 0.05). Regarding endoscopic findings, multiple ulcers and gastric mucosal nodularity differed among the 5 groups (all p < 0.05). When comparing the EoGE ulcer group with the others, EoGE group revealed older ages (p = 0.022), higher rates of ulcer recurrence (p = 0.018), atopic dermatitis history (p = 0.001), and both blood and tissue eosinophilia (both p = 0.001).

Conclusions

EoGE ulcers constituted 10.2% of HNGN-PU in pediatric patients. In children with HNGN-PU, peripheral eosinophilia, ulcer recurrence, and atopic dermatitis history might imply EoGE, necessitating thorough investigation of tissue eosinophils during endoscopic biopsy.

Trial registration

A total of 255 children was retrospectively registered between between July 2003 and April 2017.
Diagnosis-linked antibiotic prescribing in Swedish primary care - a comparison between in-hours and out-of-hours
Authors: Cronberg Olof , Tyrstrup Mia , Ekblom Kim , Hedin Katarina
Published: August 2020

Background

The rise in antibiotic resistance is a global public health concern, and antibiotic overuse needs to be reduced. Earlier studies of out-of-hours care have indicated that antibiotic prescribing is less appropriate than that of in-hours care. However, no study has compared the out-of-hours treatment of infections to in-hours treatment within the same population.

Methods

This retrospective, descriptive study was based on data retrieved from the Kronoberg Infection Database in Primary Care (KIDPC), which consists of all visits to primary care with an infection diagnosis or prescription of antibiotics during 2006–2014. The purpose was to study the trends in antibiotic prescribing and to compare consultations and prescriptions between in-hours and out-of-hours.

Results

The visit rate for all infections was 434 visits per 1000 inhabitants per year. The visit rate was stable during the study period, but the antibiotic prescribing rate decreased from 266 prescriptions per 1000 inhabitants in 2006 to 194 prescriptions in 2014 (mean annual change − 8.5 [95% CI − 11.9 to − 5.2]). For the out-of-hours visits (12% of the total visits), a similar reduction in antibiotic prescribing was seen. The decrease was most apparent among children and in respiratory tract infections.

When antibiotic prescribing during out-of-hours was compared to in-hours, the unadjusted relative risk of antibiotic prescribing was 1.37 (95% CI 1.36 to 1.38), but when adjusted for age, sex, and diagnosis, the relative risk of antibiotic prescribing was 1.09 (95% CI 1.08 to 1.10). The reduction after adjustment was largely explained by a higher visit rate during out-of-hours for infections requiring antibiotics (acute otitis media, pharyngotonsillitis, and lower urinary tract infection). The choices of antibiotics used for common diagnoses were similar.

Conclusions

Although the infection visit rate was unchanged over the study period, there was a significant reduction in antibiotic prescribing, especially to children and for respiratory tract infections. The higher antibiotic prescribing rate during out-of-hours was small when adjusted for age, sex, and diagnosis. No excess prescription of broad-spectrum antibiotics was seen. Therefore, interventions selectively aiming at out-of-hours centres seem to be unmotivated in a low-prescribing context.
Prevalence and trends of transfusion transmissible infections among blood donors in the State of Qatar, 2013–2017
Authors: Aabdien Mohamed , Selim Nagah , Himatt Sayed , Hmissi Saloua , Merenkov Zeyd , AlKubaisi Noora , Abdel-Rahman Manar E. , Abdelmola Abdelatif , Khelfa Shadi , Farag Elmoubasher , Al-Romaihi Hamad E. , Al-Thani Mohamed , Derbala Moutaz , Al-Kaabi Saad
Published: August 2020

Background

Millions of lives around the world are being saved annually through blood transfusion. However, blood transfusion is among the essential vehicles for transmitting infections. The overall prevalence of Transfusion Transmissible Infections among blood donors differs around the world, reflecting the variation in the prevalence of these infections. This study aims to assess the prevalence and trends of Transfusion Transmissible Infections among blood donors in Qatar.

Methods

This is a cross-sectional study utilizing donation records of 5 years from January 2013 to December 2017. We included in the study results for all screening and confirmatory tests for Hepatitis B Virus, Hepatitis C Virus, Human T-lymphotropic Virus-I/II, Syphilis and Malaria.

Results

Among the 190,509 donations received at the donation centre during the study period, about 91% of donations were received from males and 9% from females. The overall positivity rate for all tests was 1.87, 2.23, 1.78, 2.31, 2.67% for the years 2013 through 2017, with an increasing yearly trend by 6% each year. The overall positivity rates for Hepatitis C Virus, Human T-lymphotropic Virus-I/II, Hepatitis B Virus, Syphilis and Malaria (2013–2017) were 0.60, 0.18, 0.30, 0.43 and 0.20%, respectively.

Conclusion

The overall positivity rate of all tests combined for the Transfusion Transmissible Infections demonstrated a gradually increasing trend from 2013 to 2017. However, the trend for each infection (Hepatitis C Virus, Hepatitis B Virus, Syphilis and Malaria) was fluctuating except for Human T-lymphotropic Virus-I/II, which was increasing. Supporting the development of effective prevention and control strategies requires further comprehensive investigations for better estimation of the burden of these infections.