bluuebunny/crossref_metadata_2025 huggingface dataset:
Down‐regulation of natural resistance‐associated macrophage protein‐1 (Nramp1) is associated with 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine (MPTP)/1‐methyl‐4‐phenylpyridinium (MPP+)‐induced α‐synuclein accumulation and neurotoxicity
Authors: Wu K.‐C. , Liou H.‐H. , Lee C.‐Y. , Lin C.‐J.
Published: April 2018

Aims

The accumulation of α‐synuclein is a hallmark in the pathogenesis of Parkinson′s disease (PD). Natural resistance‐associated macrophage protein‐1 (Nramp1) was previously shown to contribute to the degradation of extracellular α‐synuclein in microglia under conditions of iron overload. This study was aimed at investigating the role of Nramp1 in α‐synuclein pathology in the neurone under 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine (MPTP)/1‐methyl‐4‐phenylpyridinium (MPP+) treatment.

Methods

The expression of Nramp1 and pathological features (including iron and α‐synuclein accumulation) were examined in the dopaminergic neurones of humans (with and without PD) and of mice [with and without receiving chronic MPTP intoxication]. The effects of Nramp1 expression on low‐dose MPP+‐induced α‐synuclein expression and neurotoxicity were determined in human dopaminergic neuroblastoma SH‐SY5Y cells.

Results

Similar to the findings in the substantia nigra of human PD, lower expression of Nramp1 but higher levels of iron and α‐synuclein were identified in the dopaminergic neurones of mice receiving chronic MPTP intoxication, compared to controls. In parallel to the loss of dopaminergic neurones, the numbers of glial fibrillary acidic protein‐ and ionized calcium‐binding adapter molecule‐1‐positive cells were significantly increased in the substantia nigra of MPTP‐treated mice. Likewise, in human neuroblastoma SH‐SY5Y cells exposed to low‐dose MPP+, Nramp1 expression and cathepsin D activity were decreased, along with an increase in α‐synuclein protein expression and aggregation. Overexpression of functional Nramp1 restored cathepsin D activity and attenuated α‐synuclein up‐regulation and neuronal cell death caused by MPP+ treatment.

Conclusions

These data suggest that the neuronal expression of Nramp1 is important for protecting against the development of MPTP/MPP+‐induced α‐synuclein pathology and neurotoxicity.
Obesity and the food system transformation inLatin America
Authors: Popkin B. M. , Reardon T.
Published: April 2018

The Latin America and the Caribbean (LAC) region faces a major diet‐related health problem accompanied by enormous economic and social costs. The shifts in diet are profound: major shifts in intake of less‐healthful low‐nutrient‐density foods and sugary beverages, changes in away‐from‐home eating and snacking and rapid shifts towards very high levels of overweight and obesity among all ages along with, in some countries, high burdens of stunting. Diet changes have occurred in parallel to, and in two‐way causality with, changes in the broad food system – the set of supply chains from farms, through midstream segments of processing, wholesale and logistics, to downstream segments of retail and food service (restaurants and fast food chains). An essential contribution of this piece is to marry and integrate the nutrition transition literature with the literature on the economics of food system transformation. These two literatures and debates have been to date largely ‘two ships passing in the night’.

This review documents in‐depth the recent history of rapid growth and transformation of that broad food system in LAC, with the rapid rise of supermarkets, large processors, fast food chains and food logistics firms. The transformation is the story of a ‘double‐edged sword’, showing its links to various negative diet side trends, e.g. the rise of consumption of fast food and highly processed food, as well as in parallel, to various positive trends, e.g. the reduction of the cost of food, de‐seasonalization, increase of convenience of food preparation reducing women's time associated with that and increase of availability of some nutritious foods like meat and dairy. We view the transformation of the food system, as well as certain aspects of diet change linked to long‐run changes in employment and demographics (e.g. the quest for convenience), as broad parameters that will endure for the next decades without truly major regulatory and fiscal changes.

We then focus in on what are the steps that are being and can be taken to curb the negative effects on diet of these changes. We show that countries in LAC are already among the global leaders in initiating demand‐related solutions via taxation and marketing controls. But we also show that this is only a small step forward. To shift LAC's food supply towards prices that incentivize consumption of healthier diets and demand away from the less healthy component is not simple and will not happen immediately. We must be cognizant that ultimately, food industry firms must be incentivized to market the components of healthy diets. This will primarily need to be via selective taxes and subsidies, marketing controls, as well as food quality regulations, consumer education and, in the medium term, consumers' desires to combine healthier foods with their ongoing quest for convenience in the face of busy lives. In the end, the food industry in LAC will orient itself towards profitable solutions, ie those demanded by the broad mass of consumers.
Longitudinal urinary metabolomic profiling reveals metabolites for asthma development in early childhood
Authors: Chiu Chih‐Yung , Lin Gigin , Cheng Mei‐Ling , Chiang Meng‐Han , Tsai Ming‐Han , Su Kuan‐Wen , Hua Man‐Chin , Liao Sui‐Ling , Lai Shen‐Hao , Yao Tsung‐Chieh , Yeh Kuo‐Wei , Huang Jing‐Long
Published: April 2018

Background

Several metabolites and altered metabolic pathways have been reported to be associated with asthma. However, longitudinal analysis of the dynamics of metabolites contributing to the development of asthma has not yet been fully clarified.

Methods

We sought to identify the metabolic mechanisms underlying asthma development in early childhood. Thirty children with asthma and paired healthy controls from a prospective birth cohort were enrolled. Time series analysis of urinary metabolites collected at ages 1, 2, 3, and 4 years was assessed using 1H nuclear magnetic resonance (NMR) spectroscopy coupled with partial least squares discriminant analysis (PLS‐DA). Metabolites identified were studied in relation to changes over time in a linear mixed model for repeated measures.

Results

A total of 172 urine samples collected from the enrolled children were analyzed. Urinary metabolomics identified four metabolites significantly associated with childhood asthma development, with longitudinal analysis. Among them, dimethylamine, a metabolite produced by intestinal bacteria, appeared to shift from higher to lower level during asthma development. A persistent lower level of 1‐methylnicotinamide and allantoin was found in children with asthma, with a peak difference at age 3 years (P = .032 and P = .021, respectively). Furthermore, a significant inverse correlation was found between allantoin and house dust mite sensitization (Spearman’s r = −.297 P = .035).

Conclusions

Longitudinal urinary metabolomic profiling provides a link of microbe‐environment interactions in the development of childhood asthma. 1‐Methylnicotinamide and allantoin may participate in allergic reactions in response to allergen exposure, potentially serving as specific biomarkers for asthma.
Associations of ultra‐processed food and drink products with asthma and wheezing among Brazilian adolescents
Authors: Melo B. , Rezende L. , Machado P. , Gouveia N. , Levy R.
Published: April 2018

Background

Although both consumptions of ultra‐processed products and asthma are common during adolescence, the epidemiological evidence in regarding their association is unclear. We investigated the associations of ultra‐processed products consumption with asthma and wheezing in a representative sample of Brazilian adolescents.

Methods

We used data from a representative sample of 109 104 Brazilian adolescents enrolled in the National Survey of School Health, 2012. The consumption of ultra‐processed products was based on the weekly consumption (0‐2, 3‐4, ≥5 d/wk) of sweet biscuits, salty biscuits, ultra‐processed meats, sweets/candies, soft drinks, and packaged snacks over the previous 7 days. We also calculated an ultra‐processed consumption score by adding partial scores corresponding to weekly frequency intake of each ultra‐processed product. The ultra‐processed consumption score ranged from 0 to 42, the higher score, the higher the intake of these products. The presence of wheezing in the previous 12 months and asthma at any time in the past was self‐reported.

Results

The adjusted odds ratios of asthma comparing the extreme categories ranged from 1.08 (95% CI 1.03‐1.13) for sweets/candies to 1.30 (1.21‐1.40) for ultra‐processed meats. Similar magnitude of associations was found for wheezing outcome. The ultra‐processed consumption score was positively associated with the presence of asthma and wheezing in a dose‐response manner. The adjusted OR of asthma and wheezing comparing highest to lowest quintile of ultra‐processed consumption score was 1.27 (95% CI 1.15‐1.41) and 1.42 (1.35‐1.50), respectively.

Conclusions

The consumption of ultra‐processed products was positively associated with the presence of asthma and wheezing in adolescents.
Burst Spinal Cord Stimulation in Peripherally Injured Chronic Neuropathic Rats: A Delayed Effect
Authors: Meuwissen Koen P. V. , Gu Jianwen Wendy , Zhang Tianhe C. , Joosten Elbert A. J.
Published: April 2018

Objective

Two well‐known spinal cord stimulation (SCS) paradigms, conventional (Con) and burst SCS, are hypothesized to exert their antinociceptive effects through different stimulation‐induced mechanisms. We studied the course of the behavioral antinociceptive effect during 60 minutes of SCS and 30 minutes post‐SCS in a rat model of chronic neuropathic pain.

Methods

Animals underwent a unilateral partial sciatic nerve ligation, after which quadripolar electrodes were implanted into the epidural space at vertebral level T13 (n = 43 rats). While receiving either Con SCS or biphasic burst SCS, the pain behavior of the rats was assessed by means of paw withdrawal thresholds (WTs) in response to the application of von Frey monofilaments.

Results

After 15 minutes of Con SCS (n = 21), WTs significantly differed from baseline (P = 0.04), whereas WTs of the burst SCS group (n = 22) did not. After 30 minutes of SCS, WTs of the Con SCS and burst SCS groups reached similar levels, both significantly different from baseline, indicating a comparable antinociceptive effect for these SCS paradigms. Yet, the WTs of the burst SCS group were still significantly increased compared with baseline at 30 minutes post‐stimulation, whereas the WTs of the Con SCS group were not.

Conclusions

To conclude, biphasic burst SCS results in a delayed antinociceptive effect after onset of the stimulation, as compared with Con SCS, in a chronic neuropathic pain model. Furthermore, biphasic burst SCS seems to exhibit a delayed wash‐out of analgesia after stimulation is turned off.
Multidimensional Patient Impression of Change Following Interdisciplinary Pain Management
Authors: Gagnon Christine M. , Scholten Paul , Atchison James
Published: April 2018

Objectives

To assess patient impression of change following interdisciplinary pain management utilizing a newly developed Multidimensional Patient Impression of Change (MPIC) questionnaire.

Methods

A heterogeneous group of chronic pain patients (N = 601) participated in an interdisciplinary treatment program. Programs included individual and group therapies (pain psychology, physical therapy, occupational therapy, relaxation training/biofeedback, aerobic conditioning, patient education and medical management). Patients completed measures of pain, mood, coping, physical functioning and pain acceptance both prior to and at completion of their treatment programs. The newly developed MPIC is an expansion to the Patient Global Impression of Change (PGIC) including seven additional domains (Pain, Mood, Sleep, Physical Functioning, Cope with Pain, Manage Pain Flare‐ups, and Medication Effectiveness). The MPIC was administered to the patients post‐treatment.

Results

There were statistically significant pre‐ to post‐treatment improvements found on all outcome measures. The majority of these improvements were significantly correlated with all domains of the MPIC. The original PGIC item was significantly associated with all of the new MPIC domains and the MPIC domains were significantly associated with each other; but there were variations in the distribution of responses highlighting variation of perceived improvements among the domains. The MPIC accounted for greater amounts of variance among the program outcomes than did the PGIC.

Conclusion

Our results support the use of the MPIC as a quick and easy post‐treatment assessment screening tool. Future research is needed to examine relevant correlates to Medication Effectiveness.
Beta Distributions and Sonine Integrals for Bessel Functions on Symmetric Cones
Authors: Rösler Margit , Voit Michael
Published: April 2018

There exist several multivariate extensions of the classical Sonine integral representation for Bessel functions of some indexwith respect to such functions of lower index μ. For Bessel functions on matrix cones, Sonine formulas involve beta densitieson the cone and trace already back to Herz. The Sonine representations known so far on symmetric cones are restricted to continuous ranges, where the involved beta densities are probability measures and the limiting indexdepends on the rank of the cone. It is zero only in the one‐dimensional case, but larger than zero in all multivariate cases. In this paper, we study the extension of Sonine formulas for Bessel functions on symmetric cones to values of ν below the critical limit μ0. This is achieved by an analytic extension of the involved beta measures as tempered distributions. Following recent ideas by A. Sokal for Riesz distributions on symmetric cones, we analyze for which indices the obtained beta distributions are still measures. At the same time, we characterize the indices for which a Sonine formula between the related Bessel functions exists. As for Riesz distributions, there occur gaps in the admissible range of indices, which are determined by the so‐called Wallach set.
Elite swimmers’ internal markers trajectories in ecological training conditions
Authors: Vacher P. , Martinent G. , Mourot L. , Nicolas M.
Published: April 2018

This study examined the trajectories of elite swimmers’ recovery‐stress states and cardiac vagal‐related markers during a 3‐month training period preceding the national championship and their within‐person relationships with perceived control. A Multilevel Growth Curve Analysis (MGCA) approach was used with 21 male elite swimmers. Four waves of assessments of psychological (stress, recovery, perceived control) and physiological (heart rate recovery, heart rate variability) markers were completed during a 3month training preparation leading to a major competition. Results of MGCA revealed (a) a significant positive linear effect of time (ie, linear increase over time) and a significant negative quadratic effect of time (ie, inverted U shape over time) on perceived stress whereas the opposite pattern of results was observed for perceived recovery; and (b) a significant positive linear effect of time for nHRR60. Both at level 1 (within‐person level of analysis) and 2 (between‐person level of analysis), perceived control was (a) positively associated with athletes’ perceived recovery and parasympathetic markers (ie, MeanRR; pNN50); and (b) negatively related to swimmers’ perceived stress. Results also indicated that within‐person interactions of perceived control with time reached significance for general recovery and HRV. Finally, within‐person interaction of perceived control with squared time reached significance for subjective sport‐specific and total stress. Overall, this study provided insights into the key role played by perceived control on both psychological and physiological markers related to recovery‐stress states’ levels during the 3‐month training period preceding the national championship.
The Metaphors of Secondary School Teachers Towards the Concept of “Multiculturalism”
Authors: Avcı Emine Karasu , Faiz Melike
Published: April 2018

In this research, it is aimed to reveal the perceptions which teachers from various branches and performing duty in secondary schools have, concerning the concept of multiculturalism, through metaphors. As one of the qualitative research methods, phenomenological design has been used in the research. The study group of the research is composed of 70 teachers who worked in the secondary schools located in Kastamonu Province and its districts in the academic year 2016-2017, and voluntarily accepted to participate in the research. Within the scope of the research, data has been obtained by asking teachers to complete the statement: Multiculturalism is like …; because …. The collected data has been analyzed by means of descriptive analysis. In the research, it has been concluded that teachers generally have positive perceptions related to the multiculturalism concept. Teachers consider the concept of multiculturalism mostly as a sense embracing differences and riches, with the metaphors which they have already enhanced. Besides, in the research, a negative result regarding multiculturalism as a divisive factor has been also received. As for the metaphors that the teachers have mainly developed, these are the metaphors of rainbow, forest, riches, jigsaw puzzle, food, garden, Noah’s pudding, synthesis and change.
Investigation of Relationship Between Theoretical Practice Course Success and Attendance
Authors: Dalkıran Oğuzhan
Published: April 2018

The aim of the study is to determine the relationship between the attendance of theoretical and applied field courses and the success status of the students attending Sports Science Faculty. The data of the study consisted of 68 female and 88 male students in the Faculty of Sports Sciences; two lectures and two practicals, and 624 grade points and 14 weekly course hours. The data were obtained from course attendance schedules of the instructors and transcripts from the academician information system. In the analysis of the data, descriptive statistical analysis in the SPSS (Ver.22) package program, the direction and strength of the relationship between dependent and independent variables in relation by the Pearson product moment correlation analysis, course attendance and academic success test by regression analysis was determined. There was a moderate, positive, and meaningful relationship between attendance and academic achievement (r = 0.528, p <.01). There was a moderate, positive and significant relationship between attendance and academic success in both theoretical and applied courses (R = 0.610, p <.01, r = 0.575, p <.01). As another result; there is a significant relationship between the predictor variable attendance and the academic success, which is the predictor variable (r = 0.528, p <.050). According to this result; it can be said that 28% of the variance related to academic achievement is explained with the attendance.
Data fitting in Monod-type models with nonlinear growth rates
Authors: Ivanov Tihomir , Velikova Gergana
Published: April 2018

We consider the classical Monod model and modify it by introducing generic growth rate for the biomass that is monotonically increasing with respect to the functional response. We show that this modification does not lead to qualitatively new possibilities for the model solutions. On the other hand, however, it allows better flexibility in terms of fitting experimental data. In particular, we use experimental data for microbial growth under inhibitory conditions, make parametric identificationВ and show that the modified model performs far better than the classical one.
80th Anniversary of the birth of Prof. Donald Knuth (1938)
Authors: Iliev Anton , Kyurkchiev Nikolay V.
Published: April 2018

In this year one of the most famous people in theoretical ComputerScience Prof. Knuth celebrates his 80th birthday.
Controlling sensation intensity for electrotactile stimulation in human-machine interfaces
Authors: Akhtar Aadeel , Sombeck Joseph , Boyce Brandon , Bretl Timothy
Published: April 2018

Modulating electrotactile stimulation parameters in response to changes in impedance reduces variation in perceived sensation.
Discovery of Four Novel Circular Single-Stranded DNA Viruses in Fungus-Farming Termites
Authors: Kerr Mason , Rosario Karyna , Baker Christopher C. M. , Breitbart Mya
Published: April 2018

Here, we describe four novel circular single-stranded DNA viruses discovered in fungus-farming termites (
Odontotermes
sp.). The viruses, named termite-associated circular virus 1 (TaCV-1) through TaCV-4, are most similar to members of the family
Genomoviridae
and were widely detected in African termite mounds.
Acidic Mammalian Chitinase Negatively Affects Immune Responses during Acute and Chronic Aspergillus fumigatus Exposure
Authors: Garth Jaleesa M. , Mackel Joseph J. , Reeder Kristen M. , Blackburn Jonathan P. , Dunaway Chad W. , Yu Zhihong , Matalon Sadis , Fitz Lori , Steele Chad
Published: April 2018

Chitin is a polysaccharide that provides structure and rigidity to the cell walls of fungi and insects. Mammals possess multiple chitinases, which function to degrade chitin, thereby supporting a role for chitinases in immune defense. However, chitin degradation has been implicated in the pathogenesis of asthma. Here, we determined the impact of acidic mammalian chitinase (AMCase) (
Chia
) deficiency on host defense during acute exposure to the fungal pathogen
Aspergillus fumigatus
as well as its contribution to
A. fumigatus
-associated allergic asthma. We demonstrate that chitin in the fungal cell wall was detected at low levels in
A. fumigatus
conidia, which emerged at the highest level during hyphal transition. In response to acute
A. fumigatus
challenge,
Chia
−/−
mice unexpectedly demonstrated lower
A. fumigatus
lung burdens at 2 days postchallenge. The lower fungal burden correlated with decreased lung interleukin-33 (IL-33) levels yet increased IL-1β and prostaglandin E
2
(PGE
2
) production, a phenotype that we reported previously to promote the induction of IL-17A and IL-22. During chronic
A. fumigatus
exposure, AMCase deficiency resulted in lower dynamic and airway lung resistance than in wild-type mice. Improved lung physiology correlated with attenuated levels of the proallergic chemokines CCL17 and CCL22. Surprisingly, examination of inflammatory responses during chronic exposure revealed attenuated IL-17A and IL-22 responses, but not type 2 responses, in the absence of AMCase. Collectively, these data suggest that AMCase functions as a negative regulator of immune responses during acute fungal exposure and is a contributor to fungal asthma severity, putatively via the induction of proinflammatory responses.
Clinical aspects of incorporating cord clamping into stabilisation of preterm infants
Authors: Knol Ronny , Brouwer Emma , Vernooij Alex S N , Klumper Frans J C M , DeKoninck Philip , Hooper Stuart B , te Pas Arjan B
Published: April 2018

Fetal to neonatal transition is characterised by major pulmonary and haemodynamic changes occurring in a short period of time. In the international neonatal resuscitation guidelines, comprehensive recommendations are available on supporting pulmonary transition and delaying clamping of the cord in preterm infants. Recent experimental studies demonstrated that the pulmonary and haemodynamic transition are intimately linked, could influence each other and that the timing of umbilical cord clamping should be incorporated into the respiratory stabilisation. We reviewed the current knowledge on how to incorporate cord clamping into stabilisation of preterm infants and the physiological-based cord clamping (PBCC) approach, with the infant’s transitional status as key determinant of timing of cord clamping. This approach could result in optimal timing of cord clamping and has the potential to reduce major morbidities and mortality in preterm infants.
Lacrimal gland pleomorphic adenoma and malignant epithelial tumours: clinical and imaging differences
Authors: Young Stephanie Ming , Kim Yoon-Duck , Shin Hyun Jin , Imagawa Yukihiro , Lang Stephanie S , Woo Kyung In
Published: April 2018

Aims

To investigate the clinical and imaging features of primary and recurrent lacrimal gland pleomorphic adenoma (LGPA), as well as lacrimal gland malignant epithelial tumours (LGMET).

Methods

Retrospective comparative case series from September 2000 to September 2016 in a single tertiary institution. Medical records of cases with histopathologically proven primary LGPA (PLGPA), recurrent LGPA (RLGPA) and LGMET were reviewed.

Results

Sixty-four patients with LGPA (55 primary and nine recurrent) and 36 patients with LGMET underwent surgical excision in the study period. There was no significant difference in terms of age, gender or laterality. In terms of symptom duration, that of LGMET (7.1 months) was significantly shorter than PLGPA (23.9 months), which in turn was significantly shorter than RLGPA (127.1 months). Proptosis was the most common presenting symptom among all three groups. On CT, LGMET and RLGPA were significantly more likely to have ill-defined margins (p<0.001) and be heterogeneous (p<0.001) than PLGPA. RLGPAs (56%) were significantly more likely to have calcification than LGMET (34%), which in turn was more likely to have calcification than PLGPA (13%); LGMET (40%) and RLGPA (33%) were significantly more likely to have bony invasion than PLGPA (2.2%). On MRI, LGMETs (55%) were significantly more likely to have a tail or wedge sign indicating infiltration into the posterior orbit than PLGPA (0%) or RLGPA (0%).

Conclusion

Our study adds important information regarding differentiating clinical and radiological features between malignant and benign epithelial lacrimal gland tumours that would aid in their management.
Intent-to-treat analysis of a simultaneous multisite telehealth diabetes prevention program
Authors: Ciemins Elizabeth L , Coon Patricia J , Coombs Nicholas C , Holloway Barbara L , Mullette Elizabeth J , Dudley William N
Published: April 2018

Objective

Determine the effectiveness of a 16-week modified diabetes prevention program (DPP) administered simultaneously to multiple rural communities from a single urban site, as compared with a similar face-to-face intervention. A 12-week intervention was evaluated to consider minimization of staff costs in communities where resources are limited.

Research design and methods

A prospective cohort study compared DPP interventions implemented in rural (via telehealth technology) and urban (face-to-face) communities using an intent-to-treat analysis. Primary outcome measures included 5% and 7% body weight loss. Logistic regression analyses were used to determine predictors of intervention success and included a variable for treatment effect.

Results

Between 2010 and 2015, up to 667 participants were enrolled in the study representing one urban and 15 rural communities across Montana. The 16-week urban and rural interventions were comparable; 33.5% and 34.6% of participants lost 7% body weight, respectively; 50% and 47% lost 5% (p=0.22). Participants who were male (OR=2.41; 95% CI 1.32 to 4.40), had lower baseline body mass index (OR=1.03; 95% CI 1.01 to 1.07), attended more sessions (OR=1.33; 95% CI 1.11 to 1.58), and more frequently reported (OR=3.84; 95% CI 1.05 to 14.13) and met daily fat gram (OR=4.26; 95% CI 1.7 to 10.6) and weekly activity goals (OR=2.46; 95% CI 1.06 to 5.71) were more likely to meet their 7% weight loss goal. Predictors of meeting weight loss goals were similar for participants enrolled in the 12-week intervention.

Conclusions

Using telehealth technology to administer a modified DPP to multiple rural communities simultaneously demonstrated weight loss results comparable to those in a face-to-face intervention. Given the limitation of resources, linking rural areas to urban centers using telemedicine may increase access to much needed services to prevent or delay progression to diabetes.
Impact of dexmedetomidine infusion during general anaesthesia on incidence of postoperative delirium in elderly patients after major non-cardiac surgery: study protocol of a randomised, double-blinded and placebo-controlled trial
Authors: Wang Bo-Jie , Li Chun-Jing , Hu Jian , Li Huai-Jin , Guo Chao , Wang Zhen-Han , Zhang Qiao-Chu , Mu Dong-Liang , Wang Dong-Xin
Published: April 2018

Introduction

Delirium is a common complication in the elderly after surgery and is associated with worse outcomes. Multiple risk factors are related with postoperative delirium, such as exposure to general anaesthetics, pain and postoperative inflammatory response. Preclinical and clinical studies have shown that dexmedetomidine attenuated neurotoxicity induced by general anaesthetics, improved postoperative analgesia and inhibited inflammatory response after surgery. Several studies found that intraoperative use of dexmedetomidine can prevent postoperative delirium, but data were inconsistent. This study was designed to investigate the impact of dexmedetomidine administered during general anaesthesia in preventing delirium in the elderly after major non-cardiac surgery.

Methods and analysis

This is a randomised, double-blinded and placebo-controlled trial. 620 elderly patients (age ≥60 years) who are scheduled to undertake elective major non-cardiac surgery (with an expected duration ≥2 hours) are randomly divided into two groups. For patients in the dexmedetomidine group, a loading dose dexmedetomidine (0.6 µg/kg) will be administered 10 min before anaesthesia induction, followed by a continuous infusion at a rate of 0.5 µg/kg/hour until 1 hour before the end of surgery. For patients in the control group, normal saline will be administered with an identical rate as in the dexmedetomidine group. The primary endpoint is the incidence of delirium during the first five postoperative days. The secondary endpoints include pain intensity, cumulative opioid consumption and subjective sleep quality during the first three postoperative days, as well as the incidence of non-delirium complications and all-cause mortality within 30 days after surgery.

Ethics and dissemination

The study protocol was approved by the Clinical Research Ethics Committee of Peking University First Hospital (2015–987) and registered at Chinese Clinical Trial Registry (http://www.chictr.org.cn) with identifier ChiCTR-IPR-15007654. The results of the study will be presented at academic conferences and submitted to peer-reviewed journals.

Trial registration number

ChiCRR-IPR-15007654; Pre-results.
Association of seasonal viral acute respiratory infection with pneumococcal disease: a systematic review of population-based studies
Authors: Li You , Peterson Meagan E , Campbell Harry , Nair Harish
Published: April 2018

Objective

Animal and in vitro studies suggest that viral acute respiratory infection (VARI) can predispose to pneumococcal infection. These findings suggest that the prevention of VARI can yield additional benefits for the control of pneumococcal disease (PD). In population-based studies, however, the evidence is not in accordance, possibly due to a variety of methodological challenges and problems in these studies. We aimed to summarise and critically review the methods and results from these studies in order to inform future studies.

Methods

We conducted a systematic review of population-based studies that analysed the association between preceding seasonal VARI and subsequent PD. We searched MEDLINE, Embase and Global Health databases using tailored search strategies.

Results

A total of 28 studies were included. After critically reviewing the methodologies and findings, 11 studies did not control for seasonal factors shared by VARI and PD. This, in turn, could lead to an overestimation of the association between the two illnesses. One case–control study was limited by its small sample size (n case=13). The remaining 16 studies that controlled for seasonal factors suggested that influenza and/or respiratory syncytial virus (RSV) infections were likely to be associated with the subsequent occurrence of PD (influenza: 12/14 studies; RSV: 4/5 studies). However, these 16 studies were unable to conduct individual patient data-based analyses. Nevertheless, these studies suggested the association between VARI and subsequent PD was related to additional factors such as virus type and subtype, age group, comorbidity status, presentation of PD and pneumococcal serotype.

Conclusions

Population-based studies do not give consistent support for an association between preceding seasonal VARI and subsequent PD incidence. The main methodological challenges of existing studies include the failure to use individual patient data, control for seasonal factors of VARI and PD, or include other factors related to the association (eg, virus, age, comorbidity and pneumococcal serotype).
Strengths and Difficulties Questionnaire: internal validity and reliability for New Zealand preschoolers
Authors: Kersten Paula , Vandal Alain C , Elder Hinemoa , McPherson Kathryn M
Published: April 2018

Objectives

This observational study examines the internal construct validity, internal consistency and cross-informant reliability of the Strengths and Difficulties Questionnaire (SDQ) in a New Zealand preschool population across four ethnicity strata (New Zealand European, Māori, Pasifika, Asian).

Design

Rasch analysis was employed to examine internal validity on a subsample of 1000 children. Internal consistency (n=29 075) and cross-informant reliability (n=17 006) were examined using correlations, intraclass correlation coefficients and Cronbach’s alpha on the sample available for such analyses.

Setting and participants

Data were used from a national SDQ database provided by the funder, pertaining to New Zealand domiciled children aged 4 and 5 and scored by their parents and teachers.

Results

The five subscales do not fit the Rasch model (as indicated by the overall fit statistics), contain items that are biased (differential item functioning (DIF)) by key variables, suffer from a floor and ceiling effect and have unacceptable internal consistency. After dealing with DIF, the Total Difficulty scale does fit the Rasch model and has good internal consistency. Parent/teacher inter-rater reliability was unacceptably low for all subscales.

Conclusion

The five SDQ subscales are not valid and not suitable for use in their own right in New Zealand. We have provided a conversion table for the Total Difficulty scale, which takes account of bias by ethnic group. Clinicians should use this conversion table in order to reconcile DIF by culture in final scores. It is advisable to use both parents and teachers’ feedback when considering children’s needs for referral of further assessment. Future work should examine whether validity is impacted by different language versions used in the same country.
Patient trajectories and their impact on mobility, social participation and quality of life in patients with vertigo/dizziness/balance disorders and osteoarthritis (MobilE-TRA): study protocol of an observational, practice-based cohort study
Authors: Kisch Rebecca , Bergmann Antje , Koller Daniela , Leidl Reiner , Mansmann Ulrich , Mueller Martin , Sanftenberg Linda , Schelling Joerg , Sundmacher Leonie , Voigt Karen , Grill Eva
Published: April 2018

Introduction

Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality. However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients’ needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing.

Objective

The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA) .

Methods

Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA. Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals.

Ethics and dissemination

The study was approved by the ethical committee of the Ludwig-Maximilians-Universität München and of the Technische Universität Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.
Pulmonary involvement in Fabry disease: effect of plasma globotriaosylsphingosine and time to initiation of enzyme replacement therapy
Authors: Franzen Daniel , Haile Sarah R , Kasper David C , Mechtler Thomas P , Flammer Andreas J , Krayenbühl Pierre A , Nowak Albina
Published: April 2018

Introduction

Anderson-Fabry disease (AFD) is an X-linked lysosomal storage disorder caused by mutations ofGLAgene leading to reduced α-galactosidase activity and resulting in a progressive accumulation of globotriaosylceramide (Gb3) and its deacylated derivative, globotriaosyl-sphingosine (Lyso-Gb3). Plasma Lyso-Gb3 levels serve as a disease severity and treatment monitoring marker during enzyme replacement therapy (ERT).

Methods

Adult patients with AFD who had yearly pulmonary function tests between 1999 and 2015 were eligible for this observational study. Primary outcome measures were the change in z-score of forced expiratory volume in the first second (FEV1) and FEV1/FVC over time. Plasma Lyso-Gb3 levels and the age of ERT initiation were investigated for their association with lung function decline.

Results

Fifty-three patients (42% male, median (range) age at diagnosis of AFD 34 (6–61) years in men, 34 (13–67) in women) were included. The greatest decrease of FEV1/FVC z-scores was observed in Classic men (−0.048 per year, 95% CI −0.081 to –0.014), compared with the Later-Onset men (+0.013,95% CI −0.055 to 0.082), Classic women (−0.008, 95% CI −0.035 to +0.020) and Later-Onset women (−0.013, 95% CI −0.084 to +0.058). Cigarette smoking (P=0.022) and late ERT initiation (P=0.041) were independently associated with faster FEV1decline. FEV1/FVC z-score decrease was significantly reduced after initiation of ERT initiation (−0.045 compared with −0.015, P=0.014). Furthermore, there was a trend towards a relevant influence of Lyso-Gb3 (P=0.098) on airflow limitation with age.

Conclusion

Early ERT initiation seems to preserve pulmonary function. Plasma Lyso-Gb3 is maybe a useful predictor for airflow limitation. Classic men need a closer monitoring of the lung function.
Cross-sectional relationship between haemoglobin concentration and measures of physical and cognitive function in an older rural South African population
Authors: Payne Collin F , Davies Justine I , Gomez-Olive F Xavier , Hands Katherine J , Kahn Kathleen , Kobayashi Lindsay C , Tipping Brent , Tollman Stephen M , Wade Alisha , Witham Miles D
Published: April 2018

Background

Age cohort differences in haemoglobin concentrations and associations with physical and cognitive performance among populations of lower income and middle-income countries have not previously been described. We examined the association between these factors among older men and women in rural South Africa.

Methods

We analysed cross-sectional data from a population-based study of rural South African men and women aged 40 and over (n=4499), with data drawn from questionnaire responses, a cognitive battery, objective physical function tests and blood tests. Anaemia was defined as a haemoglobin concentration <12 g/dL for women and <13 g/dL for men. We related haemoglobin concentrations to each of age, grip strength, walk speed and a latent cognitive function z-score for men and women separately. We used unadjusted correlations and linear models to adjust for comorbidities and inflammation.

Results

In total, 1042 (43.0%) women and 833 (40.1%) men were anaemic. Haemoglobin concentrations were inversely correlated with age for men but not for women; in adjusted analyses, haemoglobin was 0.3 g/dL lower per decade older for men (95% CI 0.2 to 0.4 g/dL). In adjusted analyses, haemoglobin concentration was independently associated with grip strength in women (B=0.391, 95% CI 0.177 to 0.605), but this did not reach significance in men (B=0.266, 95% CI −0.019 to 0.552); no associations were observed between haemoglobin levels and walk speed or cognitive score.

Conclusions

Anaemia was prevalent in this study population of middle-aged and older, rural South African adults, but in contrast to high-income countries, it was not associated with poor physical or cognitive function. Our findings need to be replicated in other populations.
Healthcare professionals’ understanding of the legislation governing research involving adults lacking mental capacity in England and Wales: a national survey
Authors: Shepherd Victoria , Griffith Richard , Sheehan Mark , Wood Fiona , Hood Kerenza
Published: April 2018

Objective

To examine health and social care professionals’ understanding of the legislation governing research involving adults lacking mental capacity in England and Wales.

Methods

A cross-sectional online survey was conducted using a series of vignettes. Participants were asked to select the legally authorised decision-maker in each scenario and provide supporting reasons. Responses were compared with existing legal frameworks and analysed according to their level of concordance.

Results

One hundred and twenty-seven professionals participated. Levels of discordance between responses and the legal frameworks were high across all five scenarios (76%–82%). Nearly half of the participants (46%) provided responses that were discordant in all scenarios. Only two participants (2%) provided concordant responses across all five scenarios.

Discussion

Participants demonstrated a lack of knowledge about the legal frameworks, the locus of authority and the legal basis for decision-making. The findings raise concern about the accessibility of research for those who lack capacity, the ability to conduct research involving such groups and the impact on the evidence base for their care.

Conclusion

This is the first study to examine health and social care professionals’ knowledge and understanding of the dual legal frameworks in the UK. Health and social care professionals’ understanding and attitudes towards research involving adults with incapacity may warrant further in-depth exploration. The findings from this survey suggest that greater training and education is required.
Ethics of routine: a critical analysis of the concept of ‘routinisation’ in prenatal screening
Authors: Kater-Kuipers Adriana , de Beaufort Inez D , Galjaard Robert-Jan H , Bunnik Eline M
Published: April 2018

In the debate surrounding the introduction of non-invasive prenatal testing (NIPT) in prenatal screening programmes, the concept of routinisation is often used to refer to concerns and potential negative consequences of the test. A literature analysis shows that routinisation has many different meanings, which can be distinguished in three major versions of the concept. Each of these versions comprises several inter-related fears and concerns regarding prenatal screening and particularly regarding NIPT in three areas: (1) informed choice, (2) freedom to choose and (3) consequences for people with a disability. Three of the strongest arguments raised under the flag of routinisation are assessed for their validity: the threat that NIPT poses to informed choice, the potential increase in uptake of first-trimester prenatal screening and its consequences for social pressure to participate in screening or terminate affected pregnancies, and the negative consequences for disabled people. These routinisation arguments lack empirical or normative ground. However, the results of this analysis do not imply that no attention should be paid to possible problems surrounding the introduction of NIPT. At least two problems remain and should be addressed: there should be an ongoing debate about the requirements of informed choice, particularly related to an expanded scope of prenatal screening. Also, reproductive autonomy can only be achieved when expecting parents’ options are variegated, real and valuable, so that they can continue to choose whether or not to screen or to terminate a pregnancy.
Fiction-reading for good or ill: eating disorders, interpretation and the case for creative bibliotherapy research
Authors: Troscianko Emily T
Published: April 2018

Compared with self-help bibliotherapy, little is known about the efficacy of creative bibliotherapy or the mechanisms of its possible efficacy for eating disorders or any other mental health condition. It is clear, however, that fiction is widely used informally as a therapeutic or antitherapeutic tool and that it has considerable potential in both directions, with a possibly significant distinction between the effects of reading fiction about eating disorders (which may—contrary to theoretical predictions—be broadly negative in effect) or one’s preferred genre of other fiction (which may be broadly positive). Research on creative bibliotherapy, especially systematic experimental research, is lacking and requires a medical humanities approach, drawing on knowledge and methods from psychology and cognitive literary studies as well as clinical disciplines to expand our understanding of how the dynamic processes of interpretation mediate between textual structures and characteristics of mental health and illness.