bluuebunny/crossref_metadata_2025 huggingface dataset:
Postpartum quality of life after normal vaginal delivery and caesarean section
Authors: Amatya Yogendra , Acharya Samita
Published: June 2018

Introductions: Caesarean section is rising. The best method of delivery, vaginal or caesarean, for postpartum quality of life in women is a matter of controversy both from professionals’ perspectives and from women’s experience of childbirth. This study analyses quality of life after these two methods of deliveries.Methods: This was a cross-sectional comparative study in postnatal care outpatient department at Patan Hospital. Primipara women with normal delivery and elective caesarean section done in Patan Hospital were enrolled to analyse postpartum quality of life. The SF-12 questionnaire tool at 6 weeks post delivery was used to compare age, ethnicity, education, family type and employment. Data was analysed using ANOVA test for descriptive parameters.Results: There were 468 primipara, age 30-45 years, 94% in 15-30 years77.8% educated, 74.4% in joint family,73.5% housewife. Normal vaginal delivery was 360 (72.6%) and 128 (27.4%) elective caesarean. Vaginal delivery group had average SF score of Physical Health Composite Score of 68.7, Mental Health CompositeScore69.5 and total SF score 67.7. While in caesarean group, it was 64.8,64.1 and 63.4.Conclusions: Normal vaginal delivery had better quality of life resulting in both superior physical as well as mental health.Journal of Patan Academy of Health Sciences, Vol. 2, No. 2, 2015. page:13-18
Challenging issues and recent R&D activities for enhancing nuclear safety in Korea
Authors: Song C.-H.
Published: June 2018

Recent nation-wide measures and actions taken in Korea after March 11, 2011 for enhancing nuclear safety and reducing public concerns are discussed by considering the lessons learned from the Fukushima Daiichi accidents as well as the amended National Safety Act, recently occurred historic earthquakes, and advanced light water reactor developments in Korea. In addition, recent R&D activities in the area of enhancing nuclear safety are introduced by focusing on the prevention and mitigation of severe accidents and the reduction of their environmental impact.
Comparison of heat transfer models with databank of supercritical fluid
Authors: Zhao M. , Liu X. , Badea A. , Feuerstein F. , Cheng X.
Published: June 2018

Because of the large variation of thermal–physical properties near pseudo-critical point, heat transfer of supercritical water shows abnormal behavior. Thus, an accurate prediction of heat transfer between the cladding and fluid plays a very important role. It is necessary to investigate the reliably of heat transfer models in the vicinity of the pseudo-critical point. In the frame of evaluating the present HT models and developing new reliable prediction models, databank of heat transfer of supercritical water flowing in tube were established by Karlsruhe Institute of Technology (KIT) with more than 35,000 experimental data. A thorough analysis and assessment was carried out, to give an insight into the characters of the database. Experimental data from different sources are compared to figure out the deviation between different sources and to present the reliability of the database.
Blankets – key element of a fusion reactor – functions, design and present state of development
Authors: Hesch K. , Boccaccini L. V. , Stieglitz R.
Published: June 2018

Blankets are key elements of a future fusion power reactor, as they breed the fusion fuel tritium, extract the heat from the reactor for power generation and contribute to the nuclear shielding of the plasma confining magnetic field coils. On the way to the engineering implementation of fusion, in particular the blanket design approach has changed substantially. Novel blanket designs require, already from the beginning, incorporating close coupling of plasma physics with engineering physics to develop robust solutions coping with thermal, mechanical and also electrodynamic loads – not only during the stationary operating phase, but also during transients. Simultaneously, nuclear licensing feasibility as well as component failure safety must be part of the design approach. This article describes advanced blanket design approaches undertaken in the past years by the example of the helium cooled pebble bed blanket (HCPB), aiming at an efficient blanket engineering design, starting from the development of modular integral reactor analysis tools, via design analysis and engineering validation of fabrication and interface performance, towards safety analysis on the reactor level.
The Relative Frequency of Haemophilia A and B
Authors: Jung Ernst G.
Published: June 2018

Two tables show the haemophilia cases observed in Zurich and the relative frequency of haemophilia A and haemophilia B in Switzerland and some other countries.
Observations on the Handling of Bovine Prothrombin and Thrombin
Authors: Steichele Diethard F. , Mammen Eberhard F. , Hatta Yoshio , Seegers Walter H.
Published: June 2018

In the handling of thrombin activity is lost by freeze drying, and by dialysis of dilute solutions. Acetone drying can be done without loss of activity. Acetylated thrombin does not lose activity during freeze drying. Prothrombin activity is retained during freeze drying and during dialysis, but is lost with acetone drying and when dilute solutions are placed in ordinary glassware that is not lined with paraffin.
The Effect of Heparin on the Bleeding Time
Authors: Hjort P. F , Borchgrevink C. F , Iversen O. H , Stormorken H
Published: June 2018

Summary and Conclusions

1. Moderate doses of heparin often prolonged the bleeding time in men, rats and mice. The bleeding was wavelike, and a sensitive method was necessary to demonstrate the prolongation.

2. Large doses gave a prolonged bleeding time, and the bleeding was often profuse and continuous.

3. Heparin did not produce thrombocytopenia. Moderate doses probably prevent viscous metamorphosis and fibrin formation, resulting in large but inefficient platelet plugs. Large doses may also interfere with the aggregation of platelets, preventing the formation of platelet plugs.
Inhibition of Clotting as the Result of Plasminogen Activation by Streptokinase
Authors: Glas P , Beller F. K
Published: June 2018

Samples of an activation mixture, consisting of fibrinogen, streptokinase and plasma (source of pro-activator) were added to thrombin at intervals of 1 minute and subjected to lysis time determinations; the absence of clotting was noted after a certain period of incubation. At this point, the lysis time was no longer measurable.

Inhibition of coagulation was not observed if either bovine fibrinogen or human plasma were incubated with streptokinase alone. If, however, human fibrinogen was used instead of bovine fibrinogen, this effect occurred even if only fibrinogen and streptokinase were incubated.

The mechanism of the process described was investigated by varying the different streptokinase- and fibrinogen concentrations, using either undiluted or diluted plasma.

It was evident that there is a relationship between the concentrations of fibrinogen and streptokinase on the one hand, and the degree of plasma dilution on the other.

Fibrinogenolysis is caused by activation of the pro-enzyme contained in the fibrinogen preparations. During this process, fibrinogen is altered to a non-coagulable protein.
Neuronal Responses to a Postural Dual-Task With Differential Attentional Prioritizations: Compensatory Resource Allocation With Healthy Aging
Authors: Yu Shu-Han , Hwang Ing-Shiou , Huang Cheng-Ya
Published: June 2018

Objectives

Restricted central processing in older adults prevents optimization of a dual task with a flexible prioritization strategy. This study investigated the neural mechanisms of task-priority in young and older adults when performing a posture-motor dual-task.

Method

Sixteen healthy young and 16 older adults performed a force-matching task on a mobile-platform under posture-focus (PF) and supraposture-focus (SF) conditions. The platform movement, force-matching performance, and event-related potentials in the preparatory period were recorded.

Results

For the elders, the postural stability and force-matching accuracy using the PF strategy were inferior to those using the SF strategy; whereas, the dual-task performances of the young adults were less affected by the prioritization. Only the elders exhibited the P1 wave, with the PF strategy associated with a smaller P1 and larger P1 than the SF strategy in the sensorimotor-parietal and right frontotemporal areas, respectively. The PF strategy also led to a larger P2 wave in the right frontotemporal area of elders, but a greater P2 wave in the sensorimotor-parietal area of young adults.

Discussion

For both prioritization strategies, older adults entailed a longer preparatory process than younger adults. Dual-task performance of older adults was more vulnerable to PF strategy, underlying compensatory resource allocation in the preparatory period for resolution of dual-task interference due to degenerated frontal function.
Nanomechanics of graphene
Authors: Wei Yujie , Yang Ronggui
Published: June 2018

The super-high strength of single-layer graphene has attracted great interest. In practice, defects resulting from thermodynamics or introduced by fabrication, naturally or artificially, play a pivotal role in the mechanical behaviors of graphene. More importantly, high strength is just one aspect of the magnificent mechanical properties of graphene: its atomic-thin geometry not only leads to ultra-low bending rigidity, but also brings in many other unique properties of graphene in terms of mechanics in contrast to other carbon allotropes, including fullerenes and carbon nanotubes. The out-of-plane deformation is of a ‘soft’ nature, which gives rise to rich morphology and is crucial for morphology control. In this review article, we aim to summarize current theoretical advances in describing the mechanics of defects in graphene and the theory to capture the out-of-plane deformation. The structure–mechanical property relationship in graphene, in terms of its elasticity, strength, bending and wrinkling, with or without the influence of imperfections, is presented.
Balanced Crystalloids Versus Saline for Perioperative Intravenous Fluid Administration in Children Undergoing Neurosurgery: A Randomized Clinical Trial
Authors: Lima Mariana F. , Neville Iuri S. , Cavalheiro Sergio , Bourguignon Dafne C. , Pelosi Paolo , Malbouisson Luiz M.S.
Published: June 2018

Background:

Balanced crystalloid solutions induce less hyperchloremia than normal saline, but their role as primary fluid replacement for children undergoing surgery is unestablished. We hypothesized that balanced crystalloids induce less chloride and metabolic derangements than 0.9% saline solutions in children undergoing brain tumor resection.

Methods:

In total, 53 patients (age range, 6 mo to 12 y) were randomized to receive balanced crystalloid (balanced group) or 0.9% saline solution (saline group) during and after (for 24 h) brain tumor resection. Serum electrolyte and arterial blood gas analyses were performed at the beginning of surgery (baseline), after surgery, and at postoperative day 1. The primary trial outcome was the absolute difference in serum chloride concentrations (post-preopΔCl−) measured after surgery and at baseline. Secondary outcomes included the post-preopΔ of other electrolytes and base excess (BE); hyperchloremic acidosis incidence; and the brain relaxation score, a 4-point scale evaluated by the surgeon for assessing brain edema.

Results:

Saline infusion increased post-preopΔCl (6 [3.5; 8.5] mmol/L) compared with balanced crystalloid (0 [−1.0; 3.0] mmol/L; P<0.001). Saline use also resulted in increased post-preopΔBE (−4.4 [−5.0; −2.3] vs. −0.4 [−2.7; 1.3] mmol/L; P<0.001) and hyperchloremic acidosis incidence (6/25 [24%] vs. 0; P=0.022) compared with balanced crystalloid. Brain relaxation score was comparable between groups.

Conclusions:

In children undergoing brain tumor resection, saline infusion increased variation in serum chloride compared with balanced crystalloid. These findings support the use of balanced crystalloid solutions in children undergoing brain tumor resection.
Dogs and Orthopaedic Injuries: Is There a Correlation With Breed?
Authors: Brice Joshua , Lindvall Eric , Hoekzema Nathan , Husak Lisa
Published: June 2018

Objectives:

To identify the incidence of orthopaedic injuries secondary to dog bites, determine the responsible breeds, and assess the severity of injury by dog breed.

Design:

Retrospective.

Setting:

Single Level I trauma center.

Patients:

Ninety-five patients treated for a dog bite that resulted in an orthopaedic injury between January 2010 and July 2016.

Intervention:

Patients were treated according to their specific orthopaedic injury.

Main Outcome Measurements:

Dog breed and type of orthopaedic injury.

Results:

Thirty-nine percent of all dog bite–related emergency department visits resulted in an orthopaedic injury requiring specialist treatment. Of the 95 patients, 50% were the result of a pit bull terrier bite and 22% by a law enforcement dog. A total of 32% were attacked by multiple dogs. There was a 51% incidence of severe injury (amputation or fracture) with a significant association with breed.

Conclusions:

Thirty-nine percent of all dog bite–related emergency department visits at our facility resulted in an injury requiring orthopaedic treatment. Pit bull terrier bites were responsible for a significantly higher number of orthopaedic injuries and resulted in an amputation and/or bony injury in 66% of patients treated, whereas bites from law enforcement dogs and other breeds were less associated with severe injuries.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
A Paradigm Shift Toward Terminally Sterilized Devices
Authors: Agarwal Aakash , MacMillan Adam , Goel Vijay , Agarwal Anand K. , Karas Chris
Published: June 2018

Given the complexity of the sterilization process, and the risk involved in absence of strict adherence to the protocol described by the medical device manufacturers, terminally sterilized devices are emerging and being promoted in the field of medical practices. The characteristics associated with conventional reprocessing are demanding logistics, costs of delay, operations and adverse events, and unacceptable liability. Demanding logistics were a result of decoupled staff between the operating room and sterilize processing department, understaffed and high-volume processing with an additional burden due to inventory management and inefficient training. Other costs arose from upkeep, delay in operating room, and surgical-site infections. Liability arose from the repeatedly use of an unquantifiable process thus adding uncertainties, limited shelf life of the reprocessed implants, contingency of flash sterilization and introduction of newer technology with higher demand on cleaning performances. In contrast, terminally sterilized single-use devices do not carry any of the aforementioned-characteristics, deeming it to be the simplest solution to the current conundrum. This review serves to provide an evaluation of logistics, costs, and potential adverse effects, both directly and indirectly, associated with current practices in the sterile processing department, and also describes as to how the use of terminally sterilized devices can help circumvent those.
Tumor Regression and Cure Depends on Sustained Th1 Responses
Authors: Dai Min , Hellstrom Ingegerd , Yip Yuen Y. , Sjögren Hans Olov , Hellstrom Karl Erik
Published: June 2018

While immunomodulatory monoclonal antibodies (mAbs) have therapeutic efficacy against many tumors, few patients are cured. Attempting to improve their therapeutic efficacy we have applied the TC1 mouse lung carcinoma model and injected established subcutaneous tumors intratumorally with 3 weekly doses of various combinations of mAbs. Combinations of mAbs to CTLA4/PD1/CD137 (the 3 mAb combination) and to CTLA4/PD1/CD137/CD19 (the 4 mAb combination) were most efficacious to induce complete regression of both the injected tumor and an untreated tumor in the same mouse. Tumor cure was consistently associated with shifting a Th2 to a Th1 response in tumor-draining lymph nodes and spleen and it involved epitope specific and long-lived memory T cells as well as M1 macrophages. This shift and accompanying tumor rejection was harder to achieve as the treated tumors increased in size. Relapse of tumors which had initially regressed following treatment with immunomodulatory mAbs was associated with return of a Th2 microenvironment in tumors, tumor-draining lymph nodes and spleens rather than the emergence of immune-resistant tumor cells. While mAbs to CTLA4 plus PD-1 were therapeutically ineffective, combining the 2 of them with intraperitoneal cisplatin, 10 mg/kg, induced long-term complete tumor regression in most mice with small TC1 tumors and the therapeutic efficacy against larger tumors improved by administrating cisplatin together with the 3 or 4 mAb combination.
Comparison of Outcomes in Patients With Muscle-invasive Bladder Cancer Treated With Radical Cystectomy Versus Bladder Preservation
Authors: Zhong Jim , Switchenko Jeffrey , Jegadeesh Naresh K. , Cassidy Richard J. , Gillespie Theresa W. , Master Viraj , Nieh Peter , Alemozaffar Mehrdad , Kucuk Omer , Carthon Bradley , Filson Christopher P. , Bilen Mehmet A. , Jani Ashesh B.
Published: June 2018

Purpose:

Radical cystectomy currently remains the standard of care for muscle-invasive bladder cancer. However, surgery can be associated with considerable morbidity and mortality, including the removal of the bladder. An alternative strategy is to preserve the bladder through concurrent chemoradiation following a maximal transurethral resection of the tumor. National protocols using a bladder-preservation approach have demonstrated disease-specific outcomes comparable to radical cystectomy in selected patients, but these results have not been replicated in previously reported population-based series. Here, we describe an outcomes analysis of patients with muscle-invasive bladder cancer treated with either radical surgery or bladder-preserving chemoradiation (BPCRT) for those patients meeting BPCRT criterion using the National Cancer Database (NCDB).

Materials and Methods:

Using the NCDB, patients with American Joint Commission on Cancer clinical T2-3, N0, M0 urothelial carcinoma diagnosed between 2004 and 2013 were included for analysis. Only patients treated with definitive intent with either radical cystectomy or concurrent chemotherapy and radiation after a maximal transurethral tumor resection were included. Propensity-score matching was used.

Results:

Among 8454 eligible patients, 7276 (86%) underwent radical cystectomy, and 1178 (14%) underwent BPCRT. Patients undergoing BPCRT were significantly older (median age, 77 vs. 68 y; P<0.001) and had higher Charlson-Deyo comorbidity scores (P=0.002). Using propensity-matched analysis, 1002 patients remained in each cohort, and there was no significant difference in survival found between the 2 cohorts (median overall survival, 2.7 vs. 3.0 y [P=0.20]; 4-year overall survival, 39.1% and 42.6% [P=0.15], for BPCRT and surgery, respectively). In addition, the hazard ratio (HR) of surgery versus BPCRT decreased over time, with an initial HR of 1.27 favoring BPCRT which decreased by a factor of 0.85 per year.

Conclusions:

From 2004 to 2013, ∼14% of patients from the NCDB who potentially met bladder-preservation criteria underwent the procedure. Our propensity-matched analysis is the only report of its kind to demonstrate similar survival outcomes with bladder preservation when patients are properly selected. This study is also the first to demonstrate a dynamic HR between radical surgery and BPCRT over time.
A Simplified Technique for Correcting Mitral Valve Regurgitation via Minimally Invasive Approach
Authors: Speziale Giuseppe , Moscarelli Marco
Published: June 2018

Mitral valve regurgitation may require complex repair techniques that are challenging in minimally invasive and may expose patients to prolonged cardiopulmonary bypass and cross-clamp times. Here, we present a stepwise operative approach that may facilitate the repair of the mitral valve in a minimally invasive fashion and may be carried out even when multiple posterior segments are involved. This how-to-do article presents a method that was performed in 148 patients that were referred to our institution for severe organic mitral regurgitation between 2008 and 2016. At mean ± SD follow-up of 45.5 ± 27 months, freedom from recurrent of mitral regurgitation 2+ or greater and reoperation was 95.2%.
Minimally Invasive Left Ventricular Assist Device
Authors: Voorhees Hannah J. , Sorensen Erik N. , Pasrija Chetan , Boulos Francesca M. , Pham Si M. , Griffith Bartley P. , Kon Zachary N.
Published: June 2018

Objective

Several centers have presented minimally invasive surgical approaches to centrifugal left ventricular assist device implantation. Although minimally invasive implantation has been successfully performed by experienced surgeons, at large implanting centers, it is unknown whether these techniques are widely adoptable. We evaluated the experience of a surgeon early in his career with conventional and minimally invasive approaches to device implantation.

Methods

All consecutive left ventricular assist device implantations by a single surgeon in the first year of practice (2015–2016) were retrospectively reviewed. Patients were stratified by standard approach, conventional full sternotomy versus a minimally invasive approach, left anterior thoracotomy and upper hemisternotomy. Demographics, perioperative variables, and short-term outcomes were compared using Wilcoxon rank-sum test.

Results

Thirteen patients were identified: six performed via the standard approach and seven performed via the minimally invasive approach. Preoperative demographics were comparable in both groups. However, there was significantly more preoperative right ventricle dysfunction in the minimally invasive group ( P = 0.01). Although operative time was significantly longer in the minimally invasive cohort, there was a trend toward decreased cardiopulmonary bypass time. Six-month survival in both groups was 100%.

Conclusions

Compared with conventional sternotomy, minimally invasive ventricular assist device implantation, performed by a surgeon in his first year of practice, had similar perioperative outcomes and excellent survival. Based on these data, minimally invasive implantation may be a feasible strategy for device implantation even early in a surgeon's career.
Severe Mycoplasma Pneumoniae Infection in Children Admitted to Pediatric Intensive Care
Authors: Moynihan Katie M. , Barlow Andrew , Nourse Clare , Heney Claire , Schlebusch Sanmarié , Schlapbach Luregn J.
Published: June 2018

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia and may cause life-threatening disease in children. We identified 30 (0.3%) confirmed M. pneumoniae cases by clinical and laboratory criteria in 11,526 pediatric intensive care unit admissions. Outcomes were comparable to patients admitted with other infections (n=3005; P > 0.1). Our findings indicate that empiric antimicrobial coverage for M. pneumoniae infection in pediatric intensive care unit is rarely needed.
Changes to Hearing Levels Over the First Year After Stapes Surgery: An Analysis of 139 Patients
Authors: Nash Robert , Patel Bhavesh , Lavy Jeremy
Published: June 2018

Background:

Stapes surgery is performed for hearing restoration in patients with otosclerosis. Results from stapes surgery are good, although a small proportion will have a persistent conductive hearing loss and will consider revision surgery. The timing of such surgery depends on expected changes to hearing thresholds during the postoperative period.

Methods:

We performed a retrospective case series analysis of a database of outcomes from stapes surgery performed between July 26, 2013 and March 11, 2016 at one center. Hearing outcomes over the year subsequent to surgery were recorded.

Results:

There was a significant improvement in hearing outcomes between the postoperative visit at 6 weeks (mean air-bone gap 6.0 dB) and the hearing outcome at 6 months (mean air-bone gap 3.3 dB) (p < 0.01). This improvement was maintained at 12 months (mean air-bone gap 3.1 dB), although there were individual patients whose hearing outcome improved or deteriorated during this period. Improvements in air conduction thresholds mirrored improvements in air-bone gap measurements.

Conclusion:

Patients with an initial suboptimal or poor result after stapes surgery may observed improvement in their hearing thresholds in the year after surgery. These patients may have large preoperative air-bone gaps, and have a trend to have obliterated footplates. Revision surgery should not be considered until at least 6 months after primary surgery.
Beyond Sentence Recognition in Quiet for Older Adults: Implications for Cochlear Implant Candidacy
Authors: Zhang Emily , Coelho Daniel H.
Published: June 2018

Objective:

To study postoperative hearing outcomes in older adult cochlear implant recipients who did not meet Medicare candidacy criteria by sentence testing in quiet.

Study Design:

Case Control Series.

Setting:

University Based Tertiary Referral Cochlear Implant Center.

Patients:

Fifty-four patients age 60 or greater with bilateral moderate to profound sensorineural hearing loss who underwent cochlear implantation. Patients were divided into three groups by preoperative testing scores: 1) sentence recognition in quiet and monosyllabic word recognition scores ≤40%, 2) sentence recognition in quiet scores >40% and sentence recognition in noise scores ≤40%, and 3) sentence recognition in quiet scores >40% and monosyllabic word recognition scores ≤40% in the ear to be implanted.

Intervention(s):

Cochlear implantation.

Main Outcome Measure(s):

Pre- versus postoperative sentence and word recognition scores.

Results:

All three groups received a statistically significant benefit from their cochlear implant as measured by both postoperative sentence and word recognition. When comparing postoperative sentence recognition scores between groups, there were no statistically significant differences (Group 1: mean 83.1%, SD ± 17.4%; Group 2: mean 90.1%, SD ± 8.0%; Group 3: mean 90.6%, SD ± 6.9%). When comparing postoperative monosyllabic word recognition scores, there were no statistically significant differences between groups (Group 1: mean 60.3%, SD ± 19.6%; Group 2: mean 66.8%, SD ± 20.0%; Group 3: mean 70.0%, SD ± 18.8%).

Conclusion:

Results of this study demonstrate that older patients who do not meet current Medicare candidacy criteria derive significant long-term benefit from cochlear implantation when either sentence in noise or monosyllabic word recognition in quiet ≤40% is used to determine candidacy. Further research and greater numbers are needed to better characterize the role of monosyllabic word recognition in cochlear implant candidacy.
Antibiotic and Modulation of Microbiota
Authors: Rizzatti Gianenrico , Ianiro Gianluca , Gasbarrini Antonio
Published: June 2018

Recently new insights on gut microbiota have revolutionized many concepts of the modern medicine. The alteration of microbiota, which is called dysbiosis, has been associated with an expanding list of diseases and conditions. The development of next-generation sequencing techniques allowed comprehensive analysis of gut microbiota composition without the limitations of classic culture methods. Furthermore, introduction of functional techniques such as metabolomics and proteomics allowed for integrated analysis thus obtaining more robust insights on microbiota functions in health and disease. These tools allow to address the role of factors able to modify the gut microbiota, the so called “microbiota influencers.” These data are useful to explain the physiopathology of several disease and thus to identify new potential therapeutic targets. Among microbiota influencers, many studies focused on the impact of antibiotic administration on the gut microbiota, because of their widespread use. Notably, beside the known beneficial effect of antibiotic in treating infectious diseases, these drugs have shown detrimental effects on gut microbiota which, in turn, might have long-term consequences on the host. Finally, therapeutic modulation of gut microbiota, by means of selected antibiotics with eubiotic effects, probiotics and with fecal microbiota transplantation seems of great interest as it might be able to prevent or even revert antibiotic-induced dysbiosis.
Oral and Otorhinolaryngological Findings in Adults Who Were Diagnosed With Pediatric Onset Crohn’s Disease
Authors: Haaramo Anu , Alapulli Heikki , Aine Liisa , Tuokkola Jetta , Saarnisto Ulla , Roine Risto P. , Pitkäranta Anne , Kolho Kaija-Leena
Published: June 2018

Background:

Up to 50% of pediatric patients with Crohn’s disease (CD) report oral manifestations, but less is known about their oral health when they become adults.

Goals:

Our aim was to provide detailed descriptions of the presence of oral and otorhinolaryngological manifestations in patients with pediatric onset CD once they reached adulthood, to look for predisposing factors and to compare the findings to matched controls.

Study:

Adult patients diagnosed with CD in childhood at the Children’s Hospital, University of Helsinki, Finland, after 2000 were invited for a follow-up appointment in 2016 and 24 were examined by a dentist and otorhinolaryngologist. They were compared with 22 matched controls from the Population Register Centre. The participants completed questionnaires about their general health, any special diets, and their health-related quality of life. Their nutrition was evaluated from food records.

Results:

Patients with CD had minor oral manifestations at a median of 9 years after their childhood diagnosis and the most common was angular cheilitis, which affected 6 patients and 1 control, but was not statistically significant (P=0.0984). CD with perianal abscessing disease correlated to orofacial findings (P=0.0312). Most of the patients had normal otorhinolaryngological findings. Subjects with oral lesions had lower mean health-related quality of life scores than subjects without oral findings and the differences were clinically but not statistically significant. Oral manifestations were not associated with differences in energy intake.

Conclusions:

Oral manifestations in adult patients with pediatric onset CD were mild and were not associated with otorhinolaryngological pathology.
Greater Reductions in Readmission Rates Achieved by Urban Hospitals Participating in the Medicare Shared Savings Program
Authors: Kim Yeunkyung , Thirukumaran Caroline P. , Li Yue
Published: June 2018

Background:

Accountable Care Organizations in the Medicare Shared Savings Program (MSSP) have financial incentives to reduce the cost and improve the quality of care delivered to Medicare beneficiaries that they serve. However, previous research about the impact of the MSSP on readmissions is limited and mixed.

Objective:

To examine the association between hospital participation in the MSSP during the 2012–2013 period and reductions in 30-day risk-standardized readmission rates for Medicare patients initially admitted for acute myocardial infarction, heart failure (HF), pneumonia, or any cause.

Research Design:

Difference-in-differences estimation to compare the change in readmission rates for hospitals participating in the MSSP with that of other hospitals.

Subjects:

Acute care hospitals that either participated in the MSSP or did not participate in any of Medicare Accountable Care Organization programs (for acute myocardial infarction, n=1631; for HF, n=1889; for pneumonia, n=1896; for any cause, n=2067).

Results:

Compared with nonparticipating hospitals, MSSP-participating hospitals showed greater reductions in readmission rates for Medicare patients originally admitted for HF by 0.47 percentage points [95% confidence interval (CI), −0.76 to −0.17] and for pneumonia by 0.26 percentage points (95% CI, −0.49 to −0.03). MSSP-participating hospitals also showed more reductions in hospital-wide all-cause readmission by 0.10 percentage points (95% CI, −0.20 to 0.01), relative to nonparticipating hospitals during the first year of MSSP.

Conclusions:

MSSP-participating hospitals showed slightly greater reductions in readmissions during postimplementation years for Medicare patients initially admitted for HF or pneumonia, compared with other hospitals.
Pulmonary Sarcomatoid Carcinomas: A Review
Authors: Weissferdt Annikka
Published: June 2018

Pulmonary sarcomatoid carcinomas belong to a group of neoplasms that remain incompletely understood. They are rare tumors of the bronchopulmonary system that incorporate a wide range of neoplasms that by definition contain a sarcomatoid component characterized by spindle or giant cells. Such classification has led to a heterogenous tumor category that includes neoplasms with different clinical, morphologic, and prognostic features. To date, the histopathologic diagnosis of pulmonary sarcomatoid carcinomas does not require the use of ancillary testing and is based on light microscopic criteria alone. However, with recent advances in immunohistochemical and molecular methods, it is becoming increasingly clear that pulmonary sarcomatoid carcinomas represent poorly differentiated or “dedifferentiated” variants of conventional non–small cell carcinomas with similar immunophenotype and molecular signatures. This review summarizes the latest insights and concepts of these unusual tumors and outlines future directions with emphasis on tumor classification and patient management.
Ectomesenchymal Chondromyxoid Tumor
Authors: Dickson Brendan C. , Antonescu Cristina R. , Argyris Prokopios P. , Bilodeau Elizabeth A. , Bullock Martin J. , Freedman Paul D. , Gnepp Douglas R. , Jordan Richard C. , Koutlas Ioannis G. , Lee Cheng-Han , Leong Iona , Merzianu Mihai , Purgina Bibianna M. , Thompson Lester D.R. , Wehrli Bret , Wright John M. , Swanson David , Zhang Lei , Bishop Justin A.
Published: June 2018

Ectomesenchymal chondromyxoid tumor is a rare and benign neoplasm with a predilection for the anterior dorsal tongue. Despite morphologic heterogeneity, most cases are characterized by a proliferation of bland spindle cells with a distinctive reticular growth pattern and myxoid stroma. The immunophenotype of these neoplasms is likewise variable; most cases express glial fibrillary acid protein and S100 protein, with inconsistent reports of keratin and myoid marker expression. The molecular pathogenesis is poorly understood; however, a subset of cases has been reported to harbor EWSR1 gene rearrangement. Following identification of an RREB1-MKL2 fusion gene by RNA Sequencing in an index patient, a retrospective review of additional cases of ectomesenchymal chondromyxoid tumors was performed to better characterize the clinical, immunohistochemical, and molecular attributes of this neoplasm. A total of 21 cases were included in this series. A marked predisposition for the dorsal tongue was confirmed. Most cases conformed to prior morphologic descriptions; however, hypercellularity, hyalinized stroma, and necrosis were rare attributes not previously emphasized. The neoplastic cells frequently coexpressed glial fibrillary acid protein, S100 protein, keratin, smooth muscle actin, and/or desmin; a single case was found to contain significant myogenin expression. An RREB1-MKL2 fusion product was identified in 19 tumors (90%), a single tumor (5%) had an EWSR1-CREM fusion product, and the remaining case lacked any known fusion gene by RNA Sequencing. The latter 2 cases subtly differed morphologically from many in the cohort. This series illustrates that recurrent RREB1-MKL2 fusions occur in most, perhaps all, cases of ectomesenchymal chondromyxoid tumor.
Multicenter Review of Current Practices Associated With Venous Thromboembolism Prophylaxis in Pediatric Patients After Trauma
Authors: Bigelow Amee M. , Flynn-O’Brien Katherine T. , Simpson Pippa M. , Dasgupta Mahua , Hanson Sheila J.
Published: June 2018

Objectives:

Frequency of venous thromboembolism in pediatric trauma patients admitted to PICUs is not insignificant, ranging up to 6%. Risk factors have been identified in this population. However, there is little consensus of actual venous thromboembolism prophylaxis practice. We examined factors associated with venous thromboembolism prophylaxis in PICUs.

Design:

A retrospective study evaluating associations with mechanical venous thromboembolism prophylaxis, pharmacologic venous thromboembolism prophylaxis, or dual therapy (DUAL) prophylaxis compared with no venous thromboembolism prophylaxis. Multivariable logistic regression explored the relationship between prophylaxis type and selected covariates with stepwise selection method to identify the independent predictors of venous thromboembolism prophylaxis utilization.

Setting:

Five level I/II pediatric trauma centers in the United States.

Patients:

Children less than 18 years from January 1, 2013, to December 31, 2013, admitted to the PICU after a trauma, identified through combined trauma registry and Virtual Pediatric Systems database.

Interventions:

None.

Measurements and Main Results:

Six hundred ninety-two patients were included in the database, with 55 excluded for missing data. Of the remaining 637 patients, 538 (84.5%) had no venous thromboembolism prophylaxis by 48 hours, 77 (12.1%) had only mechanical venous thromboembolism prophylaxis, 11 (1.7%) had DUAL, and 11 (1.7%) had pharmacologic venous thromboembolism prophylaxis alone. Multivariable analysis showed increased age, and orthopedic procedure was associated with all forms of prophylaxis. Orthopedic procedures were associated with higher utilization of dual prophylaxis use (odds ratio, 5.2; 95% CI, 1.2–21.8), pharmacologic venous thromboembolism prophylaxis (odds ratio, 8.5; 95% CI, 2.3–31.7), and mechanical venous thromboembolism prophylaxis (odds ratio, 2.2; 95% CI, 1.1–4.2) alone. Brain/spinal cord procedures (odds ratio, 3.7; 95% CI, 1.9–7.3) and abdominal procedures (odds ratio, 6.6; 95% CI, 2.5–17.1) were associated with mechanical venous thromboembolism prophylaxis. Head injury was associated with a decreased use of any prophylaxis (odds ratio, 0.5; 95% CI, 0.3–0.9). Patient comorbidities were associated with decreased use of mechanical venous thromboembolism prophylaxis (odds ratio, 0.5; 95% CI, 0.3–1.0).

Conclusions:

Pharmacologic venous thromboembolism prophylaxis is not common in critically ill children after trauma. Patient age, orthopedic and vascular procedures, and higher injury severity are associated with pharmacologic venous thromboembolism prophylaxis.
Totally Robotic Versus Totally Laparoscopic Surgery for Rectal Cancer
Authors: Esen Eren , Aytac Erman , Ağcaoğlu Orhan , Zenger Serkan , Balik Emre , Baca Bilgi , Hamzaoğlu İsmail , Karahasanoğlu Tayfun , Buğra Dursun
Published: June 2018

In this study, perioperative and short-term postoperative results of totally robotic versus totally laparoscopic rectal resections for cancer were investigated in a comparative manner by considering risk factors including obesity, male sex, and neoadjuvant treatment. In addition to overall comparison, the impact of sex, obesity (body mass index ≥30 kg/m2), and neoadjuvant treatment was assessed in patients who had a total mesorectal excision (TME). Operative time was longer in the robotic group (P<0.001). In obese patients who underwent TME, the mean length of hospital stay was shorter (7±2 vs. 9±4 d, P=0.01), and the mean number of retrieved lymph nodes was higher (30±19 vs. 23±10, P=0.02) in the robotic group. Totally robotic and totally laparoscopic surgery appears to be providing similar outcomes in patients undergoing rectal resections for cancer. Selective use of a robot may have a role for improving postoperative outcomes in some challenging cases including obese patients undergoing TME.
The impact of news exposure on collective attention in the United States during the 2016 Zika epidemic
Authors: Tizzoni Michele , Panisson André , Paolotti Daniela , Cattuto Ciro
Published: June 2018

In recent years, many studies have drawn attention to the important role of collective awareness and human behaviour during epidemic outbreaks. A number of modelling efforts have investigated the interaction between the disease transmission dynamics and human behaviour change mediated by news coverage and by information spreading in the population. Yet, given the scarcity of data on public awareness during an epidemic, few studies have relied on empirical data. Here, we use fine-grained, geo-referenced data from three online sources – Wikipedia, the GDELT Project and the Internet Archive – to quantify population-scale information seeking about the 2016 Zika virus epidemic in the U.S., explicitly linking such behavioural signal to epidemiological data. Geolocalized Wikipedia pageview data reveal that visiting patterns of Zika-related pages in Wikipedia were highly synchronized across the United States and largely explained by exposure to national television broadcast. Contrary to the assumption of some theoretical models, news volume and Wikipedia visiting patterns were not significantly correlated with the magnitude or the extent of the epidemic. Attention to Zika, in terms of Zika-related Wikipedia pageviews, was high at the beginning of the outbreak, when public health agencies raised an international alert and triggered media coverage, but subsequently exhibited an activity profile that suggests nonlinear dependencies and memory effects in the relation between information seeking, media pressure, and disease dynamics. This calls for a new and more general modelling framework to describe the interaction between media exposure, public awareness and disease dynamics during epidemic outbreaks.
Crohn’s disease patients effectively mobilize peripheral blood stem cells to perform autologous haematopoietic stem cell transplantation
Authors: Ruiz Milton Artur , Kaiser Roberto Luiz , Piron – Ruiz Lilian , Peña-Arciniegas Tatiana , Castiglioni Lilian , Samara Saran Priscila , De Quadros Luiz Gustavo , Gouvea Faria Mikaell Alexandre , Siqueira Rubens Camargo , Liedtke Kaiser Fernanda Soubhia , Comenalli Marques José Francisco
Published: June 2018

Background

Treatment with high doses chemotherapy followed by autologous haematopoietic stem cell transplantation is promising for refractory Crohn’s disease patients with no therapeutic option and at imminent risk of further surgeries.

Objectives

To evaluate the feasibility and efficacy of haematopoietic progenitor cell mobilization in a group of Crohn’s disease patients preparing for autologous unselected haematopoietic stem cell transplantation in a single institution. This is the first study to evaluate mobilization for Crohn’s disease.

Methods

Patients were selected according to criteria of the European Bone Marrow Transplant Society.

Results

All patients mobilized with the mean number of haematopoietic progenitor cells obtained and infused being 16.17 × 106/CD34+/kg. Most patients required only one leukapheresis session to reach the ideal number of cells. Grafting occurred around ten days after cells infusion. Complications and adverse events during the mobilization period were rare with only one patient presenting sepsis as a relevant event in the period.

Most patients 20 (70%) had anaemia from the beginning of the mobilization but only 11 (37.9%) received packed red blood cell transfusions.

Conclusion

Mobilization in patients with Crohn’s disease is effective and it seems they are good mobilizers.
A Multi-Objective-Driven Placement Technique for Digital Microfluidic Biochips
Authors: Wan Chaowei , Chen Xiaodao , Liu Dongbo
Published: June 2018

Microfluidic biochips are extensively utilized in biochemistry procedures due to their low cost, high precision and efficiency when compared to traditional laboratory procedures. Recent, computer-aided design (CAD) techniques enable a high performance in digital microfluidic biochip design. A key part in digital microfluidic biochip CAD design is the biochip placement procedure which determines the physical location for biological reactions during the physical design. For the biochip physical design, multiple objects need to be considered, such as the size of the chip and the total operation time. In this paper, a multi-objective optimization is proposed based on Markov decision processes (MDPs). The proposed method is evaluated on a set of standard biochip benchmarks. Compared to existing works, experimental results show that the total operation time, the capacity for routing and the chip size can be optimized simultaneously.
EFFECT OF NITROGEN AMOUNT ON TRIBOLOGICAL BEHAVIOR OF PLASMA NITRIDED 31CrMoV9 STEEL
Authors: ÇOMAKLI O. , YETIM A. F. , KARACA B. , ÇELIK A.
Published: June 2018

The 31CrMoV9 steels were plasma nitrided under different gas mixture ratios to investigate an influence of nitrogen amount on wear behavior. The structure, mechanical and tribological behavior of untreated and nitrided 31CrMoV9 steels were analyzed with X-ray diffraction (XRD), scanning electron microscopy (SEM), energy dispersive X-ray spectroscopy (EDS), microhardness device, 3D profilometer and pin-on-disk wear tester. The analysis outcomes displayed that the compound layer consists of nitride phases (Fe2N, Fe3N, Fe4N and CrN). Additionally, the thickness of the compound layers, surface hardness and roughness increased with increasing nitrogen amount in the gas mixture. The highest friction coefficient value was obtained at nitrogen amount of 50%, but the lowest value was seen at nitrogen amount of 6%. It was observed that wear resistance of 31CrMoV9 steel improved after plasma nitriding, and the best wear resistance was also obtained from plasma nitrided sample at the gas mixture of 94% H[Formula: see text]% N2.
The Modified VIM for Certain Type of the Nonlinear Two-Point Boundary Value Problems
Authors: Ghorbani Asghar , Passandideh Hadi
Published: June 2018

In the current paper, we introduce a different version of the variational iteration method (VIM) that provide an easy and effective procedure for solving nonlinear two-point boundary-value problems appearing in applied and engineering applications. For problems where convergence rate of the original VIM is slow, the method can be readily improved to increase convergence rate. Convergence analysis and error bounds are discussed. Finally, applicability of the proposed method and accuracy are examined by solving three problems.
Fabrication of porous nickel–silica composite particles through catalytic hydrogen evolution reaction from aqueous ammonia borane solution
Authors: Umegaki Tetsuo , Takahashi Mamoru , Kojima Yoshiyuki
Published: June 2018

In this work, we investigated fabrication of porous nickel–silica composite particles through catalytic hydrogen evolution reaction from aqueous solution including sodium borohydride and ammonia borane. Aggregated nickel species were observed in the samples with high nickel content from scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) results, indicating that dispersion of active nickel species was significantly influenced by nickel content. The dispersion influenced hydrogen evolution amount and rate from aqueous solution including sodium borohydride and ammonia borane, and the samples with highly dispersed active nickel species showed high hydrogen evolution amount. The particles after the hydrogen evolution process showed significantly high specific surface area with large number of nanopores. UV-Vis spectra of the samples after the hydrogen evolution process indicated that the particles with high hydrogen evolution amount from aqueous solution including sodium borohydride and ammonia borane included high amount of reduced nickel species.