bluuebunny/crossref_metadata_2025 huggingface dataset:
Endotracheal tube cuff pressure changes during manual cuff pressure control manoeuvres: An in‐vitro assessment
Authors: Aeppli Norbert , Lindauer Bastian , Steurer Marc P. , Weiss Markus , Dullenkopf Alexander
Published: August 2018

Background

Endotracheal tube (ETT) cuffs are designed to seal the lower airway for precise ventilation and to protect against ingress of pathogens from the pharyngeal space. Therefore, a minimal continuous cuff pressure must be maintained. Aim of this study was to analyse the course of cuff pressure in an in‐vitro model during manual cuff pressure control manoeuvres.

Methods

An artificial trachea was intubated with an appropriately sized ETT and cuff pressure set to 20 cm H2O. Thirty‐two experienced ICU nurses each performed six cuff pressure control manoeuvres (three times in two different ETTs) using a manual cuff pressure manometer. Course of cuff pressure from connecting the manometer to disconnecting it from the cuff pilot balloon was recorded using a pressure transducer.

Results

There were 190 cuff pressure control manoeuvres suitable for analysis. In all control manoeuvres a cuff pressure below 20 cm H2O was noted. In 20.0% of the control manoeuvres the cuff pressure dropped below 10 cm H2O. Cuff pressure drops were mainly caused by initially connecting the manometer to the pilot balloon, less frequently by manipulating the pressure gauge of the manometer. Disconnecting the manometer after the control manoeuvre caused a cuff pressure drop in 78.1% of cases, contributing to a final cuff pressure below 20 cm H2O in 31.3% of control manoeuvres.

Conclusion

Routine manual cuff pressure control manoeuvres in ETT cuffs result in considerable cuff pressure drops. This may have an impact on silent aspiration of pharyngeal contents passing along the cuff into the lower airway.
Adult Sox2+ stem cell exhaustion in mice results in cellular senescence and premature aging
Authors: Vilas Jéssica M. , Carneiro Carmen , Da Silva‐Álvarez Sabela , Ferreirós Alba , González Patricia , Gómez María , Ortega Sagrario , Serrano Manuel , García‐Caballero Tomás , González‐Barcia Miguel , Vidal Anxo , Collado Manuel
Published: August 2018

Aging is characterized by a gradual functional decline of tissues with age. Adult stem and progenitor cells are responsible for tissue maintenance, repair, and regeneration, but during aging, this population of cells is decreased or its activity is reduced, compromising tissue integrity and causing pathologies that increase vulnerability, and ultimately lead to death. The causes of stem cell exhaustion during aging are not clear, and whether a reduction in stem cell function is a cause or a consequence of aging remains unresolved. Here, we took advantage of a mouse model of induced adult Sox2+ stem cell depletion to address whether accelerated stem cell depletion can promote premature aging. After a short period of partial repetitive depletion of this adult stem cell population in mice, we observed increased kyphosis and hair graying, and reduced fat mass, all of them signs of premature aging. It is interesting that cellular senescence was identified in kidney after this partial repetitive Sox2+ cell depletion. To confirm these observations, we performed a prolonged protocol of partial repetitive depletion of Sox2+ cells, forcing regeneration from the remaining Sox2+ cells, thereby causing their exhaustion. Senescence specific staining and the analysis of the expression of genetic markers clearly corroborated that adult stem cell exhaustion can lead to cellular senescence induction and premature aging.
Knockdown of Mns1 Increases Susceptibility to Craniofacial Defects Following Gastrulation‐Stage Alcohol Exposure in Mice
Authors: Boschen Karen E. , Gong Henry , Murdaugh Laura B. , Parnell Scott E.
Published: August 2018

Background

MNS1 (meiosis‐specific nuclear structural protein 1) is necessary for motile cilia function, such as sperm flagella or those found in the embryonic primitive node. While little is known regarding the function or expression pattern of MNS1 in the embryo, co‐immunoprecipitation experiments in sperm have determined that MNS1 interacts with ciliary proteins, which are also important during development. Establishment of morphogenic gradients is dependent on normal ciliary motion in the primitive node beginning during gastrulation (gestational day [GD] 7 in the mouse, second–third week of pregnancy in humans), a critical window for face, eye, and brain development and particularly susceptible to perturbations of developmental signals. The current study investigates the role of Mns1 in craniofacial defects associated with gastrulation‐stage alcohol exposure.

Methods

On GD7, pregnant Mns1+/− dams were administered 2 doses of ethanol (5.8 g/kg total) or vehicle 4 hours apart to target gastrulation. On GD17, fetuses were examined for ocular defects by scoring each eye on a scale from 1 to 7 (1 = normal, 2 to 7 = defects escalating in severity). Craniofacial and brain abnormalities were also assessed.

Results

Prenatal alcohol exposure (PAE) significantly increased the rate of defects in wild‐type fetuses, as PAE fetuses had an incidence rate of 41.18% compared to a 10% incidence rate in controls. Furthermore, PAE interacted with genotype to significantly increase the defect rate and severity in Mns1+/− (64.29%) and Mns1−/− mice (92.31%). PAE Mns1−/− fetuses with severe eye defects also presented with craniofacial dysmorphologies characteristic of fetal alcohol syndrome and midline tissue loss in the brain, palate, and nasal septum.

Conclusions

These data demonstrate that a partial or complete knockdown of Mns1 interacts with PAE to increase the susceptibility to ocular defects and correlating craniofacial and brain anomalies, likely though interaction of alcohol with motile cilia function. These results further our understanding of genetic risk factors that may underlie susceptibility to teratogenic exposures.
A Unifying Hypothesis Linking Hepatic Adaptations for Ethanol Metabolism to the Proinflammatory and Profibrotic Events of Alcoholic Liver Disease
Authors: Zhong Zhi , Lemasters John J.
Published: August 2018

The pathogenesis of alcoholic liver disease (ALD) remains poorly understood but is likely a multihit pathophysiological process. Here, we propose a hypothesis of how early mitochondrial adaptations for alcohol metabolism lead to ALD pathogenesis. Acutely, ethanol (EtOH) feeding causes a near doubling of hepatic EtOH metabolism and oxygen consumption within 2 to 3 hours. This swift increase in alcohol metabolism (SIAM) is an adaptive response to hasten metabolic elimination of both EtOH and its more toxic metabolite, acetaldehyde (AcAld). In association with SIAM, EtOH causes widespread hepatic mitochondrial depolarization (mtDepo), which stimulates oxygen consumption. In parallel, voltage‐dependent anion channels (VDAC) in the mitochondrial outer membrane close. Together, VDAC closure and respiratory stimulation promote selective and more rapid oxidation of EtOH first to AcAld in the cytosol and then to nontoxic acetate in mitochondria, since membrane‐permeant AcAld does not require VDAC to enter mitochondria. VDAC closure also inhibits mitochondrial fatty acid oxidation and ATP release, promoting steatosis and a decrease in cytosolic ATP. After acute EtOH, these changes revert as EtOH is eliminated with little hepatocellular cytolethality. mtDepo also stimulates mitochondrial autophagy (mitophagy). After chronic high EtOH exposure, the capacity to process depolarized mitochondria by mitophagy becomes compromised, leading to intra‐ and extracellular release of damaged mitochondria, mitophagosomes, and/or autolysosomes containing mitochondrial damage–associated molecular pattern (mtDAMP) molecules. mtDAMPs cause inflammasome activation and promote inflammatory and profibrogenic responses, causing hepatitis and fibrosis. We propose that persistence of mitochondrial responses to EtOH metabolism becomes a tipping point, which links initial adaptive EtOH metabolism to maladaptive changes initiating onset and progression of ALD.
Genome‐wide association analyses of lesion counts in group‐housed pigs
Authors: Wurtz K. E. , Siegford J. M. , Ernst C. W. , Raney N. E. , Bates R. O. , Steibel J. P.
Published: August 2018

Aggression in group‐housed pigs is a welfare concern and can negatively affect production. Skin lesions are reliable indicators of aggression and are moderately heritable, suggesting that selective breeding may reduce aggression. To further understand the genetic control of behavioral traits, such as the aggressive response to regrouping, associated single nucleotide polymorphisms (SNPs) can be identified within the genome, and the region in which these SNPs are located can be related to known genes. To investigate SNPs associated with aggression, 1093 purebred Yorkshire pigs were strategically remixed into new groups of familiar and unfamiliar animals at three life stages and lesion counts were recorded. Genomic best linear unbiased prediction (GBLUP) models were fitted for each trait. The genetic additive effect was obtained from a genetic relationship matrix constructed from the 50 924 SNPs. SNP effects and their variances were estimated from the GBLUP objects. SNPs that were associated with a significant portion of the trait variance were identified for lesions to the anterior (three SNPs, FDR <5%) and central (one SNP, FDR <5%) portions of the body in grow‐finish pigs. These SNPs were located on chromosome 11, suggesting that chromosome 11 contains a region explaining variation in lesion counts that should be further explored to identify genes underlying biological control of aggression.
Genetic role ofCYP4A11polymorphisms in the risk of developing cardiovascular and cerebrovascular diseases
Authors: Yu Kuiying , Zhang Tao , Li Xuhua
Published: August 2018

Background

We are interested in comprehensively evaluating the potential genetic influence of rs9332978 A/G, rs1126742 T/C, and rs9333025 G/A polymorphisms ofCYP4A11(cytochrome P450 family 4, subfamily A, member 11) in the risk of developing cardiovascular and cerebrovascular diseases.

Methods

A meta‐analysis was carried out using articles obtained from online databases and Stata/SE 12.0 software. We primarily used aPvalue of association test (Passociation) and odds ratios (OR) to assess the genetic relationships.

Results

We included 22 eligible case‐control articles for our meta‐analysis. For the overall meta‐analysis of the rs9332978 A/G polymorphism, there was an increased risk of cardiovascular and cerebrovascular diseases in cases under the models of allele G vs. A (Passociation = 0.001, OR = 1.16), AG vs. AA (Passociation < 0.001, OR = 1.22), and AG+GG vs. AA (Passociation < 0.001, OR = 1.22) compared with the controls. There were similar results in the subgroup analysis of “hypertension” (Passociation = 0.024 for the allele model;Passociation = 0.003 for the heterozygote model; andPassociation = 0.005 for the dominant model). For rs1126742, there was a significant difference between cases and controls in the overall meta‐analysis and subgroup of “Caucasian,” “hypertension,” and “population‐based (PB)” under all of the genetic models (allPassociation < 0.05, OR > 1). Furthermore, a decreased risk was detected in the overall and “PB” subgroup meta‐analysis of rs9333025 under the models of A vs. G, AA vs. GG, and AA vs. GG+GA (allPassociation < 0.05, OR < 1).

Conclusion

The rs1126742 T/C polymorphism ofCYP4A11is more likely to be a genetic risk factor for the hypertension cases in the Caucasian population. Moreover, whereas the AG genotype ofCYP4A11rs9332978 may be associated with an increased risk of hypertension, the AA genotype of rs9333025 may be linked to a decreased risk of cardiovascular and cerebrovascular diseases.
Therapeutic doses of neostigmine, depolarising neuromuscular blockade and muscle weakness in awake volunteers: a double‐blind, placebo‐controlled, randomised volunteer study
Authors: Kent N. B. , Liang S. S. , Phillips S. , Smith N. A. , Khandkar C. , Eikermann M. , Stewart P. A.
Published: August 2018

Neostigmine reverses non‐depolarising neuromuscular blockade, but may cause muscle weakness when administered after full recovery of neuromuscular function. We hypothesised that neostigmine in therapeutic doses impairs muscle strength and respiratory function in awake healthy volunteers. Twenty‐one volunteers were randomised to receive two doses of either intravenous (i.v.) neostigmine 2.5 mg with glycopyrrolate 450 μg (neostigmine group, n = 14) or normal saline 0.9% (placebo group, n = 7). The first dose was administered immediately after obtaining baseline measurements, and the second dose was administered 15 min later. All 14 volunteers in the neostigmine group received the first dose, mean (SD) 35 (5.8) μg.kg−1, but only nine of these volunteers agreed to receive the second dose, 34 (3.5) ?g.kg‐1. The primary outcome was hand grip strength. Secondary outcomes were train‐of‐four ratio, single twitch height, forced expiratory volume in 1 s, forced vital capacity, forced expiratory volume in 1 s/forced vital capacity ratio, oxygen saturation, heart rate and mean arterial pressure. The first dose of intravenous neostigmine with glycopyrrolate resulted in reduced grip strength compared with placebo, −20 (20) % vs. +4.3 (9.9) %, p = 0.0016; depolarising neuromuscular blockade with decreased single twitch height, −14 (11) % vs. −3.8 (5.6) %, p = 0.0077; a restrictive spirometry pattern with decreased predicted forced expiratory volume in 1 s, −15 (12) % vs. −0.47 (3.4) %, p = 0.0011; and predicted forced vital capacity, −20 (12) % vs. −0.59 (3.2) %, p < 0.0001 at 5 min after administration. The second dose of neostigmine with glycopyrrolate further decreased grip strength mean (SD) −41 (23) % vs. +1.0 (15) %, p = 0.0004; single twitch height −25 (15) % vs. −2.5 (6.6) %, p = 0.0030; predicted forced expiratory volume in 1 s −23 (24) % vs. −0.7 (4.4) %, p = 0.0063; and predicted forced vital capacity, −27.1 (22.0) % vs. −0.66 (3.9) %, p = 0.0010. Train‐of‐four ratio remained unchanged (p = 0.22). In healthy volunteers, therapeutic doses of neostigmine induced significant and dose‐dependent muscle weakness, demonstrated by a decrease in maximum voluntary hand grip strength and a restrictive spirometry pattern secondary to depolarising neuromuscular blockade.
An investigation on the influence of yogic methods on heart rate variability
Authors: Senthilnathan Sengottuvel , Patel Rajesh , Narayanan Mariyappa , Katholil Gireesan , Janawadkar Madhukar Pandurang Rao , Radhakrishnan Thimmakudy Sambasiva , Sharma Krishna K.
Published: August 2018

Background

The role of underlying mechanisms of yogic strategies which exert beneficiary effects on cardiac autonomic control is poorly understood. We have performed heart rate variability (HRV) analysis on subjects performing yogic methods and control subjects who mimic them through paced breathing and focused attention tasks using external cues.

Methods

Heart rate (HR) time series is generated from electrocardiogram measured from subjects of yogic group (YG); performing yogic practices (n = 15), paced breathing group (PBG); involved in breathing exercises cued at breathing rates (BR) from 3 to 15 cycles per minute (cpm) (n = 23), normal breathing group (NBG) under regular breathing (n = 15), and subjects performing three different cognitive tasks designated as focused attention group (FAG), (n = 24). HRV is analyzed using coherence plots, spectrograms, HRV parameters, and instantaneous frequency recurrence plots (IFRP).

Results

HRV is similar among YG and PBG (at BR <12 cpm) and significantly different for YG vs. NBG (p < 0.001) and PBG vs. NBG (p < 0.001). Regularity of breathing oscillations observed in HR is quantified using IFRP and is identical among FAG, PBG, and YG and significantly different for YG vs. NBG (p < 0.01), PBG vs. NBG (p < 0.01), and FAG vs. NBG (p < 0.05).

Conclusions

Low‐frequency breathing (BR <12 cpm) plays a primary role in eliciting physiologically significant changes in HRV. By identifying a similarity in breathing oscillations of HR of FAG, YG, and PBG, the results recognize the coexistence of attention and breathing strategies and postulate their joint role in sustaining autonomic benefits, while effects induced by breathing alone on HRV could be attained even intermittently.
A mixed‐methods evaluation of continuous electronic fetal monitoring for an extended period
Authors: Crawford Alexandra , Anyadi Patrick , Stephens Louise , Thomas Suzanne L. , Reid Holly , Higgins Lucy E. , Warrander Lynne K. , Johnstone Edward D. , Heazell Alexander E. P.
Published: August 2018

Introduction

Continuous fetal monitoring is used to objectively record the fetal heart rate and fetal activity over an extended period of time; however, its feasibility and acceptability to women is currently unknown. The study addressed the hypothesis that continuous fetal monitoring is feasible and acceptable to pregnant women.

Material and methods

Pregnant participants (n = 22) were monitored using a continuous fetal electrocardiography device, the Monica AN24. Signal quality, duration of recording and cardiotocography findings were correlated with maternal and fetal factors. Participants’ change in anxiety before and after monitoring was assessed using validated questionnaires. Participants’ experiences were explored through a questionnaire (n = 20) and semi‐structured interview (n = 13).

Results

Recordings were successfully obtained in 19 of the 22 participants (86.3%). The mean recording quality of fetal heart rate was 69.0% (range 17.4%‐99.4%) and maternal heart rate was 99.0% (90.9%‐100.0%). Recording quality was positively correlated with gestational age (P = 0.05) and negatively correlated with uterine activity and maternal movement (P < 0.001). Overall, participants were satisfied with their experience of continuous fetal monitoring; 30% considered it preferable to intermittent monitoring. Continuous fetal monitoring did not significantly increase maternal anxiety, with a trend towards a reduction in Pregnancy Specific Anxiety score (P = 0.07). Qualitative analysis grouped women’s responses into three themes: (a) reassurance and anxiety, (b) the physical device and (c) future developments in continuous fetal monitoring.

Conclusions

Continuous fetal monitoring is a feasible and acceptable form of monitoring to pregnant women although further practical improvements could be incorporated. Further research is required to assess the ability of continuous fetal monitoring to detect fetal compromise.
Evaluation of Two Femoral Arterial Cannulae With Conventional Non‐Pulsatile and Alternative Pulsatile Flow in a Simulated Adult ECLS Circuit
Authors: Wang Shigang , Force Madison , Kunselman Allen R. , Brehm Christoph , Ündar Akif
Published: August 2018

The objective of this study is to evaluate the hemodynamic characteristics of two femoral arterial cannulae in terms of circuit pressure, pressure drop, and hemodynamic energy transmission under non‐pulsatile and pulsatile modes in a simulated adult extracorporeal life support (ECLS) system. The ECLS circuit consisted of i‐cor diagonal pump and console (Xenios AG, Heilbronn, Germany), an iLA membrane ventilator (Xenios AG), an 18 Fr or 16 Fr femoral arterial cannula (Xenios AG), and a 23/25 Fr Estech remote access perfusion (RAP) femoral venous cannula (San Ramon, CA, USA). The circuit was primed with lactated Ringer’s solution and packed red blood cells to achieve a hematocrit of 35%. All trials were conducted at room temperature with flow rates of 1–4 L/min (1 L/min increments). The pulsatile flow settings were set at pulsatile frequency of 75 bpm and pulsatile amplitudes of 1000–4000 rpm (1000 rpm increments). Flow and pressure data were collected using a custom data acquisition system. Total hemodynamic energy (THE) is calculated by multiplying the ratio between the area under the hemodynamic power curve (∫flow × pressure dt) and the area under the pump flow curve (∫flow dt) by 1332. The pressure drop across the arterial cannula increased with increasing flow rate and decreasing cannula size. The pressure drops of 18 Fr and 16 Fr cannulae were 19.4–24.5 and 38.4–45.3 mm Hg at 1 L/min, 55.2–56.8 and 110.9–118.3 mm Hg at 2 L/min, 94.1–105.1 and 209.7–215.1 mm Hg at 3 L/min, and 169.2–172.6 and 376.4 mm Hg at 4 L/min, respectively. Pulsatile flow created more hemodynamic energy than non‐pulsatile flow, especially at lower flow rates. The percentages of THE loss across 18 Fr and 16 Fr cannula were 16.0–18.7 and 27.5–30.8% at 1 L/min, 35.1–35.7 and 52.3–53.8% at 2 L/min, 48.3–50.3 and 67.3–68.4% at 3 L/min and 62.9–63.1 and 79.0% at 4 L/min. The hemodynamic performance of the arterial cannula should be evaluated before use in clinical practice. The pressure drops and percentages of THE loss across two cannulae tested using human blood were higher compared to the manufacturer’s data tested using water. The cannula size should be chosen to match the expected flow rate. In addition, this novel i‐cor ECLS system can provide non‐pulsatile and ECG‐synchronized pulsatile flow without significantly increasing the cannula pressure drop and hemodynamic energy loss.
Half a Century of Work–Nonwork Interface Research: A Review and Taxonomy of Terminologies
Authors: Beigi Mina , Shirmohammadi Melika , Otaye‐Ebede Lilian
Published: August 2018

The extensive interest in the work‐nonwork interface over the years has allowed scholars from multiple disciplines to contribute to this literature and to shed light on how professional and personal lives are related. In this paper, we have identified 48 terminologies that describe the interface or relationship between work and nonwork, and have organised them into mature, intermediate, and immature categories according to their stage of development and theoretical grounding. We also provide a taxonomy that places work‐nonwork interface terminologies into a matrix of six cells based on two dimensions: (1) type of nonwork being narrow or broad; and (2) nature of the mutual impact of work and nonwork domains on one another, characterising the impact as negative, positive, or balanced. The type of nonwork dimension was informed by Frone’s (2003) classification of employees’ lives into multiple subdomains; the mutual impact dimension was informed by frameworks that organised the literature in part by negative, positive, and balanced work‐nonwork interface constructs (e.g., Allen, 2012; Greenhaus & Allen, 2011). Theoretical contributions of the proposed taxonomy are discussed along with suggestions on important avenues for future research.
Editorial: control of acid secretion
Authors: Sachs G. , Marcus E. A. , Wen Y. , Munson K.
Published: August 2018

Linked Content

This article is linked to Sunwoo et al paper. To view this article visit https://doi.org/10.1111/apt.14818.
Editorial: paradoxical skin lesions during anti‐TNF treatment—an additional argument to consider new biologics as first line therapy in inflammatory bowel disease
Authors: Pariente B. , Blondeaux A.
Published: August 2018

This article is linked to Bae et al and Lee et al papers. To view these articles visit https://doi.org/10.1111/apt.14822 and https://doi.org/10.1111/apt.14917.
Editorial: paradoxical skin lesions during anti‐TNF treatment—an additional argument to consider new biologics as first‐line therapy in inflammatory bowel disease. Authors’ reply
Authors: Lee Han Hee , Bae Jung Min , Lee Bo‐In
Published: August 2018

This article is linked to Bae et al and Pariente and Blondeaux papers. To view these articles visit https://doi.org/10.1111/apt.14822 and https://doi.org/10.1111/apt.14903.
Editorial: anxiety and depression in inflammatory bowel disease – authors’ reply
Authors: Stapersma Luuk , van den Brink Gertrude , Szigethy Eva M. , Escher Johanna C. , Utens Elisabeth M. W. J.
Published: August 2018

This article is linked to Stapersma et al and Mikocka‐Walus and Knowles papers. To view these articles visit https://doi.org/10.1111/apt.14865 and https://doi.org/10.1111/apt.14912.
Islands of design: Reshaping land, sea and space
Authors: Johnson Henry
Published: August 2018

This paper takes a critical comparative approach to the reshaping of land, sea and space that often transform islands. I show how island physicality is part of a fluid process of reshaping the environment by discussing four dynamic spheres of change: upward, downward, outward and inward. Islands are sometimes joined to a mainland or to each other as a way of enlarging terrain or increasing mobility. Joining occurs through land reclamation, the building of bridges or the excavation of tunnels, with each method representing a distinct transformation of islands and islandness. Islands are often divided for political or cultural reasons, yet they might also be physically divided or reshaped. Islands are often distinct within urbanisation processes where physical features extend an island both vertically and horizontally, including the creation of new islands. Islands are sometimes levelled, either in part or in full, which serves to erase island space. The transformation of land, sea and space accompanying the reshaping of islands often occurs through human intervention, yet some islands have undergone rapid change due to natural phenomena. This paper offers a critical study of four dynamic spheres, including cases from around the world, as a way of extending discourse within the field of Island Studies in order to highlight the shifting physicality of island space and to contribute to discussion on the dynamics of island spatial fluidity.
Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report
Authors: Hisano Kyoko , Ueki Takashi , Kono Hiroshi , Ikenaga Naoki , Maeyama Ryo , Konomi Hiroyuki , Okido Masayuki , Yamashita Nobuaki , Motoshita Junichi , Ichimiya Hitoshi
Published: August 2018

Persistent mesocolon is an embryological anomaly of the colon resulting from failure of the primitive dorsal mesocolon to fuse with the parietal peritoneum. We herein present a case of laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons and a right‐bound inferior mesenteric artery. Preoperative 3‐D CT demonstrated that the sigmoid colon had shifted to the right abdomen and was located under the ascending colon. Moreover, the inferior mesenteric artery and vein traveled toward the right abdomen accompanied by the mesentery of the descending colon. Adhesiolysis between the ascending and sigmoid colon was initially performed, and the sigmoid colon was placed in its normal position. The inferior mesenteric artery was then divided with lymph node dissection using a medial approach, and high anterior resection was completed. An understanding of the anatomical characteristics of persistent mesocolon is important to ensure safe laparoscopic surgery.
Learning curve for single‐incision laparoscopic totally extraperitoneal inguinal hernia repair
Authors: Wakasugi Masaki , Nakahara Yujiro , Hirota Masaki , Matsumoto Takashi , Kusu Takashi , Takemoto Hiroyoshi , Takachi Ko , Oshima Satoshi
Published: August 2018

Introduction

The learning curve for totally extraperitoneal repair (TEP) is longer and steeper than that for transabdominal preperitoneal repair (TAPP) due to the preperitoneal view to which the surgeon is not accustomed and the limited working space. The aim of this study was to clarify the learning curve for SILS‐TEP.

Methods

A retrospective analysis of 80 consecutive patients with unilateral inguinal hernia was performed. All patients underwent elective SILS‐TEP performed by a single learning surgeon with a teaching assistant between July 2016 and March 2018 at Kinki Central Hospital.

Results

The operative time decreased gradually after 20 cases and stabilized after 40 cases. The first 40 cases were categorized as the learning period group, and the remaining 40 cases were categorized as the experienced period group. More patients received antithrombotic therapy in the experienced period than in the learning period (P < 0.05). The median operative time was 107 and 60 min in the learning period and the experienced period, respectively (P < 0.05). There were no significant differences in blood loss peritoneal injury, conversion to a different procedure, postoperative hospital stay, complications, and recurrence between the two groups. No major complications or hernia recurrence were noted during follow‐up.

Conclusions

The learning curve for SILS‐TEP might take 40 cases to reduce the operative time. SILS‐TEP can be performed safely by a learning surgeon with a teaching assistant.
Precaution, threshold risk and public deliberation
Authors: Holm Sune
Published: August 2018

It has been argued that the precautionary principle is incoherent and thus useless as a guide for regulatory policy. In a recent paper in Bioethics, Wareham and Nardini propose a response to the ‘precautionary paradox’ according to which the precautionary principle's usefulness for decision making in policy and regulation contexts can be justified by appeal to a probability threshold discriminating between negligible and non‐negligible risks. It would be of great significance to debates about risk and precaution if there were a sound method for determining a minimum probability threshold of negligible risk. This is what Wareham and Nardini aim to do. The novelty of their approach is that they suggest that such a threshold should be determined by a method of public deliberation. In this article I discuss the merits of Wareham and Nardini’s public deliberation method for determining thresholds. I raise an epistemic worry about the public deliberation method they suggest, and argue that their proposal is inadequate due to a hidden assumption that the acceptability of a risk can be completely analysed in terms of its probability.
On Doubly Robust Estimation of the Hazard Difference
Authors: Dukes Oliver , Martinussen Torben , Tchetgen Tchetgen Eric J. , Vansteelandt Stijn
Published: August 2018

The estimation of conditional treatment effects in an observational study with a survival outcome typically involves fitting a hazards regression model adjusted for a high-dimensional covariate. Standard estimation of the treatment effect is then not entirely satisfactory, as the misspecification of the effect of this covariate may induce a large bias. Such misspecification is a particular concern when inferring the hazard difference, because it is difficult to postulate additive hazards models that guarantee non-negative hazards over the entire observed covariate range. We therefore consider a novel class of semiparametric additive hazards models which leave the effects of covariates unspecified. The efficient score under this model is derived. We then propose two different estimation approaches for the hazard difference (and hence also the relative chance of survival), both of which yield estimators that are doubly robust. The approaches are illustrated using simulation studies and data on right heart catheterization and mortality from the SUPPORT study.
Anticipated and imagined futures: prospective cognition and depressed mood following brain injury
Authors: Murphy Fionnuala C. , Peers Polly V. , Blackwell Simon E. , Holmes Emily A. , Manly Tom
Published: August 2018

Objectives

Depression, which is common following acquired brain injury (ABI), has been shown to predict cognitive impairment, rehabilitation outcome, and quality of life. Whilst many studies have examined links between depression and cognitive–affective processing in the non‐ABI population, their applicability to this important clinical group, where cognitive difficulties can be marked, remains unknown. Here, we investigated biases in prospective cognition, which is known to be disrupted in (non‐ABI) depression yet important for well‐being.

Design

Cross‐sectional design with three groups (depressed ABI, non‐depressed ABI, and non‐ABI control participants). Continuous data were additionally analysed in correlation analyses.

Methods

Individuals with ABI varying in extent of self‐reported depression and matched non‐ABI control participants completed assessments of mood and prospective cognition (anticipating and imagining future events), alongside background tests of executive function and fluid intelligence.

Results

Relative to non‐depressed ABI and control participants, depressed ABI individuals demonstrated a reduced positive bias in prospective cognition: whereas non‐depressed ABI and control participants generated more examples of likely or possible positive versus negative future events, there was no evidence for such a positive bias in depressed ABI participants. Non‐depressed ABI and control participants also reported more vivid mental imagery for positive versus negative future scenarios, whereas such a pattern was not evident in depressed ABI participants. This pattern emerged despite background impairments in fluid intelligence and executive function associated with ABI.

Conclusions

These findings (1) elucidate depression‐linked cognitive–affective processes following ABI, where cognitive difficulties are common, and (2) highlight psychological processes associated with depression that are common to ABI and non‐ABI populations.

Practitioner points

Clinical implications

A relative negative bias in future‐directed cognition is associated with depressed mood in individuals with chronic ABI.

Such processes may contribute to the onset and maintenance of depression following ABI.

These findings suggest it may be important to consider a role for prospective cognition in psychological interventions for depression following ABI.

Limitations of the study

The extent to which depressed mood following ABI is associated with biases in other cognitive domains remains unclear.

Whether similar patterns would be observed in acute patients with more profound cognitive difficulties requires further investigation.

Despite large effect sizes, our sample size is modest; these effects thus require replication in larger groups.
Earth surface modeling for education: How effective is it? Four semesters of classroom tests with WILSIM‐GC
Authors: Luo Wei , Smith Thomas J. , Whalley Kyle , Darling Andrew , Ormand Carol , Hung Wei‐Chen , Chiang Jui‐Ling , Pelletier Jon , Duffin Kirk
Published: August 2018

This paper presents results from a randomized experimental design replicated over four semesters that compared students’ performance in understanding landform evolution processes as measured by the pretest to posttest score growth between two treatment methods: an online interactive simulation tool and a paper‐based exercise. While both methods were shown to be effective at enhancing students’ learning of the landform concepts and processes, there was no statistically significant difference in score growth between the two instructional methods. However, the attitudinal survey indicated that students consistently favored the simulation approach over the paper‐based exercise. With the simulation method, female students showed greater score growth than males, especially for test items requiring higher level thinking. This indicates that the visually rich interactive simulation tool may be integrated to better support female students’ learning in geoscience. Science major students generally outperformed non‐science major students in terms of score growth, which suggests that background knowledge played an important role in realizing the potential of computer modeling in enhancing students’ learning. Sufficient scaffolding is necessary to maximize the effect of interactive earth surface modeling in geoscience education.
Community detection with opinion leaders’ identification for promoting collaborative problem‐based learning performance
Authors: Chen Chih‐Ming , You Zong‐Lin
Published: August 2018

In the 21st century when knowledge‐based economy is emphasized, the cultivation of autonomous learning and problem‐solving abilities presents the importance. With web‐based collaborative problem‐based learning (CPBL), learners could more conveniently cultivate their problem‐solving abilities through autonomous learning. Nevertheless, learners are often guided to solve a target problem by the information announced by teachers during the CPBL processes. Individual learners often could not effectively absorb such standard information, thus ignoring the important information from teachers. In the information communication theory, the two‐step flow of communication through opinion leaders has been proved that it can better change audiences’ attitudes than the one‐step flow of communication through mass media. This study thus employs the modularity Q function as the fitness function of genetic algorithm to optimally detect learning communities and uses PageRank measure to accurately find out community opinion leaders according to the social network interaction data of learners in the CPBL process. Based on quasi‐experimental design, this study examines whether learners in the experimental group using the two‐step flow of communication through opinion leaders to convey information for solving the target CPBL missions could more significantly enhance web‐based CPBL performance, social network interaction and group cohesion than learners in the control group using the one‐step flow of communication through teachers’ information. Analytical results show learners in the experimental group remarkably outperform those in the control group on learning performance and peer interaction under a CPBL environment. Particularly, female learners in the experimental group notably outperform female learners in the control group on learning performance, while there is no significant difference in male learners between both groups. More importantly, learners in the experimental group present significantly higher group cohesion than those in the control group. This study confirms that using the two‐step flow of communication instead of the one‐step flow of communication traditionally used in web‐based learning environments could significantly promote web‐based CPBL performance, social network interaction and group cohesion.
Nuciferine ameliorates hepatic steatosis in high‐fat diet/streptozocin‐induced diabetic mice through a PPARα/PPARγ coactivator‐1α pathway
Authors: Zhang Chao , Deng Jianjun , Liu Dan , Tuo Xingxia , Xiao Lei , Lai Baochang , Yao Qinyu , Liu Jia , Yang Haixia , Wang Nanping
Published: August 2018

Background and Purpose

Nuciferine, an alkaloid found in Nelumbo nucifera leaves, alleviates dyslipidemia in vivo. However, whether it improves liver injury in diabetic conditions and the underlying mechanism is unclear. The present study aimed to investigate the effects of nuciferine on lipid and glucose metabolism in a murine model of Type 2 diabetes mellitus (T2DM) and to determine the underlying mechanisms of these effects.

Experimental Approach

A murine model of T2DM was induced by high‐fat diet (HFD) feeding combined with streptozocin (STZ) injections, and the diabetic mice were treated with nuciferine in their food. The underlying mechanism of the anti‐steatotic effect of nuciferine was further explored in HepG2 hepatocytes cultured with palmitic acid. Major signalling profiles involved in fatty acid oxidation were then evaluated, using Western blot, RT‐qPCR and si‐RNA techniques, along with immunohistochemistry.

Key Results

Nuciferine restored impaired glucose tolerance and insulin resistance in diabetic mice. Hepatic levels of total cholesterol, triglycerides and LDL were decreased, as were the number of lipid droplets, by nuciferine treatment. Furthermore, nuciferine up‐regulated β‐oxidation related genes in livers of diabetic mice. Luciferase reporter cell assay showed that nuciferine directly reversed palmitic acid‐induced inhibition of PPARα transcriptional activity. Silencing PPARγ coactivator‐1α (PGC1α) expression in HepG2 cells abolished the effects of nuciferine in accelerating β‐oxidation.

Conclusions and Implications

Nuciferine improved lipid profile and attenuated hepatic steatosis in HFD/STZ‐induced diabetic mice by activating the PPARα/PGC1α pathway. Nuciferine may be a potentially important candidate in improving hepatic steatosis and the management of T2DM.
Epithelial folliculin enhances airway inflammation in aspirin‐exacerbated respiratory disease
Authors: Trinh Hoang Kim Tu , Pham Duy Le , Choi Youngwoo , Kim Hyun‐Mi , Kim Seung‐Hyun , Park Hae‐Sim
Published: August 2018

Background

Clinical features of aspirin‐exacerbated respiratory disease (AERD) are characterized by overproduction of cysteinyl leukotrienes (LT) and eosinophil activation, in which epithelial cells contribute to eosinophilic airway inflammation. Folliculin (FLCN) helps maintain the integrity of epithelial barrier, but little is known about FLCN in AERD.

Objective

We investigated the role of FLCN in the pathogenic mechanisms of AERD.

Methods

We recruited 178 subjects with AERD, 276 subjects with aspirin‐tolerant asthma (ATA) and 71 normal healthy controls (NC) at Ajou Medical Center. Levels of FLCN and interleukin (IL)‐8 in sera and supernatants were measured by ELISA. Peripheral blood eosinophils isolated from asthmatic patients were cocultured with human airway epithelial cells (HAECs) pretreated with LTE4, dexamethasone and montelukast. The intracellular expressions of FLCN, tight (TJ) (occludins, claudin‐1) and adherens (AJ) junctions (E‐cadherin) were analysed by Western blotting. shRNA was used to down‐regulate FLCN (shFLCN) in HAECs.

Results

Serum FLCN levels were significantly higher in AERD group than in ATA and NC groups (all P < 0.001). The cut‐off value of 56.6 pg/mL was used to define the high FLCN phenotype (highFLCN). Asthmatic patients with highFLCN were associated with increased airway hyperresponsiveness to methacholine (P = 0.015). The serum FLCN level could discriminate AERD group from NC group with 82% sensitivity (AUC = 0.793, P < 0.001). When HAECs were exposed to LTE4, FLCN release was increased significantly (P < 0.05), which were amplified along with disruption of TJ and AJ expressions when HAECs were cocultured with eosinophils and LTE4 (all P < 0.05); these effects were suppressed by dexamethasone and montelukast. FLCN knockdown reduced IL‐8 release and occludin expression from shFLCN HAECs.

Conclusions

Our findings suggest that high LT and airway eosinophilia increased FLCN release from HAECs, which enhance epithelial activation and disruption. Modulation of FLCN may be a potential target for AERD.
Surface characteristics and dyeing properties of polyimide fabric treated with sodium hydroxide
Authors: Bai Gang , Liu Yanchun , Qian Hongfei
Published: August 2018

A polyimide fabric was treated with sodium hydroxide to improve its dyeing property. The X‐ray photoelectron spectroscopy analysis showed that carboxyl groups were introduced onto the fibre surface after an alkali treatment. The mean zeta potentials were 7.19 mV for the original sample and –12.1 mv for the treated sample. The surface morphology measured using atomic force microscopy and scanning electron microscopy indicated the presence of a very rough surface structure for the alkali‐treated sample. The alkali‐treated sample showed a higher equilibrium exhaustion than the untreated sample did. The adsorption isotherms of the treated fabric followed the Langmuir sorption model.
A study on mother‐to‐fetus/infant transmission of influenza A(H7N9) virus: Two case reports and a review of literature
Authors: Wang Jiajia , Xu Hua , Mu Chuanyong , Chen Cheng , Guo Lingchuan , Chen Liling , Huang Jian‐an , Guo Qiang
Published: August 2018

Objectives

The prevention strategies for mother‐to‐fetus/infant transmission of H7N9 virus have not been well understood, and the study on this subject will provide further insights.

Methods

Reverse transcriptase polymerase chain reaction assay was undertaken to detect H7N9 virus in samples from a pregnant women, a postpartum woman, and their fetus/infant. Pathological features of tissues from the dead fetus were evaluated with hematoxylin and eosin staining. Hemagglutination inhibition assay was used to detect virus‐specific antibodies. Furthermore, relevant literatures were reviewed and analyzed.

Results

A 28‐year‐old pregnant woman was hospitalized for H7N9 infection and prescribed with oseltamivir and peramivir for 2 days before admission. The fetal heart beating stopped on day 4, the dead fetus was delivered on day 13, and the woman expired on day 26. All fetal tissues were H7N9 virus‐negative. A 28‐year‐old woman delivered a newborn on December 20, 2016. Five days later, she developed influenza‐like symptoms and was confirmed with H7N9 infection. She had close contact with her infant for 9 days. Oseltamivir and peramivir were prescribed within 2 days after illness onset. A throat swab and a pair of serum samples from the infant were all negative for H7N9 virus during 4‐week follow‐up. In total, ten studies referring to transplacental transmission and four reports on maternal infection of H7N9 virus were reviewed and analyzed.

Conclusion

No evidence showed H7N9 virus infection in both fetus and infant. The early administration of neuraminidase inhibitor seemed beneficial in preventing mother‐to‐fetus/infant transmission of H7N9 virus.
Pain interventions for organ transplant patients undergoing incisional hernia repair: Is epidural or transversus abdominus plane block a better option?
Authors: Yeap Yar Luan , Wolfe John , Fridell Jonathan A. , Ezell Jake , Powelson John A.
Published: August 2018

Background

Postoperative pain management in transplant recipients undergoing incisional herniorraphy is challenging. Historically limited to intravenous or oral opioids, alternatives including transversus abdominus plane (TAP) block catheters and thoracic epidural catheters have been introduced. The aim of this study was to determine whether TAP catheters and thoracic epidural analgesia significantly impacted on postoperative pain and opioid usage in transplant recipients undergoing incisional hernia repair.

Methods

This single‐center retrospective study included 154 patients undergoing incisional hernia repair from January 2011 to June 2015. Of these, 56 received epidurals, 51 received TAP catheters, and 47 received no intervention.

Results

Demographic profiles were comparable among the three groups including type of previous transplant and type of hernia surgery. Thoracic epidural analgesia was associated with lower median, mean, and maximum pain scores (P < 0.001) and less opioid requirement (P < 0.001). There was no difference in pain scores and opioid usage among the TAP catheter and no intervention groups. There was no difference in time to first flatus or first bowel movement, length of hospital stay, individual opioid‐related side effects, and adverse reactions among the three groups.

Conclusion

This study supports the use of thoracic epidural analgesia in patients undergoing hernia repair after transplant surgery.