bluuebunny/crossref_metadata_2025 huggingface dataset:
Perineal tap water burns in the elderly: at what cost?
Authors: Potter Michael D. E. , Maitz Peter K. M. , Kennedy Peter J. , Goltsman David
Published: February 2016

Background

Burn injuries are expensive to treat. Burn injuries have been found to be difficult to treat in elderly patients than their younger counterparts. This is likely to result in higher financial burden on the healthcare system; however, no population‐specific study has been conducted to ascertain the inpatient treatment costs of elderly patients with hot tap water burns.

Methods

Six elderly patients (75–92 years) were admitted for tap water burns at Concord Hospital during 2010. All costs incurred during their hospitalization were followed prospectively, and were apportioned into ‘direct’ and ‘indirect’ costs. Direct costs encompassed directly measurable costs, such as consumables used on the ward or in theatres, and indirect costs included hospital overheads, such as bed and theatre costs.

Results

Three males and three females admitted with burns to the buttocks, legs or feet. Total burn surface area (TBSA) ranged from 9–21% (mean 12.8%). Length of stay ranged from 26–98 days (mean 46 days). One patient died, and four required surgical management or grafting. Total inpatient costs ranged from $69 782.33 to $254 652.70 per patient (mean $122 800.20, standard deviation $67 484.46). TBSA was directly correlated with length of stay (P < 0.01) and total cost (P < 0.01).

Conclusion

Hot water burns among the elderly are associated with high treatment costs, which are proportional to the size of the burn. The cost of treating this cohort is higher than previously reported in a general Australian burn cohort.
Determinants of underage induced abortion – the 1987 Finnish Birth Cohort study
Authors: Leppälahti Suvi , Heikinheimo Oskari , Paananen Reija , Santalahti Päivi , Merikukka Marko , Gissler Mika
Published: February 2016

Introduction

Although underage pregnancies often end in induced abortion, data on girls who undergo termination of pregnancy are lacking. Our aim was to identify determinants of underage induced abortion and compare them with those of childbirth.

Material and methods

All girls born in 1987 in Finland surviving the perinatal period (n = 29 041) were included in the study and divided into three study groups: Girls undergoing induced abortion (n = 1041, 3.6%) or childbirth (n = 395, 1.4%) at <18 years of age and girls with no underage pregnancies (n = 27 605, 95.0%).

Results

Shared risk factors of underage induced abortion and childbirth included early onset behavioral and emotional disorders [adjusted OR 1.9 (1.4–2.5) and 2.7 (95% CI 1.8–3.9)], a history of foster care [1.5 [1.1–1.9] and 3.0 [2.3–4.1)], and socioeconomic factors, including living in a family receiving income support [1.8 (1.5–2.1) and 3.4 (2.7–4.4)], respectively. Specific risk factors of underage induced abortion were psychoactive substance use disorders [2.2 (1.3–3.5)], having a mother who smoked during pregnancy [1.5 (1.3–1.8)] or had undergone induced abortion [1.8 (1.5–2.2)]. Coping with a chronic physical illness [0.7 (0.5–0.9)], and perinatal problems [0.6 (0.4–0.7)] were inversely associated with underage induced abortion.

Conclusions

The traditionally acknowledged determinants of underage childbirth played a less prominent role in induced abortion. Novel risk factors of underage induced abortion were found, including severe substance abuse and adverse maternal reproductive history, and should be addressed at all levels offering youth healthcare and social welfare services.
Red light of the visual spectrum attenuates cell death in culture and retinal ganglion cell death in situ
Authors: del Olmo‐Aguado Susana , Núñez‐Álvarez Claudia , Osborne Neville N.
Published: February 2016

Purpose

To ascertain whether red light, known to enhance mitochondrial function, can blunt chemical insults to cell cultures and ischaemic insults to the rat retina.

Methods

Raised intraocular pressure (IOP, 140 mmHg, 60 min) or ischaemia was delivered in complete darkness or in the presence of low intensity red light (16.5 watts/m2, 3000 lux, 625–635 nm) to one eye of each rat. Animals were killed at specific times after ischemia and retinas analysis for ganglion cell numbers, the localization of specific antigens or for changes in defined RNAs. RGC‐5 cell cultures were also exposed to various chemical insults in the presence or absence of red light. Significant differences were determined by t‐test and anova.

Results

Elevation of IOP causes changes in the localization of glial fibrillary acid protein (GFAP), calretinin, calbindin, choline acetyltransferase, ganglion cell numbers and an elevation (GFAP, vimentin, HO‐1 and mTORC1) or reduction (Thy‐1 and Brn3a) of mRNAs in the rat retina. These negative effects to the rat retina caused by ischaemia are reduced by red light. Moreover, chemical insults to cell cultures are blunted by red light.

Conclusions

Low, non‐toxic levels of red light focussed on the retina for a short period of time are sufficient to attenuate an insult of raised IOP to the rat retina. Since mitochondrial dysfunctions are thought to play a major role in ganglion cell death in glaucoma, we propose the potential use of red light therapy for the treatment of the disease.
Using text messaging to obtain weekly data on infant feeding in a Danish birth cohort resulted in high participation rates
Authors: Bruun Signe , Wedderkopp Niels , Mølgaard Christian , Kyhl Henriette B , Zachariassen Gitte , Husby Steffen
Published: February 2016

Aim

Our aim was to use text message questions to obtain prospective, real‐time data on exclusive and partial breastfeeding and introduction to complementary foods in a Danish birth cohort. We also wanted to identify factors influencing breastfeeding initiation and cessation.

Methods

This study formed part of the Odense Child Cohort and focused on mothers who gave birth to full‐term singletons between April and October 2012. They received the same three to five questions, about breastfeeding, infant formula and introduction to complementary food, three days after birth and then at weekly intervals.

Results

We recruited 499 mothers, and the response rate to the first of the weekly questions was ≥89.4% during the study. Three days after birth, 96.7% of mothers were breastfeeding, 61.2% exclusively and 30.2% partially, and 26 weeks after birth 60.2% of mothers were breastfeeding, 1.1% exclusively. Complementary food was introduced at an average age of 20 weeks. Breastfeeding cessation was associated with maternal smoking, lower maternal age and supplementation with infant formula in the first days after birth (all p < 0.05).

Conclusion

Most mothers initiated breastfeeding, but only 1.1% were exclusively breastfeeding at 26 weeks. Text messaging resulted in high response rates and was a feasible data collection method.
Transurethral instillation with fusion protein MrpH.FimH induces protective innate immune responses against uropathogenic Escherichia coli and Proteus mirabilis
Authors: Habibi Mehri , Asadi Karam Mohammad Reza , Bouzari Saeid
Published: February 2016

Urinary tract infections (UTIs) are among the most common infections in human. Innate immunity recognizes pathogen‐associated molecular patterns (PAMPs) by Toll‐like receptors (TLRs) to activate responses against pathogens. Recently, we demonstrated that MrpH.FimH fusion protein consisting of MrpH from Proteus mirabilis and FimH from Uropathogenic Escherichia coli (UPEC) results in the higher immunogenicity and protection, as compared with FimH and MrpH alone. In this study, we evaluated the innate immunity and adjuvant properties induced by fusion MrpH.FimH through in vitro and in vivo methods. FimH and MrpH.FimH were able to induce significantly higher IL‐8 and IL‐6 responses than untreated or MrpH alone in cell lines tested. The neutrophil count was significantly higher in the fusion group than other groups. After 6 h, IL‐8 and IL‐6 production reached a peak, with a significant decline at 24 h post‐instillation in both bladder and kidney tissues. Mice instilled with the fusion and challenged with UPEC or P. mirabilis showed a significant decrease in the number of bacteria in bladder and kidney compared to control mice. The results of these studies demonstrate that the use of recombinant fusion protein encoding TLR‐4 ligand represents an effective vaccination strategy that does not require the use of a commercial adjuvant. Furthermore, MrpH.FimH was presented as a promising vaccine candidate against UTIs caused by UPEC and P. mirabilis.
The significance of Sarcina in routine surgical pathology practice
Authors: Gaspar Balan Louis
Published: February 2016

Sarcina was first described by Goodsir. The appearance of this bacterium is so characteristic that the diagnosis can be made on light microscopy. Although the original description of Sarcina was made more than 150 years ago, little is known about its role in various human diseases. This study was undertaken with the aim to analyze critically the reason for this sudden recent interest in human Sarcina infection. The results indicate that Sarcina is a histopathological marker of functional or anatomical causes of gastric stasis, and has a possible association with life‐threatening emphysematous gastritis. Hence, its documentation in the final report is warranted as the patient might need further work‐up.
Epidemiological investigation of grass seed foreign body‐related disease in dogs of the Riverina District of rural Australia
Authors: Hicks A , Golland D , Heller J , Malik R , Combs M
Published: February 2016

Objective

To characterise disease presentations caused by grass seed foreign body‐related disease (GSFBD) in dogs, identify predisposing risk factors and suggest effective prevention strategies.

Methods

A retrospective, case–control, telephone survey was conducted to obtain information on GSFBD in dogs from the Riverina district of New South Wales (NSW). Additionally, retrospective case records were obtained from Wagga Wagga Veterinary Hospital and Charles Sturt University Veterinary Teaching Hospital over the period July 2006 to October 2011. Signalment, history, investigative strategies, location and severity of lesion(s), cost of therapy, length of hospitalisation, recurrence rate and microbiology data were recorded.

Results

Cases (473 dogs) meeting stringent inclusion criteria were identified. GSFBD comprised 2.0% of hospital presentations. Breeds with high‐density coats were overrepresented. Otitis externa was the most common manifestation of GSFBD in the general practice (47%). In the referral practice pyothorax was the most common entity (34%). In both practices the range of clinical manifestations was broad, including a small number of dogs with catastrophic intracranial disease. Univariable and multivariable logistic regression analyses demonstrated dogs with GSFBD had 3‐fold greater odds of having medium coats than short coats and 5‐fold less odds of being groomed.

Conclusions and clinical relevance

Grass seeds are a major cause of disease in the dogs of south‐west rural NSW, with presentations ranging from mild lameness to severe neurological disease. Some protection from GSFBD was achieved with frequent grooming. Clipping or coat searching without grooming was ineffective as a prevention strategy.
Langerhans cell histiocytosis in children: from the bench to bedside for an updated therapy
Authors: Aricò Maurizio
Published: February 2016

Langerhans cell histiocytosis (LCH) is a rare disease, affecting subjects of any age, with extremely variable clinical manifestations. Although most patients with LCH have localized disease, requiring local or even no therapy, those patients with disseminated, ‘multi‐system’ disease require specific therapy because they may be at risk for morbidity or even mortality. The current standard of care has developed empirically, based mainly on the experience of treating children with leukaemia and other haemo‐proliferative disorders. At the time of writing, the combined use of vinblastine and prednisone remains the standard of care for children with multi‐system LCH. The combination of cytarabine and cladribine is the current standard for second‐line therapy of refractory cases with vital organ dysfunction. Recent advances in the knowledge of the pathogenesis of LCH may support a change in treatment strategy. Evidence of mutations that aberrantly activate RAF/MEK/ERK signalling in over two thirds of patients with LCH may direct a target therapy strategy. Vemurafenib, a small molecule widely used in the treatment of melanoma, is the main candidate for testing in prospective trials for patients with evidence of BRAFV600E mutation on lesional tissue. Additional molecules, including the recently approved trametinib, could follow. Identification of mutations in other genes in the remaining multisystem LCH cases could contribute to define a scenario in which target therapy becomes the main therapeutic choice in this intriguing disorder. However, because the long‐term risks and benefits of these agents in children are unknown, and other effective treatments exist for many LCH patients, the optimal indications for administering a tyrosine kinase inhibitor to children is an open question.
A national study on conditional survival, excess mortality and second cancer after high dose therapy with autologous stem cell transplantation for non‐Hodgkin lymphoma
Authors: Smeland Knut B. , Kiserud Cecilie E. , Lauritzsen Grete F. , Blystad Anne K. , Fagerli Unn‐Merete , Falk Ragnhild S. , Fluge Øystein , Fosså Alexander , Kolstad Arne , Loge Jon H. , Maisenhölder Martin , Østenstad Bjørn , Kvaløy Stein , Holte Harald
Published: February 2016

This national population‐based study aimed to investigate conditional survival and standardized mortality ratios (SMR) after high‐dose therapy with autologous stem‐cell transplantation (HDT‐ASCT) for non‐Hodgkin lymphoma (NHL), and to analyse cause of death, relapses and second malignancies. All patients ≥18 years treated with HDT‐ASCT for NHL in Norway between 1987 and 2008 were included (n = 578). Information from the Cause of Death Registry and Cancer Registry of Norway were linked with clinical data. The 5‐, 10‐ and 20‐year overall survival was 61% (95% confidence interval [CI] 56–64%), 52% (95%CI 48–56%) and 45% (95%CI 40–50%), respectively. The 5‐year survival conditional on having survived 2, 5 and 10 years after HDT‐ASCT was 81%, 86% and 93%. SMRs were 12·3 (95%CI 11·0–13·9), 4·9 (95%CI 4·1–5·9), 2·4 (95%CI 1·8–3·2) and 1·0 (95%CI 0·6–1·8) for the entire cohort and for patients having survived 2, 5 and 10 years after HDT‐ASCT respectively. Of the 281 deaths observed, 77% were relapse‐related. Treatment‐related mortality was 3·6%. The 10‐year cumulative incidence of second malignancies was 7·9% and standardized incidence ratio was 2·0 (95%CI 1·5–2·6). NHL patients treated with HDT‐ASCT were at increased risk of second cancer and premature death. The mortality was still elevated at 5 years, but after 10 years mortality equalled that of the general population.
Shock wave lithotripsy (SWL): outcomes from a national SWL database in New Zealand
Authors: Alexander Cameron E. , Gowland Stuart , Cadwallader Jon , Reynard John M. , Turney Benjamin W.
Published: February 2016

Objectives

To present the national outcomes for New Zealand of over 9 000 stone cases treated with SWL at 21 centres over a 20 year period.

Subjects/patients and methods

Stone cases treated with SWL on board the Mobile Medical Technology (MMT) vehicle between 19 June 1995 and 1 December 2014 were identified, and data collection undertaken prospectively for patient, stone and treatment characteristics, and retrospectively for treatment outcomes. The primary outcome was treatment success, defined as complete stone clearance or clinically insignificant residual fragments (CIRFs) of ≤4mm. Secondary outcomes were stone free rate, complications and auxiliary procedures, and all statistical analyses were descriptive.

Results

9 538 stone cases (7 769 patients) were included. The overall, cumulative success rate was 58.7%; this included 45.1% that were stone free and 13.5% in which there were CIRFs ≤4mm. Success rates varied widely by stone size and location. Overall rates of urinary tract infection, perinephric haematoma, hospital admission and ureteral stent placement were 1.1%, 0.2%, 6.8% and 4.1%, respectively. Variations in SWL protocols across centres limits the overall reliability of our findings.

Conclusion

SWL remains a low morbidity management option requiring careful patient selection. This study provides valuable data for patient counseling and the formation of evidence based guidelines in SWL. The MMT SWL service has demonstrated that is it possible to deliver a high volume specialist stone service without requiring patients to travel further for treatment.
Mid‐term outcomes after AdVanceXP male sling implantation
Authors: Kretschmer Alexander , Grabbert Markus , Sommer Anne , Stief Christian G. , Bauer Ricarda M.
Published: February 2016

Objective

To describe efficacy and safety of the AdVanceXP (Boston Scientific, Marlborough, MA, USA) retrourethral transobturator male sling after a mean follow‐up of almost 3 years.

Patients and Methods

A total of 41 patients underwent AdVanceXP implantation between July 2010 and March 2012 by a single surgeon. Patients were prospectively evaluated at baseline, after a mean follow‐up of 12months and after an individual maximum follow‐up. Efficacy was evaluated by daily pad usage, 24‐h pad testing, and validated questionnaires (International Consultation on Incontinence questionnaire [ICIQ]). Patient satisfaction was determined using the Patient's Global Impression of Improvement score; quality of life was evaluated using the International Quality of Life (IQOL) score. Patients needing 0 or 1 safety pad with a daily urine loss <8 g were classified as cured. To assess the changes in outcome over time, a Wilcoxon signed‐rank test was used. A P value <0.05 was taken to indicate statistical significance.

Results

The mean ± sd follow‐up was 33.1 ± 8.1 months. A total of four patients (9.8%) were lost to follow‐up. At follow‐up, 56.1% of patients used 0 or 1 dry safety pad, 17.1% used 1 pad, and 17.1% used 2 pads. Mean pad use was 0.6 pads per day (P < 0.001 vs baseline) with a mean urine loss of 14 g per day. After nearly 3 years, 46.3% of the patients could be classified as cured and 29.3% could be classified as improved. When comparing respective outcomes after 1 and 3 years, no significant changes in mean daily pad use (0.8 at 1 year; P = 1.000), in ICIQ score (5.0 at 3 years vs 5.2 at 1 year; P = 0.500), or in IQOL score (89.2 at 3 years vs 86.8 at 1 year; P = 0.500) were observed. Patients lost less urine based on 24‐h pad testing after nearly 3 years (14 g at 3 years vs 28 g at 1 year; P = 0.106). Subgroup analyses showed no significant differences in efficacy in patients who had previously received radiotherapy or in patients with mild preoperative incontinence. Between 1 and 3 years postoperatively, no complications were detected.

Conclusions

The present study had the longest follow‐up for AdVanceXP to date and is the first to show a high efficacy even after a mean follow‐up of almost 3 years. The results indicate that late‐onset complications are rare after AdVanceXP implantation.
Association between periodontitis and salivary 8‐hydroxydeoxyguanosine among Korean rural adults
Authors: Shin Myung‐Seop , Shin Hye‐Sun , Ahn Yoo‐Been , Kim Hyun‐Duck
Published: February 2016

Objectives

This study aimed to evaluate the association between salivary 8‐hydroxydeoxyguanosine (8‐OHdG) and periodontitis among community‐dwelling Korean adults.

Methods

A total of 211 adults (80 men and 131 women) were cross‐sectionally surveyed from the Sunchang Longevity Cohort. Periodontitis was defined as having at least 30% of teeth with proximal attachment loss ≥5 mm. The salivary 8‐OHdG level was categorized into tertiles: low (<0.916 ng/ml), medium (0.916 to <2.675 ng/ml) and high (≥2.675 ng/ml). Sociodemographic, habitual and systemic health‐related factors were controlled for. Logistic regression analysis was performed for the outcome of severe periodontitis. Analysis of covariance in general linear model was performed for the outcome of 8‐OHdG.

Results

The high 8‐OHdG level showed a significant association with periodontitis. The odds ratio (95% confidence interval) was 2.40 (1.05–5.51), and it was highlighted by adding the interaction term with drinking and smoking. The adjusted mean log‐transformed value of 8‐OHdG was significantly higher in the severe periodontitis group (1.40 ng/ml) than in the control group (1.02 ng/ml) (ancova, P = 0.028).

Conclusions

8‐OHdG was associated with periodontitis. Thus, salivary 8‐OHdG could be a useful marker for periodontitis.
Oxidized limonene and oxidized linalool – concomitant contact allergy to common fragrance terpenes
Authors: Bråred Christensson Johanna , Karlberg Ann‐Therese , Andersen Klaus E. , Bruze Magnus , Johansen Jeanne D. , Garcia‐Bravo Begoña , Giménez Arnau Ana , Goh Chee‐Leok , Nixon Rosemary , White Ian R.
Published: February 2016

Background

Limonene and linalool are common fragrance terpenes. Both oxidized R‐limonene and oxidized linalool have recently been patch tested in an international setting, showing contact allergy in 5.2% and 6.9% of dermatitis patients, respectively.

Objective

To investigate concomitant reactions between oxidized R‐limonene and oxidized linalool in consecutive dermatitis patients.

Methods

Oxidized R‐limonene 3.0% (containing limonene hydroperoxides 0.33%) and oxidized linalool 6% (linalool hydroperoxides 1%) in petrolatum were tested in 2900 consecutive dermatitis patients in Australia, Denmark, Singapore, Spain, Sweden, and the United Kingdom.

Results

A total of 281 patients reacted to either oxidized R‐limonene or oxidized linalool. Of these, 25% had concomitant reactions to both compounds, whereas 29% reacted only to oxidized R‐limonene and 46% only to oxidized linalool. Of the 152 patients reacting to oxidized R‐limonene, 46% reacted to oxidized linalool, whereas 35% of the 200 patients reacting to oxidized linalool also reacted to oxidized R‐limonene.

Conclusions

The majority of the patients (75%) reacted to only one of the oxidation mixtures, thus supporting the specificity of the reactions. The concomitant reactions to the two fragrance allergens suggest multiple sensitizations, which most likely reflect the exposure to the different fragrance materials in various types of consumer products. This is in accordance with what is generally seen for patch test reactions to fragrance materials.
The Power of 2: How an Apparently Irregular Numeration System Facilitates Mental Arithmetic
Authors: Bender Andrea , Beller Sieghard
Published: February 2016

Mangarevan traditionally contained two numeration systems: a general one, which was highly regular, decimal, and extraordinarily extensive; and a specific one, which was restricted to specific objects, based on diverging counting units, and interspersed with binary steps. While most of these characteristics are shared by numeration systems in related languages in Oceania, the binary steps are unique. To account for these characteristics, this article draws on—and tries to integrate—insights from anthropology, archeology, linguistics, psychology, and cognitive science more generally. The analysis of mental arithmetic with these systems reveals that both types of systems entailed cognitive advantages and served important functions in the cultural context of their application. How these findings speak to more general questions revolving around the theoretical models and evolutionary trajectory of numerical cognition will be discussed in the .
A randomized, prospective comparison of transition to sirolimus‐based CNI‐minimization or withdrawal in African American kidney transplant recipients
Authors: Fleming James N. , Taber David J. , Pilch Nicole A. , McGillicuddy John W. , Srinivas Titte R. , Baliga Prabhakar K. , Chavin Kenneth D. , Bratton Charles F.
Published: February 2016

Background

There is a lack of conclusive evidence to suggest if calcineurin inhibitor (CNI) withdrawal or minimization with sirolimus is the best strategy for African Americans.

Methods

This was a randomized, prospective, open‐label, pilot study comparing the two mammalian target of rapamycin (mTOR) transition strategies in adult African Americans between six and 24 wk post‐transplant. The primary outcome was a comparison of the eGFR at one yr after conversion.

Results

Forty patients were randomized and analyzed in an intent‐to‐treat fashion. Median day of transition was day 96 (withdrawal) and 68 (minimization). Patients in the CNI‐withdrawal group (n = 23) had significantly higher eGFR at one yr compared to the CNI‐minimization group (n = 17, 73 vs. 56 mL/min, p = 0.03), as well as a significantly larger increase in eGFR from baseline (12 vs. 5 mL/min, p = 0.03). There were no differences in infections, acute rejection, death, or graft loss. Both regimens were constrained by disproportionately high discontinuation rates despite modest toxicity profiles.

Conclusion

In spite of considerable withdrawal rate across both study arms, African American kidney transplant recipients who underwent early transition to a sirolimus‐based CNI‐withdrawal regimen had significantly better graft function at one yr compared to those transitioned to a sirolimus‐based CNI‐minimization regimen. Clinicaltrials.gov identifier: NCT01005706.
Sodium bicarbonate infusion in patients undergoing orthotopic liver transplantation: a single center randomized controlled pilot trial
Authors: Weinberg Laurence , Broad Jeremy , Pillai Param , Chen Guangjun , Nguyen Micheline , Eastwood Glenn M. , Scurrah Nick , Nikfarjam Mehrdad , Story David , McNicol Larry , Bellomo Rinaldo
Published: February 2016

Background

Liver transplantation‐associated acute kidney injury (AKI) carries significant morbidity and mortality. We hypothesized that sodium bicarbonate would reduce the incidence and/or severity of liver transplantation‐associated AKI.

Methods

In this double‐blinded pilot RCT, adult patients undergoing orthotopic liver transplantation were randomized to an infusion of either 8.4% sodium bicarbonate (0.5 mEq/kg/h for the first hour; 0.15 mEq/kg/h until completion of surgery); (n = 30) or 0.9% sodium chloride (n = 30). Primary outcome: AKI within the first 48 h post‐operatively.

Results

There were no significant differences between the two treatment groups with regard to baseline characteristics, model for end‐stage liver disease and acute physiology and chronic health evaluation (APACHE) II scores, and pre‐transplantation renal function. Intra‐operative factors were similar for duration of surgery, blood product requirements, crystalloid and colloid volumes infused and requirements for vasoactive therapy. Eleven patients (37%) in the bicarbonate group and 10 patients (33%) in the sodium chloride group developed a post‐operative AKI (p = 0.79). Bicarbonate infusion attenuated the degree of immediate post‐operative metabolic acidosis; however, this effect dissipated by 48 h. There were no significant differences in ventilation hours, ICU or hospital length of stay, or mortality.

Conclusions

The intra‐operative infusion of sodium bicarbonate did not decrease the incidence of AKI in patients following orthotopic liver transplantation.
A2 incompatible kidney transplantation does not adversely affect graft or patient survival
Authors: Forbes Rachel C. , Feurer Irene D. , Shaffer David
Published: February 2016

Background

The new United Network for Organ Sharing (UNOS) kidney allocation system (KAS) incorporates A2 and A2B to B transplantation to reduce wait times for blood group B candidates. Few studies have employed multicenter data or comprehensively defined donor‐to‐recipient ABO classification systems.

Methods

We retrospectively analyzed UNOS data from 1987–2013 to evaluate the effect of A2 incompatible (A2i) kidney transplantation on graft and patient survival. Records of 314 056 adults (340 150 transplants) were classified as A2i (560 transplants in A2 to B or O, A2B to B) or compatible. Methods included Kaplan–Meier survival and multivariable Cox proportional hazards regression.

Results

Graft survival after A2i transplant (median = 116 months) did not differ (log‐rank p ≥ 0.101) from any compatible class (medians = 106–119 months); there was no effect of A2i on patient survival (log‐rank p ≥ 0.286). After adjusting for age, race, donor type, pancreas, or previous kidney transplant, A2i was not associated with graft (p ≥ 0.263) or patient (p ≥ 0.060) survival in this largest cohort to date.

Conclusions

A2i kidney transplantation does not adversely affect graft or patient survival. A2i kidney transplantation has been included in the new KAS and represents a viable option for transplant centers to increase transplant volume and reduce wait times for disadvantaged B waitlist recipients.
Paediatric brainstem encephalitis associated with glial and neuronal autoantibodies
Authors: Hacohen Yael , Nishimoto Yukihiro , Fukami Yuki , Lang Bethan , Waters Patrick , Lim Ming J , Yuki Nobuhiro , Vincent Angela
Published: February 2016

Aim

Central nervous system (CNS) autoantibodies have been reported in a range of neuroimmune diseases, but there has not been a systematic evaluation of autoantibodies in paediatric patients with brainstem encephalitis.

Method

Serum samples from 57 children (40 male, 17 female, median age 12y, range 0.6–18y) with a diagnosis of brainstem encephalitis were tested retrospectively for antibodies to GQ1b, aquaporin‐4 (AQP4), myelin oligodendrocyte glycoprotein (MOG), N‐methyl‐D‐aspartate receptor, LGI1, CASPR2, glycine receptor (GlyR), DPPX, and the voltage gated potassium channel (VGKC)‐complex.

Results

Disease localized to the brainstem was seen in 19 patients: Bickerstaff's brainstem encephalitis (n=14) and clinically isolated syndrome (n=5). Polyfocal presentation was seen in 38 children, with predominantly white matter disease in 18 patients and grey matter in 20 patients. CNS surface antibodies were found in 22/57 patients (two patients with double positivity): GQIb (n=6), NMDAR (n=7), GlyR (n=5), MOG (n=5), and one AQP4. Three patients were positive for VGKC‐complex antibodies. All patients were negative for antibodies to DPPX and the VGKC‐complex antigens LGI1, CASPR2, and contactin‐2. Although there were some partial differences in the presentations, the clinical features and outcomes did not relate clearly to the presence or absence of specific antibodies.

Interpretation

As determined retrospectively, 39% of patients had cell surface antibodies. The results did not suggest any relationship with treatment or outcomes obtained but it is possible that specific antibody detection could be a helpful guide to more intensive immunotherapies in some cases.
Revitalization of pioglitazone: the optimum agent to be combined with a sodium‐glucose co‐transporter‐2 inhibitor
Authors: DeFronzo R. A. , Chilton R. , Norton L. , Clarke G. , Ryder R. E. J. , Abdul‐Ghani M.
Published: February 2016

The recently completed EMPA‐REG study showed that empagliflozin significantly decreased the major adverse cardiac events (MACE) endpoint, which comprised cardiovascular death, non‐fatal myocardial infarction (MI) and stroke, in patients with high‐risk type 2 diabetes (T2DM), primarily through a reduction in cardiovascular death, without a significant decrease in either MI or stroke. In the PROactive study, pioglitazone decreased the MACE endpoint by a similar degree to that observed in the EMPA‐REG study, through a marked reduction in both recurrent MI and stroke and a modest reduction in cardiovascular death. These observations suggest that pioglitazone might be an ideal agent to combine with empagliflozin to further reduce cardiovascular events in patients with high‐risk diabetes as empagliflozin also promotes salt/water loss and would be expected to offset any fluid retention associated with pioglitazone therapy. In the present paper, we provide an overview of the potential benefits of combined pioglitazone/empagliflozin therapy to prevent cardiovascular events in patients with T2DM.
Association of serum amyloid A and oxidative stress with paraoxonase 1 in sarcoidosis patients
Authors: Ivanišević Jasmina , Kotur‐Stevuljević Jelena , Stefanović Aleksandra , Spasić Slavica , Vučinić Mihailović Violeta , Videnović Ivanov Jelica , Jelić‐Ivanović Zorana
Published: February 2016

Background

It has been reported that high‐density lipoprotein (HDL) particles have anti‐inflammatory and antioxidant roles thanks to different enzymes such as paraoxonase 1 (PON1). Under inflammatory and oxidative stress conditions, HDL particles may lose their protective properties. Sarcoidosis is an inflammatory disease characterized by excessive oxidative stress. Serum amyloid A (SAA) is produced in liver and in granulomas, and its concentration increases in inflammatory conditions contributing to increased catabolism of HDL particles. The aim of our study was to determine PON1 activity, SAA concentration and their associations in patients with sarcoidosis.

Materials and methods

Inflammatory [high‐sensitive C‐reactive protein (hsCRP), angiotensin‐converting enzyme (ACE), SAA], lipid [total cholesterol (TC), HDL‐cholesterol (HDL‐c), low‐density lipoprotein cholesterol (LDL‐c), triglycerides (TG)] oxidative stress status parameters [total oxidant status (TOS), malondialdehyde (MDA), pro‐oxidant–antioxidant balance (PAB), sulfhydryl (SH) groups] and PON1 activities were determined in serum of 72 patients with sarcoidosis and 62 healthy subjects.

Results

HsCRP (P < 0·05), TC, LDL‐c, TG, SAA, TOS, MDA and PAB (P < 0·001) were significantly higher, whereas HDL‐c, SH groups and PON1 activity (P < 0·001) were significantly lower in patients with sarcoidosis when compared with controls. PON1 showed significant association with SAA, MDA and PAB. It was shown that 71% of decrease in PON1 activity may be explained by increase in TOS, PAB and SAA concentration.

Conclusions

We found decreased PON1 activity and increased SAA concentration in patients with sarcoidosis. Inflammatory condition presented by high SAA was implicated in impaired HDL functionality evident through dysregulated PON1 activity. Excessive oxidative stress was also involved in dysregulation of PON1 activity.
Validation of DIAGNOdent laser fluorescence and the International Caries Detection and Assessment System (ICDAS) in diagnosis of occlusal caries in permanent teeth: an in vivo study
Authors: Castilho Lia S. , Cotta Fernanda V. M. D. , Bueno Audrey C. , Moreira Allyson N. , Ferreira Efigênia F. , Magalhães Cláudia S.
Published: February 2016

The aim of this in vivo study was to validate the DIAGNOdent laser fluorescence method and the International Caries Detection and Assessment System (ICDAS) for caries classification against the gold standard, histological examination, for detecting occlusal caries on permanent molars; the thresholds used were the outer enamel (D1), the inner enamel and outer third of the dentine (D2), and the inner two‐thirds of the dentine (D3). Patients with non‐impacted third molars (n = 43) were recruited from a university clinic. A trained examiner performed the examinations. After the teeth were extracted, the histological criterion was used to determine the severity of the lesions. Intra‐examiner agreement (weighted kappa) for ICDAS was 0.60 and reliability (intraclass correlation coefficient) for DIAGNOdent was 0.968. The correlations with the histological reference were weak for DIAGNOdent (rs = 0.369) and moderate for ICDAS (rs = 0.515). The areas under the receiver–operating characteristics (ROC) curve at D1, D2, and D3 were 0.60, 0.69, and 0.91, respectively, for ICDAS and 0.55, 0.65, and 0.92, respectively, for DIAGNOdent. ICDAS and DIAGNOdent proved to be reproducible methods with similar performance in the detection of occlusal carious lesions in dentine. The ability of DIAGNOdent to detect initial enamel lesions was higher than that of ICDAS, but with low specificity. The usefulness of DIAGNOdent as an adjunct method for assessment of initial occlusal caries in permanent molars is questionable.
Equine faecal microbiota transplant: Current knowledge, proposed guidelines and future directions
Authors: Mullen K. R. , Yasuda K. , Divers T. J. , Weese J. S.
Published: February 2016

While certainly not a novel concept, faecal microbiota transplant (FMT) has recently garnered renewed interest in veterinary medicine due to its remarkable success in treating recurrent Clostridium difficile infection (CDI) in man. There is a dearth of information on indications and efficacy of FMT for the treatment of gastrointestinal disorders in the horse; however, based on evidence in man and other veterinary species, and anecdotal reports in horses, FMT may be a useful treatment for selected cases of acute and chronic diarrhoea and inflammatory bowel disease (IBD) in the horse. In the absence of evidence, expert opinion is offered on case selection and FMT procedure. More research is needed to explore the efficacy, indications and optimal preparation, storage and delivery of FMT to horses.
Fatigue strength of self‐piercing riveted joints in lap‐shear specimens of aluminium and steel sheets
Authors: Chung C.‐S. , Kim H.‐K.
Published: February 2016

The self‐piercing riveting (SPR) process is gaining popularity because of its many advantages. This study investigated the fatigue strength of SPR joints in tensile‐shear specimens with dissimilar Al‐5052 and steel sheets. A structural analysis of the specimen was conducted. For this specimen, the upper steel sheet withstood applied load in a monotonic test and played a major role in the low‐cycle region. In the high‐cycle region, however, the harder surface of the upper steel sheet reduced the fatigue strength by enhancing fretting crack initiation on the opposite softer aluminium surface. Therefore, the fatigue endurance of the specimen was reduced. The fatigue endurance of a SPR joint with the combination of steel and aluminium sheets was found to be governed by the strength of the lower sheet, which is more vulnerable to the applied loading. Thus, it is desirable to use a stronger metal sheet as the lower sheet with regard to the fatigue performance. Scanning acoustic microscopy was effectively used to reveal and prove the formation and growth of subsurface cracks in SPR joints. The structural stress can predict the fatigue lifetimes of the SPR joint specimens within a factor of three.
Towards protecting the Great Barrier Reef from land‐based pollution
Authors: Kroon Frederieke J. , Thorburn Peter , Schaffelke Britta , Whitten Stuart
Published: February 2016

The Great Barrier Reef (GBR) is an iconic coral reef system extending over 2000 km along the north‐east coast of Australia. Global recognition of its Outstanding Universal Value resulted in the listing of the 348 000 km2 GBR World Heritage Area (WHA) by UNESCO in 1981. Despite various levels of national and international protection, the condition of GBR ecosystems has deteriorated over the past decades, with land‐based pollution from the adjacent catchments being a major and ongoing cause for this decline. To reduce land‐based pollution, the Australian and Queensland Governments have implemented a range of policy initiatives since 2003. Here, we evaluate the effectiveness of existing initiatives to reduce discharge of land‐based pollutants into the waters of the GBR. We conclude that recent efforts in the GBR catchments to reduce land‐based pollution are unlikely to be sufficient to protect the GBR ecosystems from declining water quality within the aspired time frames. To support management decisions for desired ecological outcomes for the GBR WHA, we identify potential improvements to current policies and incentives, as well as potential changes to current agricultural land use, based on overseas experiences and Australia's unique potential. The experience in the GBR may provide useful guidance for the management of other marine ecosystems, as reducing land‐based pollution by better managing agricultural sources is a challenge for coastal communities around the world.
Dialysate‐induced hypocalcemia presenting as acute intradialytic hypotension: A case report, safety review, and recommendations
Authors: Thurlow John S. , Yuan Christina M.
Published: February 2016

Intradialytic hypotension is the most common complication associated with hemodialysis. We describe a case of severe intradialytic hypotension during routine chronic dialysis, the presenting symptom of hypocalcemia due to a procedural error involving a zero calcium liquid acid dialysate concentrate. Although human factors were the root cause of this event, we discuss physical and procedural controls that may help to minimize the risk of human error. Citrate anticoagulation for renal replacement therapy is increasingly used, particularly in acute kidney injury. Thus, zero calcium liquid acid dialysate is more likely to be stocked by dialysis units that serve both inpatients and outpatients. Providers in such units must maintain the utmost vigilance for human error involving these concentrates, as it is likely that the reported literature does not accurately reflect the frequency of such adverse events occurring during dialysis. Structured and universal reporting of errors to allow systematic analysis of hemodialysis device related hazards would allow identification of engineering controls that could prevent such potentially catastrophic clinical errors.
Why do pregnant women participate in research? A patient participation investigation using Q‐Methodology
Authors: Meshaka Riwa , Jeffares Stephen , Sadrudin Farah , Huisman Nicole , Saravanan Ponnusamy
Published: February 2016

Background

Patient participation in study design is paramount to design studies that are acceptable to patients. Despite an increase in research involving pregnant women, relatively little is known about the motivational factors that govern their decision to be involved in a clinical trial, compared to other patient groups.

Objective

To better understand the viewpoints of pregnant women who take part in clinical trials.

Method

We chose to use Q‐Methodology, a method of exploring the structure of opinions surrounding a topic. We developed a set of 40 statements that encompassed the reasons why pregnant women might want to take part in research and 30 research participants from the PRiDE study (an observational trial investigating the role of micronutrients in gestational diabetes) were asked to rank them in order of agreement. The finished matrices from each participant were compared and analysed to produce capturing viewpoints.

Results

About 30 women aged 19–40 involved in the PRiDE study completed the questionnaire. There were two overarching motivators that emerged: a willingness to help medical research and improve our knowledge of medical science, and having a personal connection to the disease, therefore a potential fear of being affected by it. A third, less significant viewpoint, was that of a lack of inconvenience being a motivating factor.

Conclusion and discussion

Understanding what motivates pregnant women to decide to take part in a research study is valuable and helps researchers maximize their uptake and retention rates when designing a trial involving pregnant women.
‘Who is on your health‐care team?’ Asking individuals with heart failure about care team membership and roles
Authors: LaDonna Kori A. , Bates Joanna , Tait Glendon R. , McDougall Allan , Schulz Valerie , Lingard Lorelei ,   the Heart Failure/Palliative Care Teamwork Research Group
Published: February 2016

Background

Complex, chronically ill patients require interprofessional teams to address their multiple health needs; heart failure (HF) is an iconic example of this growing problem. While patients are the common denominator in interprofessional care teams, patients have not explicitly informed our understanding of team composition and function. Their perspectives are crucial for improving quality, patient‐centred care.

Objectives

To explore how individuals with HF conceptualize their care team, and perceive team members' roles.

Setting and Participants

Individuals with advanced HF were recruited from five cities in three Canadian provinces.

Design

Individuals were asked to identify their HF care team during semi‐structured interviews. Team members' titles and roles, quotes pertaining to team composition and function, and frailty criteria were extracted and analysed using descriptive statistics and content analysis.

Results

A total of 62 individuals with HF identified 2–19 team members. Caregivers, nurses, family physicians and cardiologists were frequently identified; teams also included dentists, foot care specialists, drivers, housekeepers and spiritual advisors. Most individuals met frailty criteria and described participating in self‐management.

Discussion

Individuals with HF perceived being active participants, not passive recipients, of care. They identified teams that were larger and more diverse than traditional biomedical conceptualizations. However, the nature and importance of team members' roles varied according to needs, relationships and context. Patients' degree of agency was negotiated within this context, causing multiple, sometimes conflicting, responses.

Conclusion

Ignoring the patient's role on the care team may contribute to fragmented care. However, understanding the team through the patient's lens – and collaborating meaningfully among identified team members – may improve health‐care delivery.
Role of aetiology in the progression, regression, and parenchymal remodelling of liver disease: implications for liver biopsy interpretation
Authors: Quaglia Alberto , Alves Venancio A , Balabaud Charles , Bhathal Prithi S , Bioulac‐Sage Paulette , Crawford James M , Dhillon Amar P , Ferrell Linda , Guido Maria , Hytiroglou Prodromos , Nakanuma Yasuni , Paradis Valerie , Snover Dale C , Theise Neil D , Thung Swan N , Tsui Wilson M S , van Leeuwen Dirk J ,   The International Liver Pathology Study Group
Published: February 2016

Clinicopathological concepts on acute and chronic liver disease have evolved rapidly during the last few years, with advances in general and specific treatment options and improved patient outcomes. The old paradigm of ‘irreversibility’ of cirrhosis had been challenged in major ways, and the validity of the usage of the term ‘cirrhosis’ has come into question. This paper addresses aetiology‐based clinicopathological concepts and features that may deserve attention because they may determine disease outcome and, specifically, patterns of regression and remodelling. A variety of therapeutic interventions may influence remaining disease features after elimination of damaging agents (virus, alcohol, etc.), and determine the final clinical outcome including the risk of hepatocellular carcinoma (HCC). New concepts create new responsibilities and opportunities for the pathologist to contribute to the understanding of liver pathology and communicate this with clinical colleagues and researchers.