bluuebunny/crossref_metadata_2025 huggingface dataset:
Revisiting Shugart and Carey’s Relation of Executive Powers and Democratic Breakdown
Authors: Morgenstern Scott , Perez Amaury , Peterson Maxfield
Published: October 2019

This work reassesses the central thesis of Shugart and Carey’s Presidents and Assemblies, that weak presidencies make stronger, more lasting democracies. We argue that a thorough review of the literature that has evaluated this thesis thus far reveals a persistent methodological flaw that has hindered an adequate conclusion on its accuracy. While many scholars have revisited the role of presidential systems in democratic failure, comparative analyses of presidential systems have relied on additive, rather than combinatorial, measures of presidential power. We demonstrate why this produces misleading inferences about presidential power, and offer a novel methodology for its assessment. Following an investigation and replication of Shugart and Carey’s original work that incorporates the progress of the cases they studied since 1992, we test our new method on their hypothesis, and find little support for their argument. However, our combinatorial approach invites future researchers to make their own theoretically informed arguments about the relative weight of different presidential powers within a methodological framework that avoids the errors of previous work on the topic.
Dynamic mechanical characteristics of jute fiber and 304 wire mesh reinforced epoxy composite
Authors: Krishnasamy Prabu , Rajamurugan G , Thirumurugan M
Published: October 2019

Adding different reinforcements to the polymer composite is gaining more importance in the manufacturing industries because of their variation in mechanical properties. To satisfy modern industrial requirements, the mono-fiber polymer composites are substituted by hybrid composites in civil and automotive applications. The present work is to develop and investigate the hybrid composite behavior reinforced with AISI 304 (500 µm) wire mesh and jute fiber with epoxy LY556 resin. To analyze the mechanical properties of hybrid composites, two different orientations (45° and 90°) of wire mesh are selected and stacked with jute fiber by hand lay-up method. The wire mesh composite or hybrid composite is subjected to mechanical characterization like tensile, flexural, impact, and interlaminar. Subsequently, the viscoelastic behavior of the wire mesh composite is observed in terms of storage modulus (E′), loss modulus (E″), and damping factor (tan δ) by the dynamic mechanical analyzer (DMS 6100). The fractured surface microstructure of the wire mesh composite is analyzed by scanning electron microscope. The 45° oriented wire mesh composite sample shows better mechanical properties in ultimate tensile strength (20.55 MPa), flexural strength (0.145 kN), percentage of elongation (2.83%), and interlaminar strength (0.120 kN). At the transition region, the peak energy absorption of 0.622 is observed in the 90° oriented wire mesh composite sample at 0.5 Hz frequency.
A Counselor’s Tale: The Need for Cultural Awareness
Authors: Cotman Ann Marie , Enyioha Jessica C. , Guerra Patricia L. , Holmes Analeasa Lopez
Published: October 2019

Culturally responsive (CR) leadership permeates all leadership practices and consists of several domains including: developing critical consciousness, supporting cultural knowledge development, and advocating for social justice within and outside of the school walls. This case focuses on the need to ground CR leadership in critical self-reflection and cultural consciousness by exploring the relationship between a White principal and his first leadership team member of Color who brings a different, bicultural perspective to his work. Assumptions that fill the void left by a lack of cultural knowledge lead to damaging effects including tokenism and stereotype threat.
A Gateway to Learning: Exploring the Role of Campus Recreation and Leisure Experiences in Developing a Sense of Purpose in African American Males at a PWI
Authors: Patterson Anthony F. , Dorwart Catherine E.
Published: October 2019

Personal, social, and cultural issues influence any student’s ability to succeed in college, but these issues are more pronounced for African American males from low socioeconomic status (SES) backgrounds attending predominantly White institutions (PWIs). Since campus engagement, recreation, and leisure can play pivotal roles in a student’s experience, investigating their influence relative to social integration might facilitate better understanding of the contemporary issues these students face. The purpose of this study was to explore how African American male undergraduates from low SES backgrounds perceived leisure and the role that campus engagement played in their social integration at a PWI. Seventeen African American male undergraduates from low SES backgrounds were interviewed. While several themes emerged, this article focuses on discovering a sense of self and navigating campus cultures. This research demonstrated that recreation and leisure spaces were instrumental in developing a sense of purpose for the young men at this PWI.
The Undeniable Role That Campus Recreation Programs Can Play in Increasing Indigenous Student Engagement and Retention
Authors: Dyk Chad Van , Weese W. James
Published: October 2019

Leaders at Canadian universities seek to attract and graduate more Indigenous students as part of their institutions’ strategic plans. Admissions and student retention data suggest that while progress is being made, a gap remains between Indigenous and non-Indigenous students and especially in the student retention area. Research has proven that student engagement plays a large role in facilitating academic progression and student retention in our institutions of higher learning. Throughout time, many students point to their experience as campus recreation program participants and/or leaders as their most important source of engagement. Some have suggested that campus recreation programs could play a larger and more effective role in engaging Indigenous students and heightening their retention rates. In this conceptual article, the authors analyze the student engagement and retention literature bases relative to Indigenous students. They also highlight the role that campus recreation programs can play in heightening Indigenous student engagement and retention and offer professionals 12 recommendations to help advance this strategic priority.
Feeling free: External influences on endogenous behaviour
Authors: Charles Lucie , Haggard Patrick
Published: October 2019

When we are presented with two equally appealing options, how does the brain break the symmetry between them and make a choice? Recent research has proposed that when no clear information can guide decisions, we use irrelevant noise to tip the scale in favour of one alternative and decide how to act. In the present study, we investigated this issue exploring how human decisions were influenced by noise in a visual signal that cued instructed or free choice. Participants were presented with random-dot kinematograms, moving unidirectionally either upwards or downwards (in instructed trials) or both upwards and downwards simultaneously (free-choice trials). By varying the coherence of dot motion, we were able to test how moment-to-moment fluctuations in motion energy could influence action selection processes. We also measured participants’ awareness of such influence. Our results revealed three novel findings: Participants’ choices tended to follow fluctuations in dot motion, showing that sensory noise biased “free” selection between actions, irrespective of the clarity of the free cue. However, participants appeared to remain unaware of that influence, because subjective ratings of freedom did not correlate with the degree of sensory biasing. In one exception to this general rule, we found that, when participants resisted the bias and made a choice opposite to the one suggested by the stimulus, they reported strong subjective sense of having chosen independently of the stimulation. This result suggests that inhibitory control is tightly linked to the sense of freedom of choice.
Phthalazines and phthalazine hybrids as antimicrobial agents: Synthesis and biological evaluation
Authors: Mourad Asmaa Kamal , Makhlouf Abdelmoneim Abdelsalam , Soliman Ahmed Yousef , Mohamed Samar Ahmed
Published: October 2019

Phthalazine and phthalazinone derivatives are important owing to their significant biological activities and pharmacological properties. Herein, a benzoic acid derivative (2), a benzoxazin-1-one derivative (3), and an oxophthalazin-2(1 H)-yl)acetohydrazide (13) are utilized as precursors to construct a novel series of phthalazinones bearing various valuable functional groups in excellent yields via several simple and promising approaches. Finally, the antimicrobial activity of the newly synthesized phthalazines is screened against different microbial strains; namely, Gram-negative and Gram-positive bacteria utilizing Amoxicillin as a standard drug.
Magnetic ZnO@CuO@Iron ore nanocomposites as a green and highly efficient heterogeneous nanocatalyst for solventless synthesis of α-aminophosphonates
Authors: Sajadi S Mohammad
Published: October 2019

A green novel synthesis of ZnO@CuO@Iron ore nanocomposites as a novel and magnetic heterogeneous nanocatalyst is used for the one-pot synthesis of α-aminophosphonates under solventless conditions. This study benefits from the magnetic iron ore acting as a multi-mineral Lewis acid system, the green properties and the large surface area due to its nanostructure. Moreover, scanning electron microscope analysis confirmed that the nanocatalyst gave an excellent yield and good recyclability; which, even after the 10th cycle of the model reaction retained its potential with no significant loss of catalytic activity.
Total synthesis and anticancer activity of the natural oleanolic acid bidesmoside saponin, albidoside A, isolated from the roots of Acacia albida
Authors: Guo Tiantian , Song Yiming , Lu Yinghui , Li Guolin , Liu Tian , Han Wenrong , Song Weiguo , Yang Chuncheng , Li Fahui , Liu Qingchao
Published: October 2019

The first synthesis of a natural triterpenoid saponin bearing N-acetylglucosamine, albidoside A, which is isolated from the roots of Acacia albida, is concisely achieved in a convergent strategy. Preliminary pharmacological research shows anticancer activity against HL-60, MCF-7, MDA-MB-231, Hep-2, and Hela cell lines. In particular, it exhibited good selectivity, which is five times more cytotoxic toward Hep-2 cells (IC50 = 8.91 μM) than the Hela cell line.
Self-assembly of phenyl-bis-(4,5-dihydroxy-2,7-disulfonato-3-naphthyl)methane, tetrasodium salt into a dimer through hydrogen bonding in water: Evidence from its encapsulation of monosubstituted benzenes, phenols, and polyaromatic hydrocarbons in water
Authors: Yue Chen Son , Poh Bo Long
Published: October 2019

Phenyl-bis-(4,5-dihydroxy-2,7-disulfonato-3-naphthyl)methane, tetrasodium salt, self-assembles into a dimer in water. The dimeric form was evidenced by its encapsulation of monosubstituted benzenes, phenols, and polyaromatic hydrocarbons. The stability constants of the inclusion complexes were determined by 1H nuclear magnetic resonance spectroscopy and the complexes formed were of 1:1 host to guest stoichiometry.
Effect of incremental increase in radial neck height on coronoid and capitellar contact pressures
Authors: Ramazanian Taghi , Müller-Lebschi Julia A , Yao Chuang Min , Vaichinger Anthony M , Fitzsimmons James S , O’Driscoll Shawn W
Published: October 2019

Background

Over-lengthening of the radial neck has been shown to affect ulnohumeral kinematics and has been proposed to affect radiocapitellar pressures. We hypothesized that an incremental increase in radial neck height increases the capitellar contact pressure and reduces the coronoid contact pressure. Knowledge of the effects of over-lengthening is clinically important in preventing pain and degenerative changes due to overstuffing.

Methods

Six human cadaveric elbows were prepared on a custom-designed apparatus simulating muscle loads and passive flexion from 0° to 90° under gravity valgus torque while measuring joint contact pressures in this biomechanical study. Each elbow was tested sequentially starting with the intact specimen followed by insertion of a radial head prosthesis with 0, +2, and +4 mm of radial neck height, respectively.

Results

Capitellar mean contact pressures significantly increased after insertion of +2 and +4 mm radial head prostheses (p < 0.03). The capitellar mean contact pressure with a 0 mm radial head prosthesis was 97 KPa. Insertion of +2 mm and +4 mm radial heads increased mean contact pressures to 391 KPa (p = 0.001) and 619 KPa (p = 0.001), respectively, with 90° of elbow flexion.

Discussion

Increasing radial prosthesis height by 2 mm significantly increases capitellar contact pressures and reduces coronoid contact pressures.
Communication skills in the context of psychological flexibility: training is associated with changes in responses to chronic pain in physiotherapy students in Spain
Authors: Montesinos Francisco , Páez Marisa , McCracken Lance M , Rodríguez-Rey Rocío , Núñez Susana , González Cristina , Díaz-Meco Raquel , Hernando Asunción
Published: October 2019

Introduction:

The aim of this study is to explore the effectiveness of a training programme aimed at managing patients’ chronic pain in physiotherapy students in Spain. The programme addressed providing them with efficient skills to manage patients’ chronic pain from psychological flexibility (PF) perspective.

Methods:

The programme integrates communication skills training into PF-based training. It sought to contribute to better recognise the role of psychosocial factors in chronic pain and to better promote adherence to treatment. This is an observational study with a pre- and post-training programme design and a 2-month follow-up. A total of 35 physiotherapy students, divided into three groups, participated in a 10-hour training course. Training focused on three areas: (1) communication skills, (2) therapeutic adherence and (3) managing distress and pain. The three areas were addressed from the PF point of view. Impact of training was measured through standardised questionnaires that assessed attitudes towards chronic pain, an ad hoc questionnaire that assessed responses to difficult communicative situations and a training satisfaction scale.

Results:

Final analyses showed that attitudes changed significantly after training, biomedical attitude scores decreased and biopsychosocial attitude increased, while pain was considered less disabling, and informed empathic responses in communication situations increased. These changes were maintained at 2-month follow-up. Satisfaction with the training was high.

Conclusion:

We conclude that a brief training programme based on the PF model may help students develop a more comprehensive approach and improve their skills for managing chronic pain.
A hydrosilver gel for plaque control in adults affected by chronic periodontitis: Effects on the ‘red complex’ bacterial load. A prospective longitudinal pilot study using polymerase chain reaction analysis
Authors: Lauritano Dorina , Nota Alessandro , Martinelli Marcella , Severino Marco , Romano Michele , Rossi Diego , Caruso Silvia
Published: October 2019

In subjects affected by chronic periodontitis, the chemical control of plaque is a strategy aiming primarily at controlling infection and bacterial loading. The aim is to evaluate the bacterial loading of the so-called ‘red complex’ associated with a short-term use of a hydrosilver gel (HSG) by using an in vivo model in adult subjects affected by chronic periodontitis. This prospective short-term clinical trial involved 10 adult volunteers using a 15-day in vivo model. After receiving professional prophylaxis at baseline (t0), each volunteer performed daily applications of HSG at home. After 15 days (t1) from the first application, subgingival plaque samples were collected, and the bacterial loading of species belonging to the red complex was evaluated using polymerase chain reaction (PCR) analyses. The bacterial loading of the red complex showed no statistically significant difference between t0 and t1, although it tended to decrease. HSG can be used at home as an adjunct to domestic oral care because it seems a promising tool, but further studies are needed to involve a larger sample and a longer follow-up.
Drug-induced gingival hyperplasia: An in vitro study using amlodipine and human gingival fibroblasts
Authors: Lauritano Dorina , Martinelli Marcella , Baj Alessandro , Beltramini Giada , Candotto Valentina , Ruggiero Francesco , Palmieri Annalisa
Published: October 2019

Gingival overgrowth is a serious side effect that accompanies the use of amlodipine. Several conflicting theories have been proposed to explain the fibroblast’s function in gingival overgrowth. To determine whether amlodipine alters the inflammatory responses, we investigated its effects on gingival fibroblast gene expression as compared with untreated cells. Fragments of gingival tissue of healthy volunteers (11 years old boy, 68 years old woman, and 20 years old men) were collected during operation. Gene expression of 29 genes was investigated in gingival fibroblast cell culture treated with amlodipine, compared with untreated cells. Among the studied genes, only 15 ( CCL1, CCL2D, CCL5, CCL8, CXCL5, CXCL10, CCR1, CCR10, IL1A, IL1B, IL5, IL7, IL8, SPP1, and TNFSF10) were significantly deregulated. In particular, the most evident overexpressed genes in treated cells were CCR10 and IL1A. These results seem to indicate a possible role of amlodipine in the inflammatory response of treated human gingival fibroblasts.
Gabapentin affects the expression of inflammatory mediators on healthy gingival cells
Authors: Candotto Valentina , Scapoli Luca , Gaudio Rosa Maria , Gianni Aldo Bruno , Bolzoni Alessandro , Racco Pierpaolo , Lauritano Dorina , Cura Francesca
Published: October 2019

Gabapentin is one of the most used drugs to treat postoperative pain with antihyperalgesic properties and has a unique mechanism of action, which differentiates it from other commonly used drugs. Various studies have shown that the perioperative use of gabapentin reduces postoperative pain. In our study, fragments of gingival tissue of healthy volunteers were collected during operation. Gene expression of 29 genes was investigated in gingival fibroblasts cell culture treated with gabapentin, compared with untreated cells. Of the different chemokines and interleukins studied, only 10 were statistically significant (CCL1, CCR1, CCR4, CCR5, CCR6, ILI1A, ILI1B, IL5, IL6R, TNFSF10). The overexpression of these cytokines, obtained in many studies, leads us to think that gabapentin can interact and cause post-inflammatory gingival hyperplasia, but, probably, in our study the gabapentin has not the same effect, because we used gingival fibroblasts of healthy people.
Evaluation of IL6, IL10 and VDR alleles distribution in an Italian large sample of subjects affected by chronic periodontal disease
Authors: Scapoli Luca , Carinci Francesco , Mucchi Damiano , Nota Alessandro , Caruso Silvia , Rossi Diego , Romano Michele , Severino Marco
Published: October 2019

In recent decades, the role played by the immune response to bacteria in the pathogenesis of chronic periodontal disease (PD) has long been studied. Although from the clinical point of view, adequate oral hygiene is essential to ensure a satisfactory response of the host to infections, modulation of the reaction of immune system could be influenced by genetic factors. The aim of the present study was to investigate the distribution of alleles of polymorphisms relevant for chronic periodontitis in a sample of adult subjects affected by chronic PD. The present study was conducted with sample collected in Italian private practice offices from January 2013 to December 2017. The sample included 744 adult patients diagnosed with chronic periodontitis. The inclusion criteria were as follows: age > 18 years, diagnosis of chronic PD. The diagnosis of chronic periodontitis was based on the criteria established by the American Academy of Periodontology. No significant difference in allele distribution among patients from different Italian regions was found. Results, supporting absence of population heterogeneity for the investigated polymorphisms in Italy, suggest similar effect in periodontitis etiology.
Association between oral cleft and transcobalamin 2 polymorphism in a sample study from Nassiriya, Iraq
Authors: Carinci Francesco , Palmieri Annalisa , Scapoli Luca , Cura Francesca , Abenavoli Fabio , Giannì Aldo Bruno , Russillo Antonio , Docimo Raffaella , Martinelli Marcella
Published: October 2019

Orofacial clefts are common congenital defects whose prevalence differs between geographical regions and ethnic groups. The inheritance is complex, involving the contribution of both genetic and environmental factors. The involvement of genes belonging to the folate pathway is still matter of debate, with strong evidences of association and conflicting results. After demonstrating the contribution, for a sample from the Italian population, of common mutations mapping on three genes of the folate pathway, our group tried to unravel their contribution in independent sample studies with different ethnicity. In the present investigation a set of 34 triads with oral cleft from Nassiriya, Iraq, has been genotyped for rs1801133 of MTHFR, rs1801198 of TCN2, and rs4920037 of CBS polymorphisms. Association analysis evidenced a decreased risk of cleft for children carrying the 667G allele at TCN2 gene ( P = 0.02). This evidence further supported the relationship between polymorphisms of folate related genes and oral clefts, and outlined the relevance of studying populations having different ethnicity.
Adapting a Prediction Rule for Metabolic Syndrome Risk Assessment Suitable for Developing Countries
Authors: Abd El–Wahab Ekram W. , Shatat Hanan Z. , Charl Fahmy
Published: October 2019

Background: Metabolic syndrome (MetS) is a cluster of cardiometabolic disturbances that increases the risk of cardiovascular diseases (CVD) and type 2 diabetes mellitus (DM). The early identification of high-risk individuals is the key for halting these conditions. The world is facing a growing epidemic MetS although the magnitude in Egypt is unknown. Objectives: To describe MetS and its determinants among apparently healthy individuals residing in urban and rural communities in Egypt and to establish a model for MetS prediction. Methods: A cross-sectional study was conducted with 270 adults from rural and urban districts in Alexandria, Egypt. Participants were clinically evaluated and interviewed for sociodemographic and lifestyle factors and dietary habits. MetS was defined according to the harmonized criteria set by the AHA/NHLBI. The risk of ischemic heart diseases (IHDs), DM and fatty liver were assessed using validated risk prediction charts. A multiple risk model for predicting MetS was developed, and its performance was compared. Results: In total, 57.8% of the study population met the criteria for MetS and were at high risk for developing IHD, DM, and fatty liver. Silent CVD risk factors were identified in 20.4% of the participants. In our proposed multivariate logistic regression model, the predictors of MetS were obesity [OR (95% CI) = 16.3 (6.03-44.0)], morbid obesity [OR (95% CI) = 21.7 (5.3-88.0)], not working [OR (95% CI) = 2.05 (1.1-3.8)], and having a family history of chronic diseases [OR (95% CI) = 4.38 (2.23-8.61)]. Consumption of caffeine once per week protected against MetS by 27.8-fold. The derived prediction rule was accurate in predicting MetS, fatty liver, high risk of DM, and, to a lesser extent, a 10-year lifetime risk of IHD. Conclusion: Central obesity and sedentary lifestyles are accountable for the rising rates of MetS in our society. Interventions are needed to minimize the potential predisposition of the Egyptian population to cardiometabolic diseases.
School Counselors’ Perceptions of Barriers to Implementing a RAMP-Designated School Counseling Program
Authors: Hilts Derron , Kratsa Kristi , Joseph Matthew , Kolbert Jered B. , Crothers Laura M. , Nice Matthew L.
Published: October 2019

This study examined what school counselors perceive to be consistent barriers to implementing a program that adheres to the ASCA National Model. The Recognized ASCA Model Program (RAMP) designates such implementation. Principal component analysis revealed six common barriers: lack of confidence, lack of administrative support, time spent on clerical and office work, lack of teacher and parent support to implement aspects of the ASCA National Model, time spent on testing and monitoring, and time constraints. Logistic regression indicated three of the six barriers were significant predictors of RAMP status. We discuss implications for the school counseling profession.
Comparative Effectiveness of Expandable Versus Static Interbody Spacers via MIS LLIF: A 2-Year Radiographic and Clinical Outcomes Study
Authors: Li Yan Michael , Frisch Richard F. , Huang Zheng , Towner James , Li Yan Icy , Greeley Samantha L. , Ledonio Charles
Published: October 2019

Study Design:

Retrospective cohort study.

Objective:

The purpose of this study is to compare the radiographic and clinical outcomes of expandable interbody spacers to static interbody spacers.

Methods:

This is a retrospective, institutional review board–exempt chart review of 62 consecutive patients diagnosed with degenerative disc disease who underwent minimally invasive spine surgery lateral lumbar interbody fusion (MIS LLIF) using static or expandable spacers. There were 27 patients treated with static spacers, and 35 with expandable spacers. Radiographic and clinical functional outcomes were collected. Statistical results were significant if P < .05.

Results:

Mean improvement in visual analogue scale back and leg pain scores was significantly greater in the expandable group compared to the static group at 6 and 24 months by 42.3% and 63.8%, respectively ( P < .05). Average improvement in Oswestry Disability Index scores was significantly greater in the expandable group than the static group at 3, 6, 12, and 24 months by 28%, 44%, 59%, 53%, and 89%, respectively ( P < .05). For disc height, the mean improvement from baseline to 24 months was greater in the static group compared to the expandable group ( P < .05). Implant subsidence was significantly greater in the static group (16.1%, 5/31 levels) compared with the expandable group (6.7%, 3/45 levels; P < .05).

Conclusions:

This study showed positive clinical and radiographic outcomes for patients who underwent MIS LLIF with expandable spacers compared to those with static spacers. Sagittal correction and pain relief was achieved and maintained through 24-month follow-up. The expandable group had a lower subsidence rate than the static group.
FASE-CPHG study: a panoramic snapshot of difficult-to-treat, severe asthma in French nonacademic hospitals
Authors: Portel Laurent , Parrat Eric , Nocent-Ejnaini Cécilia , Mangiapan Gilles , Prud'homme Anne , Oster Jean-Philippe , Aperre de Vecchi Corinne , Maurer Cyril , Raherison Chantal , Debieuvre Didier
Published: October 2019

Background

Real-world data describing management of patients with severe asthma are limited. To address this issue, we conducted FASE-CPHG (France Asthme Sevère – Collège des Pneumologues des Hôpitaux Généraux), a descriptive, multicentric, and observational cross-sectional study.

Methods

French pulmonologists from nonacademic hospitals completed questionnaires on patient characteristics and ongoing asthma treatment for severe asthmatic patients observed during the inclusion period. In addition, we collected data from patientsviaself-assessment questionnaires.

Findings

104 physicians recruited 1502 patients within 1 year. The mean age of the 1465 patients analysed was 54.4±16.1 years. Severe asthmatic patients were more frequently female (63%), with a history of atopy (65%). Most patients remained poorly controlled or uncontrolled, with an important difference between physicians' opinion and the Global Initiative for Asthma criteria (63%versus96%). The most common comorbidities included ear, nose and throat diseases (59% of cases); anxiety (40%); and gastro-oesophageal reflux disease (39%). Allergic sensitisation tests and/or blood eosinophil count evaluation, and spirometry were performed in 92% and 98% of patients, respectively. The mean eosinophil count and total serum IgE were 437 cells·mm−3and 546 UI·L−1, respectively. In addition to high doses of inhaled corticosteroids plus long-acting β2-agonists, patients were receiving leukotriene receptor antagonists (52%), anticholinergic drugs (34%), anti IgE (27%) and oral corticosteroids (17%); 65% adhered to their treatment.

Interpretation

This study provides insight into the characteristics and management of severe asthma in France and may help improve knowledge on this pathology, which represents a high burden to healthcare.
Prevalence of oral corticosteroid use in the German severe asthma population
Authors: Taube Christian , Bramlage Peter , Hofer Annette , Anderson Dörte
Published: October 2019

Aims

We investigated the prevalence of severe asthma, its comorbidities, and especially the use of oral corticosteroid (OCS) therapy in patients with severe asthma.

Methods

Pooled data from 3 961 429 patients insured (with statutory health insurance) during the year 2015 were analysed. Prevalence rates of severe asthma and its OCS-associated comorbidities in patients on high-dosage (HD) inhaled corticosteroid (ICS) in combination with a long-acting β agonist (LABA) therapy were compared with those of patients who were also treated with OCSs.

Results

The asthma prevalence was 7.3%, of which 8.7% (0.6% absolute) were treated with HD-ICS/LABAs. Of these, 33.6% received additional OCSs with calculated dosages between 0.9 and 9.1 mg·day−1. More than 80% of patients on HD-ICS/LABAs had at least one comorbidity. Disorders of the heart (67.5%), metabolism/ nutrition (51.4%), psychiatric disorders (36.0%), skeletal muscle/connective tissue and bone disorders (20.3%), and eye disorders (20.0%) were predominant. The prevalence of these disorders increased for patients also receiving OCS therapy, depending on the length of treatment. Mean therapy costs ranged from €4266 per patient without OCS therapy to €11 253 per patient on long-term OCS treatment. The largest share of costs was attributable to inpatient care.

Conclusion

The analyses show that OCSs are frequently prescribed in patients receiving HD-ICS/LABAs because of severe asthma and are they are frequently associated with adverse effects commonly reported with steroid usage. These data support a necessary change in severe asthma treatment, which is reflected in current treatment guidelines.
Recommendations for travelling with bronchiectasis: a joint ELF/EMBARC/ERN-Lung collaboration
Authors: Shteinberg Michal , Crossley Barbara , Lavie Tal , Nadler Sima , Boyd Jeanette , Ringshausen Felix C. , Aksamit Tim , Chalmers James D. , Goeminne Pieter
Published: October 2019

Introduction

People with bronchiectasis frequently request specialist advice to prepare for travelling, but there are few publications providing advice on safe travel with bronchiectasis. There is a need for recommendations on adapting everyday treatment to the requirements during travelling.

Methods

A panel of 13 patient volunteers formulated questions regarding different aspects of travelling, including safety of travel, maintaining regular treatment during travel, and dealing with deterioration while away. Patient input was used to derive a questionnaire and circulated among a panel of bronchiectasis experts. Where 80% or more experts agreed on a response, a recommendation was made.

Results

A total of 26 bronchiectasis experts answered the questionnaire. Recommendations were made on safety of travel, choice of destinations and activities, choice of travel insurance, carrying medications and devices, maintaining regular treatments in transport, documentation to be provided and oxygen requirements. Some statements did not reach an 80% agreement; in many cases these statements may be valid for some, but not all bronchiectasis patients.

Conclusions

The general agreement was that it is considered safe for most people with bronchiectasis to travel. Careful planning and preparation with robust communication between patients and their healthcare provider prior to travel for different scenarios is fundamental to a successful journey.
Matrisome analysis of intrahepatic cholangiocarcinoma unveils a peculiar cancer-associated extracellular matrix structure
Authors: Carpino Guido , Overi Diletta , Melandro Fabio , Grimaldi Alessio , Cardinale Vincenzo , Di Matteo Sabina , Mennini Gianluca , Rossi Massimo , Alvaro Domenico , Barnaba Vincenzo , Gaudio Eugenio , Mancone Carmine
Published: October 2019

Background

Intrahepatic cholangiocarcinoma (iCCA) is a malignancy that arises from the intrahepatic biliary tree, showing high mortality rates due to its late clinical presentation and limited treatment options. iCCA is characterized by a dense, reactive desmoplastic stroma marked by a dramatic accumulation of extracellular matrix (ECM). Although recent results strongly suggest a relationship between increasing desmoplastic stroma and the enhanced malignant behaviour of iCCA, the importance of ECM proteins in the pathogenesis of iCCA still have to be addressed.

Methods

iCCA ECM fibrillar structural organization was characterized by histological analysis. ECM proteome profiles from decellularized iCCA and surrounding noncancerous tissues were analysed by nLC coupled to MALDI-TOF/TOF analysis.

Results

iCCA tissues displayed high levels of collagen fibers and low abundance of reticular and elastic fibers, suggesting stiffness and loss of polarity. The ECM proteome profiles of iCCA samples, when compared to those obtained from the surrounding noncancerous tissues showed a dismantling of the basement membrane, a reduced angiogenesis and a downregulation of oncosuppressive activity. In particular, we focused on the effects of the overexpression of collagen type III alpha 1 chain (COL3A1) in iCCA, thus providing evidences that COL3A1 promotes iCCA cells migration and is a component of tumor-associated aligned collagen.

Conclusions

Overall, this study contributes to the understanding of molecular basis underlying desmoplasia in iCCA and indicates the type III collagen as a promising therapeutic target.
Impact of merging commercial breeding lines on the genetic diversity of Landrace pigs
Authors: Hulsegge Ina , Calus Mario , Hoving-Bolink Rita , Lopes Marcos , Megens Hendrik-Jan , Oldenbroek Kor
Published: October 2019

Background

The pig breeding industry has undergone a large number of mergers in the past decades. Various commercial lines were merged or discontinued, which is expected to reduce the genetic diversity of the pig species. The objective of the current study was to investigate the genetic diversity of different former Dutch Landrace breeding lines and quantify their relationship with the current Dutch Landrace breed that originated from these lines.

Results

Principal component analysis clearly divided the former Landrace lines into two main clusters, which are represented by Norwegian/Finnish Landrace lines and Dutch Landrace lines. Structure analysis revealed that each of the lines that are present in the Dutch Gene bank has a unique genetic identity. The current Dutch Landrace breed shows a high level of admixture and is closely related to the six former lines. The Dumeco N-line, which is conserved in the Dutch Gene bank, is poorly represented in the current Dutch Landrace. All seven lines (the six former and the current line) contribute almost equally to the genetic diversity of the Dutch Landrace breed. As expected, the current Dutch Landrace breed comprises only a small proportion of unique genetic diversity that was not present in the other lines. The genetic diversity level, as measured by Eding’s core set method, was equal to 0.89 for the current Dutch Landrace breed, whereas total genetic diversity across the seven lines, measured by the same method, was equal to 0.99.

Conclusions

The current Dutch Landrace breed shows a high level of admixture and is closely related to the six former Dutch Landrace lines. Merging of commercial Landrace lines has reduced the genetic diversity of the Landrace population in the Netherlands, although a large proportion of the original variation is maintained. Thus, our recommendation is to conserve breeding lines in a gene bank before they are merged.
Functional analysis of GhCHS, GhANR and GhLAR in colored fiber formation of Gossypium hirsutum L
Authors: Gao Jianfang , Shen Li , Yuan Jingli , Zheng Hongli , Su Quansheng , Yang Weiguang , Zhang Liqing , Nnaemeka Vitalis Ekene , Sun Jie , Ke Liping , Sun Yuqiang
Published: October 2019

Background

The formation of natural colored fibers mainly results from the accumulation of different anthocyanidins and their derivatives in the fibers of Gossypium hirsutum L. Chalcone synthase (CHS) is the first committed enzyme of flavonoid biosynthesis, and anthocyanidins are transported into fiber cells after biosynthesis mainly by Anthocyanidin reductase (ANR) and Leucoanthocyanidin reductase (LAR) to present diverse colors with distinct stability. The biochemical and molecular mechanism of pigment formation in natural colored cotton fiber is not clear.

Results

The three key genes of GhCHS, GhANR and GhLAR were predominantly expressed in the developing fibers of colored cotton. In the GhCHSi, GhANRi and GhLARi transgenic cottons, the expression levels of GhCHS, GhANR and GhLAR significantly decreased in the developing cotton fiber, negatively correlated with the content of anthocyanidins and the color depth of cotton fiber. In colored cotton Zongxu1 (ZX1) and the GhCHSi, GhANRi and GhLARi transgenic lines of ZX1, HZ and ZH, the anthocyanidin contents of the leaves, cotton kernels, the mixture of fiber and seedcoat were all changed and positively correlated with the fiber color.

Conclusion

The three genes of GhCHS, GhANR and GhLAR were predominantly expressed early in developing colored cotton fibers and identified to be a key genes of cotton fiber color formation. The expression levels of the three genes affected the anthocyanidin contents and fiber color depth. So the three genes played a crucial part in cotton fiber color formation and has important significant to improve natural colored cotton quality and create new colored cotton germplasm resources by genetic engineering.
Comparing complications of urethral stricture across various ages: a retrospective analysis of findings from retrograde urethrogram and voiding cysto-urethrogram over 10 years
Authors: Nnabugwu Ikenna I. , Onuh Augustine C. , Anyimba Solomon K. , Mgbor Samuel O.
Published: October 2019

Objective

To determine the rate and the distribution of the structural defects in the urinary bladder complicating urethral stricture in men, and to compare the complications observed in the younger patients to those observed in the older patients.

Methods

Retrospectively, case files of patients diagnosed of urethral stricture using retrograde urethrogram (RUG) and voiding cysto-urethrogram (VCUG) from February 2009 to August 2018 were analyzed. Stricture characteristics were outlined. In addition, complicating structural defects in the lower urinary tract proximal to the stricture site were documented. The complicating defects identified in the patients were segregated according to age for any observable associations. Logistic regression analysis was used to define the nature of the association of patient age, stricture site, number and length, with distribution of complicating structural defects. Analyses were done using SPSS® version 20.

Results

Within the 10-year review period, 257 of 421 suspected cases of urethral stricture were confirmed. Patients are between 1 and 104 years of age (mean: 50.1 ± 19.1 years; median: 51.0 years IQR 35.0–65.0). Bulbar (34.2%); short segment (62.6%); partial (73.9%) strictures are prevalent. Forty-seven (18.3%) of 257 patients presented with 1 or more complications. Bladder diverticulum (8.6%) and urethra-cutaneous fistula (6.6%) are prevalent complications. The distribution of complications does not vary with age, or with stricture characteristics.

Conclusion

Presentation with complications is not uncommon. The distribution of these complications does not vary with age or with stricture characteristics.
Muir–Torre syndrome: sebaceous carcinoma concurrent with colon cancer in a kidney transplant recipient; a case report
Authors: Tomonari Masahiro , Shimada Mariko , Nakada Yasuyuki , Yamamoto Izumi , Itoh Munenari , Koike Yusuke , Kobayashi Akimitsu , Miki Jun , Yamada Hiroki , Kimura Takahiro , Saito Shinya , Sugano Kokichi , Sekine Shigeki , Yamamoto Hiroyasu , Asahina Akihiko , Yokoo Takashi
Published: October 2019

Background

Sebaceous carcinoma is a rare but progressive malignant skin cancer, and the incidence is approximately five times higher in post-transplant patients than in people who have not received kidney transplants. Sebaceous carcinoma is sometimes found concurrently with visceral cancers and a genetic abnormality, Muir–Torre syndrome. We report the case of a female kidney transplant recipient with sebaceous carcinoma concurrent with colon cancer 10 years after transplantation.

Case presentation

A 43-year-old woman was admitted due to a rapidly progressive tumor on her head. Histologically, the tumor was diagnosed as sebaceous carcinoma. We diagnosed her with Muir–Torre syndrome based on the following evidence: 1) high prevalence of microsatellite instability in gene locus assay, 2) absence of mismatch repair proteins in the sebaceous carcinoma on immunohistochemical analysis, and 3) a genetic mutation of 1226_1227delAG in the MSH2 exon 7 in the lesion detected by DNA sequencing analysis. Several reports have shown an association between immunosuppressive agents and latent Muir–Torre syndrome progression. Therefore, the progression of colon cancer in this case originated from her genetic mutation for Muir–Torre syndrome and long-term use of immunosuppressive agents.

Conclusion

This case report not only highlights the importance of adequate diagnosis and therapy for Muir–Torre syndrome, but also suggests the further prevention of the development of malignant tumors in kidney transplant recipients. Physicians should be mindful that sebaceous carcinoma in kidney transplant recipients is highly concurrent with Muir–Torre syndrome.
Resection of intrahepatic cholangiocarcinoma in elderly patients – is it reasonable?
Authors: Bartsch Fabian , Baumgart Janine , Tripke Verena , Hoppe-Lotichius Maria , Heinrich Stefan , Lang Hauke
Published: October 2019

Background

Intrahepatic cholangiocarinoma (ICC) has a rising incidence in western countries. Often major or extended resections are necessary for complete tumor removal. Due to demographical trends the number of elderly patients diagnosed with ICC is rising accordingly. Aim of this study is to show whether resection of ICC in elderly patients is reasonable or not.

Methods

Between January 2008 and June 2018 all consecutive patients with ICC were collected. Analyses were focussed on the performed resection, its extent, postoperative morbidity and mortality as well as survival. Statistics were performed with Chi2 test for categorical data and for survival analyses the Kaplan Meier model with log rank test was used.

Results

In total 210 patients underwent surgical exploration with 150 resections (71.4%). Patients were divided in 70-years cut-off groups (> 70 vs < 70 years of age) as well as a young (age 30–50, n = 23), middle-age (50–70, n = 76) and old (> 70, n = 51) group, whose results are presented here. Resectability (p = 0.709), extent of surgery (p = 0.765), morbidity (p = 0.420) and mortality (p = 0.965) was comparable between the different age groups. Neither visceral (p = 0.991) nor vascular (p = 0.614) extension differed significantly, likewise tumor recurrence (p = 0.300) or the localisation of recurrence (p = 0.722). In comparison of patients > or < 70 years of age, recurrence-free survival (RFS) was significantly better for the younger group (p = 0.047). For overall survival (OS) a benefit could be shown, but without reaching significance (p = 0.072). In subgroup analysis the middle-age group had significant better OS (p = 0.020) and RFS (p = 0.038) compared to the old group. Additionally, a better OS (p = 0.076) and RFS (p = 0.179) was shown in comparison with the young group as well, but without reaching significance. The young compared to the old group had analogous OS (p = 0.931) and RFS (p = 0.845).

Conclusion

Resection of ICC in elderly patients is not associated with an increased perioperative risk. Even extended resections can be performed in elderly patients without obvious disadvantages. Middle-age patients have a clear benefit for OS and RFS, while young and old patients have a comparable and worse long-term outcome.
ACR TI-RADS and ATA US scores are helpful for the management of thyroid nodules with indeterminate cytology
Authors: Barbosa Thayse Lozovoy Madsen , Junior Cleo Otaviano Mesa , Graf Hans , Cavalvanti Teresa , Trippia Marcus Adriano , da Silveira Ugino Ricardo Torres , de Oliveira Gabriel Lucca , Granella Victor Hugo , de Carvalho Gisah Amaral
Published: October 2019

Background

Cytologically indeterminate thyroid nodules currently present a challenge for clinical decision-making. The main aim of our study was to determine whether the classifications, American College of Radiology (ACR) TI-RADS and 2015 American Thyroid Association (ATA) guidelines, in association with The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC), could be used to stratify the malignancy risk of indeterminate thyroid nodules and guide their clinical management.

Methods

The institutional review board approved this retrospective study of a cohort of 140 thyroid nodules in 139 patients who were referred to ultrasound-guided fine-needle aspiration cytology (FNAC) from January 2012 to June 2016 with indeterminate cytological results (44 Bethesda III, 52 Bethesda IV and 44 Bethesda V) and in whom pre-FNAC thyroid US images and histological results after surgery were available. Each included nodule was classified by one radiologist blinded to the cytological and histological diagnoses according to the ACR TIRADS scores and the US patterns as recommended in the 2015 ATA guidelines. The risk of malignancy was estimated for Bethesda, TI-RADS scores, ATA US patterns and their combination.

Results

Of the 140 indeterminate thyroid nodules examined, 74 (52.9%) were histologically benign. A different rate of malignancy (p < 0.001) among Bethesda III, IV and V was observed. The rate of malignancy increased according to the US suspicion categories (p < 0.001) in both US classifications (TI-RADS and ATA). Thyroid nodules classified as Bethesda III and the lowest risk US categories (very low, low and intermediate suspicion by ATA and 2, 3 and 4a by TI-RADS) displayed a sensitivity of 95.3% for both classifications and a negative predictive value of 94.3 and 94.1%, respectively. The highest risk US categories (high suspicion by ATA and 4b,4c and 5 by TI-RADS) were significantly associated with cancer (odds ratios [ORs] 14.7 and 9.8, respectively).

Conclusions

Ultrasound classifications, ACR TI-RADS and ATA guidelines, may help guide the management of indeterminate thyroid nodules, suggesting a conservative approach to nodules with low-risk US suspicion and Bethesda III, while molecular testing and surgery should be considered for nodules with high-risk US suspicion and Bethesda IV or V.