bluuebunny/crossref_metadata_2025 huggingface dataset:
How to deal with the EU landing obligation: lessons from an English discard ban sea trial
Authors: Catchpole Thomas L , Elliott Sam , Peach Dave , Mangi Stephen C , Gray Tim S
Published: June 2017

A new EU Common Fisheries Policy (CFP) came into force on 1 January 2014. Article 15 of the new CFP basic regulation introduced a discard ban or landing obligation (LO) in EU fisheries whereby the discarding of quota species is prohibited. There is an urgent need to understand the impact of this new regulation on the UK fishing industry and fishing industries elsewhere in Europe. This study conducted a discard ban trial to provide an opportunity for the fishing industry to demonstrate what a LO would mean for them. The results are mostly illustrative and qualitative, designed to inform policy decisions and identify areas of future work to assist in the implementation of the discard ban. Five recommendations are made, which if adopted, would significantly improve the prospects of a smooth transition to a largely discard-free EU fishery.
Propofol Affects Neurodegeneration and Neurogenesis by Regulation of Autophagy via Effects on Intracellular Calcium Homeostasis
Authors: Qiao Hui , Li Yun , Xu Zhendong , Li Wenxian , Fu Zhijian , Wang Yuezhi , King Alexander , Wei Huafeng
Published: June 2017

Background

In human cortical neural progenitor cells, we investigated the effects of propofol on calcium homeostasis in both the ryanodine and inositol 1,4,5-trisphosphate calcium release channels. We also studied propofol-mediated effects on autophagy, cell survival, and neuro- and gliogenesis.

Methods

The dose–response relationship between propofol concentration and duration was studied in neural progenitor cells. Cell viability was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and lactate dehydrogenase release assays. The effects of propofol on cytosolic calcium concentration were evaluated using Fura-2, and autophagy activity was determined by LC3II expression levels with Western blot. Proliferation and differentiation were evaluated by bromodeoxyuridine incorporation and immunostaining with neuronal and glial markers.

Results

Propofol dose- and time-dependently induced cell damage and elevated LC3II expression, most robustly at 200 µM for 24 h (67 ± 11% of control, n = 12 to 19) and 6 h (2.4 ± 0.5 compared with 0.6 ± 0.1 of control, n = 7), respectively. Treatment with 200 μM propofol also increased cytosolic calcium concentration (346 ± 71% of control, n = 22 to 34). Propofol at 10 µM stimulated neural progenitor cell proliferation and promoted neuronal cell fate, whereas propofol at 200 µM impaired neuronal proliferation and promoted glial cell fate (n = 12 to 20). Cotreatment with ryanodine and inositol 1,4,5-trisphosphate receptor antagonists and inhibitors, cytosolic Ca2+ chelators, or autophagy inhibitors mostly mitigated the propofol-mediated effects on survival, proliferation, and differentiation.

Conclusions

These results suggest that propofol-mediated cell survival or neurogenesis is closely associated with propofol’s effects on autophagy by activation of ryanodine and inositol 1,4,5-trisphosphate receptors.
Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort
Authors: Hu Danqing , Flick Randall P. , Zaccariello Michael J. , Colligan Robert C. , Katusic Slavica K. , Schroeder Darrell R. , Hanson Andrew C. , Buenvenida Shonie L. , Gleich Stephen J. , Wilder Robert T. , Sprung Juraj , Warner David O.
Published: June 2017

Background

Exposure of young animals to general anesthesia causes neurodegeneration and lasting behavioral abnormalities; whether these findings translate to children remains unclear. This study used a population-based birth cohort to test the hypothesis that multiple, but not single, exposures to procedures requiring general anesthesia before age 3 yr are associated with adverse neurodevelopmental outcomes.

Methods

A retrospective study cohort was assembled from children born in Olmsted County, Minnesota, from 1996 to 2000 (inclusive). Propensity matching selected children exposed and not exposed to general anesthesia before age 3 yr. Outcomes ascertained via medical and school records included learning disabilities, attention-deficit/hyperactivity disorder, and group-administered ability and achievement tests. Analysis methods included proportional hazard regression models and mixed linear models.

Results

For the 116 multiply exposed, 457 singly exposed, and 463 unexposed children analyzed, multiple, but not single, exposures were associated with an increased frequency of both learning disabilities and attention-deficit/hyperactivity disorder (hazard ratio for learning disabilities = 2.17 [95% CI, 1.32 to 3.59], unexposed as reference). Multiple exposures were associated with decreases in both cognitive ability and academic achievement. Single exposures were associated with modest decreases in reading and language achievement but not cognitive ability.

Conclusions

These findings in children anesthetized with modern techniques largely confirm those found in an older birth cohort and provide additional evidence that children with multiple exposures are more likely to develop adverse outcomes related to learning and attention. Although a robust association was observed, these data do not determine whether anesthesia per se is causal.
A New Lateral Fixed Angle Locking Ankle Arthrodesis Plate: Technique and Rate of Union
Authors: Davies Mark B. , Blundell Chris M.
Published: June 2017

Arthrodesis of the ankle joint is a well-established treatment for painful, end-stage ankle arthritis. Managing deformity, poor bone quality or bone loss poses greater challenges for the surgeon. As a result, angle-stable devices such as blade plates and nonanatomic locking plates have been studied biomechanically and found to exhibit some mechanical advantages over screws in stabilizing the arthrodesis, thus potentially offering a solution. A new anatomically contoured, fixed angled lateral locking ankle arthrodesis plate was developed and its efficacy was assessed for rate of union in patients with deformity, poor bone quality, and with bone loss. The operative technique for using this plate is presented. Eighty-two consecutive cases were treated using this plate in our institution. The plate was used to treat 3 groups of patients with ankle pain: 70 patients with degenerative ankle arthropathy, 6 cases of nonunion following previous attempts at ankle arthrodesis and 6 cases following failed total ankle replacement. There were 70 primary fusions in the study with 40 cases of <10 degrees deformity and 30 cases of >10 degrees deformity in the coronal plane. A higher rate of fusion (97%) was achieved in the cases with <10 degrees deformity compared with 92% in >10 degrees deformity but there was no significant difference (P=0.35) between these groups [time to union in weeks: <10 degrees deformity mean 18 degrees (range, 6 to 42 vs. <10 degrees), deformity mean 21 degrees (range, 11 to 77 degrees). In those cases of nonunion treated with the plate, union was achieved in 5 of the 6 (83%) procedures with a mean time to union of 25 weeks (range, 12 to 44 wk). In those cases of arthrodesis for salvaging failed total ankle replacement, all cases achieved union of their arthrodesis with a mean time to fusion of 20 weeks (range, 11 to 43 wk). This lateral locking plate system is a suitable fixation device in achieving ankle arthrodesis in the presence of deformity, poor bone quality or bone loss. The study supports the concept of locking plate internal fixation for ankle arthrodesis.

Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Fat Grafting for Esthetic Correction of the Muscle Atrophy Secondary to Ulnar Nerve Lesion
Authors: Ribak Samuel , Vasconcelos André L. , Oliveira Ricardo K.
Published: June 2017

Patients with hand muscular atrophy due to damage of the ulnar nerve could be stigmatized for their appearance. Unsatisfactory results in the attempt to correct the atrophy are reported in the literature. Fat grafting is an autologous and easily obtainable graft, antigenic response is very unlikely, it does not require any special material, and the procedure has a low cost. The technique of autologous fat grafting by using fat block, to remodel the first interdigital space, is useful and safe in correcting muscle atrophy of the first interdigital space caused by the injury of the ulnar nerve. This technique is suitable for muscular atrophy caused by injury of the ulnar nerve and nerve compression as well as patients present with esthetic complaints. Fifteen cases were operated using this technique. After the surgery, the resorption of the graft ranged between 12.5% and 66.7%, averaging 28%. Patients were able to check the benefit provided by filling of the atrophied area, which allowed a serene return to their daily life activities, living with others, reducing the need to hide their hands, and even facilitating their reintegration into the labor market.
Two Cases of Sinusitis Induced by Immune Checkpoint Inhibition
Authors: Dein Eric , Sharfman William , Kim Jean , Gellad Fouad , Shah Ami A. , Bingham Clifton O. , Cappelli Laura C.
Published: June 2017

We report the acute onset of aseptic sinusitis in 2 patients receiving the immune checkpoint inhibitors, ipilimumab and nivolumab, for treatment of metastatic melanoma. Ipilimumab, a monoclonal antibody targeting cytotoxic T-lymphocyte antigen-4, and nivolumab, targeting programmed cell death-1, have been associated with numerous immune-related adverse events. To the authors’ knowledge, this is the first report of aseptic sinusitis as a consequence of immune checkpoint inhibition therapy.
Quantification of microRNA-21 and microRNA-125b in melanoma tissue
Authors: Wandler Anne , Riber-Hansen Rikke , Hager Henrik , Hamilton-Dutoit Stephen J. , Schmidt Henrik , Nielsen Boye S. , Stougaard Magnus , Steiniche Torben
Published: June 2017

Although microRNAs (miRNAs) have emerged as potent mediators of melanoma development and progression, a precise understanding of their oncogenic role remains unclear. In this study, we analysed formalin-fixed and paraffin-embedded tissues from two separate melanoma cohorts and from a series of benign melanocytic nevi. Using three different quantification methods [array analysis, quantitative PCR (qPCR) and in-situ hybridization (ISH) quantified by digital image analysis], we found considerable miRNA dysregulation in tumours. Using array analysis, samples mainly clustered according to their biological group (benign vs. malignant) and 77 miRNAs differed significantly between nevi and melanoma samples. Increase of miR-21 and miR-142, and decrease of miR-125b, miR-211, miR-101 and miR-513c in the melanomas were verified in both cohorts using qPCR, whereas the decrease of miR-205 observed with array analysis could not be confirmed using qPCR. ISH with digital quantification showed expression of miR-21 and miR-125b in the melanocytic lesions. miR-21 ISH was increased in melanomas, whereas quantification of miR-125b showed uniform ISH expression across nevi and melanomas. Our results support the important involvement of different miRNAs in melanoma biology and may serve as solid basics for further miRNA investigations in melanoma formalin-fixed and paraffin-embedded tissue. In particular, there is increased expression of miR-21 in melanomas compared with benign nevi.
Characteristics of melanoma in Japan: a nationwide registry analysis 2011–2013
Authors: Tomizuka Taro , Namikawa Kenjiro , Higashi Takahiro
Published: June 2017

The distribution and incidence of melanoma vary among different races and ethnic groups. This study aimed to investigate the characteristics of cutaneous melanoma, mucosal melanoma, uveal melanoma, and melanoma of unknown primary (MUP) origin in a Japanese population. We studied these four types of melanoma in patients registered in Hospital Based Cancer Registries in Japan from 2011 to 2013. A total of 5566 patients with melanoma were identified. The distribution of sex, age, primary site, and clinical stage was analyzed. The number of patients, proportion in comparison with all melanoma cases, and crude incidence rate per 100 000 person-year of each melanoma type were 4481, 80.5%, and 1.24 in invasive cutaneous; 821, 14.8%, and 0.32 in mucosal; 163, 2.9%, and 0.064 in uveal; and 101, 1.8%, and 0.039 in MUP origin, respectively. Including the patients with in-situ cutaneous melanoma and stage unknown cutaneous melanoma, the crude incidence rate of cutaneous melanoma increased at 1.75. Almost half of the cutaneous melanomas were located in the lower limb. Cutaneous melanoma was the most common, but less frequent than that in western countries. Mucosal melanoma was quite rare, but its proportion and crude incidence rate were higher than those in western countries. Uveal melanoma was particularly rare, and its crude incidence rate was lower than that in western countries. MUP origin was also particularly rare, but it had almost the same incidence rate as that in other countries. Melanoma in Japan was heterogeneous among the four melanoma types and shares some attributes with that in western countries.
Histopathologic Findings of Cutaneous Hyperpigmentation in Addison Disease and Immunostain of the Melanocytic Population
Authors: Fernandez-Flores Angel , Cassarino David S.
Published: June 2017

The histopathological features of cutaneous hyperpigmentation in Addison disease have very occasionally been reported, and they include acanthosis, hyperkeratosis, focal parakeratosis, spongiosis, superficial perivascular lymphocytic infiltrate, basal melanin hyperpigmentation, and superficial dermal melanophages. We present a study on 2 biopsies from the arm and the thigh in a 77-year-old woman with a long clinical history of Addison disease as well as senile purpura and alopecia of female pattern. The patient presented diffuse hyperpigmentation of the skin, more pronounced on her face, and left upper forehead. The skin biopsies showed no remarkable dermal inflammatory infiltrate with melanocytic hyperpigmentation of the basal layer of the epidermis as well as a mild amount of melanophages in the papillary dermis. In addition, we found lipofuscin in the luminal pole of the secretory epithelium of the eccrine glands. In the perieccrine areas, there was Perls-positive pigment in the cytoplasm of macrophages most likely related to the senile purpura. An immunohistochemical study with Melan-A showed a melanocyte/keratinocyte ratio of 1:20 (5%) in the arm and of less than 1:50 (only 2 melanocytes in the whole section; <2%) in the thigh.
Cytokine profiles in osteoporosis suggest a proresorptive bias
Authors: Azizieh Fawaz , Raghupathy Raj , Shehab Diaa , Al-Jarallah Khaled , Gupta Renu
Published: June 2017

Objective:

As the immune system is suggested to contribute to the pathophysiology of osteoporosis in menopause, we compared the levels of proresorptive and antiresorptive cytokines produced by peripheral blood mononuclear cells (PBMCs) from postmenopausal women with normal and low bone mineral density (BMD).

Methods:

Seventy-one postmenopausal women were studied; 25 had normal BMD and 46 had low BMD. Participants were categorized as normal (n = 25), osteopenic (n = 31), and osteoporotic (n = 15) based on T-scores. Levels of 10 cytokines produced by mitogen-stimulated PBMCs were measured by Multiplex ELISA.

Results:

PBMCs from women with low BMD produced higher levels of the proresorptive cytokines tumor necrosis factor-alpha, interleukin (IL)-6, IL-12, and IL-17 (P = 0.014, 0.012, 0.011, and 0.049), and lower levels of the antiresorptive cytokines IL-4, IL-10, and IL-23 (P = 0.003, 0.018, and 0.025) compared with women with normal BMD. Proresorptive cytokines were similar in osteopenic and osteoporotic women, but both had higher levels than women with normal BMD. Osteoporotic women produced lower levels of the antiresorptive cytokines IL-4, IL-10, IL-13, and IL-23 compared with the normal BMD group (P = 0.001, 0.05, 0.05, and 0.026), and lower levels of IL-4 as compared with osteopenic women (P = 0.05). Osteopenic women produced lower levels of IL-4 and IL-10 compared with the normal BMD group (P = 0.025 and 0.038). Ratios of proresorptive to antiresorptive cytokines suggest a stronger proresorptive cytokine bias in women with low BMD. Most of the ratios are lowest in the normal BMD group, modest in osteopenic women, and highest in the osteoporotic group.

Conclusions:

Women with low BMD have a proresorptive cytokine bias.
Prevalence, severity, and associated factors of menopausal symptoms in middle-aged Chinese women: a community-based cross-sectional study in southeast China
Authors: Lan Yibing , Huang Yizhou , Song Yang , Ma Linjuan , Chen Peiqiong , Ying Qian , Li Wei , Cai Yuqun , Zhou Jianhong
Published: June 2017

Objective:

The aim of the study was to specify the prevalence and severity of menopausal symptoms, and to investigate associated factors in Chinese middle-aged women.

Methods:

A cross-sectional, community-based study was carried out involving 1,054 participants aged 40 to 60 years in Gongshu District, Hangzhou, Zhejiang, PR China. The presence and severity of symptoms were evaluated by having the participants complete a modified Kupperman Menopausal Index questionnaire. Serum levels of follicle-stimulating hormone and estradiol were measured. Physical and sociodemographic characteristics including height, weight, education, occupation, and income were collected. Statistical analysis was performed to identify factors associated with the occurrence of the menopausal syndrome according to the modified Kupperman Menopausal Index score rank.

Results:

The mean (SD) age of all participants was 50.85 (5.55) years. Overall, 32.6% of the participants were premenopausal, 20.2% were perimenopausal, and 47.1% were postmenopausal. The three most prevalent symptoms suffered by all participants were muscle/joint pain (54.5%), sexual problems (48.7%), and fatigue (46.1%). The prevalence of sexual problems and muscle/joint pain increased from the premenopausal stage to the postmenopausal stage (P < 0.001 for both). Compared with premenopausal women, perimenopausal and postmenopausal women have a significantly increased risk of menopausal syndrome (P < 0.001 for both). The logistic regression model revealed that the place of residence and level of education were significantly associated with the occurrence of menopausal syndrome (P < 0.05).

Conclusions:

Perimenopausal women are prone to the highest prevalence and severity of menopausal symptoms. Sexual problems and muscle/joint pain are noticeable symptoms in postmenopausal women. Further studies are required to verify the influences of level of education, place of residence, and other factors on menopausal symptoms in Chinese women.
Effects of a Mindfulness-Based Stress Reduction Program on the Physical and Psychological Status and Quality of Life in Patients With Metastatic Breast Cancer
Authors: Lee Chung Eun , Kim Sanghee , Kim Sue , Joo Hye Myung , Lee Soohyeon
Published: June 2017

This nonequivalent control group pre-/posttest study investigated the effectiveness of a mindfulness-based stress reduction program at improving both the physical status and psychological status of 18 patients with metastatic breast cancer. The mindfulness-based stress reduction program had a mild effect of improving average pain and alleviating distress.
miR-34c-5p functions as pronociceptive microRNA in cancer pain by targeting Cav2.3 containing calcium channels
Authors: Gandla Jagadeesh , Lomada Santosh Kumar , Lu Jianning , Kuner Rohini , Bali Kiran Kumar
Published: June 2017

Pathophysiological mechanisms underlying pain associated with cancer are poorly understood. microRNAs (miRNAs) are a class of noncoding RNAs with emerging functional importance in chronic pain. In a genome-wide screen for miRNAs regulated in dorsal root ganglia (DRG) neurons in a mouse model of bone metastatic pain, we identified miR-34c-5p as a functionally important pronociceptive miRNA. Despite these functional insights and therapeutic potential for miR-34c-5p, its molecular mechanism of action in peripheral sensory neurons remains unknown. Here, we report the identification and validation of key target transcripts of miRNA-34c-5p. In-depth bioinformatics analyses revealed Cav2.3, P2rx6, Oprd1, and Oprm1 as high confidence putative targets for miRNA-34c-5p. Of these, canonical and reciprocal regulation of miR-34c-5p and Cav2.3 was observed in cultured sensory neurons as well as in DRG in vivo in mice with cancer pain. Coexpression of miR-34c-5p and Cav2.3 was observed in peptidergic and nonpeptidergic nociceptors, and luciferase reporter assays confirmed functional binding of miR-34c-5p to the 3′ UTR of Cav2.3 transcripts. Importantly, knocking down the expression of Cav2.3 specifically in DRG neurons led to hypersensitivity in mice. In summary, these results show that Cav2.3 is a novel mechanistic target for a key pronociceptive miRNA, miR-34c-5p, in the context of cancer pain and indicate an antinociceptive role for Cav2.3 in peripheral sensory neurons. The current study facilitates a deeper understanding of molecular mechanisms underlying cancer pain and suggests a potential for novel therapeutic strategies targeting miR-34c-5p and Cav2.3 in cancer pain.
Translational pain assessment: could natural animal models be the missing link?
Authors: Klinck Mary P. , Mogil Jeffrey S. , Moreau Maxim , Lascelles B. Duncan X. , Flecknell Paul A. , Poitte Thierry , Troncy Eric
Published: June 2017

Failure of analgesic drugs in clinical development is common. Along with the current “reproducibility crisis” in pain research, this has led some to question the use of animal models. Experimental models tend to comprise genetically homogeneous groups of young, male rodents in restricted and unvarying environments, and pain-producing assays that may not closely mimic the natural condition of interest. In addition, typical experimental outcome measures using thresholds or latencies for withdrawal may not adequately reflect clinical pain phenomena pertinent to human patients. It has been suggested that naturally occurring disease in veterinary patients may provide more valid models for the study of painful disease. Many painful conditions in animals resemble those in people. Like humans, veterinary patients are genetically diverse, often live to old age, and enjoy a complex environment, often the same as their owners. There is increasing interest in the development and validation of outcome measures for detecting pain in veterinary patients; these include objective (eg, locomotor activity monitoring, kinetic evaluation, quantitative sensory testing, and bioimaging) and subjective (eg, pain scales and quality of life scales) measures. Veterinary subject diversity, pathophysiological similarities to humans, and diverse outcome measures could yield better generalizability of findings and improved translation potential, potentially benefiting both humans and animals. The Comparative Oncology Trial Consortium in dogs has pawed the way for translational research, surmounting the challenges inherent in veterinary clinical trials. This review describes numerous conditions similarly applicable to pain research, with potential mutual benefits for human and veterinary clinicians, and their respective patients.
Suprameatal Cochlear Implantation in a CHARGE Patient With a Novel CHD7 Variant and KALLMANN Syndrome Phenotype: A Case Report
Authors: Ganaha Akira , Tono Tetsuya , Kaname Tadashi , Yanagi Kumiko , Higa Teruyuki , Kondo Shunsuke , Maeda Hiroyuki , Suzuki Mikio
Published: June 2017

Objective:

We present the clinical findings, technique of the suprameatal cochlear implantation, postoperative auditory results, and genetic analysis of the CHD7 gene.

Patient:

A 19-year-old Japanese woman was referred because of progressive hearing loss since early childhood. She had used verbal language for the main mode of communication until the age of 17. Examination revealed coloboma, heart defect, choanal atresia, genital hypoplasia, and deafness, which was diagnosed as CHARGE syndrome. Examination also revealed features of Kallmann syndrome.

Interventions:

Cochlear implantation was performed in the left ear at age 20. Targeted resequencing of the CHD7 gene was performed by next-generation sequencing.

Results:

Cochlear implantation was performed using a suprameatal approach (SMA) with cartilage protection because of a venous malformation of the temporal bone. The electrode introduced into the scala tympani through the cochleostomy could be fully inserted. The electrode was covered with cartilage to avoid contact with the skin of the external auditory canal. No intra- or postoperative complications have occurred up to 4 years postoperatively, and the patient uses verbal language again as the main mode of communication. A novel variant c.6405_6406delAG,p.(Ala2137Argfs∗2) in CHD7 was identified by next-generation and Sanger sequencing analyses, resulting in a 2137-amino-acid truncated polypeptide. Parental genetic screening confirmed the sporadic origin of the mutation.

Conclusion:

Cochlear implantation surgery using the SMA with cartilage protection technique appears to be a feasible and effective option for patients with ear anomalies that obstruct the usual approach. A novel frameshift variant c.6405_6406delAG,p.(Ala2137Argfs∗2) in CHD7 was also identified in this patient.
The value of dynamic preload variables during spontaneous ventilation
Authors: Perel Azriel
Published: June 2017

Purpose of review

To discuss the physiological significance and clinical value of dynamic preload variables in spontaneously breathing patients.

Recent findings

Dynamic preload variables reflect the response of the cardiac output to a modification of preload and can therefore be used to assess fluid responsiveness. Continuous dynamic parameters that are calculated from the variations in the arterial and plethysmographic waveforms following a mechanical breath have been shown to predict fluid responsiveness much better than static preload parameters. These parameters are displayed on many patient monitors though their use is limited to mechanically ventilated patients. However, spontaneous breathing may also induce significant hemodynamic changes because of the repetitive negative swings in the pleural pressure. By better understanding the physiological basis of these changes, the same ‘dynamic parameters’ can be used to gain unique physiological insights during spontaneous breathing. These include the ability to identify and/or monitor respiratory rate, respiratory effort (e.g., patient–ventilator asynchrony), fluid responsiveness (to some degree), pulsus paradoxus (e.g. asthma, cardiac tamponade), and, importantly, upper airway obstruction.

Although originally intended to be used only during mechanical ventilation, ‘dynamic parameters’ may offer valuable clinical information in spontaneously breathing patients.
Role of Octreotide in Pediatric Gastrointestinal Bleeding Secondary to Angiodysplasia in Children With Right Heart Failure
Authors: Puri Kanika , Caldwell Randall L. , Molleston Jean P.
Published: June 2017

Objectives:

Angiodysplasia (AD) is a relatively uncommon cause of gastrointestinal bleeding in children and may be seen in right heart failure. Octreotide has been used successfully in adult patients with gastrointestinal bleeding due to ADs.

Methods:

We describe 2 patients who had congenital heart disease with right heart failure and gastrointestinal bleeding from AD.

Results:

AD lesions were documented on traditional endoscopy and capsule endoscopy. Bleeding resolved after initiation of IV octreotide and did not recur on subcutaneous octreotide during the 2‐year follow‐up period.

Conclusions:

Based on the successful outcomes in the 2 patients, a trial of octreotide may be considered in pediatric patients who present with gastrointestinal bleeding secondary to AD.
Comorbid PTSD and Social Anxiety Disorder
Authors: McMillan Katherine A. , Asmundson Gordon J.G. , Sareen Jitender
Published: June 2017

Posttraumatic stress disorder (PTSD) and social anxiety disorder (SAD) frequently co-occur. Preliminary data from treatment-seeking and veteran samples suggest that the impact of PTSD-SAD comorbidity may be additive, conferring distress and impairment beyond that of either disorder alone. The current study sought to clarify and extend existent research using wave 2 of the National Epidemiologic Survey of Alcohol and Related Conditions, an epidemiological sample of American adults. Individuals who met criteria for comorbid PTSD-SAD were compared to those with either disorder alone on measures of lifetime suicide attempts or quality of life as measured by the Medical Outcomes Study Questionnaire. Relative to those with either PTSD or SAD, individuals with comorbid PTSD-SAD demonstrated an elevated risk of lifetime suicide attempts and substantially lower levels of physical and mental quality of life. The psychosocial consequences of PTSD-SAD comorbidity are substantial. Patients may benefit from early interventions to remediate social distress and improve support networks before more intensive psychotherapeutic interventions.
Effect of Povidone Iodine 5% on the Cornea, Vision, and Subjective Comfort
Authors: Ridder William H. , Oquindo Caren , Dhamdhere Kavita , Burke James
Published: June 2017

Purpose

To determine the effects of povidone iodine 5% (Betadine 5%) applied to the eye on visual function, corneal integrity, and subjective complaints.

Methods

Ten subjects were chosen to participate in this study (average age 40.6 ± 19.6; age range 22–68). LogMAR acuity, contrast sensitivity, corneal fluorescein staining, and subjective complaints were measured before and after 60 μl of Betadine 5% or saline were applied to one eye (eligibility visit, baseline, 5, 30, and 60 minutes and 4 and 24 hours post-application). Contrast sensitivity at 14 cpd was determined with a spatial two-alternative, forced choice procedure (Beethoven software). The National Eye Institute (NEI) grid pattern was used to grade corneal staining with sodium fluorescein. To avoid the detrimental effects of sodium fluorescein administration on functional vision, the corneal staining baseline was measured at the eligibility visit. Subjective complaints were monitored using the Schein dry eye questionnaire.

Results

The data were analyzed with an ANOVA. Saline administration did not alter logMAR acuity, contrast sensitivity, corneal fluorescein staining, or subjective complaints at any visit. Betadine administration significantly reduced the logMAR acuity, compared to baseline and the saline data, at the 30- and 60-minute visits (all P values <.05). The contrast sensitivity was significantly reduced compared to the baseline and the saline results at 5, 30, and 60 minutes after Betadine application (all P values <.05). The Betadine significantly increased the Schein questionnaire score, compared both to baseline and the saline data, at the 1- and 4-hour visits (all P values <.05). Total corneal staining and the maximum NEI sector staining were significantly different from baseline and from the saline results at every visit (all P values <.05).

Conclusions

Betadine 5% application significantly decreases epithelial integrity of the cornea, decreases functional vision, and increases subjective complaints.
Evaluation and Impact of the “Advanced Pediatric Life Support” Course in the Care of Pediatric Emergencies in Spain
Authors: Benito Javier , Luaces-Cubells Carlos , Mintegi Santiago , Manrique Martínez Ignacio , De la Torre Espí Mercedes , Miguez Navarro Concepción , Vazquez López Paula , Campos Calleja Carmen , Ferres Serrat Francesc , Alonso Salas María Teresa , González del Rey Javier
Published: June 2017

Introduction

The Advanced Pediatric Life Support (APLS) course was introduced in the training of professionals who care for pediatric emergencies in Spain in 2005.

Objective

To analyze the impact of the APLS course in the current clinical practice in Spanish PEDs.

Methods

The directors of APLS courses were asked about information regarding the courses given to date, especially on the results of the satisfaction survey completed by students at the end of the course. Furthermore, in December 2014, a survey was conducted through Google Drive, specifically asking APLS students about the usefulness of the APLS course in their current clinical practice.

Results

In the last 10 years since the APLS course was introduced in Spain, there have been 40 courses in 6 different venues. They involved a total of 1520 students, of whom 958 (63.0%) felt that the course was very useful for daily clinical practice. The survey was sent to 1,200 students and answered by 402 (33.5%). The respondent group most represented was pediatricians, 223 (55.5%), of whom 61 (27.3%) were pediatric emergency physicians, followed by pediatric residents, 122 (30.3%). One hundred three (25.6%) respondents had more than 10 years of professional practice and 291 (72.4%) had completed the course in the preceding four years. Three hundred forty-one of the respondents (84.9%: 95% confidence interval [CI], 81.9–87.9) said that they always use the pediatric assessment triangle (PAT) and 131 (32.6%: 95% CI, 28–37.1) reported that their organization has introduced this tool into their protocols. Two hundred twenty-three (55.5%: 95% CI, 50.6–60.3) believed that management of critically ill patients has improved, 328 (81.6%: 95% CI, 77.8–85.3) said that the PAT and the systematic approach, ABCDE, help to establish a diagnosis, and 315 (78.4%: 95% CI, 74.3–82.4) reported that the overall number of treatments has increased but that these treatments are beneficial for patients. Hospital professionals (191; 47.5%) include the PAT in their protocols more frequently than pre-hospital professionals (68.5% vs 55.4%; p <0.01) and consider PAT useful in the management of patients (60.2% vs 51.1%; p <0.05). Neither the time elapsed since the completion of the course, nor category and years of professional experience had any influence on the views expressed about the impact of the APLS course in clinical practice.

Conclusions

Most health professionals who have received the APLS course, especially those working in the hospital setting, think that the application of the systematic methods learned, the PAT and ABCDE, has a major impact on clinical practice.
The Use of Intranasal Dexmedetomidine and Midazolam for Sedated Magnetic Resonance Imaging in Children
Authors: Sulton Carmen , Kamat Pradip , Mallory Michael , Reynolds Jason
Published: June 2017

Objective

The objective of this study was to describe the use of intranasal dexmedetomidine (IN DEX) for sedated magnetic resonance imaging (MRI) examinations in children. The use of IN DEX for MRI in children has not been well described in the literature.

Materials and Methods

The Pediatric Sedation Research Consortium (PSRC) is a collaborative and multidisciplinary group of sedation practitioners dedicated to understanding and improving the process of pediatric sedation. We searched the 2007 version of the PSRC database solely for instances in which IN DEX was used for MRI diagnostic studies. Patients receiving intravenous medications were excluded. Patient demographics, IN DEX dose, adjunct medications and dose, as well as procedure completion, complications, interventions, and monitoring providers were analyzed.

Results

A total of 224 sedation encounters were included in our primary analysis. There were no major adverse events. Most sedations (88%) required no intervention. Registered nurses were the monitoring provider in over 99% of cases. The median (interquartile range) dose of dexmedetomidine was 3 (2.5–3) mcg/kg. Adjunctive midazolam was used in 219/224 (98%) of the cases. All procedures were completed.

Conclusions

This report from the PSRC shows that IN DEX in combination with midazolam is an effective medication regimen for children who require an MRI with sedation.
Factors Associated with Lymphosclerosis: An Analysis on 962 Lymphatic Vessels
Authors: Yamamoto Takumi , Yamamoto Nana , Yoshimatsu Hidehiko , Narushima Mitsunaga , Koshima Isao
Published: June 2017

Background:

Lymphaticovenular anastomosis is a useful treatment option for compression-refractory lower extremity lymphedema, but its efficacy depends largely on the severity of lymphosclerosis. To maximize lymphaticovenular anastomosis efficacy, it is important to elucidate factors associated with severe lymphosclerosis.

Methods:

Medical charts of 134 lower extremity lymphedema patients who underwent preoperative indocyanine green lymphography and lymphaticovenular anastomosis were reviewed to obtain data of clinical demographics, indocyanine green lymphography findings, and intraoperative findings. Based on intraoperative findings of lymphatic vessels, severity of lymphosclerosis was classified into s0, s1, s2, and s3. Severe lymphosclerosis was defined as lymphatic vessels with s3 sclerosis. Logistic regression analysis was used to identify independent factors associated with severe lymphosclerosis.

Results:

In total, 962 lymphatic vessels were analyzed, among which severe lymphosclerosis was observed in 97 (10.1 percent). Multivariate analysis revealed that independent factors associated with severe lymphosclerosis were higher body mass index (OR, 1.803; 95 percent CI, 1.041 to 3.123; p = 0.035), incision site in the thigh/foot compared with in the groin (OR, 2.355/4.471; 95 percent CI, 1.201 to 4.617/2.135 to 9.362; p = 0.013/p < 0.001), and S-region/D-region on indocyanine green lymphography compared with L-region (OR, 83.134/1441.126; 95 percent CI, 11.296 to 611.843/146.782 to 14149.195; p < 0.001/p < 0.001). Inverse associations were observed in positive history of radiation therapy (OR, 0.461; 95 percent CI, 0.269 to 0.788; p = 0.005).

Conclusions:

Independent factors associated with severe lymphosclerosis were clarified. Indocyanine green lymphography pattern had the strongest association with severe lymphosclerosis. D-region on indocyanine green lymphography should be avoided for lymphaticovenular anastomosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Safety and Indications of Laparoscopic Surgery for Postoperative Small-bowel Obstruction: A Single-center Study of 121 Patients
Authors: Nakamura Takatoshi , Ishii Yoshiyuki , Tsutsui Atsuko , Kaneda Munehisa , Sato Takeo , Watanabe Masahiko
Published: June 2017

Background/Aims:

The purpose of this study was to evaluate the safety and effectiveness of laparoscopic surgery for the treatment of small-bowel obstruction.

Materials and Methods:

The study group comprised 121 patients who underwent laparoscopic surgery for small-bowel obstruction.

Results:

Previous operations were open surgery in 107 patients and laparoscopic surgery in 14. On univariate analysis, 4 risk factors were related to conversion to open surgery: radiotherapy (P=0.0002), previous episode of intestinal obstruction (P=0.0064), bleeding volume of ≥50 mL (P=0.0059), and the presence or absence of previous bowel resection (P=0.0269). On multivariate analysis, only radiotherapy was an independent risk factor for conversion to open surgery (odds ratio, 5.5141; P=0.0091).

Conclusions:

Laparoscopic surgery can be safely performed in patients with postoperative small-bowel obstruction and is considered an effective treatment with a low rate of recurrent bowel obstruction.
Pharmacology of cough in palliative care
Authors: Morice Alyn H. , Shanks Gabriella
Published: June 2017

Purpose of review

Cough is a common and distressing symptom. It has a marked decrement on quality-of-life particularly in the arena of palliative care where coexisting symptoms such as pain may be exacerbated. Whilst local definitive treatment may alleviate coughing it usually requires general measures. The purpose of the review is to assess the current evidence relating to the pharmacological management of cough.

Recent findings

Key to understanding cough is the realization that most cough is because of a hypersensitivity of the afferent vagus nerve. Cough suppression with opioids and first-generation antihistamines may produce relief. However, much cough in palliative medicine is caused by unrecognized nonacid reflux and aspiration. Promotility agents may be dramatically effective at both preventing cough and recurrent aspiration.

The implications of this review will aid practitioners understanding of cough in a variety of settings, including palliative care.
Clean energy and the hydrogen economy
Authors: Brandon N. P. , Kurban Z.
Published: June 2017

In recent years, new-found interest in the hydrogen economy from both industry and academia has helped to shed light on its potential. Hydrogen can enable an energy revolution by providing much needed flexibility in renewable energy systems. As a clean energy carrier, hydrogen offers a range of benefits for simultaneously decarbonizing the transport, residential, commercial and industrial sectors. Hydrogen is shown here to have synergies with other low-carbon alternatives, and can enable a more cost-effective transition to de-carbonized and cleaner energy systems. This paper presents the opportunities for the use of hydrogen in key sectors of the economy and identifies the benefits and challenges within the hydrogen supply chain for power-to-gas, power-to-power and gas-to-gas supply pathways. While industry players have already started the market introduction of hydrogen fuel cell systems, including fuel cell electric vehicles and micro-combined heat and power devices, the use of hydrogen at grid scale requires the challenges of clean hydrogen production, bulk storage and distribution to be resolved. Ultimately, greater government support, in partnership with industry and academia, is still needed to realize hydrogen's potential across all economic sectors.

This article is part of the themed issue ‘The challenges of hydrogen and metals’.
A kinetic Monte Carlo approach to diffusion-controlled thermal desorption spectroscopy
Authors: Schablitzki T. , Rogal J. , Drautz R.
Published: June 2017

Atomistic simulations of thermal desorption spectra for effusion from bulk materials to characterize binding or trapping sites are a challenging task as large system sizes as well as extended time scales are required. Here, we introduce an approach where we combine kinetic Monte Carlo with an analytic approximation of the superbasins within the framework of absorbing Markov chains. We apply our approach to the effusion of hydrogen from BCC iron, where the diffusion within bulk grains is coarse grained using absorbing Markov chains, which provide an exact solution of the dynamics within a superbasin. Our analytic approximation to the superbasin is transferable with respect to grain size and elliptical shapes and can be applied in simulations with constant temperature as well as constant heating rate. The resulting thermal desorption spectra are in close agreement with direct kinetic Monte Carlo simulations, but the calculations are computationally much more efficient. Our approach is thus applicable to much larger system sizes and provides a first step towards an atomistic understanding of the influence of structural features on the position and shape of peaks in thermal desorption spectra.

This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Isotopic tracing of hydrogen transport and trapping in nuclear materials
Authors: Chêne Jacques , Martin Frantz
Published: June 2017

Some illustrations of the use of deuterium or tritium for isotopic tracing of hydrogen absorption, transport and trapping in nuclear materials are presented. Isotopic tracing of hydrogen has been shown to be successful for the determination of the boundaries conditions for hydrogen desorption or absorption in a material exposed to a hydrogen source. Also, the unique capabilities of isotopic tracing and related techniques to characterize H interactions with point defects and dislocations acting as moving traps has been demonstrated. Such transport mechanisms are considered to play a major role in some stress corrosion cracking and hydrogen embrittlement mechanisms.

This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Alloy and composition dependence of hydrogen embrittlement susceptibility in high-strength steel fasteners
Authors: Brahimi S. V. , Yue S. , Sriraman K. R.
Published: June 2017

High-strength steel fasteners characterized by tensile strengths above 1100 MPa are often used in critical applications where a failure can have catastrophic consequences. Preventing hydrogen embrittlement (HE) failure is a fundamental concern implicating the entire fastener supply chain. Research is typically conducted under idealized conditions that cannot be translated into know-how prescribed in fastener industry standards and practices. Additionally, inconsistencies and even contradictions in fastener industry standards have led to much confusion and many preventable or misdiagnosed fastener failures. HE susceptibility is a function of the material condition, which is comprehensively described by the metallurgical and mechanical properties. Material strength has a first-order effect on HE susceptibility, which increases significantly above 1200 MPa and is characterized by a ductile--brittle transition. For a given concentration of hydrogen and at equal strength, the critical strength above which the ductile–brittle transition begins can vary due to second-order effects of chemistry, tempering temperature and sub-microstructure. Additionally, non-homogeneity of the metallurgical structure resulting from poorly controlled heat treatment, impurities and non-metallic inclusions can increase HE susceptibility of steel in ways that are measurable but unpredictable. Below 1200 MPa, non-conforming quality is often the root cause of real-life failures.

This article is part of the themed issue ‘The challenges of hydrogen and metals’.
Hydrogen-related challenges for the steelmaker: the search for proper testing
Authors: Thiessen R. G.
Published: June 2017

The modern steelmaker of advanced high-strength steels has always been challenged with the conflicting targets of increased strength while maintaining or improving ductility. These new steels help the transportation sector, including the automotive sector, to achieve the goals of increased passenger safety and reduced emissions. With increasing tensile strengths, certain steels exhibit an increased sensitivity towards hydrogen embrittlement (HE). The ability to characterize the material's sensitivity in an as-delivered condition has been developed and accepted (SEP1970), but the complexity of the stress states that can induce an embrittlement together with the wide range of applications for high-strength steels make the development of a standardized test for HE under in-service conditions extremely challenging. Some proposals for evaluating the material's sensitivity give an advantage to materials with a low starting ductility. Despite this, newly developed materials can have a higher original elongation with only a moderate reduction in elongation due to hydrogen. This work presents a characterization of new materials and their sensitivity towards HE.

This article is part of the themed issue ‘The challenges of hydrogen and metals’.