bluuebunny/crossref_metadata_2025 huggingface dataset:
Risks and outcomes of direct current cardioversion in children and young adults with congenital heart disease
Authors: Morello Melissa L. , Khoury Philip R. , Knilans Timothy K. , Veldtman Gruschen , Spar David S. , Anderson Jeffery B. , Czosek Richard J.
Published: February 2018

Objectives

Evaluate the efficacy, outcomes, and complications associated with direct current cardioversion (DCCV) in the treatment of arrhythmias in pediatric and adult congenital heart disease (CHD) populations and identify patient and procedural characteristics associated with adverse events.

Background

Pediatric and adult patients with CHD are at risk of atrial arrhythmias. DCCV is effective but is associated with potential complications.

Methods

In this single‐center retrospective series, patients who underwent DCCV between January 2010 and May 2015 were identified and categorized as pediatric (<18 years) or adult (> 18 years). Records were reviewed for demographic, arrhythmic, and CHD‐specific characteristics; acute efficacy; and 3‐month arrhythmia recurrence. Complications were categorized as life‐threatening (LT) or non‐life‐threatening (NLT). Univariate followed by multiple variable and logistic regression (LR) analyses were used to identify characteristics associated with complications.

Results

We identified 104 patients with 152 discrete DCCV events with median age 17.4 years (0.15–62.2). DCCV efficacy was 89% with 3‐month recurrence of 46%. There were 52 complications among 24 patients, median age 17.7 years (0.15–49). Risks associated with NLT complications are as follows: moderate–severe systolic dysfunction (8/152 encounters, P = < 0.01) and more than one shock per DCCV encounter (P = < 0.01). Six of eight encounters with moderate–severe systolic dysfunction were <18 years (P = 0.1). Risks for LT complications included age >18 years and associated NLT complication. Adults had more frequent arrhythmia recurrence within 3 months than children (P = < 0.01).

Conclusions

DCCV is effective for arrhythmias but is associated with frequent recurrence, particularly in adult patients. Complications associated with DCCV may be greater than previously reported. Additional support and precautions should be in place for those at greatest risk.
Induction and recovery of copy number variation in banana through gamma irradiation and low‐coverage whole‐genome sequencing
Authors: Datta Sneha , Jankowicz‐Cieslak Joanna , Nielen Stephan , Ingelbrecht Ivan , Till Bradley J.
Published: February 2018

Traditional breeding methods are hindered in bananas due to the fact that major cultivars are sterile, parthenocarpic, triploid and thus clonally propagated. This has resulted in a narrow genetic base and limited resilience to biotic and abiotic stresses. Mutagenesis of in vitro propagated bananas is one method to introduce novel alleles and broaden genetic diversity. We previously established a method for the induction and recovery of single nucleotide mutations generated with the chemical mutagen EMS. However, officially released mutant banana varieties have been created using gamma rays, a mutagen that can produce large genomic insertions and deletions (indels). Such dosage mutations may be important for generating observable phenotypes in polyploids. In this study, we establish a low‐coverage whole‐genome sequencing approach in triploid bananas to recover large genomic indels caused by treatment with gamma irradiation. We first evaluated the commercially released mutant cultivar ‘Novaria’ and found that it harbours multiple predicted deletions, ranging from 0.3 to 3.8 million base pairs (Mbp). In total, predicted deletions span 189 coding regions. To evaluate the feasibility of generating and maintaining new mutations, we developed a pipeline for mutagenesis and screening for copy number variation in Cavendish bananas using the cultivar ‘Williams’. Putative mutations were recovered in 70% of lines treated with 20 Gy and 60% of the lines treated with 40 Gy. While deletion events predominate, insertions were identified in 20 Gy‐treated material. Based on these results, we believe this approach can be scaled up to support large breeding projects.
Linkage and association mapping reveals the genetic basis of brown fibre (Gossypium hirsutum)
Authors: Wen Tianwang , Wu Mi , Shen Chao , Gao Bin , Zhu De , Zhang Xianlong , You Chunyuan , Lin Zhongxu
Published: February 2018

Brown fibre cotton is an environmental‐friendly resource that plays a key role in the textile industry. However, the fibre quality and yield of natural brown cotton are poor, and fundamental research on brown cotton is relatively scarce. To understand the genetic basis of brown fibre cotton, we constructed linkage and association populations to systematically examine brown fibre accessions. We fine‐mapped the brown fibre region, Lc1, and dissected it into 2 loci, qBF‐A07‐1 and qBF‐A07‐2. The qBF‐A07‐1 locus mediates the initiation of brown fibre production, whereas the shade of the brown fibre is affected by the interaction between qBF‐A07‐1 and qBF‐A07‐2. Gh_A07G2341 and Gh_A07G0100 were identified as candidate genes for qBF‐A07‐1 and qBF‐A07‐2, respectively. Haploid analysis of the signals significantly associated with these two loci showed that most tetraploid modern brown cotton accessions exhibit the introgression signature of Gossypium barbadense. We identified 10 quantitative trait loci (QTLs) for fibre yield and 19 QTLs for fibre quality through a genome‐wide association study (GWAS) and found that qBF‐A07‐2 negatively affects fibre yield and quality through an epistatic interaction with qBF‐A07‐1. This study sheds light on the genetics of fibre colour and lint‐related traits in brown fibre cotton, which will guide the elite cultivars breeding of brown fibre cotton.
Sensitivity of different Lupinus species to calcium under a low phosphorus supply
Authors: Ding Wenli , Clode Peta L. , Clements Jonathan C. , Lambers Hans
Published: February 2018

To study mechanism underpinning the calcifuge habit of some Lupinus species, especially under low‐phosphorus (P) conditions, Lupinus species that were likely to respond differently to calcium (Ca) availability were assembled, and the sensitivity to Ca under a low‐P supply was assessed. Seven Lupinus species (9 genotypes, L. albus L. cv Kiev, L. albus L. P26766, L. angustifolius L. cv Mandelup, L. angustifolius L. P26723, L. luteus L. cv Pootalong, L. hispanicus ssp. bicolor Boiss. and Reut. P22999, L. pilosus Murr. P27440, L. cosentinii Guss. P27225, and L. atlanticus Gladst. P27219) were grown hydroponically at 10 or 6000 μM Ca. Leaf symptoms, gas exchange and biomass were recorded; leaf and root nutrient concentrations were analysed, and the leaf cell types in which Ca and P accumulated were determined using elemental X‐ray microanalyses. Calcium toxicity was demonstrated for L. angustifolius P26723, L. hispanicus ssp. bicolor. P22999, and L. cosentinii P27225, whereas the other species were tolerant of a high Ca supply under low‐P conditions. In addition, genotypic differences in Ca toxicity were found within L. angustifolius. Most Ca accumulated in the mesophyll cells in all species, whereas most P was located in epidermal cells.
Expression of interleukin‐17 in primary Sjögren's syndrome and the correlation with disease severity: A systematic review and meta‐analysis
Authors: Zhang L.‐W. , Zhou P.‐R. , Wei P. , Cong X. , Wu L.‐L. , Hua H.
Published: February 2018

The aberrant expression of interleukin‐17 (IL‐17) has been reported in primary Sjögren's syndrome (pSS). Abnormalities in IL‐17 can promote the production of pro‐inflammatory cytokines and aggravate autoimmune disorders. The aim of this study was to investigate alterations of IL‐17 in patients with pSS and explore the correlation between IL‐17 and disease severity. Eight databases were searched for original studies reporting the expression of IL‐17 in patients with pSS and controls. Eligible reports were included in the pooled analysis, and subgroup evaluations were performed according to different types of controls and IL‐17 measurement methods. Newcastle‐Ottawa Scale criteria were used to assess the risk of bias of the included studies. In total, 45 articles are included in the meta‐analysis. The expression of IL‐17 is significantly increased in patients with pSS compared to controls. Furthermore, patients with pSS without immunosuppressive treatment show markedly higher IL‐17 levels. In addition, patients with pSS with positive rheumatoid factors tend to express a higher level of IL‐17 than patients with negative rheumatoid factors. Negative correlations between IL‐17 levels and ocular parameters are also found in patients with pSS. The results are similar after adjustment by “trim and fill” methods. In conclusion, the expression of IL‐17 is obviously increased in patients with pSS, especially among those without immunosuppressive treatment. In addition, IL‐17 level correlates with the disease severity of pSS. These findings demonstrate the significance of IL‐17 overexpression in patients with pSS and may provide insights for the development of therapeutic interventions targeting IL‐17 for pSS.
Sustainable Companies, Addressing Climate Change. A Theoretical Review
Authors: Soler Carmen Echazarreta , Marcé Albert Costa
Published: February 2018

Climate change is an unavoidable threat with potentially irreversible effects. In the current economic context, globalization significantly increases the unbalanced use of finite, non-renewable sources of energy. This study aims to describe the main characteristics of sustainable companies, based on ideals and values that are committed to the development of the planet, consuming fewer resources than those that they create. Sustainable companies are based on fundamental principles such as the environment (renewable energy resources, sustainable development, preservation of the environment, responsible energy use, minimization of emissions, eco-efficiency, and the circular economy) and mobility (collective public transport, electric vehicles, clean non-motorized mobility systems). In light of this situation, a number of improvement actions have been proposed aimed at sustainable business development (smart environmental sensor networks, energy efficiency, integrated water cycle management, efficient lighting, smart metering, smart irrigation, environmental protection, smart waste management, smart public transport, monitoring of tolls and access to restricted areas, traffic management, fleet management, smart parking, and electric vehicles). Following a theoretical review of the main related studies, it is concluded that there are gaps in information and research related to climate change. At the same time, a further conclusion is that the instruments currently used to mitigate its effects are insufficient and inadequate. Greater indexes of governance and transnational strategy are urgently needed. Finally, there is also a need for sustainable companies that combine business development with the environment and the protection of the planet.
The Relation between Acculturation and Psychological Well-Being among Adolescents of Asian Origin
Authors: Li Yong , Guo Yuqi
Published: February 2018

The current study aimed to test the direct and indirect effects of acculturation on the psychological well-being among the adolescent children of Asian origin. Subgroup analysis was conducted to compare these effects between Asian refugee and non-refugee children. Data were from the follow-up survey of the Children of Immigrants Longitudinal Study (CILS). The analytic sample included adolescents from Asian refugee families (N = 563) and non-refugee families (N = 779). Adolescent acculturation was assessed by three proxy measures: nativity, time in the United States, and U.S. preference. Family dynamics were measured by adolescents’ perceptions about parent-child conflict and family cohesion. Multi-group structural equation modeling was used to analyze the data. Findings suggested that the direct effects of acculturation on psychological well-being were dependent upon the proxy measure of acculturation and the immigration type. Mediation analyses showed that higher level of acculturation was generally related to higher parent-child conflict and lower family cohesion, which, in turn, were associated with lower psychological well-being in the refugee subsample, but not the non-refugee subsample. Our findings call for programs that can take advantage of the protective role of family cohesion and reduce the negative impact of parent-child conflict. Special attention needs to be paid to the refugee population from Asia.
Gender Issues in Involuntary Resettlement due to Dam Construction: “Dam Brides” and the Tokuyama Dam in Japan
Authors: Yamazawa Shuichi , Moriya Kanae , Nakayama Mikiyasu
Published: February 2018

Many dams have been constructed around the world. Consequently, a great number of people have been displaced from their homelands by dam construction. These developments have tended to overlook gender differences. Thus, the resettlement process may exacerbate existing gender disparities in the communities affected by the project. Gender issues have seldom been studied in involuntary resettlements due to dam construction projects in Japan. This study was conducted about the Tokuyama dam, which has the largest storage capacity in Japan. Previous studies implicitly assume that all of the displaced people were originally from the submerged old Tokuyama village. However, our study revealed that some resettlers were in fact from outside of the old Tokuyama village. These were women called “dam brides” because they married men who were originally from Tokuyama, in the period immediately prior to the dam construction and subsequent resettlement. The men mostly met these “dam brides” in cities where they worked as seasonal workers in the winter. Knowing that the men would secure hefty compensation by leaving their homes in the old Tokuyama village, the “dam brides” decided to get married. They lived in the old Tokuyama village for only a few years before relocating to areas which were more “urban” than Tokuyama. These “dam brides,” originally from cities, behaved differently after relocation than those from Tokuyama. They were keener to establish amicable relations with the people in the host community and were thus pivotal in accelerating the merging of the resettlers into their host community.
Feminist and Ecofeminist Christology
Authors: Sahinidou Ioanna
Published: February 2018

The Incarnation of Christ, known by the eastern fathers as Christological perichoresis as a theological idea becomes experienced ecological reality, if we realize its kenotic, Christological, relating cosmic dimensions. It shows how we can bring together different entities, such as God and nature, look at them in unity, as the one person of Christ, and acknowledge the perichoresis between divine and human and nature. Christ lived as one person: both God-Creator and creature. If ecofeminist theologies need a place in the Christian church, they must seek a Christological salvific foundation. Our encounter with God in Christ is a transformation and a renewal of ourselves so as to discern the will of God and follow it; a kenosis of our egocentric self so that Christ to be reborn in us. Paul sees the encounter with God as a rebirth, not as intellectually gained knowledge.
Echogenicity and ultrasound visibility of peripheral nerves of the upper extremity
Authors: Stolz Lori A , Acuna Josie Galarza , Gaskin Kevin , Murphy Amanda M , Friedman Lucas , Stears-Ellis Summer , Javedani Parisa , Stolz Uwe , Adhikari Srikar
Published: February 2018

Aim: Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves.Material and methods: This is a prospective observational study. A convenience sample of adult emergency department patients were enrolled. Gender, BMI, history of diabetes, neck circumference and arm circumference were recorded. Sonographic images of the brachial plexus at interscalene and supraclavicular levels, the median, the radial and ulnar nerves were recorded. Three reviewers independently graded the echogenicity and visibility using subjective scales.Results: 395 peripheral nerves were included. Nerves of the forearm (median, ulnar, radial nerves) were found to be more echogenic (OR=9.3; 95% CI: 5.7, 15.3) and visible (OR=10.0; 6.3, 16.0) than more proximal nerves (brachial plexus at interscalene and supraclavicular levels). Gender, BMI, and history of diabetes mellitus were not significantly related to nerve visibility (p=0.9, 0.2, 0.2, respectively) or echogenicity (p=0.3, 0.8, 0.3). Neck circumference was not related to visibility or echogenicity of proximal nerves. Increased forearm circumference improved echogenicity (OR=1.25; 1.09, 1.43) but not visibility of forearm nerves.Conclusions: Gender, BMI and presence of diabetes were not related to echogenicity or visibility of upper extremity nerves. Increasing forearm circumference was associated with increased echogenicity of the adjacent nerves, but not visibility. Neck circumference was not associated with either nerve visibility or echogenicity of brachial plexus nerve bundles.
Impact of Strain Elastography on BI-RADS classification in small invasive lobular carcinoma
Authors: Chiorean Angelica Rita , Szep Mădălina Brîndușa , Feier Diana Sorina , Duma Magdalena , Chiorean Marco Andrei , Strilciuc Ștefan
Published: February 2018

Aims: The purpose of this study was to determine the impact of strain elastography (SE) on the Breast Imaging Reporting Data System (BI-RADS) classification depending on invasive lobular carcinoma (ILC) lesion size.Materials and methods: We performed a retrospective analysis on a sample of 152 female subjects examined between January 2010 – January 2017. SE was performed on all patients and ILC was subsequently diagnosed by surgical or ultrasound-guided biopsy. BI-RADS 1, 2, 6 and Tsukuba BGR cases were omitted. BI-RADS scores were recorded before and after the use of SE. The differences between scores were compared to the ILC tumor size using nonparametric tests and logistic binary regression. We controlled for age, focality, clinical assessment, heredo-collateral antecedents, B-mode and Doppler ultrasound examination. An ROC curve was used to identify the optimal cut-off point for size in relationship to BI-RADS classificationdifference using Youden’s index.Results: The histological subtypes of ILC lesions (n=180) included in the sample were luminal A (70%, n=126), luminal B (27.78%, n=50), triple negative (1.67%, n=3) and HER2+ (0.56%, n=1). The BI-RADS classification was higher when SE was performed (Z=- 6.629, p<0.000). The ROC curve identified a cut-off point of 13 mm for size in relationship to BI-RADS classification difference (J=0.670, p<0.000). Small ILC tumors were 17.92% more likely to influence BI-RADS classification (p<0.000).Conclusions: SE offers enhanced BI-RADS classification in small ILC tumors (<13 mm). Sonoelastography brings added value to B-mode breast ultrasound as an adjacent to mammography in breast cancer screening.
Interconversion of elasticity measurements between two-dimensional shear wave elastography and transient elastography
Authors: Kim Yeun-Yoon , Kim Myung-Joon , Shin Hyun Joo , Yoon Haesung , Kim Ha Yan , Lee Mi-Jung
Published: February 2018

Aims: To enable comparison and interconversion of elasticity measurements between two-dimensional (2D) shear wave elastography (SWE) and transient elastography (TE).Materials and methods: Elasticities of three phantoms were measured by 2D SWE (supersonic shear imaging) using four probes and TE using two probes. We performed regression analyses to evaluate correlation between the measurements and phantom elasticities, and make converting equations. In pediatric biliary atresia patients who had stiffness measurements by both 2D SWE and TE within 1-year interval, TE measurements were retrospectively converted into correlating 2D SWE values. We compared the calculated values with 2D SWE measurements by intraclass correlation coefficient.Results: Measurements in phantoms varied according to elastography method and probe selection. However, the measurement by both 2D SWE (R2, 0.974-0.985; p<0.001) and TE (R2, 0.996-0.999; p<0.001) showedsignificant linear correlation with phantom elasticity in all probe settings. From 67 biliary atresia patients (age, 2 months-20 years), agreements between the measured and calculated values were excellent in all 88 examinations within 1-year interval(ρ=0.828; p<0.001) and in 63 examinations within 2-month interval (ρ=0.863, p<0.001). Conclusions: The equations enabledinterconversion of elasticity values among different probes of 2D SWE and TE and provided reliable estimation of elasticityvalues for different probe settings in biliary atresia patients.
Intracardiac echocardiography to guide catheter ablation of an accessory pathway in Ebstein’s anomaly. A case report
Authors: Cismaru Gabriel , Muresan Lucian , Rosu Radu , Puiu Mihai , Gusetu Gabriel , Toganel Rodica , Pop Dana , Zdrenghea Dumitru
Published: February 2018

We present the case of a 17-year-old girl with Ebstein anomaly and repeated episodes of reentrant tachycardia due to a right posterior accessory pathway. Catheter ablation was performed using intracardiac echocardiography. A ViewFlex Xtra probe was inserted and showed an anormal tricuspid valve with elongated anterior leaflet and low insertion of the septal leaflet towards the apex. The anatomical annulus was identified by the course of the right coronary artery. RF application on the posterior annulus stopped the reentrant arrhythmia. After ablation, programmed stimulation showed absence of both antegrade and retrograde conduction through the accessory pathway.
Age-Related Differences in Spatiotemporal Variables and Ground Reaction Forces During Sprinting in Boys
Authors: Nagahara Ryu , Takai Yohei , Haramura Miki , Mizutani Mirai , Matsuo Akifumi , Kanehisa Hiroaki , Fukunaga Tetsuo
Published: February 2018

Purpose: We aimed to elucidate age-related differences in spatiotemporal and ground reaction force variables during sprinting in boys over a broad range of chronological ages. Methods: Ground reaction force signals during 50-m sprinting were recorded in 99 boys aged 6.5–15.4 years. Step-to-step spatiotemporal variables and mean forces were then calculated. Results: There was a slower rate of development in sprinting performance in the age span from 8.8 to 12.1 years compared with younger and older boys. During that age span, mean propulsive force was almost constant, and step frequency for older boys was lower regardless of sprinting phase. During the ages younger than 8.8 years and older than 12.1 years, sprint performance rapidly increased with increasing mean propulsive forces during the middle acceleration and maximal speed phases and during the initial acceleration phase. Conclusion: There was a stage of temporal slower development of sprinting ability from age 8.8 to 12.1 years, being characterized by unchanged propulsive force and decreased step frequency. Moreover, increasing propulsive forces during the middle acceleration and maximal speed phases and during the initial acceleration phase are probably responsible for the rapid development of sprinting ability before and after the period of temporal slower development of sprinting ability.
Relationships Between Training Load, Sleep Duration, and Daily Well-Being and Recovery Measures in Youth Athletes
Authors: Sawczuk Thomas , Jones Ben , Scantlebury Sean , Till Kevin
Published: February 2018

Purpose: To assess the relationships between training load, sleep duration, and 3 daily well-being, recovery, and fatigue measures in youth athletes. Methods: Fifty-two youth athletes completed 3 maximal countermovement jumps (CMJs), a daily well-being questionnaire (DWB), the perceived recovery status scale (PRS), and provided details on their previous day’s training loads (training) and self-reported sleep duration (sleep) on 4 weekdays over a 7-week period. Partial correlations, linear mixed models, and magnitude-based inferences were used to assess the relationships between the predictor variables (training and sleep) and the dependent variables (CMJ, DWB, and PRS). Results: There was no relationship between CMJ and training (r = −.09; ±.06) or sleep (r = .01; ±.06). The DWB was correlated with sleep (r = .28; ±.05, small), but not training (r = −.05; ±.06). The PRS was correlated with training (r = −.23; ±.05, small), but not sleep (r = .12; ±.06). The DWB was sensitive to low sleep (d = −0.33; ±0.11) relative to moderate; PRS was sensitive to high (d = −0.36; ±0.11) and low (d = 0.29; ±0.17) training relative to moderate. Conclusions: The PRS is a simple tool to monitor the training response, but DWB may provide a greater understanding of the athlete’s overall well-being. The CMJ was not associated with the training or sleep response in this population.
Quantum valence criticality in a correlated metal
Authors: Kuga Kentaro , Matsumoto Yosuke , Okawa Mario , Suzuki Shintaro , Tomita Takahiro , Sone Keita , Shimura Yasuyuki , Sakakibara Toshiro , Nishio-Hamane Daisuke , Karaki Yoshitomo , Takata Yasutaka , Matsunami Masaharu , Eguchi Ritsuko , Taguchi Munetaka , Chainani Ashish , Shin Shik , Tamasaku Kenji , Nishino Yoshinori , Yabashi Makina , Ishikawa Tetsuya , Nakatsuji Satoru
Published: February 2018

We discover the experimental case of a quantum valence criticality leading to the breakdown of the Fermi liquid state.
Current-induced magnetization switching using an electrically insulating spin-torque generator
Authors: An Hongyu , Ohno Takeo , Kanno Yusuke , Kageyama Yuito , Monnai Yasuaki , Maki Hideyuki , Shi Ji , Ando Kazuya
Published: February 2018

This paper reports the first demonstration of current-induced magnetization switching using an ordinary insulator.
Fifteen-minute consultation: The child with an incidental finding of low IgA
Authors: Sullivan Adrienne , Bland Ruth M , Hague Rosie
Published: February 2018

Low or absent immunoglobulin A (IgA) levels are frequently found in children in whom immunodeficiency is not suspected. IgA deficiency is the most common primary immunodeficiency disorder in the UK affecting approximately 1 in 600 people. Isolated IgA deficiency is often identified coincidentally when investigating a child for conditions such as coeliac disease. The aim of this article is to provide a structured approach to the history, investigation and management of an isolated IgA deficiency.
2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries
Authors: Ardern Clare L , Ekås Guri Ranum , Grindem Hege , Moksnes Håvard , Anderson Allen F , Chotel Franck , Cohen Moises , Forssblad Magnus , Ganley Theodore J , Feller Julian A , Karlsson Jón , Kocher Minider S , LaPrade Robert F , McNamee Michael , Mandelbaum Bert , Micheli Lyle , Mohtadi Nicholas , Reider Bruce , Roe Justin , Seil Romain , Siebold Rainer , Silvers-Granelli Holly J , Soligard Torbjørn , Witvrouw Erik , Engebretsen Lars
Published: February 2018

In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions.
Prevalence, causes and mental health impact of workplace bullying in the Neonatal Intensive Care Unit environment
Authors: Chatziioannidis Ilias , Bascialla Francesca Giuseppina , Chatzivalsama Panagiota , Vouzas Fotios , Mitsiakos Georgios
Published: February 2018

Objectives

The aim of this study is to examine the prevalence, to report barriers and mental health impact of bullying behaviours and to analyse whether psychological support at work could affect victims of bullying in the healthcare workplace.

Design

Self-administered questionnaire survey.

Setting

20 in total neonatal intensive care units in 17 hospitals in Greece.

Participants

398 healthcare professionals (doctors, nurses).

Main outcome measures

The questionnaire included information on demographic data, Negative Act Questionnaire-Revised (NAQ-R) behaviour scale, data on sources of bullying, perpetrators profile, causal factors, actions taken and reasons for not reporting bullying, psychological support and 12-item General Health Questionnaire (GHQ-12) scores to investigate psychological distress.

Results

Prevalence of bullying measured by the NAQ-R was 53.1% for doctors and 53.6% for nurses. Victims of bullying differed from non-bullied in terms of gender and job experience, among demographic data. Crude NAQ-R score was found higher for female, young and inexperienced employees. Of those respondents who experienced bullying 44.9% self-labelled themselves as victims. Witnessing bullying of others was found 83.2%. Perpetrators were mainly females 45–64 years old, most likely being a supervisor/senior colleague. Common reasons for not reporting bullying was self-dealing and fear of consequences. Bullying was attributed to personality trait and management. Those who were bullied, self-labelled as a victim and witnessed bullying of others had higher GHQ-12 score. Moreover, psychological support at work had a favour effect on victims of bullying.

Conclusions

Prevalence of bullying and witnessing were found extremely high, while half of victims did not consider themselves as sufferers. The mental health impact on victims and witnesses was severe and support at work was necessary to ensure good mental health status among employees.
Chinese observational prospective study of ageing population with chronic kidney disease (C-OPTION): a study protocol
Authors: Liang Shuang , Wang Wen-Ling , Zhu Fang-Lei , Duan Shu-Wei , Sun Xue-Feng , Chen Xiang-Mei , Cai Guang-Yan
Published: February 2018

Introduction

The proportion of elderly people is steadily rising worldwide, especially in low-income and middle-income countries, including China. Chronic kidney disease (CKD) is a common disorder in older people. However, little is known about the epidemiology of CKD and its consequences among the elderly. Improvements on clinical guidelines and healthcare policies for this population are required. This study aims to examine the risk factors for progression of CKD among the elderly and develop models to identify subgroups who are at high risk.

Methods and analysis

This is a prospective, multicentre, cohort study. The study population comprises ~3000 patients with predialysis CKD, aged ≥65 years, recruited between March 2016 and December 2017. After the baseline assessments, these patients will be followed for 5 years or until the occurrence of primary outcomes. Assessments that include anthropomorphic measures, laboratory tests, questionnaires, and blood and urine specimen collection will be performed at baseline and at follow-ups. Data on demographic information, cognitive function, depression, risk of malnutrition, physical activity and quality of life will be collected. The primary outcomes are incidence of end-stage renal disease, loss of renal function (≥40% decline in glomerular filtration rate from baseline), and death. The secondary outcomes are acute coronary syndrome, hospitalisation for heart failure or unstable angina, cerebrovascular events, and peripheral arterial disease.

Ethics and dissemination

This study protocol has been approved by the ethics committees of the Chinese People’s Liberation Army General Hospital and the participating centres. All the participants gave written informed consent before data collection. The findings of the study will be published in peer-reviewed journals and will be presented at national or international conferences.

Trial registration number

NCT03246204; Pre-results.
UK guidelines on oesophageal dilatation in clinical practice
Authors: Sami Sarmed S , Haboubi Hasan N , Ang Yeng , Boger Philip , Bhandari Pradeep , de Caestecker John , Griffiths Helen , Haidry Rehan , Laasch Hans-Ulrich , Patel Praful , Paterson Stuart , Ragunath Krish , Watson Peter , Siersema Peter D , Attwood Stephen E
Published: February 2018

These are updated guidelines which supersede the original version published in 2004. This work has been endorsed by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG) under the auspices of the oesophageal section of the BSG. The original guidelines have undergone extensive revision by the 16 members of the Guideline Development Group with representation from individuals across all relevant disciplines, including the Heartburn Cancer UK charity, a nursing representative and a patient representative. The methodological rigour and transparency of the guideline development processes were appraised using the revised Appraisal of Guidelines for Research and Evaluation (AGREE II) tool.

Dilatation of the oesophagus is a relatively high-risk intervention, and is required by an increasing range of disease states. Moreover, there is scarcity of evidence in the literature to guide clinicians on how to safely perform this procedure. These guidelines deal specifically with the dilatation procedure using balloon or bougie devices as a primary treatment strategy for non-malignant narrowing of the oesophagus. The use of stents is outside the remit of this paper; however, for cases of dilatation failure, alternative techniques—including stents—will be listed. The guideline is divided into the following subheadings: (1) patient preparation; (2) the dilatation procedure; (3) aftercare and (4) disease-specific considerations. A systematic literature search was performed. The Grading of Recommendations Assessment, Develop­ment and Evaluation (GRADE) tool was used to evaluate the quality of evidence and decide on the strength of recommendations made.
Maternal veterinary occupation and adverse birth outcomes in Washington State, 1992–2014: a population-based retrospective cohort study
Authors: Meisner Julianne , Vora Manali V , Fuller Mackenzie S , Phipps Amanda I , Rabinowitz Peter M
Published: February 2018

Objective

Women in veterinary occupations are routinely exposed to potential reproductive hazards, yet research into their birth outcomes is limited. We conducted a population-based retrospective cohort study of the association between maternal veterinary occupation and adverse birth outcomes.

Methods

Using Washington State birth certificate, fetal death certificate and hospital discharge data from 1992 to 2014, we compared birth outcomes of mothers in veterinary professions (n=2662) with those in mothers in dental professions (n=10 653) and other employed mothers (n=8082). Relative risks (RRs) and 95% CIs were estimated using log binomial regression. Outcomes studied were premature birth (<37 weeks), small for gestational age (SGA), malformations and fetal death (death at ≥20 weeks gestation). Subgroup analyses evaluated risk of these outcomes among veterinarians and veterinary support staff separately.

Results

While no statistically significant associations were found, we noted a trend for SGA births in all veterinary mothers compared with dental mothers (RR=1.16, 95% CI 0.99 to 1.36) and in veterinarians compared with other employed mothers (RR=1.37, 95% CI 0.96 to 1.96). Positive but non-significant association was found for malformations among children of veterinary support staff.

Conclusions

These results support the need for further study of the association between veterinary occupation and adverse birth outcomes.
Troponin and BNP are markers for subsequent non-ischaemic congestive heart failure: the Caerphilly Prospective Study (CaPS)
Authors: Patterson Christopher C , Blankenberg Stefan , Ben-Shlomo Yoav , Heslop Luke , Bayer Anthony , Lowe Gordon , Zeller Tanja , Gallacher John , Young Ian , Yarnell John W G
Published: February 2018

Objective

To examine the long-term predictive value of 28 biomarkers for subsequent non-ischaemic congestive heart failure (CHF) and separately for other cardiovascular outcomes (myocardial infarction (MI) and stroke).

Methods

The Caerphilly Prospective Study recruited 2171 men aged 55–69 years from the general population in 1989–1993; men were screened for evidence of cardiovascular disease (CVD) and followed for clinical cardiovascular events. Fasting blood samples were stored at −70°C until assayed for novel biomarkers in 2010–2013. A competing risks proportional hazards regression analysis was used to estimate subhazard ratios (SHRs) for each biomarker for each cardiovascular outcome.

Results

During follow-up (average 13 years), only new, initial events were evaluated in the whole cohort: 584 MIs, 313 strokes and 261 episodes of CHF (not associated with acute MI). In a subcohort of men who had no clinical history or evidence of CVD at baseline examination (n=1279) those in the top third of the distributions of troponin and B-type natriuretic peptide (BNP) showed a threefold increase in risk for subsequent CHF as afirstevent after adjustment for all conventional risk factors (SHRs 3.37, 95% CI 1.39 to 8.14 and 3.23, 95% CI 1.45 to 7.23), respectively, in contrast to moderate elevations in risk for acute MI (troponin SHR 1.63, 95% CI 1.10 to 2.41) and for stroke (BNP SHR 1.75 95% CI 1.06 to 2.88).

Conclusion

Troponin and BNP could be considered as potentially useful screening tools to detect subjects without prior CVD at increased risk of developing CHF in subsequent years in addition to having lesser roles for predicting subsequent MI (troponin) or stroke (BNP).
Rationale and design of the ranolazine PH–RV study: a multicentred randomised and placebo-controlled study of ranolazine to improve RV function in patients with non-group 2 pulmonary hypertension
Authors: Han Yuchi , Forfia Paul R , Vaidya Anjali , Mazurek Jeremy A , Park Myung H , Ramani Gautam , Chan Stephen Y , Waxman Aaron B
Published: February 2018

Introduction

A major determining factor on outcomes in patients with pulmonary arterial hypertension (PAH) is right ventricular (RV) function. Ranolazine, which is currently approved for chronic stable angina, has been shown to improve RV function in an animal model and has been shown to be safe in small human studies with PAH. We aim to study the effect of ranolazine on RV function using cardiovascular magnetic resonance (CMR) in patients with pulmonary hypertension (non-group 2 patients) and monitor the effect of ranolazine on metabolism using metabolic profiling and changes of microRNA.

Methods and analysis

This study is a longitudinal, randomised, double-blind, placebo-controlled, multicentre proof-of-concept study in 24 subjects with pulmonary hypertension and RV dysfunction treated with ranolazine over 6 months. Subjects who meet the protocol definition of RV dysfunction (CMR RV ejection fraction (EF) <45%) will be randomised to ranolazine or placebo with a ratio of 2:1. Enrolled subjects will be assessed for functional class, 6 min walk test and health outcome based on SF-36 tool. Peripheral blood will be obtained for N-terminal-pro brain natriuretic peptide, metabolic profiling, and microRNA at baseline and the conclusion of the treatment period. CMR will be performed at baseline and the conclusion of the treatment period. The primary outcome is change in RVEF. The exploratory outcomes include clinical, other CMR parameters, metabolic and microRNA changes.

Ethics and dissemination

The trial protocol was approved by Institutional Review Boards. The trial findings will be disseminated in scientific journals and meetings.

Trial registration numbers

NCT01839110 andNCT02829034;Pre-results.
Comprehensive update on the new indications for transcatheter aortic valve replacement in the latest 2017 European guidelines for the management of valvular heart disease
Authors: Thonghong Tasalak , De Backer Ole , Søndergaard Lars
Published: February 2018

New European guidelines on the management of valvular heart disease—supported by the European Society of Cardiology (ESC) and European Association of CardioThoracic Surgery (EACTS)—were recently published. Although these guidelines are very comprehensive, these typically are not very inviting to read. In this document, we aimed to distil all the information about transcatheter aortic valve replacement (TAVR) in the new 2017 ESC/EACTS guidelines to the essential and give additional comments on the position of TAVR in 2017.
Diastolic Blood Pressure and Adverse Outcomes in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial
Authors: Sandesara Pratik B. , O'Neal Wesley T. , Kelli Heval M. , Topel Matthew , Samman‐Tahhan Ayman , Sperling Laurence S.
Published: February 2018

Background

Although diastolic blood pressure (
DBP
) is independently associated with an increased risk of adverse cardiovascular outcomes in the general population, it is unclear if a similar relationship exists in patients with heart failure with preserved ejection fraction.

Methods and Results

This analysis included 1703 (mean age, 72±10 years; 50% men; 78% white) patients with heart failure with preserved ejection fraction enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) Trial from the Americas who were treated for hypertension. Multivariable Cox regression was used to examine the risk of hospitalization for heart failure, death, and cardiovascular death associated with
DBP
. The relationship between hospitalization for heart failure and
DBP
was linear, with an increased risk observed with decreasing
DBP
values (≥90 mm Hg: referent; 80–89 mm Hg: hazard ratio [HR], 1.44; 95% confidence interval [CI], 0.85–2.44; 70–79 mm Hg:
HR
, 1.18; 95%
CI
, 0.69–2.01; 60–69 mm Hg:
HR
, 1.54; 95%
CI
, 0.90–2.63; <60 mm Hg:
HR
, 2.12; 95%
CI
, 1.20–3.74;
P
=0.0055 for trend). The associations of
DBP
with death (≥90 mm Hg:
HR
, 1.86; 95%
CI
, 1.12–3.06; 80–89 mm Hg:
HR
, 1.23; 95%
CI
, 0.89–1.70; 70–79 mm Hg: referent; 60–69 mm Hg:
HR
, 1.20; 95%
CI
, 0.90–1.59; <60 mm Hg:
HR
, 1.68; 95%
CI
, 1.21–2.33) and cardiovascular death (≥90 mm Hg:
HR
, 2.02; 95%
CI
, 1.10–3.71; 80–89 mm Hg:
HR
, 1.17; 95%
CI
, 0.77–1.79; 70–79 mm Hg: referent; 60–69 mm Hg:
HR
, 1.16; 95%
CI
, 0.80–1.70; <60 mm Hg:
HR
, 1.85; 95%
CI
, 1.21–2.82) were nonlinear, with a greater risk of each outcome observed with
DBP
values ≥90 and <60 mm Hg.

Conclusions

DBP
values ≥90 and <60 mm Hg are associated with a significant risk of adverse outcomes in patients with heart failure with preserved ejection fraction who are treated for hypertension. Further research is needed to determine optimal
DBP
targets to reduce the risk of adverse events in patients with heart failure with preserved ejection fraction.
Prospective Randomized Evaluation of Implantable Cardioverter‐Defibrillator Programming in Patients With a Left Ventricular Assist Device
Authors: Richardson Travis D. , Hale Leslie , Arteaga Christopher , Xu Meng , Keebler Mary , Schlendorf Kelly , Danter Matthew , Shah Ashish , Lindenfeld JoAnn , Ellis Christopher R.
Published: February 2018

Background

Ventricular arrhythmias are common in patients with left ventricular assist devices (LVADs) but are often hemodynamically tolerated. Optimal implantable cardioverter defibrillator (ICD) tachy‐programming strategies in patients with LVAD have not been determined. We sought to determine if an ultra‐conservative ICD programming strategy in patients with LVAD affects ICD shocks.

Methods and Results

Adult patients with an existing ICD undergoing continuous flow LVAD implantation were randomized to standard ICD programming by their treating physician or an ultra‐conservative ICD programming strategy utilizing maximal allowable intervals to detection in the ventricular fibrillation and ventricular tachycardia zones with use of ATP. Patients with cardiac resynchronization therapy (CRT) devices were also randomized to CRT ON or OFF. Patients were followed a minimum of 6 months. The primary outcome was time to first ICD shock. Among the 83 patients studied, we found no statistically significant difference in time to first ICD shock or total ICD shocks between groups. In the ultra‐conservative group 16% of patients experienced at least one shock compared with 21% in the control group (
P
=0.66). There was no difference in mortality, arrhythmic hospitalization, or hospitalization for heart failure. In the 41 patients with CRT ICDs fewer shocks were observed with CRT‐ON but this was not statistically significant: 10% of patients with CRT‐ON (n=21) versus 38% with CRT‐OFF (n=20) received shocks (
P
=0.08).

Conclusions

An ultra‐conservative programming strategy did not reduce ICD shocks. Programming restrictions on ventricular tachycardia and ventricular fibrillation zone therapy should be reconsidered for the LVAD population. The role of CRT in patients with LVAD warrants further investigation.

Clinical Trial Registration

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01977703.
Predictive Value of Collagen Biomarkers for Heart Failure With and Without Preserved Ejection Fraction: MESA (Multi‐Ethnic Study of Atherosclerosis)
Authors: Duprez Daniel A. , Gross Myron D. , Kizer Jorge R. , Ix Joachim H. , Hundley William G. , Jacobs David R.
Published: February 2018

Background

Collagen biomarkers may correlate with incident heart failure (
HF
) and its subtypes. We hypothesized that circulating procollagen type
III
N‐terminal propeptide (
PIIINP
) and collagen type I carboxy‐terminal telopeptide (
ICTP
) predict incident
HF
.

Methods and Results

We used a stratified sampling design in a multiethnic sample of 3187 subjects, initially aged 45 to 84 years and free of cardiovascular disease. We assayed baseline serum
PIIINP
and
ICTP
concentrations using radioimmunoassay. Incident
HF
was adjudicated, distinguishing reduced ejection fraction (
HF
r
EF
;
EF
<45%) from preserved
EF
(
HF
p
EF
;
EF
≥45%). The incidence density for
HF
p
EF
and
HF
r
EF
was computed using Poisson regression per
SD
for each of
PIIINP
and
ICTP
, adjusting in model 1 for age, race, sex, and renal function or in model 2 for these variables plus blood pressure and medication. Mean (
SD
)
ICTP
was 3.38±1.77 μg/L, and mean (
SD
)
PIIINP
was 5.48±2.04 μg/L. Among the
HF
cases, 96 were
HF
r
EF
and 107 were
HF
p
EF
. Neither
ICTP
nor
PIIINP
significantly predicted incident
HF
r
EF
. The incidence density for
HF
p
EF
per 100 people observed for 13 years was 1.65 for low
PIIINP
(lower 6 octiles) versus 3.00 for higher
PIIINP
(
P
=0.002) in model 1 and correspondingly 1.45 versus 2.59 (
P
=0.003) in model 2. For low
ICTP
(lower 7 octiles) versus higher
ICTP
(octile 8), incidence densities were 1.79 versus 3.64 (
P
=0.002) in model 1 and 1.58 versus 3.12 (
P
=0.002) in model 2.

Conclusions

High levels of circulating
ICTP
and
PIIINP
as collagen biomarkers appear to be associated with incident
HF
p
EF
, but not
HF
r
EF
.