bluuebunny/crossref_metadata_2025 huggingface dataset:
Homophilic and heterophilic cadherin bond rupture forces in homo- or hetero-cellular systems measured by AFM based SCFS
Authors: Viji Babu Prem Kumar , Mirastschijski Ursula , Belge Gazanfer , Radmacher Manfred
Published: February 2020

Cadherins enable intercellular adherens junctions to withstand tensile forces in tissues, e.g. generated by intracellular actomyosin contraction. Single molecule force spectroscopy experiments inin-vitroexperiments can reveal the cadherin-cadherin extracellular region binding dynamics such as bond formation and strength. However, characterization of cadherin homophilic and heterophilic binding in their native conformational and functional state in living cells has rarely been done. Here, we used Atomic Force Microscopy (AFM) based Single cell force Spectroscopy (SCFS) to measure rupture forces of homophilic and heterophilic bond formation of N-, OB- and E-cadherins in living fibroblast and epithelial cells in homo- and hetero-cellular arrangements, i.e. between same type of cells and between cells of different type. In addition, we used indirect immunofluorescence labelling to study and correlate the expression of these cadherins in intercellular adherens junctions. We showed that N/N and E/E cadherin homophilic bindings are stronger than N/OB, E/N and E/OB heterophilic bindings. Disassembly of intracellular actin filaments reduces the cadherin bond rupture forces suggesting a contribution of actin filaments in cadherin extracellular binding. Inactivation of myosin did not affect the cadherin rupture force in both homo- and hetero-cellular arrangements. Whereas, myosin inactivation particularly strengthened the N/OB heterophilic bond and reinforced the other cadherins homophilic bonds.
Niche theory for mutualism: A graphical approach to plant-pollinator network dynamics
Authors: Valdovinos Fernanda S. , Marsland Robert
Published: February 2020

Contemporary Niche Theory is a useful framework for understanding how organisms interact with each other and with their shared environment. Its graphical representation, popularized by Tilman’s Resource Ratio Hypothesis, facilitates the analysis of the equilibrium structure of complex dynamical models including species coexistence. This theory has been applied primarily to resource competition since its early beginnings. Here, we integrate mutualism into niche theory by expanding Tilman’s graphical representation to the analysis of consumer-resource dynamics of plant-pollinator networks. We graphically explain the qualitative phenomena previously found by numerical simulations, including the effects on community dynamics of nestedness, adaptive foraging, and pollinator invasions. Our graphical approach promotes the unification of niche and network theories, and deepens the synthesis of different types of interactions within a consumer-resource framework.

Secondary Abstract

Teoría de Nicho para Mutualismos: Una aproximación gráfica a la dinámica de redes planta-polinizador

La Teoría Contemporánea de Nicho es un marco útil para entender cómo los organismos interactúan entre ellos y con su ambiente compartido. Su representatión gráfica, popularizada por la Hipótesis de Razón de Recursos de Tilman, facilita el análisis de la estructura de equilibrio de modelos dinámicos complejos, incluyendo la coexistencia de especies. Esta teoría ha sido aplicada primariamente a competencia por recursos desde sus inicios. Aquí, integramos el mutualismo dentro de la teoría de nicho al expandir la representatión gráfica de Tilman al análisis de la dinámica consumidor-recurso de las redes planta-polinizador. Explicamos gráficamente fenómenos cualitativos encontrados previamente mediante simulaciones numéricas, incluyendo los efectos sobre la dinámica comunitaria del anidamiento, forrajeo adaptativo y de las invasiones por polinizadores. Nuestra aproximación gráfica promueve la unificatión de las teorías de nicho y de redes, y profundiza la síntesis de diferentes tipos de interacciones dentro de un marco de consumidor-recurso.
Identifying states of collateral sensitivity during the evolution of therapeutic resistance in Ewing’s sarcoma
Authors: Scarborough Jessica A. , McClure Erin , Anderson Peter , Dhawan Andrew , Durmaz Arda , Lessnick Stephen L. , Hitomi Masahiro , Scott Jacob G.
Published: February 2020

Advances in the treatment of Ewing’s sarcoma (EWS) are desperately needed, particularly in the case of metastatic disease. A deeper understanding of collateral sensitivity, where the evolution of therapeutic resistance to one drug aligns with sensitivity to another drug, may improve our ability to effectively target this disease. For the first time in a solid tumor, we produced a temporal collateral sensitivity map that demonstrates the evolution of collateral sensitivity and resistance in EWS. We found that the evolution of collateral resistance was predictable with some drugs, but had significant variation in response to other drugs. Using this map of temporal collateral sensitivity in EWS, we can see that the path towards collateral sensitivity is not always repeatable, nor is there always a clear trajectory towards resistance or sensitivity. Identifying transcriptomic changes that accompany these states of transient collateral sensitivity could improve treatment planning for EWS patients.
Presynaptic inhibition rapidly stabilises recurrent excitation in the face of plasticity
Authors: Naumann Laura Bella , Sprekeler Henning
Published: February 2020

Hebbian plasticity, a mechanism believed to be the substrate of learning and memory, detects and further enhances correlated neural activity. Because this constitutes an unstable positive feedback loop, it requires additional homeostatic control.

Computational work suggests that in recurrent networks, the homeostatic mechanisms observed in experiments are too slow to compensate instabilities arising from Hebbian plasticity and need to be complemented by rapid compensatory processes. We suggest presynaptic inhibition as a candidate that rapidly provides stability by compensating recurrent excitation induced by Hebbian changes. Presynaptic inhibition is mediated by presynaptic GABA receptors that effectively and reversibly attenuate transmitter release. Activation of these receptors can be triggered by excess network activity, hence providing a stabilising negative feedback loop that weakens recurrent interactions on sub-second timescales. We study the stabilising effect of presynaptic inhibition in a recurrent networks, in which presynaptic inhibition is implemented as a multiplicative reduction of recurrent synaptic weights in response to increasing inhibitory activity. We show that networks with presynaptic inhibition display a gradual increase of firing rates with growing excitatory weights, in contrast to traditional excitatory-inhibitory networks. This alleviates the positive feedback loop between Hebbian plasticity and network activity and thereby allows homeostasis to act on timescales similar to those observed in experiments. Our results generalise to spiking networks with a biophysically more detailed implementation of the presynaptic inhibition mechanism. In conclusion, presynaptic inhibition provides a powerful compensatory mechanism that rapidly reduces effective recurrent interactions and thereby stabilises Hebbian learning.
Bile acid composition regulates the manganese transporter Slc30a10 in intestine
Authors: Ahmad Tiara R. , Higuchi Sei , Bertaggia Enrico , Hung Allison , Shanmugarajah Niroshan , Guilz Nicole C. , Gamarra Jennifer R. , Haeusler Rebecca A.
Published: February 2020

Bile acids (BAs) comprise heterogenous amphipathic cholesterol-derived molecules that carry out physicochemical and signaling functions. A major site of BA action is the terminal ileum, where enterocytes actively reuptake BAs and express high levels of BA-sensitive nuclear receptors. BA pool size and composition are affected by changes in metabolic health, and vice versa. One of several factors that differentiate BAs is the presence of a hydroxyl group on C12 of the steroid ring. 12a-hydroxylated BAs (12HBAs) are altered in multiple disease settings, but the consequences of 12HBA abundance are incompletely understood. We employed mouse primary ileum organoids to investigate the transcriptional effects of varying 12HBA abundance in BA pools. We identifiedSlc30a10as one of the top genes differentially induced by BA pools with varying 12HBA abundance. SLC30A10 is a manganese (Mn) efflux transporter critical for whole-body manganese excretion. We found that BA pools, especially those low in 12HBAs, induce cellular manganese efflux, and thatSlc30a10induction by BA pools is driven primarily by lithocholic acid signaling via the vitamin D receptor. Administration of lithocholic acid or a vitamin D receptor agonist resulted in increasedSlc30a10expression in mouse ileum epithelia. These data demonstrate a previously unknown role for BAs in intestinal control of Mn homeostasis.
Characterizing the tumor microenvironment of metastatic ovarian cancer by single cell transcriptomics
Authors: Olalekan Susan , Xie Bingqing , Back Rebecca , Eckart Heather , Basu Anindita
Published: February 2020

Epithelial ovarian cancer is a highly heterogenous, metastatic and lethal disease. The presence of CD8+T cells within ovarian tumors is positively associated with overall patient survival. Determining if a patient has T cells that respond to immunotherapies, their characteristics and how they can be manipulated to target cancer cells is an area of intense investigation in cancer therapy. This study determines the cellular composition and the transcriptional state of immune cells in metastatic ovarian cancer samples from patients using single cell RNA sequencing (scRNA-seq). Hierarchical clustering stratified our patient cohort into 2 main groups: 1) a high T cell infiltration (high Tinf) group and 2) a low T cell infiltration (low Tinf) group. To assess the immune response in these patient samples, we performed an unsupervised clustering of the T cell population in each group. The T cell population clustered into 4 and 3 subpopulations in the high TinfT cell and low Tinfrespectively. A granulysin expressing T cell cluster was identified and unique to the High Tinfgroup. Interestingly, although both groups had resident memory CD8+T (CD8+Trm) cells, only the CD8+Trm cells in the high Tinfgroup expressed TOX, a recently described transcription factor. TOX confers longevity to T cells within immunosuppressive environment such as cancer. Interestingly, along with TOX+T cells, we found a unique plasmablast cluster and an IRF8+macrophage cluster unique to the high Tinfgroup. Our comprehensive scRNA-seq study provides important insights in elucidating the immune response in ovarian cancer patients.
Molecular control of interfacial protein structure on graphene-based substrates steers cell fate
Authors: Kumar Sachin , Parekh Sapun H.
Published: February 2020

The use of graphene-based materials (GBMs) for tissue-engineering applications is growing exponentially due to the seemingly endless multi-functional and tunable physicochemical properties of graphene, which can be exploited to influence cellular behaviours. Despite many demonstrations wherein cell physiology can be modulated on GBMs, a clear mechanism connecting the different physicochemical properties of different GBMs to cell fate has remained elusive. In this work, we demonstrate how different GBMs can be used to cell fate in a multi-scale study – starting from serum protein (Fibronectin) adsorption to molecular scale morphology, structure and bioactivity, and finally ending with stem cell response. By changing the surface chemistry of graphene substrates with only heating, we show that molecular conformation and morphology of surface adsorbed fibronectin controls epitope presentation, integrin binding, and stem cell attachment. Moreover, this subtle change in protein structure is found to drive increased bone differentiation of cells, suggesting that physicochemical properties of graphene substrates exert cell control by influencing adsorbed protein structure.
Interneuronal mechanisms underlying a learning-induced switch in a sensory response that anticipates changes in behavioural outcomes
Authors: Pirger Zsolt , László Zita , Naskar Souvik , O’Shea Michael , Benjamin Paul R. , Kemenes György , Kemenes Ildikó
Published: February 2020

How an animal responds to a particular sensory stimulus will to a great extent depend on prior experience associated with that stimulus. For instance, aversive associative learning may lead to a change in the predicted outcomes, which suppresses the behavioural response to an otherwise rewarding stimulus. However, the neuronal mechanisms of how aversive learning can result in the suppression of even a vitally important innate behaviour is not well understood. Here we used the model system ofLymnaea stagnalisto address the question of how an anticipated aversive outcome can alter the behavioural response to a previously effective feeding stimulus. We found that aversive classical conditioning with sucrose as the CS (conditioned stimulus) and strong touch as the aversive US (unconditioned stimulus) reverses the decision so that the same salient feeding stimulus inhibits feeding, rather than activating it. Key to the understanding of the neural mechanism underlying this switch in the behavioural response is the PlB (pleural buccal) extrinsic interneuron of the feeding network whose modulatory effects on the feeding circuit inhibit feeding. After associative aversive training, PlB is excited by sucrose to reverse its effects on the feeding response. Aversive associative learning induces a persistent change in the electrical properties of PlB that is both sufficient and necessary for the switch in the behavioural output. In addition, the strong touch used as the US during the associative training protocol can also serve as a sensitizing stimulus to lead to an enhanced defensive withdrawal response to a mild touch stimulus. This non-associative effect of the strong touch is probably based on the facilitated excitatory output of a key identified interneuron of the defensive withdrawal network, PeD12.
India’s destination image and loyalty perception in Thailand
Authors: Erawan Theera
Published: February 2020

Purpose

The purpose of this paper is to examine the direct and indirect effects of destination image on destination loyalty. Indirect effects are measured via tourists’ satisfaction.

Design/methodology/approach

A reliable conceptual framework was developed through a mixed methods research methodology. A three-pronged approach was used to cross-validate the results from a literature review, expert interviews, and exploratory study. Structural equation modeling was used in conceptual model development and hypotheses testing.

Findings

Exploratory dimensions of destination image, satisfaction and destination loyalty of Indian cities were revealed from Thai tourists’ perception. The positive indirect effects of destination image on destination loyalty via satisfaction is supported.

Research limitations/implications

This study is limited to tourists of Thai nationality who visited India’s travel destinations. Future research should include further generalization of the research methodology to specific travel destination.

Practical implications

This study provides useful information for India’s tourism industry, specifically for the marketing of historical cities as travel destinations.

Originality/value

By proposing a reliable conceptual model based on a mixed methods research methodology, this study is among the first to explore destination image, satisfaction and destination loyalty in India’s tourism context. The mediating role of satisfaction on destination image and destination loyalty was also recognized as an extension of, and contribution, to the theoretical foundation for the destination image concept.
Consumers’ responses to mobile app advertisements during holiday periods
Authors: Sung Eunyoung (Christine)
Published: February 2020

Purpose

This paper aims to investigate factors affecting the relationship between consumers’ brand trust and purchase intentions after exposure to targeted mobile app ads during holiday periods, including the mediating roles of consumers’ ad attitudes, different discount levels and their interactions; and the moderating roles of the anticipated gain (loss) (i.e. access to discounts) associated with mobile app usage (non-usage).

Design/methodology/approach

Data were collected from 559 respondents who were randomly assigned to six groups based on a 2 (ad type: new, holiday-themed vs regular product) × 3 (promotion level: 0% vs 20% vs 40%) between-subjects design. Regression analysis and structural equation modeling techniques are used to test the hypothesized mediators and moderators.

Findings

Consumers with high brand trust are likely to purchase both new and regular products. Consumers with low brand trust are most responsive to mobile app ads for regular products when offered a high discount. Ad attitudes across all discount rates and product types mediate the relationship between brand trust and purchase intentions; the anticipated gain associated with using a mobile app (i.e. access to discounts) moderates the effect of attitudes toward ads promoting regular products when a high discount is offered.

Originality/value

To the best of the author’s knowledge, this is one of the first studies to explore how interactions among important factors in contexts involving mobile apps and holiday promotions influence and mediate the relationship between brand trust and purchase intentions. This study also reveals an important boundary condition that moderates consumers’ responses to targeted mobile app ads in the context of holiday marketing.
Modeling and transportation planning for US noncombatant evacuation operations in South Korea
Authors: Kearby John A. , Winz Ryan D. , Hodgson Thom J. , Kay Michael G. , King Russell E. , McConnell Brandon M.
Published: February 2020

Purpose

The purpose of this paper is to investigate US noncombatant evacuation operations (NEO) in South Korea and devise planning and management procedures that improve the efficiency of those missions.

Design/methodology/approach

It formulates a time-staged network model of the South Korean noncombatant evacuation system as a mixed integer linear program to determine an optimal flow configuration that minimizes the time required to complete an evacuation. This solution considers the capacity and resource constraints of multiple transportation modes and effectively allocates the limited assets across a time-staged network to create a feasible evacuation plan. That solution is post-processed and a vehicle routing procedure then produces a high resolution schedule for each individual asset throughout the entire duration of the NEO.

Findings

This work makes a clear improvement in the decision-making and resource allocation methodology currently used in a NEO on the Korea peninsula. It immediately provides previously unidentifiable information regarding the scope and requirements of a particular evacuation scenario and then produces an executable schedule for assets to facilitate mission accomplishment.

Originality/value

The significance of this work is not relegated only to evacuation operations on the Korean peninsula; there are numerous other NEO and natural disaster related scenarios that can benefit from this approach.
Demand forecasting in the beauty industry using fuzzy inference systems
Authors: Souza Ricardo Felicio , Wanke Peter , Correa Henrique
Published: February 2020

Purpose

This study aims to analyze the performance of four different fuzzy inference system-based forecasting tools using a real case company.

Design/methodology/approach

The forecasting tools were tested using 27 products of the nail polish line of a multinational beauty company and the performance of said tools was compared to those of the company’s previous forecasting methods that were basically qualitative (informal and intuition-based).

Findings

The performance of the methods analyzed was compared by using mean absolute percentage error. It was possible to determine the characteristics and conditions that make each model the best for each situation. The main takeaways were that low kurtosis, negatively skewed demand time-series and longer horizon forecasts that favor the fuzzy inference system-based models. Besides, the results suggest that the fuzzy forecasting tools should be preferred for longer horizon forecasts over informal qualitative methods.

Originality/value

Notwithstanding the proposed hybrid modeling approach based on fuzzy inference systems, our research offers a relevant contribution to theory and practice by shedding light on the segmentation and selection of forecasting models, both in terms of time-series characteristics and forecasting horizon. The proposed fuzzy inference systems showed to be particularly useful not only when time-series distributions present no clear central tendency (that is, they are platykurtic or dispersed around a large plateau around the median, which is the characteristic of negative kurtosis), but also when mode values are greater than median values, which in turn are greater than mean values. This large tail to the left (negative skewness) is typical of successful products whose sales are ramping up in early stages of their life cycle. For these, fuzzy inference systems may help managers screen out forecast bias and, therefore, lower forecast errors. This behavior also occurs when managers deal with forecasts of longer horizons. The results suggest that further research on fuzzy inference systems hybrid approaches for forecasting should emphasize short-term forecasting by trying to better capture the “tribal” managerial knowledge instead of focusing on less dispersed and slower moving products, where the purely qualitative forecasting methods used by managers tend to perform better in terms of their accuracy.
Impact of social media activity outcomes on brand equity
Authors: Lim Jeen-Su , Pham Phuoc , Heinrichs John H.
Published: February 2020

Purpose

Firms are increasingly using social media platforms to engage with individuals, as it is recognized that a firm’s social media activity outcomes, such as number of user comments, followers or likes, impact brand equity. This study aims to evaluate both the extent that these social media activity outcomes relate to brand equity and the classification of firms which benefit from the various types of social media activity outcomes.

Design/methodology/approach

This study identifies various components of social media activity and then captures specific social media activity outcomes for Fortune 500 firms. This study then performs a hierarchical regression analysis to assess the impact of the various social media activity outcomes on brand equity.

Findings

The results show significant relationships of social media activity outcomes with brand equity. The activity outcome measures of social networking and content communities platform are significantly related to a firm’s brand equity. This study also found that the social media activity outcome levels of various types of social media platforms are contingent upon a firm’s brand country of origin and industry classification type.

Practical implications

The results help firms gain a clearer view of potential applications of social media platforms, thus improving their understanding of the impact of social media. This study can enhance social media strategy and design tactics to improve brand equity. The findings can also guide firms in evaluating which social media activity outcomes enhance brand equity.

Originality/value

The results highlight that activity outcomes in a firm’s selected content communities platform and social networking platform are related to brand equity.
Experiences of community-based tourism in Romania: chances and challenges
Authors: Havadi Nagy Kinga Xénia , Espinosa Segui Ana
Published: February 2020

Purpose

The purpose of this paper is to analyse community-based tourism (CBT) initiatives in the post-socialist rural Romania in terms of the holism of the tourist project and the implementation of the local participation. The paper focusses on chances and challenges of CBT.

Design/methodology/approach

Once the main objective was established, three research interests arose: How and why tourism played a significant role in the economic and social development of the rural local community? How has the local community participated in the starting and maintenance of the CBT projects and who played a key part? How can the level of success of the CBT implementations be qualitatively measured? Qualitative methodologies (interviews, on-site observations, informal discussions) were applied to survey the four case studies.

Findings

Natural and cultural features ensure a versatile potential for touristic exploitation of the Romanian rural area, but the villages are endangered by post-socialist economic and social transformations. Innovative approaches of CBT in rural areas ignited by charismatic leaders with entrepreneurial spirit develop based on the existent social, natural and cultural capital, but on the other hand, endeavours can be vulnerable because of hindering local municipalities or sustainability issues.

Practical implications

The findings facilitate recommendations in favour of effective CBT ventures.

Originality/value

Learning about the contribution of CBT to a sustainable development of rural regions with no/little tradition of private entrepreneurship can contribute to the revitalization of rural areas facing post-socialist challenges.
The effects of corporate governance mechanisms on the financial leverage–profitability relation
Authors: Pham Hanh Song Thi , Nguyen Duy Thanh
Published: February 2020

Purpose

This paper aims to investigate the moderating effects of corporate governance mechanisms on the financial leverage–profitability relation in emerging market firms.

Design/methodology/approach

The paper examines the impacts by estimating the empirical model in which a firm’s accounting profitability is a dependent variable, while financial leverage, board size, board independence, CEO duality, CEO ownership, state ownership and the interaction variables are predictors. The paper uses the panel data set of 295 listed firms in Vietnam in the period 2011-2015 and two key econometric methods for panel data, namely, the two-stage least square instrumental variable and general moments method.

Findings

The paper finds the evidence for the significant and positive effect of board size, board independence and state ownership on the financial leverage–profitability relation. The effect of CEO duality on the financial leverage–profitability relation tends to be negative, and the impact CEO ownership inclines to be positive, although both of them are statistically insignificant. The results are consistent across different estimation methods.

Originality/value

This paper is the first investigating the moderating effect of various corporate governance mechanisms on the financial leverage–profitability relationship in emerging market firms.
The green identity formation process in organic consumer communities
Authors: Saraiva Artur , Fernandes Emília , von Schwedler Moritz
Published: February 2020

Purpose

The market system and a materialistic lifestyle have contributed to some of the environmental and social problems that currently affect the world. However, only a few consumers are willing to express ecological oriented consumption. This study aims to analyse how organic food consumers build a green identity, as well as the new expressions that arise from this identity construction.

Design/methodology/approach

A hermeneutical approach was adopted to address the narratives of 31 frequent consumers of organic products motivated by environmental issues. The narratives were collected through the interview method, which was further complemented by participant observation.

Findings

The following five phases of identity formation were identified: consciousness, gathering, negotiation, stabilisation and sharing. By looking at the different identity stages, it becomes visible how organic consumption and pro-environmental behaviours act as transformative practices, promoting ecological activism and fortifying a green identity.

Originality/value

This study extends the “processual theory of identity” by analysing how organic products help shape consumer practices and their lifestyle. Moreover, a contribution is provided on how we can build an ecological citizenship by reducing consumption and also by adopting alternative practices of consumption.
‘One step up, but not there yet’: using client feedback to optimise the therapeutic alliance in family therapy
Authors: Rober Peter , Van Tricht Karine , Sundet Rolf
Published: February 2020

As research suggests that there is a strong link between the quality of the therapeutic alliance and the effectiveness of psychotherapy, family therapists should reflect on ways to improve the quality of the alliance. The systematic use of client feedback can be a rich resource as a response to the complexity of the alliance in the family therapy setting. In this paper the focus is on ways in which the client’s systematic feedback can contribute to an optimisation of the therapeutic alliance. We present the Dialogical Feedback Tool (DFT), a simple feedback instrument to be used especially in family therapy sessions in which young children are involved. A case study illustrates how the feedback of clients on their experiences in therapy can help therapists to better attune to family members' experiences and expectations about therapy.

Practitioner points

The therapeutic alliance in family therapy is complex, especially when children are involved

Using a simple feedback instrument can help deal with the complexity of the therapeutic alliance

The most important challenge for therapists using feedback instruments is how to integrate the feedback in a constructive way in the therapeutic process
Warming blood prior to transfusion using latent heat
Authors: Roxby David , Sobieraj‐Teague Magdalena , von Wielligh Jacoba , Sinha Romi , Kuss Bryone , Smith Anne‐Louise , McEwen Mark
Published: February 2020

Objective

Major trauma is associated with blood loss and hypothermia. It is common to replace lost fluid with red cells stored at 2–6°C, and/or colloid/crystalloid fluid stored at ambient temperature, thus increasing hypothermia risk. At trauma and medical retrieval sites, mains electricity powered fluid warmers cannot be generally used. Latent heat provides an alternate practical method of portable temperature‐controlled intravenous fluid warming. This work investigates the safety and efficacy of a fluid warmer powered by latent heat.

Methods

Twenty‐five haematology patients received red cell transfusions, one through a fluid warmer, using latent heat from a super‐cooled liquid and one without warming. Temperature of donor red cell units was measured after passing through fluid warmers. Blood samples were collected from red cell units and patients, prior and after each transfusion. These were tested for haemolysis markers (plasma haemoglobin, potassium, lactate dehydrogenase, bilirubin) and for traces of super‐cooled liquid. Patient physiological parameters (oxygen saturation, pulse, temperature, blood pressure, respiration) were monitored during each transfusion.

Results

Patient's physiological signs remained stable and no transfusion reactions were observed during warm transfusions. Latent heat fluid warmers increased the temperature of red cell units to approximately 35°C. There were no significant differences in haemolysis markers following warmed and unwarmed transfusions, and no contamination of red cell units by super‐cooled liquid was detected.

Conclusion

The latent heat fluid warmer was shown to safely warm transfused blood in a controlled clinical setting.
Pain relief after varicocele embolization: The patient’s perspective
Authors: Sheehan Mark , Briody Hayley , O’Neill Damien C , Bowden Dermot , Davis Niall F , Given Mark , Mohan Ponnusamy , Lee Michael J
Published: February 2020

Introduction

Long‐term efficacy of treatment with varicocele embolization is poorly documented from the patient’s perspective. This study assessed patients’ perceived changes in pain scores pre‐ and post‐testicular vein embolization. In addition, the effect of testicular vein embolization on quality of life (QoL) parameters was assessed.

Methods

All patients treated with embolization for varicocele‐related orchalgia were analysed (2009–2015). A standardized pain impact questionnaire was used to assess pain scores pre‐ and post‐procedure. The primary outcome was to assess patients’ pain relief post‐varicocele embolization. The secondary outcome was patients’ perceived efficacy of the embolization procedure in terms of improvement in QoL parameters.

Results

Sixty patients underwent varicocele embolization due to persistent orchalgia; of which 44 responded to the questionnaire. The mean pre‐procedural pain score was 5.4/10 (range of 1.5–9). Post‐procedure questionnaire was performed at a median of 58 months (range 28–106 months). At 1, 6 and 12 months post–procedure, the mean pain score was 1.57, 0.55 and 0.3, respectively. 50% (n = 22) reported complete pain relief 1‐month post‐embolization while 89% (n = 39) of patients reported complete resolution of pain at 1 year. Among the measured QoL parameters; varicocele embolization resulted in significant improvement in return to work, housework, socializing, exercise, sexual relations, and sleeping post‐embolization (P < 0.01).

Conclusion

Varicocele embolization results in a durable reduction in pain scores compared to their pre‐operative values. Information from this study will allow clinicians to convey the potential improvements in pain parameters to patients undergoing embolization of symptomatic varicoceles.
DEX‐2‐TKA ‐ DEXamethasone twice for pain treatment after Total Knee Arthroplasty: Detailed statistical analysis plan for a randomized, blinded, three‐group multicentre clinical trial
Authors: Gasbjerg Kasper S. , Hägi‐Pedersen Daniel , Lunn Troels H. , Overgaard Søren , Pedersen Niels Anker , Bagger Jens , Lindholm Peter , Brorson Stig , Schrøder Henrik M. , Thybo Kasper H. , Mathiesen Ole , Jakobsen Janus C.
Published: February 2020

Background

Optimization of post‐operative pain treatment is of upmost importance. Multimodal analgesia is the main post‐operative pain treatment principle, but the evidence on optimal analgesic combinations is unclear. With the “DEXamethasone twice for pain treatment after TKA” trial, we aim to investigate the role of one or two doses of glucocorticoid for post‐operative pain treatment after total knee arthroplasty. To ensure transparency and minimization of bias, we present this article with a detailed statistical analysis plan, to be published before the last participant is enrolled.

Methods

“DEXamethasone twice for pain treatment after TKA” (DEX‐2‐TKA) is a randomized, blinded, three‐group multicentre clinical trial. Participants will be randomized to one of three intervention groups: single dose of iv dexamethasone 24 mg, two consecutive doses of iv dexamethasone 24 mg or matching iv placebo. All three intervention groups will receive paracetamol, NSAID (ibuprofen) and local infiltration analgesia. Participants, treatment providers, outcome assessors, data managers, statisticians and conclusion drawers will be blinded to the allocated intervention. The primary outcome is total opioid consumption (iv morphine milligram equivalents) 0‐48 hours post‐operatively. Secondary outcomes are (1) visual analogue scale pain levels: (a) during active 45 degrees flexion of the knee at 24 and 48 hours post‐operatively, (b) at rest at 24 and 48 hours post‐operatively, and (c) during 0‐24 hours (highest score) and 24‐48 hours post‐operatively (highest score); and (2) the proportion of participants with one or more adverse events within 48 hours post‐operatively.

Discussion

The DEX‐2‐TKA trial will provide high quality data regarding benefits and harms of adding one or two high‐doses of dexamethasone to a multimodal analgesic regimen.

Trial registration

EudraCT: 2018‐001099‐39 (08/06‐18); ClinicalTrials.gov: NCT03506789 (24/04‐2019).
Traumatic experiences, ICD‐11 PTSD, ICD‐11 complex PTSD, and the overlap with ICD‐10 diagnoses
Authors: Møller L. , Augsburger M. , Elklit A. , Søgaard U. , Simonsen E.
Published: February 2020

Objectives

This study investigated the frequency of traumatic experiences, prevalence rates of ICD‐11 post‐traumatic stress disorder (PTSD) and complex PTSD (CPTSD), and overlap with ICD‐10 classified disorders in outpatient psychiatry.

Method

Overall, 165 Danish psychiatric outpatients answered the International Trauma Questionnaire, the Life Event Checklist, and the World Health Organization Well‐being Index. ICD‐10 diagnoses were extracted from the hospital record. Chi‐square analysis, t‐tests, and conditional probability analysis were used for statistical analysis.

Results

Nearly, all patients (94%) had experienced at least one traumatic event. CPTSD (36%) was more common than PTSD (8%) and had considerable overlap with ICD‐10 affective, anxiety, PTSD, personality, adjustment and stress‐reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. ICD‐11 PTSD overlapped with ICD‐10 anxiety, PTSD, adjustment and stress‐reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. A subgroup of patients with ICD‐10 PTSD (23%) did not meet criteria for ICD‐11 PTSD or CPTSD.

Conclusion

Traumatic experiences are common. ICD‐11 CPTSD is a highly prevalent disorder in psychiatric outpatients. One quarter with ICD‐10 PTSD did not meet criteria for either ICD‐11 PTSD or CPTSD. PTSD and CPTSD had considerable overlap with ICD‐10 disorders.
Absolute and relative differential blood count predicts survival of AJCC stage I‐II melanoma patients scheduled for sentinel lymph node biopsy
Authors: Wagner Nikolaus B , Luttermann Felix , Gassenmaier Maximilian , Forschner Andrea , Leiter Ulrike , Garbe Claus , Eigentler Thomas K
Published: February 2020

Background/Objectives

Elevated neutrophil‐to‐lymphocyte ratio (NLR) in peripheral blood is associated with poor overall survival (OS) in metastatic melanoma patients receiving immunotherapy. However, the impact of peripheral blood cells in patients undergoing sentinel lymph node biopsy (SLNB) is still unclear. This study was intended to characterize the impact of peripheral blood leukocytic cells on overall survival (OS) in melanoma patients undergoing SLNB.

Methods

A total of 1412 AJCC stage I‐II melanoma patients scheduled for SLNB at a single institution in the period 2010–2015 with available perioperative blood tests were randomly assigned to two independent cohorts. Associations of peripheral blood leukocytes with OS were analysed using Kaplan–Meier estimator and multivariate Cox proportional hazards model.

Results

NLR >4.26, absolute neutrophil count >5800/µL, relative neutrophil count >69.7% and relative lymphocyte count ≤ 17.5% were significantly associated with reduced OS in both cohorts. Absolute monocytes >810/µL, absolute eosinophils ≤200/µL, relative monocytes >6.6%, relative eosinophils ≤2.7% and relative basophils ≤0.6% were significantly associated with reduced OS in one cohort each. On multivariate analysis, a combined score including absolute levels of neutrophils, lymphocytes, monocytes and eosinophils was significantly associated with OS in both cohorts. The hazard ratio of patients with a risk score of 3–4 was 5.42 (95% confidence interval: 1.52–19.42, P = 0.0094) in cohort 1 and 9.42 (2.06–43.06, P = 0.0038) in cohort 2, respectively.

Conclusions

We conclude that peripheral blood leukocytes are independently associated with OS in stage I‐II melanoma patients and should be considered as prognostic markers in these patients. Eosinophils and basophils deserve more attention in future investigations.
Determining the effective pre‐oxygenation interval in obstetric patients using high‐flow nasal oxygen and standard flow rate facemask: a biased‐coin up–down sequential allocation trial
Authors: Au K. , Shippam W. , Taylor J. , Albert A. , Chau A.
Published: February 2020

Using biased‐coin sequential allocation, we sought to determine the effective time interval in 90% of healthy parturients to achieve a target endpoint end‐tidal oxygen of ≥ 90% using standard flow rate facemask and high‐flow nasal oxygen. Eighty healthy parturients were randomly assigned to standard facemask (n = 40) or high‐flow nasal oxygen (n = 40) groups; half of the parturients in the high‐flow nasal oxygen group also used a simple no‐flow facemask to minimise air entrainment. The effective time interval for 90% of parturients to achieve the target endpoint for standard facemask was 3.6 min (95%CI 3.3–6.7 min), but could not be estimated for the high‐flow nasal oxygen groups with or without an additional simple facemask, as eight minutes was insufficient to achieve the target endpoint for 55% and 92% of parturients, respectively. Furthermore, after three minutes, the target endpoint was reached by 71% in the standard facemask group vs. 0% in the high‐flow nasal oxygen groups. After four minutes, the target endpoint was reached by 100% in the standard facemask, 80% in the high‐flow nasal oxygen with simple facemask and 67% in the high‐flow nasal oxygen groups. Beyond four minutes, there was no improvement in pre‐oxygenation success using high‐flow nasal oxygen. In conclusion, under the conditions of our study, the effective time interval for 90% of parturients to achieve an end‐tidal oxygen ≥ 90% for standard flow rate facemask was estimated to be 3.6 min, but could not be estimated for high‐flow nasal oxygen groups even after eight minutes.
Fibrin lysability is associated with central obesity and inflammation in women with polycystic ovary syndrome
Authors: Godtfredsen Anne C. M. , Sidelmann Johannes J. , Gram Jørgen B. , Andersen Marianne , Glintborg Dorte
Published: February 2020

Introduction

Polycystic ovary syndrome (PCOS) is characterized by increased central fat mass (CFM), hyper‐inflammation, and hemostatic alterations; the risk of cardiovascular disease may also be increased. Reduced fibrin lysability is a risk factor for cardiovascular disease. The present study assessed fibrin lysability in women with PCOS and controls of similar age and body mass index.

Material and methods

Ninety women with PCOS and 35 controls of comparable age and body mass index were included. Hemostatic markers (fibrin lysability, fibrinogen, coagulation factor XIII, plasminogen, plasminogen activator inhibitor 1 [PAI‐1], plasmin inhibitor, thrombin activatable fibrinolysis inhibitor (TAFI), D‐dimer), C‐reactive protein (CRP), body mass index, waist‐to‐hip ratio, CFM determined by Dual‐energy X‐ray absorptiometry scan, and sex hormones (testosterone estradiol, and sex hormone binding globulin) were determined.

Results

TAFI and CRP were higher in women with PCOS, than controls. In women with PCOS, fibrin lysability correlated with CFM, waist‐to‐hip ratio, CRP, fibrinogen, and all hemostatic variables (P ≤ .004) except TAFI and D‐dimer. CFM correlated with fibrinogen, CRP, coagulation factor XIII, waist‐to‐hip ratio, plasminogen, PAI‐1, plasmin inhibitor, and TAFI (P < .02). In controls, fibrin lysability correlated with CFM, fibrinogen, coagulation factor XIII, and plasmin inhibitor (P ≤ .02). CFM correlated with PAI‐1, plasmin inhibitor, coagulation factor XIII, fibrinogen, and CRP (P ≤ .05). Stepwise regression analysis revealed that fibrin lysability was associated with CFM, fibrinogen and CRP in women with PCOS (r2 = .46, P ≤ .001), but only with CFM in controls (r2 = .28, P < .001).

Conclusions

Fibrin lysability was comparable in women with PCOS and controls. Fibrin lysability was associated with CFM and hyper‐inflammation in women with PCOS, but only with CFM in controls. These findings suggest that obese women with PCOS and augmented inflammation could have an increased risk of cardiovascular disease.
Letter: is additional catheter‐directed thrombolysis post‐TIPSS associated with higher risk of severe complications?
Authors: Wang Xiaobing , Zhao Qiu , Chen Liping
Published: February 2020

LINKED CONTENT

This article is linked to Rodrigues et al paper. To view this article, visit
https://doi.org/10.1111/apt.15044.
New Zealand ophthalmologists' opinions and behaviours on climate, carbon and sustainability
Authors: Chandra Pratik , Gale Jesse , Murray Neil
Published: February 2020

Importance

Ophthalmology faces imperatives to improve sustainability, but there is uncertainty about how to respond.

Background

We sought New Zealand ophthalmologists' opinions on climate change, sustainability and the role of ophthalmologists in responding to these issues, as well as information on the extent that ophthalmology practices are acting on sustainability.

Design

Anonymous online survey of New Zealand fellows and trainees (178) of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) was conducted.

Participants

Forty‐seven respondents (response rate 26%) were included in the study.

Methods

Respondents were asked their level of agreement with statements on climate, health and sustainability and invited to comment. Current sustainability activities were collected from clinical leaders and directors of hospital departments and private practices.

Main Outcome Measure

Distribution of agreement scores was the main outcome measure.

Results

Agreement with mainstream positions on climate change was as expected. A minority of up to 19% expressed the opinion that climate change was not due to human activity, and did not require mitigation. Younger ophthalmologists tended to have greater agreement with the need for broad‐based political action on climate mitigation than those aged over 50 years. Most practices had room to improve on reducing waste, travel and carbon footprints.

Conclusions and Relevance

The majority of New Zealand ophthalmologists are concerned about anthropogenic climate change. Currently, sustainability is not a performance indicator for New Zealand district health boards, so there is limited incentive to drive improvements. These data form a reference point to compare future opinions and ophthalmology carbon footprinting.