bluuebunny/crossref_metadata_2025 huggingface dataset:
Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos)
Authors: Yokoe Masamichi , Hata Jiro , Takada Tadahiro , Strasberg Steven M. , Asbun Horacio J. , Wakabayashi Go , Kozaka Kazuto , Endo Itaru , Deziel Daniel J. , Miura Fumihiko , Okamoto Kohji , Hwang Tsann‐Long , Huang Wayne Shih‐Wei , Ker Chen‐Guo , Chen Miin‐Fu , Han Ho‐Seong , Yoon Yoo‐Seok , Choi In‐Seok , Yoon Dong‐Sup , Noguchi Yoshinori , Shikata Satoru , Ukai Tomohiko , Higuchi Ryota , Gabata Toshifumi , Mori Yasuhisa , Iwashita Yukio , Hibi Taizo , Jagannath Palepu , Jonas Eduard , Liau Kui‐Hin , Dervenis Christos , Gouma Dirk J. , Cherqui Daniel , Belli Giulio , Garden O. James , Giménez Mariano Eduardo , de Santibañes Eduardo , Suzuki Kenji , Umezawa Akiko , Supe Avinash Nivritti , Pitt Henry A. , Singh Harjit , Chan Angus C. W. , Lau Wan Yee , Teoh Anthony Yuen Bun , Honda Goro , Sugioka Atsushi , Asai Koji , Gomi Harumi , Itoi Takao , Kiriyama Seiki , Yoshida Masahiro , Mayumi Toshihiko , Matsumura Naoki , Tokumura Hiromi , Kitano Seigo , Hirata Koichi , Inui Kazuo , Sumiyama Yoshinobu , Yamamoto Masakazu
Published: October 2017

The Tokyo Guidelines 2013 (TG13) for acute cholangitis and cholecystitis were globally disseminated and various clinical studies about the management of acute cholecystitis were reported by many researchers and clinicians from all over the world. The 1st edition of the Tokyo Guidelines 2007 (TG07) was revised in 2013. According to that revision, the TG13 diagnostic criteria of acute cholecystitis provided better specificity and higher diagnostic accuracy. Thorough our literature search about diagnostic criteria for acute cholecystitis, new and strong evidence that had been released from 2013 to 2017 was not found with serious and important issues about using TG13 diagnostic criteria of acute cholecystitis. On the other hand, the TG13 severity grading for acute cholecystitis has been validated in numerous studies. As a result of these reviews, the TG13 severity grading for acute cholecystitis was significantly associated with parameters including 30‐day overall mortality, length of hospital stay, conversion rates to open surgery, and medical costs. In terms of severity assessment, breakthrough and intensive literature for revising severity grading was not reported. Consequently, TG13 diagnostic criteria and severity grading were judged from numerous validation studies as useful indicators in clinical practice and adopted as TG18/TG13 diagnostic criteria and severity grading of acute cholecystitis without any modification. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
Magnetic resonance elastography is as accurate as liver biopsy for liver fibrosis staging
Authors: Morisaka Hiroyuki , Motosugi Utaroh , Ichikawa Shintaro , Nakazawa Tadao , Kondo Tetsuo , Funayama Satoshi , Matsuda Masanori , Ichikawa Tomoaki , Onishi Hiroshi
Published: October 2017

Background

Liver MR elastography (MRE) is available for the noninvasive assessment of liver fibrosis; however, no previous studies have compared the diagnostic ability of MRE with that of liver biopsy.

Purpose

To compare the diagnostic accuracy of liver fibrosis staging between MRE‐based methods and liver biopsy using the resected liver specimens as the reference standard.

Study Type

A retrospective study at a single institution.

Population

In all, 200 patients who underwent preoperative MRE and subsequent surgical liver resection were included in this study. Data from 80 patients were used to estimate cutoff and distributions of liver stiffness values measured by MRE for each liver fibrosis stage (F0–F4, METAVIR system). In the remaining 120 patients, liver biopsy specimens were obtained from the resected liver tissues using a standard biopsy needle.

Field Strength/Sequence

2D liver MRE with gradient‐echo based sequence on a 1.5 or 3T scanner was used.

Assessment

Two radiologists independently measured the liver stiffness value on MRE and two types of MRE‐based methods (threshold and Bayesian prediction method) were applied. Two pathologists evaluated all biopsy samples independently to stage liver fibrosis. Surgically resected whole tissue specimens were used as the reference standard.

Statistical Tests

The accuracy for liver fibrosis staging was compared between liver biopsy and MRE‐based methods with a modified McNemar's test.

Results

Accurate fibrosis staging was achieved in 53.3% (64/120) and 59.1% (71/120) of patients using MRE with threshold and Bayesian methods, respectively, and in 51.6% (62/120) with liver biopsy. Accuracies of MRE‐based methods for diagnoses of ≥F2 (90–91% [108–9/120]), ≥F3 (79–81% [95–97/120]), and F4 (82–85% [98–102/120]) were statistically equivalent to those of liver biopsy (≥F2, 79% [95/120], P ≤ 0.01; ≥F3, 88% [105/120], P ≤ 0.006; and F4, 82% [99/120], P ≤ 0.017).

Data Conclusion

MRE can be an alternative to liver biopsy for fibrosis staging.

Level of Evidence: 3.

Technical Efficacy: Stage 2

J. Magn. Reson. Imaging 2018;47:1268–1275.
A scoping approach to systematically review published reviews: Adaptations and recommendations
Authors: Schultz Annette , Goertzen Leah , Rothney Janet , Wener Pamela , Enns Jennifer , Halas Gayle , Katz Alan
Published: October 2017

Knowledge translation is a central focus of the health research community, which includes strategies to synthesize published research to support uptake within health care practice and policy arenas. Within the literature concerning review methodologies, a new discussion has emerged concerning methods that review and synthesize published review articles. In this paper, our multidisciplinary team from family medicine, nursing, dental hygiene, kinesiology, occupational therapy, physiology, population health, clinical psychology, and library sciences contributes to this discussion by sharing our experiences in conducting 3 scoping reviews of published review studies. A brief discussion of Cochrane Collaboration overview reviews and Joanna Briggs Institute umbrella reviews foreshadows a discussion of insights from our experiences of conducting the 3 scoping reviews of published reviews. We address 6 adaptations along with our recommendations for each, which may guide other researchers with designing scoping review approaches to synthesize published reviews. The ability of researchers to publish research findings is growing, and our ability to effectively transfer findings into useful evidence for health care practice and policy is imperative to our work.
Fabrication of tailorable pH responsive cationic amphiphilic microgels on a microfluidic device for drug release
Authors: Lu Bingyuan , Tarn Mark D. , Pamme Nicole , Georgiou Theoni K.
Published: October 2017

Cationic, amphiphilic microgels of differing compositions based on hydrophilic, pH, and thermoresponsive 2‐(dimethylamino)ethyl methacrylate (DMAEMA) and hydrophobic, nonionic n‐butyl acrylate (BuA) are synthesized using a lab‐on‐a‐chip device. Hydrophobic oil‐in‐water (o/w) droplets are generated via a microfluidic platform, with the dispersed (droplet) phase containing the DMAEMA and BuA, alongside the hydrophobic cross‐linker, ethylene glycol dimethacrylate, and a free radical initiator in an organic solvent. Finally, the hydrophobic droplets are photopolymerized via a UV light source as they traverse the microfluidic channel to produce the cationic amphiphilic microgels. This platform enables the rapid, automated, and in situ production of amphiphilic microgels, which do not match the core‐shell structure of conventionally prepared microgels but are instead based on random amphiphilic copolymers of DMAEMA and BuA between the hydrophobic cross‐links. The microgels are characterized in terms of their swelling and encapsulation abilities, which are found to be influenced by both the pH response and the hydrophobic content of the microgels. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2018, 56, 59–66
Norbornene‐functionalized PEO‐b‐PCL: A versatile platform for mikto‐arm star, umbrella‐like, and comb‐like graft copolymers
Authors: N'Guyen Duc Anh , Montembault Véronique , Piogé Sandie , Pascual Sagrario , Fontaine Laurent
Published: October 2017

Well‐defined in‐chain norbornene‐functionalized poly(ethylene oxide)‐b‐poly(ɛ‐caprolactone) copolymers (NB‐PEO‐b‐PCL) were synthesized from a dual clickable containing both hydroxyl‐ and alkyne‐reactive groups, namely heterofunctional norbornene 3‐exo‐(2‐exo‐(hydroxymethyl)norborn‐5‐enyl)methyl hexynoate. A range of NB‐PEO‐b‐PCL copolymers were obtained using a combination of orthogonal organocatalyzed ring‐opening polymerization (ROP) and click copper‐catalyzed azide–alkyne cycloaddition (CuAAC). Ring‐opening metathesis polymerization (ROMP) of NB‐PEO‐b‐PCL macromonomers using ruthenium‐based Grubbs’ catalysts provides comb‐like and umbrella‐like graft copolymers bearing both PEO and PCL grafts on each monomer unit. Mikto‐arm star A2B2 copolymers were obtained through a new strategy based on thiol–norbornene photoinitiated click chemistry between 1,3‐propanedithiol and NB‐PEO‐b‐PCL. The results demonstrate that in‐chain NB‐PEO‐b‐PCL copolymers can be used as a platform to prepare mikto‐arm star, umbrella‐, and comb‐like graft copolymers. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2017, 55, 4051–4061
Designing catechol‐end functionalized poly(DMAm‐co‐NIPAM) by RAFT with tunable LCSTs
Authors: Oyeneye Olabode O. , Xu William Z. , Charpentier Paul A.
Published: October 2017

Providing catechol‐end functionality to controlled structure lower critical solution temperature (LCST) copolymers is attractive, given the versatility of catechol chemistry for tethering to nanostructures. Controlled polymer chain lengths with catechol RAFT end groups are of interest to provide tunable LCST behavior to nanoparticles, although these polymerizations are relatively unexplored. Herein, the reactivity ratios for the RAFT copolymerization of N,N‐dimethylacrylamide (DMAm) and N‐isopropylacrylamide (NIPAM) pairs based on catechol‐end RAFT agents using an in situ NMR technique were first determined. Several catechol‐end poly(DMAm‐co‐NIPAM) samples were then prepared using the RAFT agent to provide copolymer. The reactivity ratios for the DMAm‐NIPAM pair were rDMAm = 1.28–1.31 and rNIPAM = 0.48–0.51. All the poly(DMAm‐co‐NIPAM) samples were found to have Mn values ≤ 26 kDa and Ð < 1.08 with LCST values ranging from 31 to 92°C, while maintaining a short range of glass transition temperature (Tg = 118–137°C). The difference in LCST values for the catechol functionalized poly(DMAm‐co‐NIPAM) based on 0.5 wt% aqueous buffered solutions at pH 5.5 and 8.5 was found to be <3.0°C. These conditions are suitable for subsequent catechol‐induced coordination and nucleophilic addition chemistry for covalent and noncovalent linkages during subsequent post‐modification. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2017, 55, 4062–4070
Semi‐perfluoroalkylated perylene diimides for conjugated polymers with high molecular weight and high electron mobility
Authors: Cai Chunsheng , Wan Ji , Zhang Youdi , Yuan Zhongyi , Huang Qingfang , Xu Guodong , Hu Yu , Zhao Xiaohong , Chen Yiwang
Published: October 2017

Perylene diimides (PDIs) and their derivatives are excellent semiconductors, while conjugated polymers based on PDIs have limited applications because of their low electron mobility (μe) derived from low molecular weight. The reported maximum number‐average molecular weight (Mn) of related polymers is only 21 kDa because PDIs have very poor solubility due to strong π–π stacking of their big planar conjugated cores. Herein, it is found that suitable semi‐perfluoroalkyl groups could enhance the solubility of PDIs significantly, and a series of semi‐perfluoroalkyl modified conjugated polymers with high molecular weight and electron mobility were synthesized. The maximum Mn reaches 94.8 kDa [P(4CF8CH‐PDI‐T2)HW]. In their space‐charge‐limited current (SCLC) devices, all polymers exhibit typical characters of electron transporting semiconductors, and the highest μe is up to 8.40 × 10−3 cm2 V−1 s−1 [P(4CF8CH‐PDI‐T2)HW], which is similar as that of widely used electron transporting semiconductor PC61BM (6.41 × 10−3 cm2 V−1 s−1). © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2018, 56, 116–124
Synthesis, characterization, and electrogenerated chemiluminescence of deep blue emitting eumelanin‐inspired poly(indoylenearylene)s for polymer light emitting diodes
Authors: Sachinthani K. A. Niradha , Kaneza Nelly , Kaudal Rajiv , Manna Eeshita , Eastman Margaret A. , Sedai Bhishma , Pan Shanlin , Shinar Joseph , Shinar Ruth , Nelson Toby L.
Published: October 2017

Deep blue emitting copolymers were synthesized by uniting the Eumelanin‐inspired indole core with fluorene and carbazole units via Suzuki polymerization. The resulting polymers, PIF and PIC, showed deep blue emission in the range of 416–418 nm and quantum yields of 0.39–0.60. Both polymers exhibited an intense and stable electrogenerated chemiluminescence. Interestingly, deep HOMO levels of −5.71 and −5.61 eV were observed for PIF and PIC, respectively. Solution processed polymer light emitting diodes (PLEDs) were fabricated using the PIF as a guest. PLEDs emitted deep blue light at 418 nm, with the luminous efficiency peaking at 1 Cd/A, given that the photopic response at that wavelength is 0.0151. The electroluminescence of PIF displayed a Commission Internationale de l'Eclairage coordinates of (0.16, 0.07) with a maximum external quantum efficiency of 1.1%. Hence, these materials prove to be promising candidates for the fabrication of deep blue PLEDs. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2018, 56, 125–131
Structural diversity in poly(disulfide)s
Authors: Bej Raju , Sarkar Jayita , Ghosh Suhrit
Published: October 2017

This article reports a synthetic methodology for single step preparation of telechelic poly(disulfide)s (PDS) by step‐growth polymerization between a di‐thiol and a commercially available monomer 2,2′‐dithiodipyridine in presence of a functional group appended pyridyl disulfide moiety as the “mono‐functional impurity” (MFI). Redox‐destructible well‐defined segmented PDSs with functional chain terminal, predicted and tunable degree of polymerization and narrow polydispersity index (<2.0) could be synthesized under a mild reaction condition. Using an appropriate MFI, PDS could be synthesized with trithiocarbonate chain terminals in a single step, which could be further used as macro chain‐transfer agent (CTA) for chain growth polymerization under RAFT mechanism producing ABA type tri‐block copolymer wherein the B block consists of the degradable PDS chain. By copolymerization between a hydrophobic di‐thiol monomer and a hydroxyl group appended di‐thiol monomer, PDS could be prepared with pendant hydroxyl functional group which was utilized to initiate ring opening polymerization of cyclic lactide monomers producing well‐defined degradable graft‐copolymer. The pendant hydroxyl groups were further utilized to anchor a polar carboxylic group to the degradable PDS backbone which under basic condition showed aqueous self‐assembly generating micelle‐like structure with hydrophobic guest encapsulation ability and glutathione responsive sustained release. © 2017 Wiley Periodicals, Inc. J. Polym. Sci., Part A: Polym. Chem. 2018, 56, 194–202
Regime dependence of ice cloud heterogeneity – a convective life‐cycle effect?
Authors: Ahlgrimm Maike , Forbes Richard M.
Published: October 2017

Cloud condensate varies on scales smaller than those typically resolved by global weather and climate models. In order to accurately predict the radiative and microphysical process rates representative of the entire model grid box, the effect of the subgrid‐scale heterogeneity of cloud must be taken into account. In this study, observed ice water content retrieved from A‐Train satellite observations is used to explore how spatial ice condensate variability, characterized by the fractional standard deviation (FSD, the standard deviation divided by the mean), varies with cloud regime. FSD is generally lower for overcast cloud scenes, but an additional predictor based on convective activity is needed to capture the high FSD associated with more turbulent clouds and reproduce the observed latitudinal and height variations of FSD. Convective clouds that extend only a few kilometres above the freezing level are likely to be smaller at an earlier stage in their life cycle, and actively growing with a higher FSD. In contrast, more mature clouds reaching the tropopause are larger and generally have a lower variability and smaller FSD. To capture this life‐cycle effect, a new parametrization is tested which uses the ratio of a model's convectively detrained condensate to the existing cloud condensate mass as a proxy for the cloud's convective life stage to highlight areas with enhanced condensate variability. The parametrization is scale‐adaptive, situation‐dependent and captures seasonally varying global patterns and the zonal mean vertical structure of observed ice condensate variability well. Ground‐based observations obtained from five Atmospheric Radiation Measurement sites provide independent confirmation that the parametrization satisfactorily captures condensate variability in high‐altitude ice clouds.
Measurement and approximation of the age spectra of rocks and minerals during 40Ar/39Ar dating
Authors: Alekseev D.V. , Travin A.V.
Published: October 2017

During 40Ar/39Ar dating, the age spectrum of the sample can be seriously distorted due to averaging of its Ar isotope composition over the fraction of gas released during the measurements. New methods of age spectrum approximation with suppression of distortions have been developed. The efficiency of these methods is experimentally demonstrated. A new high-resolution method for measuring age spectra from the fraction of gas released is proposed. This method is based on experimental data and permits refining the age spectrum or its fragments. The applicability and efficiency of this method are also shown experimentally. The proposed measurement method can be used not only to measure age spectra during 40Ar/39Ar dating but also to measure other isotope characteristics of rock and mineral samples during stepwise separation of analytes.
Compositions of gabbro intrusions in the Krestovsky zone (western Baikal region): A record of plume–suprasubduction mantle interaction
Authors: Lavrenchuk A.V. , Sklyarov E.V. , Izokh A.E. , Kotov A.B. , Sal’nikova E.B. , Fedorovsky V.S. , Mazukabzov A.M.
Published: October 2017

We provide new geochemical and isotope–geochronological evidence for gabbro intrusions of the Krestovsky zone in the Olkhon composite terrane. The intrusions belong to the Birkhin (~500 Ma) and Ust’-Krestovsky (~470 Ma) complexes, which underwent several pulses of magmatism. Rock structures and textures record magma crystallization in tectonically turbulent conditions. The compositions of gabbro are similar to those of subduction-related basalts, but the Ust’-Krestovsky gabbro is richer in incompatible elements than the Birkhin rocks. A similar composition trend of gabbro is observed in other areas of the Central Asian Orogenic Belt (CAOB): southeastern Tuva, Gornaya Shoria, and western Mongolia. We suggest a model of regular composition changes in parental magmas during the interaction of a mantle plume with suprasubductional lithospheric mantle.
Error sources in basal yield stress inversions for Jakobshavn Isbræ, Greenland, derived from residual patterns of misfit to observations
Authors: HABERMANN MARIJKE , TRUFFER MARTIN , MAXWELL DAVID
Published: October 2017

The basal interface of glaciers is generally not directly observable. Geophysical inverse methods are therefore used to infer basal parameters from surface observations. Such methods can also provide information about potential inadequacies of the forward model. Ideally an inverse problem can be regularized so that the differences between modeled and observed surface velocities reflect observational errors. However, deficiencies in the forward model usually result in additional errors. Here we use the spatial pattern of velocity residuals to discuss the main error sources for basal stress inversions for Jakobshavn Isbræ, Greenland. Synthetic tests with prescribed patterns of basal yield stress with varying length scales are then used to investigate different weighting functions for the data-model misfit and for the ability of the inversion to resolve details in basal yield stress. We also test real-data inversions for their sensitivities to prior estimate, forward model parameters, data gaps, and temperature fields. We find that velocity errors are not sufficient to explain the residual patterns of real-data inversions. Conversely, ice-geometry errors and especially simulated errors in model simplifications are capable of reproducing similar error patterns and magnitudes. We suggest that residual patterns can provide useful guidance for forward model improvements.
A dynamic linear modelling approach to public policy change
Authors: Loftis Matt W. , Mortensen Peter B.
Published: October 2017

Theories of public policy change, despite their differences, converge on one point of strong agreement: the relationship between policy and its causes can and does change over time. This consensus yields numerous empirical implications, but our standard analytical tools are inadequate for testing them. As a result, the dynamic and transformative relationships predicted by policy theories have been left largely unexplored in time series analysis of public policy. This article introduces dynamic linear modelling (DLM) as a useful statistical tool for exploring time-varying relationships in public policy. The article offers a detailed exposition of the DLM approach and illustrates its usefulness with a time series analysis of United States defense policy from 1957 to 2010. The results point the way for a new attention to dynamics in the policy process, and the article concludes with a discussion of how this research programme can profit from applying DLMs.
Influenza vaccination status and outcomes among influenza-associated hospitalizations in Columbus, Ohio (2012–2015)
Authors: ZIVICH P. N. , TATHAM L. , LUNG K. , TIEN J. , BOLLINGER C. E. , BOWER J. K.
Published: October 2017

Prior studies suggest that the influenza vaccine is protective against some outcomes in hospitalized patients infected with influenza despite vaccination. We utilized surveillance data from Columbus, Ohio to investigate this association over multiple influenza seasons and age groups. Data on laboratory-confirmed influenza-associated hospitalizations were collected as a part of the Influenza Hospitalization Surveillance Project for the 2012–2013, 2013–2014, and 2014–2015 influenza seasons. The association between influenza vaccination status was examined in relation to the outcomes of severe influenza and diagnosis of pneumonia among patients receiving antiviral treatment. Data were analyzed using multivariable logistic regression. We observed no overall association between influenza vaccination status and severe influenza among hospitalized patients. During the 2013–2014 season, those who were vaccinated were 41% less likely to be diagnosed with pneumonia compared with those who were unvaccinated (OR = 0·59 95% CI 0·41–0·86). The influenza vaccine may provide a secondary preventive function against pneumonia among influenza cases requiring hospitalization. However, a protective effect was only observed in 2013–2014, an influenza H1N1 dominant year. Differences in circulating influenza virus strains and vaccine matching to the circulating strains during influenza seasons may impact this association.
Amphetamine Modestly Improves Conners’ Continuous Performance Test Performance in Healthy Adults
Authors: MacQueen David A. , Minassian Arpi , Henry Brook L. , Geyer Mark A. , Young Jared W. , Perry William
Published: October 2017

Objectives: Amphetamine improves vigilance as assessed by continuous performance tests (CPT) in children and adults with attention deficit hyperactivity disorder (ADHD). Less is known, however, regarding amphetamine effects on vigilance in healthy adults. Thus, it remains unclear whether amphetamine produces general enhancement of vigilance or if these effects are constrained to the remediation of deficits in patients with ADHD. Methods: We tested 69 healthy adults (35 female) on a standardized CPT (Conner’s CPT-2) after receiving 10- or 20-mg d-amphetamine or placebo. To evaluate potential effects on learning, impulsivity, and perseveration, participants were additionally tested on the Iowa Gambling Task (IGT) and Wisconsin Card Sorting Task (WCST). Results: Participants receiving placebo exhibited the classic vigilance decrement, demonstrated by a significant reduction in attention (D’) across the task. This vigilance decrement was not observed, however, after either dose of amphetamine. Consistent with enhanced vigilance, the 20-mg dose also reduced reaction time variability across the task and the ADHD confidence index. The effects of amphetamine appeared to be selective to vigilance since no effects were observed on the IGT, WCST, or response inhibition/perseveration measures from the CPT. Conclusions: The present data support the premise that amphetamine improves vigilance irrespective of disease state. Given that amphetamine is a norepinephrine/dopamine transporter inhibitor and releaser, these effects are informative regarding the neurobiological substrates of attentional control. (JINS, 2018, 24, 283–293)
Ultra-processed foods, protein leverage and energy intake in the USA
Authors: Martínez Steele Euridice , Raubenheimer David , Simpson Stephen J , Baraldi Larissa Galastri , Monteiro Carlos A
Published: October 2017

Objective

Experimental studies have shown that human macronutrient regulation minimizes variation in absolute protein intake and consequently energy intake varies passively with dietary protein density (‘protein leverage’). According to the ‘protein leverage hypothesis’ (PLH), protein leverage interacts with a reduction in dietary protein density to drive energy overconsumption and obesity. Worldwide increase in consumption of ultra-processed foods (UPF) has been hypothesized to be an important determinant of dietary protein dilution, and consequently an ecological driving force of energy overconsumption and the obesity pandemic. The present study examined the relationships between dietary contribution of UPF, dietary proportional protein content and the absolute intakes of protein and energy.

Design

National representative cross-sectional study.

Setting

National Health and Nutrition Examination Survey 2009–2010.

Subjects

Participants (n 9042) aged ≥2 years with at least one day of 24 h dietary recall data.

Results

We found a strong inverse relationship between consumption of UPF and dietary protein density, with mean protein content dropping from 18·2 to 13·3 % between the lowest and highest quintiles of dietary contribution of UPF. Consistent with the PLH, increase in the dietary contribution of UPF (previously shown to be inversely associated with protein density) was also associated with a rise in total energy intake, while absolute protein intake remained relatively constant.

Conclusions

The protein-diluting effect of UPF might be one mechanism accounting for their association with excess energy intake. Reducing UPF contribution in the US diet may be an effective way to increase its dietary protein concentration and prevent excessive energy intake.
Has iodized salt reduced iodine-deficiency disorders among school-aged children in north-west Iran? A 9-year prospective study
Authors: Nouri Saeidlou Sakineh , Babaei Fariba , Ayremlou Parvin , Entezarmahdi Rasoul
Published: October 2017

Objective

Low iodine intakes are associated with goitre and other iodine-deficiency disorders (IDD) that have affected billions of people worldwide. We aimed to assess total goitre rate (TGR) and urinary iodine concentration (UIC) in schoolchildren between 2007 and 2015, percentage of iodized salt consumption by households, and salt iodine content at production, distribution and household levels in north-west Iran.

Design/Setting/Subjects

UIC assessed among schoolchildren in nine consecutive years; 240 schoolchildren aged 8–10 years selected by systematic random sampling each year in the West Azerbaijan Province.

Results

Median UIC was >100 μg/l in all years. More than 50 % of children had iodine deficiency (UIC≤99 μg/l) in 2010 and 2011, while this rate was approximately 15–35 % in other years. Proportion with UIC below 50 μg/l was <20 % in all years except 2010 and 2011. Excessive UIC (≥300 μg/l) rate was between 5·4 and 27·5 %. TGR decreased from 44 % in 1996 to 7·6 % and 0·4 % in 2001 and 2007, respectively. Regular surveys from 2002 to 2015 showed that 98 % or more of households consumed iodized salt. Iodine level ≥20 ppm was observed in 87·5, 83 and 73 % of salt at production, distribution and household level, respectively (data from national study in 2007). The last national study in 2014 showed that median iodine level in household salt was 27 ppm.

Conclusions

Our focused data suggest that the universal salt iodization programme is improving the iodine status of schoolchildren in the West Azerbaijan Province of Iran. Reduction of TGR to less than 5 % in schoolchildren indicates successful elimination of IDD as a major public health problem.
Formative qualitative research to develop community-based interventions addressing low birth weight in the plains of Nepal
Authors: Morrison Joanna , Dulal Sophiya , Harris-Fry Helen , Basnet Machhindra , Sharma Neha , Shrestha Bhim , Manandhar Dharma , Costello Anthony , Osrin David , Saville Naomi
Published: October 2017

Objective

To explore the factors affecting intra-household food allocation practices to inform the development of interventions to prevent low birth weight in rural plains of Nepal.

Design

Qualitative methodology using purposive sampling to explore the barriers and facilitating factors to improved maternal nutrition.

Setting

Rural Dhanusha District, Nepal.

Subjects

We purposively sampled twenty-five young daughters-in-law from marginalised groups living in extended families and conducted semi-structured interviews with them. We also conducted one focus group discussion with men and one with female community health volunteers who were mothers-in-law.

Results

Gender and age hierarchies were important in household decision making. The mother-in-law was responsible for ensuring that a meal was provided to productive household members. The youngest daughter-in-law usually cooked last and ate less than other family members, and showed respect for other family members by cooking only when permitted and deferring to others’ choice of food. There were limited opportunities for these women to snack between main meals. Daughters-in-law’ movement outside the household was restricted and therefore family members perceived that their nutritional need was less. Poverty affected food choice and families considered cost before nutritional value.

Conclusions

It is important to work with the whole household, particularly mothers-in-law, to improve maternal nutrition. We present five barriers to behaviour change: poverty; lack of knowledge about cheap nutritional food, the value of snacking, and cheap nutritional food that does not require cooking; sharing food; lack of self-confidence; and deference to household guardians. We discuss how we have targeted our interventions to develop knowledge, discuss strategies to overcome barriers, engage mothers-in-law, and build the confidence and social support networks of pregnant women.
Is There a Greenhouse Effect in the Ionosphere, Too? Likely Not
Authors: Zastrow Mark
Published: October 2017

Controversial observations of long-term changes in the ionosphere appear to be explained by the Sun’s 11-year cycle of activity, not human greenhouse gas emissions.
Ten Mesmerizing Geophysical Maps That Double as Works of Art
Authors: Wendel JoAnna , Kumar Mohi
Published: October 2017

From tiny seafloor features in the Gulf of Mexico to craters pocking the surface of Mars, the details on these maps captivate and fascinate.
Diagonal non-semicontinuous variational problems
Authors: Zagatti Sandro
Published: October 2017

We study the minimum problem for non sequentially weakly lower semicontinuos functionals of the form

F(u)=∫If(x,u(x),u′(x))dx,

defined on Sobolev spaces, where the integrand
f:I×ℝm×ℝm→ℝ
is assumed to be non convex in the last variable. Denoting by
f̅
the lower convex envelope of f with respect to the last variable, we prove the existence of minimum points of
F
assuming that the application
p↦f̅(⋅,p,⋅)
is separately monotone with respect to each component pi of the vector p and that the Hessian matrix of the application
ξ↦f̅(⋅,⋅,ξ)
is diagonal. In the special case of functionals of sum type represented by integrands of the form f(x, p, ξ) = g(x, ξ) + h(x, p), we assume that the separate monotonicity of the map p↦h(⋅, p) holds true in a neighbourhood of the (unique) minimizer of the relaxed functional and not necessarily on its whole domain.
Genetics of Pulmonary Arterial Hypertension
Authors: Chew Joshua , Loyd James , Austin Eric
Published: October 2017

Tremendous progress has been made in understanding the genetics of pulmonary arterial hypertension (PAH) since its description in the 1950s as a primary disorder of the pulmonary vasculature. Heterozygous germline mutations in the gene coding bone morphogenetic receptor type 2 (BMPR2) are detectable in the majority of cases of heritable PAH, and in approximately 20% of cases of idiopathic pulmonary arterial hypertension (IPAH). However, recent advances in gene discovery methods have facilitated the discovery of additional genes with mutations among those with and without familial PAH. Heritable PAH is an autosomal dominant disease characterized by reduced penetrance, variable expressivity, and female predominance. Biallelic germline mutations in the gene EIF2AK4 are now associated with pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis. Growing genetic knowledge enhances our capacity to pursue and provide genetic counseling, although the issue remains complex given that the majority of carriers of PAH-related mutations will never be diagnosed with the disease.
Screening of Pulmonary Arterial Hypertension
Authors: Celermajer David , Keogh Anne , Thakkar Vivek , Lau Edmund
Published: October 2017

The majority of patients with pulmonary arterial hypertension (PAH) present in advanced stages of the disease, when therapeutic interventions may potentially be less effective. Early diagnosis is associated with improved outcomes, supporting best practice recommendations that asymptomatic patients in high-risk populations such as systemic sclerosis or carriers of a PAH-causing mutation should be offered periodic screening for PAH. An evidence-based algorithm for screening systemic sclerosis-associated PAH is now available based on the DETECT study. A multimodal approach using Doppler echocardiography, lung function testing, and B-type natriuretic peptides improves screening accuracy but at the expense of higher health care costs. Patients with abnormal hemodynamics but who do not meet definition for diagnosis of pulmonary hypertension (such as mean pulmonary artery pressure between 21 and 24 mm Hg) should be closely followed up given their increased risk of progression to PAH. This review summarizes the current approach to screening for PAH and discusses areas of uncertainties that require further research.
Pulmonary Hypertension Complicating Connective Tissue Disease
Authors: Saggar Rajan , Belperio John , Volkmann Elizabeth , Chung Augustine , Lynch Joseph
Published: October 2017

Pulmonary hypertension (PH) may complicate connective tissue disease (CTD; particularly systemic sclerosis [scleroderma]), and is associated with increased mortality. More than 70% of cases of PH complicating CTD occur in patients with systemic sclerosis (SSc), which is the major focus of this article. Pulmonary complications (i.e., interstitial lung disease [ILD] and PH) are the leading causes of SSc-related deaths. “Isolated” PH (i.e., without ILD) complicates SSc in 7.5 to 20% of cases; secondary PH may also occur in patients with SSc-associated ILD. Several clinical markers and specific autoantibody profiles have been associated with PH in SSc. The role of PH-specific therapy in improving CTD-PH outcomes is under investigation, as prognosis and responsiveness to therapy appear to be worse in SSc-associated PH compared with idiopathic pulmonary arterial hypertension. We discuss medical therapies for CTD-associated PH and the role of lung transplantation for patients who fail medical therapy.
Pathology and Pathobiology of Pulmonary Hypertension
Authors: Dorfmüller Peter , Guignabert Christophe
Published: October 2017

Pulmonary hypertension (PH) is a hemodynamic state defined by a mean pulmonary artery pressure ≥ 25 mm Hg during resting right heart catheterization. PH can result from precapillary (arterial) or postcapillary (venous) pathophysiological mechanisms. Interestingly, recent PH pathology has shown that pulmonary arterial or pulmonary venous remodelling are rarely independent phenomena, but frequently occur in combined fashion in lungs from patients suffering from different forms of PH, including pulmonary arterial hypertension (PAH). In PAH, it is now becoming clear that aberrant signals present in vessel wall microenvironment, which is largely orchestrated by dysfunctional pulmonary endothelial cells, are key contributors of the pulmonary vascular remodeling process, fostering proliferation, and survival and migration of resident pulmonary vascular cells such as smooth muscle cells, myofibroblasts, and pericytes. In addition, both genetic and environmental factors are also critical in the development of pulmonary vascular inflammation and chronic impairment of the pulmonary endothelium. This article outlines the current understanding of this disease from the point of view of pathology and pathobiology.
Pulmonary Arterial Hypertension Complicating Congenital Heart Disease: Advances in Therapy
Authors: Brida Margarita , Price Laura , McCabe Colm , Alonso-Gonzalez Rafael , Wort Stephen , Kempny Aleksander , Dimopoulos Konstantinos , Gatzoulis Michael , Nashat Heba
Published: October 2017

Congenital heart disease (CHD) is the most common inborn defect, affecting approximately 1% of all newborns worldwide. Advances in its diagnosis and treatment have led to dramatic improvements in patients' quality of life and long-term survival. Nevertheless, despite these innovations many patients require life-long follow-up and are at risk of numerous complications, namely, residual or progressive hemodynamic lesions, arrhythmia, sudden cardiac death, and the development of heart failure and pulmonary arterial hypertension (PAH), despite timely surgical intervention. Ill advisedly, some patients are also lost to follow-up, assuming that their early life surgical or catheter-based intervention was curative, hence missing out on invaluable lifetime screening and timely interventions that may be necessary. Additionally, there are many patients with undiagnosed or unoperated CHD in the developing world presenting later in life with irreversible complications. Even in this modern era of diagnosis and screening, PAH-CHD remains a burden in patients with CHD, with approximations of up to 10% in this heterogeneous group and is associated with an adverse impact on quality of life and survival.
Lung Transplantation for Pulmonary Hypertension and Strategies to Bridge to Transplant
Authors: Baillie Timothy , Granton John
Published: October 2017

Despite an expanded armamentarium of medical therapies, pulmonary arterial hypertension (PAH) remains a progressive disease associated with significant morbidity and premature mortality. Lung transplantation (LT) is the last safety net for patients failing medical therapy, providing excellent overall long-term survival and health-related quality-of-life outcomes in line with more common parenchymal lung disease indications. Waitlist mortality remains disproportionally elevated, however, reflecting an inability of the lung allocation score to completely capture PAH disease severity, and a propensity for PAH to deteriorate rapidly without warning, even in patients who appear externally “well.” Early referral to a LT center can mitigate these risks and facilitate rapid listing if necessary. Several bridging therapies are available to support severely unwell patients to LT, such as extracorporeal life support (ECLS) and atrial septostomy. Unique perioperative considerations include higher rates of primary graft dysfunction and dynamic right ventricular outflow obstruction which may, at least in part, reflect rapid afterload reduction in the face of a conditioned right ventricle. Extending ECLS into the perioperative period may ameliorate these risks by allowing more gradual adaptation of both ventricles to their new loading conditions. Chronic lung allograft dysfunction, particularly bronchiolitis obliterans syndrome, remains a major cause of long-term morbidity and mortality, and complications from corticosteroid and immunosuppressive therapy are common. Nevertheless, the morbidity, mortality, and burden of disease management after LT continue to improve and compare favorably to that of refractory PAH in carefully selected patients.
Chronic Thromboembolic Pulmonary Hypertension: Advances in Therapy
Authors: Kim Nick , Fisher Micah
Published: October 2017

Chronic thromboembolic pulmonary hypertension is a progressive disease characterized by obstruction of the pulmonary vascular bed by insufficient resolution of thromboemboli leading to increased pulmonary vascular resistance with resultant right heart dysfunction and poor long-term survival. Estimates of cumulative incidence after an acute pulmonary embolism range from 1 to 4% within 2 years of an initial event. Current recommendations focus on screening patients being evaluated for pulmonary hypertension with ventilation/perfusion scans and then considering them for potentially curative surgery consisting of a pulmonary endarterectomy. Outcomes at high-volume surgical centers continue to improve and overall perioperative mortality is close to 2 to 4% with excellent reported long-term survival. Unfortunately, adherence with guidelines remains poor and patients with this potentially remediable disease are being missed. In addition, a significant number of patients who are diagnosed are not felt to be operative candidates based on location of disease, hemodynamics, or comorbidities. Several new advances may improve outcomes for such patients who are not operative candidates or who have persistent pulmonary hypertension after surgery, including medical therapy and balloon pulmonary angioplasty. Further studies are needed to answer questions about how best to incorporate these advances into our overall treatment algorithm.
Idiopathic Pulmonary Arterial Hypertension: Evolving Therapeutic Strategies
Authors: Kanwar Manreet , Raina Amresh , Passineau Michael , Benza Raymond
Published: October 2017

The field of pulmonary arterial hypertension (PAH) has seen substantial changes in the epidemiology, associated comorbidities, treatment algorithms, and prognosis in the past decade. Specifically for idiopathic PAH (IPAH), there has been a noted increase in the age of initial diagnosis. Increasing focus is being placed on appropriate categorization of patients with PAH, both in terms of diagnosis and individualized risk stratification. This is especially relevant given that patients being diagnosed with incident IPAH are now older and with multiple comorbidities, putting them at a higher risk of being mislabeled as PAH. The biggest impact has been seen in the number of pharmaceutical options available for these patients, resulting in improvement in both short- and long-term outcomes. In addition, there has been a shift in the treatment approach to the early use of combination therapies in PAH, since it has been demonstrated to improve clinical outcomes. Novel therapies are in the pipeline for patients with IPAH to impact both the morbidity and mortality of this deadly disease.
Quantity of Lymph Nodes in the Vascularized Lymph Node Transfer Influences Its Lymphaticovenous Drainage
Authors: Kwiecien Grzegorz , Gharb Bahar , Tadisina Kashyap , Madajka Maria , Drazba Judith , Zins James , Schwarz Graham
Published: October 2017

Background The purpose of this study was to: (1) evaluate the mechanism of lymph drainage through a vascularized lymph node (VLN) flap, and (2) investigate if the number of VLNs impacts lymph transit time through the flap.

Methods Twenty-seven axillary VLN flaps were elevated in 14 Sprague-Dawley rats and divided into three groups (n = 9 each) based on the number of lymph nodes present: group 1 (0-VLNs), group 2 (2-VLNs), and group 3 (4-VLNs). Indocyanine green (n = 8/group) and Alexa680-albumin (n = 1/group) were injected into the edge of flaps and the latency period between injection and fluorescence in the axillary vein was recorded. Stereomicroscopic fluorescent lymphography was performed to directly visualize lymphatic transit through VLNs.

Results Fluorescence was detected in the axillary vein after 229s [47–476], 79s [15–289], and 56s [16–110] in group 1, 2, and 3, respectively (p < 0.01). There was a negative correlation between the number of VLNs in the flap and the latency period (r = -0.59; p < 0.05). Median flap weights were comparable in group 1, 2, and 3 (258 mg [196–349], 294 mg [212–407], 315 mg [204–386], respectively; p = 0.54). Stereoscopic lymphography allowed direct visualization of lymphatic fluid transit through VLNs.

Conclusion Lymphatic fluid in VLN flaps drains into the venous system mainly by passing through the afferent lymphatics and lymph nodes. A secondary mechanism appears to be the diffusion of fluid into the venous system via intratissue lymphaticovenous connections created during flap elevation. Increasing the number of lymph nodes in the flap is associated with a more rapid transit of fluid.
Pulmonary Hypertension Due to Left Heart Disease
Authors: Gerges Mario , Gerges Christian , Naeije Robert , Lang Irene
Published: October 2017

Pulmonary hypertension (PH) due to left heart disease (PH-LHD) is a significant predictor of outcome for patients with any type of heart failure (HF), and represents a subset of PH affecting a large number of patients. Because the condition is no standalone inherent pulmonary vascular disorder but the consequence of heart disease, its understanding is dependent on a thorough insight in current HF epidemiology, pathophysiology, diagnosis, and treatments. Although the age-specific incidence of HF is decreasing, this trend is less dramatic for HF with preserved ejection fraction than for HF with reduced ejection fraction. Both the current 2015 ESC/ERS guidelines for the diagnosis and treatment of PH, and the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic HF have adopted new insights in the current understanding of PH-LHD (PH group 2), but no consensus has been reached. Due to multimorbidity, advanced age, referral biases, and a large proportion of noncardiovascular deaths in this population, proper hemodynamic and clinical characterization of patients with and without significant pulmonary vascular disease is important. Definitions largely depend on fluid status which should be assessed prior to any hemodynamic assessment. Benefit from pulmonary arterial hypertension–targeted treatments appears unlikely from today's perspective, but there is an immense unmet need for any treatments of this condition, and proper trials still have to be done.