bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Trends in Aortic Root Surgery
Authors: Abjigitova Djamila , Panagopoulos Georgia , Orlov Oleg , Shah Vishal , Plestis Konstadinos A.
Published: April 2018

Objective

The mini-sternotomy approach is becoming a widespread technique for aortic valve surgery. However, its safety for aortic root replacement has yet to be established. The aim of the present study was to compare the operative outcomes of patients who underwent aortic root replacement via upper mini-sternotomy (mini-Bentall) to patients who underwent Bentall procedure via median sternotomy (full-sternotomy Bentall).

Methods

Between November 1998 and November 2016, 91 consecutive patients underwent full-sternotomy Bentall procedure and 26 patients underwent mini-Bentall procedure. The mini-Bentall procedure was performed via an upper hemisternotomy incision extending to the right fourth intercostal space. Patients with concomitant procedures and those who underwent deep hypothermic circulatory arrest were excluded from the analysis. Outcome variables were operative mortality and major surgical complications, including prolonged length of hospital stay, transfusion rates, reoperation for bleeding, and prolonged ventilatory support.

Results

No significant differences were observed on the preoperative, operative, and postoperative characteristics between the two treatment groups. The median cardiopulmonary bypass and aortic cross-clamp times were 169 minutes (interquartile range = 156.0–188.5) and 148 minutes (interquartile range = 131.3–160.3) in the mini-Bentall group, respectively. The median duration of hospitalization in the mini-Bentall group was 6.5 days (interquartile range = 5.0–11.0 days). In-hospital mortality and new renal insufficiency occurred at a frequency of 1.1% and reoperation for bleeding at 6.6% in the group of patients who underwent the conventional Bentall procedure compared with 0% for all these measures in the mini-Bentall group ( P > 0.33). There was no significant difference in intraoperative red blood cell transfusion and other major postoperative complications. No strokes were observed in either group, and there were no conversions to median sternotomy in the mini-Bentall group.

Conclusions

An upper hemisternotomy is a feasible technique in patients undergoing elective aortic root replacement surgery. However, future prospective studies are required before these procedures become the standard of care.
Slowly Evolving Brain Abscess Caused by Nocardia beijingensis in a Kidney Transplant Patient
Authors: Nasser Roni , Korytny Alexander , Geffen Yuval , Andraous Maisa , Paul Mical , Braun Eyal
Published: April 2018

A 71-year-old actively working farmer was admitted because of progressive weakness of the left hand and leg starting 5 weeks before admission. He has been suffering from headaches in the last 4 years. He has undergone kidney transplantation 14 years before admission. Brain magnetic resonance imaging (MRI) revealed a right frontoparietal hypodense lesion measuring 22 × 34 × 17 mm, causing edema, suspected to represent an abscess. Reviewing 2 brain MRI scans performed 4 years 10 months before admission showed a gradually worsening pathological process in the same region. Open surgery revealed an abscess, and drainage was performed. Gram stain and culture from the pus were negative, but panbacterial polymerase chain reaction was positive for Nocardia beijingensis. The patient was treated with ceftriaxone and linezolid for 3 months followed by trimethoprim-sulfamethoxazole. Repeated MRI 2 weeks after drainage showed reduction in abscess size. Brain computed tomography 3 months later showed further improvement. The patient has never recovered and died 8 months later.
Postoperative B-Type Natriuretic Peptide as Predictor for Postoperative Outcomes in Patients Implanted With Left Ventricular Assist Devices
Authors: Yost Gardner , Bhat Geetha , Pappas Patroklos , Tatooles Antone
Published: April 2018

B-type natriuretic peptide (BNP) is a cardiac neurohormone known to correlate with left ventricular (LV) dilation, decreased contractility, and increased stiffness. Consequently, BNP has been used as a prognostic tool to assess the degree of LV unloading for patients supported by continuous-flow LV assist devices (LVADs). We assessed the prognostic value of changes in BNP in the 2 weeks after LVAD implantation. This retrospective study analyzed laboratory findings and outcomes of 189 LVAD patients. Patients were separated into two groups based on whether serum BNP levels had improved from preoperative levels by postoperative day 14. Group 1 had improvement in BNP levels, whereas group 2 had no improvement or worsening in BNP. There were no significant differences between the groups in age, gender, race, body mass index, or comorbidities. Group 1 had preoperative BNP 1,125 ± 1,078.3 pg/dl and postoperative BNP 440.2 ± 267.7 pg/dl (preoperative minus postoperative [ΔBNP] = −693.09 ± 942.4 pg/dl), whereas group 2 had preoperative BNP 346.0 ± 309.1 pg/dl and postoperative BNP 631.57 ± 483.4 pg/dl (ΔBNP = 289.32 ± 329.7 pg/dl). Postoperative survival in group 2 was significantly worse than in group 1. Rates of right ventricular failure (RVF) were significantly higher in group 2 (group 1: 39%, group 2: 52.7%; p = 0.01). In most patients implanted with a LVAD, BNP improves significantly in the postoperative period as the LV is unloaded. Our results indicate that lack of improvement in postoperative BNP is associated with longer length of stay, increased rates of RVF, and is an independent risk factor for reduced postoperative survival.
Lifestyle interventions for patients with nonalcoholic fatty liver disease: a network meta-analysis
Authors: Zou Tian-Tian , Zhang Chao , Zhou Yi-Fan , Han Yi-Jing , Xiong Jiao-Jiao , Wu Xi-Xi , Chen Yong-Ping , Zheng Ming-Hua
Published: April 2018

Lifestyle interventions remain the first-line therapy for nonalcoholic fatty liver disease (NAFLD). This study aims to evaluate the individual impact of exercise and/or dietary interventions on the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), homeostasis model of assessment for insulin resistance index (HOMA-IR), and BMI. Randomized-controlled trials from patients diagnosed with NAFLD were included in the meta-analysis if they reported the associations between changes in ALT, AST, HOMA-IR, or BMI and types of lifestyle interventions. Nineteen eligible articles were included. Compared with observation, aerobic exercise training (AEx) plus diet [weighted mean difference (WMD)=−25.85; 95% confidence interval (CI): −43.90 to −7.80], AEx (WMD=−8.81; 95% CI: −20.22–2.60) and diet (WMD=−11.85; 95% CI: −47.65–24.95) showed significant efficacy in the improvement of ALT levels. Also AST, AEx plus diet showed a significant tendency to reduce AST levels. In addition, progressive resistance training (WMD=−1.70; 95% CI: −5.61–2.21) led to the most obvious reduction in HOMA-IR compared with observation, but appeared to show no significant effect in BMI (WMD=0.27; 95% CI: −0.48 to −0.07), whereas AEx plus diet (WMD=−0.96; 95% CI: −1.54 to −0.38 and WMD=−1.96; 95% CI: −2.79 to −1.12) showed great efficacy both in the improvement of HOMA-IR and BMI. AEx plus diet is the most effective intervention in the management of patients with NAFLD. Dietary intervention may be more effective in the improvements of aminotransferases, whereas exercise shows superiority in improving insulin sensitivity and reduction of BMI.
Bladder Versus Enteric Drainage of Exocrine Secretions in Pancreas Transplantation
Authors: Siskind Eric J. , Amodu Leo I. , Pinto Sonia , Akerman Meredith , Jonsson Johann , Molmenti Ernesto P. , Ortiz Jorge
Published: April 2018

Objectives

The method for drainage of exocrine secretions in pancreas transplantation remains a matter of debate. Different methods have evolved over time. Most data on these methods are from single-center studies with small sample sizes. Larger studies have yielded conflicting results.

Methods

Data from the United Network for Organ Sharing database on all adult subjects who received pancreas and kidney-pancreas transplants between 1996 and 2012 were analyzed (n = 19,934). Subjects were divided into 3 groups: enteric drainage with Roux-en-Y (n = 4308), enteric drainage without Roux-en-Y (n = 11,145), and bladder drainage (n = 4481). Primary end points were patient and graft survival at 1, 3, 5, 10, and 15 years.

Results

There was a patient and graft survival advantage with enteric drainage without Roux-en-Y reconstruction compared with the other methods. This was consistent at 1, 3, 5, 10, and 15 years.

Conclusions

Our study demonstrated increased graft and patient survival when comparing enteric drainage of the transplanted pancreas without Roux-en-Y reconstruction to enteric drainage with Roux-en-Y and bladder drainage at 1, 3, 5, 10, and 15 years. Based on this study, we recommend enteric drainage without Roux-en-Y reconstruction as the method of choice in pancreas transplantation.
Pancreatic Neuroendocrine Tumors and Intraductal Papillary Mucinous Neoplasm of the Pancreas
Authors: Manuel-Vazquez Alba , Ramia José Manuel , Latorre-Fragua Raquel , Valle-Rubio Ainhoa , Arteaga-Peralta Vladimir , Ramiro-Pérez Carmen , de la Plaza-Llamas Roberto
Published: April 2018

Objectives

This study aimed to identify factors that explain the association of intraductal papillary mucinous neoplasms-pancreatic neuroendocrine tumors (IPMNs-PNETs), radiological characteristics, and factors that might guide therapy.

Methods

We performed a systematic review of the literature to search for articles on concurrent IPMN-PNET, mixed endocrine-exocrine pancreatic tumors, and/or PNET with an intraductal growth pattern.

Results

A review of the literature suggests that there is some confusion about association of IPMNs-PNETs. Regarding this association, the studies collected data from 32 patients. Eleven patients presented concurrent tumors, 9 mixed endocrine-exocrine tumors, and no data were available in the remaining 7. In addition, the relationship IPMN-PNET focuses not only on the coexistence of the 2 lesions, but also on the possibility of the intraductal growth of the endocrine lesion. In the literature, in 4 cases, the preoperative radiological diagnosis had been IPMN.

Conclusions

Intraductal papillary mucinous neoplasms and PNETs may be associated in a number of scenarios. The association may be due to the concurrent existence of independent lesions, may be a mixed endocrine-exocrine tumor, or may be due to intraductal growth of the endocrine lesion. But the literature is confusing. It is not known whether the association is accidental or whether there is an etiological reason. Further studies are needed to investigate this scenario.
SLCO1B1 Polymorphisms are Associated With Drug Intolerance in Childhood Leukemia Maintenance Therapy
Authors: Eldem İrem , Yavuz Duygu , Cumaoğullari Özge , İleri Talia , Ünal İnce Elif , Ertem Mehmet , Doğanay Erdoğan Beyza , Bindak Recep , Özdağ Hilal , Şatiroğlu-Tufan N. Lale , Uysal L. Zümrüt
Published: April 2018

Background:

Therapy discontinuations and toxicities occur because of significant interindividual variations in 6-mercaptopurine (6-MP) and methotrexate (MTX) response during maintenance therapy of childhood acute lymphoblastic leukemia (ALL). 6-MP/MTX intolerance in some of the patients cannot be explained by thiopurine S-methyl transferase (TPMT) gene variants. In this study, we aimed to investigate candidate pharmacogenetic determinants of 6-MP and MTX intolerance in Turkish ALL children.

Methods:

In total, 48 children with ALL who had completed or were receiving maintenance therapy according to Children’s Oncology Group (COG) protocols were enrolled. Fifteen single-nucleotide polymorphisms in 8 candidate genes that were related to drug toxicity or had a role in the 6-MP/MTX metabolism (TPMT, ITPA, MTHFR, IMPDH2, PACSIN2, SLCO1B1, ABCC4, and PYGL) were genotyped by competitive allele-specific PCR (KASP). Drug doses during maintenance therapy were modified according to the protocol.

Results:

The median drug dose intensity was 50% (28% to 92%) for 6-MP and 58% (27% to 99%) for MTX in the first year of maintenance therapy, which were lower than that scheduled in all patients. Among the analyzed polymorphisms, variant alleles in SLCO1B1 rs4149056 and rs11045879 were found to be associated with lower 6-MP/MTX tolerance.

Conclusions:

SLCO1B1 rs4149056 and rs11045879 polymorphisms may be important genetic markers to individualize 6-MP/MTX doses.
Romiplostim for Immune Thrombocytopenia in Neuroblastoma Patients Receiving Chemotherapy
Authors: Fassel Hannah , Bussel James B. , Roberts Stephen S. , Modak Shakeel
Published: April 2018

Thrombocytopenia, a serious complication of myelosuppressive chemotherapy in cancer patients, is managed with platelet transfusions until recovery of platelet counts. However, children receiving chemotherapy can rarely develop immune thrombocytopenia (ITP) that is refractory to transfused platelets. This limits the ability to achieve adequate platelet counts and administer further myelosuppressive chemotherapy safely, especially if first-line ITP therapy is ineffective. We report 2 cases of intravenous immunoglobulin refractory ITP in children receiving chemotherapy for high-risk neuroblastoma. ITP was successfully treated with the thrombopoietin-receptor-agonist romiplostim, allowing safe and timely continuation of antineuroblastoma therapies in these high-risk patients.
Rasch Analysis of the 9-Item Shared Decision Making Questionnaire in Women With Breast Cancer
Authors: Wu Tzu-Yi , Chen Cheng-Te , Huang Yi-Jing , Hou Wen-Hsuan , Wang Jung-Der , Hsieh Ching-Lin
Published: April 2018

Background

Shared decision making (SDM) is a best practice to help patients make optimal decisions by a process of healthcare, especially for women diagnosed with breast cancer and having heavy burden in long-term treatments. To promote successful SDM, it is crucial to assess the level of perceived involvement in SDM in women with breast cancer.

Objective

The aims of this study were to apply Rasch analysis to examine the construct validity and person reliability of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in women with breast cancer.

Methods

The construct validity of SDM-Q-9 was confirmed when the items fit the Rasch model's assumptions of unidimensionality: (1) infit and outfit mean square ranged from 0.6 to 1.4; (2) the unexplained variance of the first dimension of the principal component analysis was less than 20%. Person reliability was calculated.

Results

A total of 212 participants were recruited in this study. Item 1 did not fit the model's assumptions and was deleted. The unidimensionality of the remaining 8 items (SDM-Q-8) was supported with good item fit (infit and outfit mean square ranging from 0.6 to 1.3) and very low unexplained variance of the first dimension (5.3%) of the principal component analysis. The person reliability of the SDM-Q-8 was 0.90.

Conclusions

The SDM-Q-8 was unidimensional and had good person reliability in women with breast cancer.

Implications for Practice

The SDM-Q-8 has shown its potential for assessing the level of perceived involvement in SDM in women with breast cancer for both research and clinical purposes.
Integrating Team Training in the Pediatric Life Support Program
Authors: Fagan Mary J. , Connelly Cynthia D. , Williams Brian S. , Fisher Erin Stucky
Published: April 2018

OBJECTIVE

The aim of this study was to examine the feasibility of integrating teamwork training into an established Pediatric Advanced Life Support (PALS) program to assess the effect on teamwork and collaboration among interprofessionals.

BACKGROUND

Lack of teamwork and ineffective communication are common contributors to hospital sentinel events. Interprofessional teamwork training to support a culture of patient safety is advocated; however, training methods and related expenses vary widely.

METHODS

This study used a descriptive design. All participants received PALS recertification training; the intervention group received an additional 2-hour TeamSTEPPS (R) 2.0 Essentials curriculum with didactic and video critique including role-play on error, communication behaviors, and standard terms. Data were collected on perceptions of teamwork and collaboration. χ2, Mann-Whitney U, and t tests were used.

RESULTS

The intervention group reported significantly higher perceptions of teamwork and collaboration, situational awareness, and ability to help a team make decisions.

CONCLUSIONS

Results suggest that integrating brief team training into an existing PALS program is a feasible, cost-effective, and sustainable method to provide interprofessional team training and positively influence the culture of safety.
Salivary Secretory Carcinoma With a Novel ETV6-MET Fusion
Authors: Rooper Lisa M. , Karantanos Theodoros , Ning Yi , Bishop Justin A. , Gordon Sarah W. , Kang Hyunseok
Published: April 2018

Secretory carcinoma of the salivary glands, also known as mammary analogue secretory carcinoma, is a recently described tumor characterized by generally indolent clinical behavior and recurrent ETV6-NTRK3 fusions. However, a small subset of recent cases with high-grade histology, aggressive behavior, or alternate molecular findings are expanding the spectrum of this entity. In this case, a 59-year-old female presented with an infiltrative submandibular gland tumor that was originally classified as a high-grade acinic cell carcinoma, papillary-cystic variant. She developed persistent local disease and, 11 years after initial presentation, was found to have widespread metastases. Rereview of her primary tumor highlighted microcystic, papillary, and solid architecture, eosinophilic cytoplasm, vesicular nuclei with prominent nucleoli, abundant mitotic figures, and necrosis. Immunostains showed the tumor cells to be positive for S100 and mammaglobin and negative for DOG-1, and fluorescence in situ hybridization highlighted an ETV6 rearrangement, supporting a diagnosis of high-grade secretory carcinoma. Finally, next-generation sequencing demonstrated a novel ETV6-MET fusion. To our knowledge, this is the first ETV6-MET fusion reported in secretory carcinoma. This finding further expands the definition of secretory carcinoma while carrying implications for selecting appropriate targeted therapy.
Characterization of the Glucocorticoid Receptor in Children Undergoing Cardiac Surgery*
Authors: Flores Saul , Cooper David S. , Opoka Amy M. , Iliopoulos Ilias , Pluckebaum Sarah , Alder Matthew N. , Krallman Kelli A. , Sahay Rashmi D. , Fei Lin , Wong Hector R.
Published: April 2018

Objectives:

Postoperative administration of corticosteroids is common practice for managing catecholamine refractory low cardiac output syndrome. Since corticosteroid activity is dependent on the glucocorticoid receptor, we sought to characterize glucocorticoid receptor levels in children undergoing cardiac surgery and examined the association between glucocorticoid receptor levels and cardiovascular dysfunction.

Design:

Prospective observational cohort study.

Setting:

Large, tertiary pediatric cardiac center.

Subjects:

Children undergoing corrective or palliative cardiac surgery.

Interventions:

None.

Measurements and Main Results:

A prospective observational cohort study was conducted in 83 children with congenital heart disease. Total glucocorticoid receptor levels were measured in the peripheral WBCs using flow cytometry. In addition, blood samples were collected for total cortisol levels. The primary outcome studied was the time to being inotrope free. An increase in glucocorticoid receptor level from postoperative day 1 to postoperative day 3 was associated with a longer time to being inotrope free (hazard ratio, 0.49 [0.29–0.81];p= 0.01) in the univariate analysis. This association remained significant after adjusting for age, weight, cardiopulmonary bypass time, cross clamp time, Risk Adjustment for Congenital Heart Surgery-1 score, and postoperative steroid use (hazard ratio, 0.53 [0.29–0.99];p= 0.05). Postoperative day 3 glucocorticoid receptor level showed a trend to have longer time to being inotrope free (hazard ratio, 0.66 [0.42–1.02];p= 0.0.06). The cortisol levels minimally increased during the study duration and did not correlate with glucocorticoid receptor levels.

Conclusions:

Increasing glucocorticoid receptor levels in peripheral WBCs of children undergoing cardiac surgery are associated with a longer time to being inotrope free. Cortisol levels minimally increased during the study duration. These results suggest that exposure to high-dose perioperative corticosteroids may suppress the hypothalamic-pituitary-adrenal axis leading to increase in glucocorticoid receptor levels in response to a low cortisol environment. Further studies are required to better delineate the interplay between glucocorticoid receptor levels, cortisol levels, corticosteroid exposure, and postoperative inotropic requirements.
Characteristics of Inpatient Units Associated With Sustained Hand Hygiene Compliance
Authors: Wolfe Jonathan D. , Domenico Henry J. , Hickson Gerald B. , Wang Deede , Dubree Marilyn , Feistritzer Nancye , Wells Nancy , Talbot Thomas R.
Published: April 2018

Objectives

Following institution of a hand hygiene (HH) program at an academic medical center, HH compliance increased from 58% to 92% for 3 years. Some inpatient units modeled early, sustained increases, and others exhibited protracted improvement rates. We examined the association between patterns of HH compliance improvement and unit characteristics.

Methods

Adult inpatient units (N = 35) were categorized into the following three tiers based on their pattern of HH compliance: early adopters, nonsustained and late adopters, and laggards. Unit-based culture measures were collected, including nursing practice environment scores (National Database of Nursing Quality Indicators [NDNQI]), patient rated quality and teamwork (Hospital Consumer Assessment of Healthcare Provider and Systems), patient complaint rates, case mix index, staff turnover rates, and patient volume. Associations between variables and the binary outcome of laggard (n = 18) versus nonlaggard (n = 17) were tested using a Mann-Whitney U test. Multivariate analysis was performed using an ordinal regression model.

Results

In direct comparison, laggard units had clinically relevant differences in NDNQI scores, Hospital Consumer Assessment of Healthcare Provider and Systems scores, case mix index, patient complaints, patient volume, and staff turnover. The results were not statistically significant. In the multivariate model, the predictor variables explained a significant proportion of the variability associated with laggard status, (R
2 = 0.35, P = 0.0481) and identified NDNQI scores and patient complaints as statistically significant.

Conclusions

Uptake of an HH program was associated with factors related to a unit’s safety culture. In particular, NDNQI scores and patient complaint rates might be used to assist in identifying units that may require additional attention during implementation of an HH quality improvement program.
Risk of Nephrotoxicity in Patients With Drug-Resistant Tuberculosis Treated With Kanamycin/Capreomycin With or Without Concomitant Use of Tenofovir-Containing Antiretroviral Therapy
Authors: Perumal Rubeshan , Abdelghani Neveen , Naidu Naressa , Yende-Zuma Nonhlanhla , Dawood Halima , Naidoo Kogieleum , Singh Nalini , Padayatchi Nesri
Published: April 2018

Background:

The intersection of HIV and drug-resistant (DR) tuberculosis (TB) presents the challenge of managing convergent drug toxicities.

Methods:

We conducted a retrospective study of adult patients with DR-TB treated with a kanamycin/capreomycin-based (KM) regimen, with or without concomitant antiretroviral therapy (ART). We estimated the incidence of nephrotoxicity (defined as an increase in serum creatinine greater than 26.5 µmol, or an increase in serum creatinine to 1.5 times the baseline value, or a decline in glomerular filtration rate to less than 60 mL/min/1.73 m2), and evaluated the association between reported drug use and nephrotoxicity using Kaplan–Meier plots.

Results:

A total of 215 patients with DR-TB were treated with a kanamycin/capreomycin-based regimen, with or without concomitant ART. The incidence rate of nephrotoxicity was 3.6 [95% confidence interval (CI): 1.4 to 7.3], 6.9 (95% CI: 5.2 to 9.0), and 12 (95% CI: 3.3 to 30.9) cases per 100 person-months of follow-up in the KM only group (n = 42), the KM + TDF (tenofovir disoproxil fumarate) group (n = 163), and the KM + Other ART group (n = 10), respectively. Using the KM only group as a reference, the hazard ratio was 2.06 (95% CI: 0.92 to 4.63) in the KM + TDF group, and 4.09 (95% CI: 1.17 to 14.25) in the KM + Other ART group. Advancing age was an independent predictor of nephrotoxicity (adjusted hazard ratio 1.29, 95% CI: 1.14 to 1.46).

Conclusions:

Our findings provide evidence of a significant risk of nephrotoxicity during treatment with a kanamycin/capreomycin-based DR-TB regimen, with or without concurrent treatment with ART. This study lends further support to calls for the substitution of TDF during the intensive phase of DR-TB treatment and for close monitoring of renal function during DR-TB treatment, especially in settings where the use of kanamycin/capreomycin is unavoidable.
EAST Multicenter Trial on targeted temperature management for hanging-induced cardiac arrest
Authors: Hsu Cindy H. , Haac Bryce E. , Drake Mack , Bernard Andrew C. , Aiolfi Alberto , Inaba Kenji , Hinson Holly E. , Agarwal Chinar , Galante Joseph , Tibbits Emily M. , Johnson Nicholas J. , Carlbom David , Mirhoseini Mina F. , Patel Mayur B. , O'Bosky Karen R. , Chan Christian , Udekwu Pascal O. , Farrell Megan , Wild Jeffrey L. , Young Katelyn A. , Cullinane Daniel C. , Gojmerac Deborah J. , Weissman Alexandra , Callaway Clifton , Perman Sarah M. , Guerrero Mariana , Aisiku Imoigele P. , Seethala Raghu R. , Co Ivan N. , Madhok Debbie Y. , Darger Bryan , Kim Dennis Y. , Spence Lara , Scalea Thomas M. , Stein Deborah M.
Published: April 2018

BACKGROUND

We sought to determine the outcome of suicidal hanging and the impact of targeted temperature management (TTM) on hanging-induced cardiac arrest (CA) through an Eastern Association for the Surgery of Trauma (EAST) multicenter retrospective study.

METHODS

We analyzed hanging patient data and TTM variables from January 1992 to December 2015. Cerebral performance category score of 1 or 2 was considered good neurologic outcome, while cerebral performance category score of 3 or 4 was considered poor outcome. Classification and Regression Trees recursive partitioning was used to develop multivariate predictive models for survival and neurologic outcome.

RESULTS

A total of 692 hanging patients from 17 centers were analyzed for this study. Their overall survival rate was 77%, and the CA survival rate was 28.6%. The CA patients had significantly higher severity of illness and worse outcome than the non-CA patients. Of the 175 CA patients who survived to hospital admission, 81 patients (46.3%) received post-CA TTM. The unadjusted survival of TTM CA patients (24.7% vs 39.4%, p < 0.05) and good neurologic outcome (19.8% vs 37.2%, p < 0.05) were worse than non-TTM CA patients. However, when subgroup analyses were performed between those with an admission Glasgow Coma Scale score of 3 to 8, the differences between TTM and non-TTM CA survival (23.8% vs 30.0%, p = 0.37) and good neurologic outcome (18.8% vs 28.7%, p = 0.14) were not significant. Targeted temperature management implementation and post-CA management varied between the participating centers. Classification and Regression Trees models identified variables predictive of favorable and poor outcome for hanging and TTM patients with excellent accuracy.

CONCLUSION

Cardiac arrest hanging patients had worse outcome than non-CA patients. Targeted temperature management CA patients had worse unadjusted survival and neurologic outcome than non-TTM patients. These findings may be explained by their higher severity of illness, variable TTM implementation, and differences in post-CA management. Future prospective studies are necessary to ascertain the effect of TTM on hanging outcome and to validate our Classification and Regression Trees models.

LEVEL OF EVIDENCE

Therapeutic study, level IV; prognostic study, level III.
Split Liver Transplantation and Pediatric Waitlist Mortality in the United States: Potential for Improvement
Authors: Perito Emily R. , Roll Garrett , Dodge Jennifer L. , Rhee Sue , Roberts John P.
Published: April 2018

Background.

In the United States, 1 in 10 infants and 1 in 20 older children die on the liver transplant waiting list. Increasing split liver transplantation could increase organ availability for these children, without decreasing transplants in adults.

Methods.

Using United Network for Organ Sharing Standard Transplant Analysis and Research data, we identified livers transplanted 2010 to 2015 that could potentially have been used for split transplant, based on strict criteria. Livers not suitable for pediatric patients or allocated to high-risk recipients were excluded. Number and distribution of potentially “split-able” livers were compared to pediatric waitlist deaths in each region.

Results.

Of 37 333 deceased donor livers transplanted, 6.3% met our strict criteria for utilization in split liver transplant. Only 3.8% of these were actually utilized for split liver transplantation. 96% were used for a single adult recipient. Of the 2253 transplanted as whole livers, 82% of their recipients were listed as willing to accept a segmental liver, and only 3% were listed as requiring a cold ischemia time less than 6 hours. Over the same 5 years, 299 children died on the waitlist. In every United Network for Organ Sharing region, there were more potentially “split-able” livers than pediatric waitlist deaths. Thirty-seven percent of pediatric waitlist deaths occurred at transplant centers that averaged 1 or less pediatric split liver transplantation annually during the study period.

Conclusions.

This comparison, although not conclusive, suggests that we might be missing opportunities to reduce pediatric waitlist mortality without decreasing access for adults—using split liver transplant. Barriers are significant, but further work on strategies to increase split liver transplant is warranted.
Curcumin-loaded graphene oxide flakes as an effective antibacterial system against methicillin-resistant
Staphylococcus aureus
Authors: Bugli F. , Cacaci M. , Palmieri V. , Di Santo R. , Torelli R. , Ciasca G. , Di Vito M. , Vitali A. , Conti C. , Sanguinetti M. , De Spirito M. , Papi M.
Published: April 2018

Methicillin-resistant
Staphylococcus aureus
(MRSA) is responsible for serious hospital infections worldwide and represents a global public health problem. Curcumin, the major constituent of turmeric, is effective against MRSA but only at cytotoxic concentrations or in combination with antibiotics. The major issue in curcumin-based therapies is the poor solubility of this hydrophobic compound and the cytotoxicity at high doses. In this paper, we describe the efficacy of a composite nanoparticle made of curcumin (CU) and graphene oxide (GO), hereafter GOCU, in MRSA infection treatment. GO is a nanomaterial with a large surface area and high drug-loading capacity. GO has also antibacterial properties due mainly to a mechanical cutting of the bacterial membranes. For this physical mechanism of action, microorganisms are unlikely to develop resistance against this nanomaterial. In this work, we report the capacity of GO to support and stabilize curcumin molecules in a water environment and we demonstrate the efficacy of GOCU against MRSA at a concentration below 2 µg ml
−1
. Further, GOCU displays low toxicity on fibroblasts cells and avoids haemolysis of red blood cells. Our results indicate that GOCU is a promising nanomaterial against antibiotic-resistant MRSA.
Aquaporin–graphene interface: relevance to point-of-care device for renal cell carcinoma and desalination
Authors: Jakowiecki Jakub , Sztyler Agnieszka , Filipek Slawomir , Li Pingzuo , Raman Karthik , Barathiraja Natarajan , Ramakrishna Seeram , Eswara Jairam R. , Altaee Ali , Sharif Adel O. , Ajayan Pulickel M. , Renugopalakrishnan Venkatesan
Published: April 2018

The aquaporin superfamily of hydrophobic integral membrane proteins constitutes water channels essential to the movement of water across the cell membrane, maintaining homeostatic equilibrium. During the passage of water between the extracellular and intracellular sides of the cell, aquaporins act as ultra-sensitive filters. Owing to their hydrophobic nature, aquaporins self-assemble in phospholipids. If a proper choice of lipids is made then the aquaporin biomimetic membrane can be used in the design of an artificial kidney. In combination with graphene, the aquaporin biomimetic membrane finds practical application in desalination and water recycling using mostlyEscherichia coliAqpZ. Recently, human aquaporin 1 has emerged as an important biomarker in renal cell carcinoma. At present, the ultra-sensitive sensing of renal cell carcinoma is cumbersome. Hence, we discuss the use of epitopes from monoclonal antibodies as a probe for a point-of-care device for sensing renal cell carcinoma. This device works by immobilizing the antibody on the surface of a single-layer graphene, that is, as a microfluidic device for sensing renal cell carcinoma.
Improving the glial differentiation of human Schwann-like adipose-derived stem cells with graphene oxide substrates
Authors: Verre Andrea Francesco , Faroni Alessandro , Iliut Maria , Silva Claudio , Muryn Cristopher , Reid Adam J. , Vijayaraghavan Aravind
Published: April 2018

There is urgent need to improve the clinical outcome of peripheral nerve injury. Many efforts are directed towards the fabrication of bioengineered conduits, which could deliver stem cells to the site of injury to promote and guide peripheral nerve regeneration. The aim of this study is to assess whether graphene and related nanomaterials can be useful in the fabrication of such conduits. A comparison is made between graphene oxide (GO) and reduced GO substrates. Our results show that the graphene substrates are highly biocompatible, and the reduced GO substrates are more effective in increasing the gene expression of the biomolecules involved in the regeneration process compared to the other substrates studied.
GWAS in 446,118 European adults identifies 78 genetic loci for self-reported habitual sleep duration supported by accelerometer-derived estimates
Authors: Dashti Hassan S , Jones Samuel E , Wood Andrew R , Lane Jacqueline M , van Hees Vincent T. , Wang Heming , Rhodes Jessica A , Song Yanwei , Patel Krunal , Anderson Simon G , Beaumont Robin , Bechtold David A , Bowden Jack , Cade Brian E , Garaulet Marta , Kyle Simon D , Little Max A , Loudon Andrew S , Luik Annemarie I , Scheer Frank AJL , Spiegelhalder Kai , Tyrrell Jessica , Gottlieb Daniel J , Tiemeier Henning , Ray David W , Purcell Shaun M , Frayling Timothy M , Redline Susan , Lawlor Deborah A , Rutter Martin K , Weedon Michael N , Saxena Richa
Published: April 2018

Sleep is an essential homeostatically-regulated state of decreased activity and alertness conserved across animal species, and both short and long sleep duration associate with chronic disease and all-cause mortality1,2. Defining genetic contributions to sleep duration could point to regulatory mechanisms and clarify causal disease relationships. Through genome-wide association analyses in 446,118 participants of European ancestry from the UK Biobank, we discover 78 loci for self-reported sleep duration that further impact accelerometer-derived measures of sleep duration, daytime inactivity duration, sleep efficiency and number of sleep bouts in a subgroup (n=85,499) with up to 7-day accelerometry. Associations are enriched for genes expressed in several brain regions, and for pathways including striatum and subpallium development, mechanosensory response, dopamine binding, synaptic neurotransmission, catecholamine production, synaptic plasticity, and unsaturated fatty acid metabolism. Genetic correlation analysis indicates shared biological links between sleep duration and psychiatric, cognitive, anthropometric and metabolic traits and Mendelian randomization highlights a causal link of longer sleep with schizophrenia.
Key analysis of the dairy value chain in Vietnam: the case of Bavi
Authors: Nguyen Viet Khoi , Thi Hai Yen Hoang , Van Khai Tong , To Linh Huong , Duc Nguyen Tien
Published: April 2018

Purpose

The purpose of this paper is to find out the distribution of benefits, costs, and value added among the actors and problems in the practical management in dairy milk value chain, especially in one of the most important dairy areas in Vietnam to see how they upgrade in the value chain.

Design/methodology/approach

A survey was carried out in Bavi, Hanoi where a large amount of fresh milk is produced annually. The content of the survey was built before conducting in Bavi with 160 questionnaires. The questionnaires were based on the criteria which reflect the main objectives of the paper such as the actor’s profits and costs, the relationship among these actors, and the advantages and disadvantages in the dairy milk’s value chain. Some part of results of the paper was evaluated by conducting interviews with the relevant target groups in the value chain of dairy milk. Data collected were aggregated and analyzed by SPSS20, Excel. The calculation of cost and profit margin of each actor in the chain was also be presented by a quantitative tool for value chain analysis.

Findings

This study pointed out the systemized problems in the value chain of one of the biggest dairy companies in Vietnam. This study revealed some wicked problems in the value chains of Vietnam under globalization.

Research limitations/implications

This study could not cover all of the detailed actors in the dairy value chain.

Originality/value

The value of income in the chain is distributed unequally. The benefits that farmers receive are inadequate with the costs they have to pay. This is a particular chain, in which the main factors boosting the chain are factories, and an increase in revenue also reflects the benefits of them. The result is that the value added in the chain is also biased toward the dairy plant. The paper also pointed out the shortcomings in the cost calculation of farmers. All the expenses, such as wages and the opportunity cost, are calculated in the total cost of the dairy plant, whereas dairy farmers do not mention these costs. Thus, in terms of benefits, farmers suffer more disadvantages, thus they should be received more value. In terms of management, Bavi’s authorities could not manage the output of milk in the perfect way. The lax management has led to a series of counterfeit goods that appear on the market today. These low-quality products are sold right on the highway and the Bavi’s tourist destination.
Pea leafminer Liriomyza huidobrensis (Diptera: Agromyzidae) uses vibrational duets for efficient sexual communication
Authors: Ge Jin , Wei Jia‐Ning , Zhang Ding‐Jie , Hu Chun , Zheng De‐Zhi , Kang Le
Published: April 2018

The pea leafminer (Liriomyza huidobrensis) is a notorious pest of vegetables and ornamental plants worldwide. Despite a large number of studies on its biology and ecology, the courtship behavior and sexual communication of this species remain unclear. Here, we studied vibrational communication in the sexual interaction of the pea leafminer. On host plant leaves, females and males behaviorally displayed the bobbing‐quivering alternation, which finally led to copulation. Moreover, records of laser vibrometry revealed three‐signal duets underlying the behavioral alternation. Sexually mature males spontaneously emitted calls (MCs) to initiate the duets. The females rapidly responded to MCs by emitting replies (FRs) that are longer in duration. The FRs further triggered male replies (MRs) in their search for potential partners. Leafminer‐produced vibrational signals convey efficient information to partners and generate pair formation on stretched substrates, such as plant leaves and nylon mesh, but cannot elicit responses on dense substrates, such as glass and plastic. Vibrational playbacks of both MCs and FRs can elicit replies in females and males, respectively. This study completely characterizes substrate‐borne vibrational duets in a dipteran insect. The discovery of vibrational sex signals in the pea leafminer provides new insights for the development of novel approaches to control the pest and its relative species.
Science and Technology and the President's Crime Commission
Authors: Blumstein Alfred
Published: April 2018

The U.S. President's Commission on Law Enforcement and Administration of Justice added a Task Force on Science and Technology as somewhat of an afterthought because there had then been very little interaction between science and technology and the criminal justice system (CJS). The task force focused on the CJS as a whole and interactions among its parts, with an important emphasis on analysis of the operating systems and on the important potential role of information systems as the technology advanced. The potential applications of contemporary information and electronic technologies is considerable, especially for assessing risk and needs of identified offenders and for providing relevant information wherever needed. There is urgent need for scientific evaluation of many of the positive and negative aspects of the operation of the CJS and of the potential for new technologies.
Patent as a Quality Signal in Entrepreneurial Finance: A Look Beneath the Surface
Authors: Chen Shi , Meng Wei , Lu Haitian
Published: April 2018

We examine the value of patents on Chinese firms’ access to venture capital (VC). We find that the patent applications (grants) of firms significantly increase their likelihood of obtaining VC funding in the following year(s), particularly for high‐quality patents in high‐tech industries. Depending on investment, patent quantity significantly improves the size of VC investment and firm valuation. This effect is pronounced in first‐round investment, strong intellectual property protection regions, during periods of loose monetary policy, and state/corporate VC. Overall, we support the use of patent as a quality signal in attracting entrepreneurial finance outside the US and warrant the conditions it holds.
Role of chemokines in metastatic niche: new insights along with a diagnostic and prognostic approach
Authors: Rezaeeyan Hadi , Shirzad Reza , McKee Trevor D. , Saki Najmaldin
Published: April 2018

Chemokines are cytokines that are involved in the movement of leukocytes and the occurrence of immune responses. It has recently been noted that these cytokines play a role in the movement of cancer cells to different parts of the body and create a suitable environment [i.e. (pre) metastatic niche] for their growth and proliferation. We studied the role of chemokines in the metastasis of cancer cells, as well as their involvement in the proliferation and growth of these cells. Relevant literature was identified by a PubMed search (2005–2017) of English language papers using the terms ‘chemokine,’ ‘metastasis niche,’ and ‘organotropism.’ Based on the nature of cancer cells, the expression of chemokine receptors on these cells leads to metastasis to various organs, which ultimately causes changes in different signaling pathways. Finally, the targeting of chemokines on cancer cells could prevent the metastasis of cancer cells toward different organs.
Letter: phenotype and natural history of elderly onset inflammatory bowel disease
Authors: Everhov Å. H. , Ludvigsson J. F. , Olén O.
Published: April 2018

Linked Content

This article is linked to Mañosa et al and Mañosa and Doménech papers. To view these articles visit https://doi.org/10.1111/apt.14494 and https://doi.org/10.1111/apt.14622.
Letter: vedolizumab for autoimmune liver disease associated inflammatory bowel disease—Authors’ reply
Authors: Christensen B. , Gibson P. R. , Rubin D. T.
Published: April 2018

Linked Content

This article is linked to Christensen et al and Pavlidis et al papers. To view these articles visit https://doi.org/10.1111/apt.14525 and https://doi.org/10.1111/apt.14603.
Are older people a vulnerable group? Philosophical and bioethical perspectives on ageing and vulnerability
Authors: Bozzaro Claudia , Boldt Joachim , Schweda Mark
Published: April 2018

The elderly are often considered a vulnerable group in public and academic bioethical debates and regulations. In this paper, we examine and challenge this assumption and its ethical implications. We begin by systematically delineating the different concepts of vulnerability commonly used in bioethics, before then examining whether these concepts can be applied to old age. We argue that old age should not, in and of itself, be used as a marker of vulnerability, since ageing is a process that can develop in a variety of different ways and is not always associated with particular experiences of vulnerability. We, therefore, turn to more fundamental phenomenological considerations in order to reconstruct from a first person perspective the intricate interconnections between the experiences of ageing and vulnerability. According to this account, ageing and old age are phenomena in which the basic anthropological vulnerability of human beings can manifest itself in an increased likelihood of harm and exploitation. Thus, we plead for a combined model of vulnerability that helps to avoid problems related to the current concepts of vulnerability. We conclude first that old age as such is not a sufficient criterion for being categorized as vulnerable in applied ethics, and second that reflections on ageing can help to develop a better understanding of the central role of vulnerability in human existence and in applied ethics.
Responsibility and age‐related dementia
Authors: Frantik Petr
Published: April 2018

This article identifies the assumption of responsibility as a basic need of human beings and applies the concept specifically to older people with dementia or Alzheimer's disease. It suggests a two‐level concept of responsibility, based on the approach of discourse ethicist Karl‐Otto Apel, as a promising approach to recognizing human diversity while at the same time respecting people's equal rights to participate in discourse. This concept can serve as a theoretical starting point for the construction of individually adapted types of responsibility. Furthermore, the article describes practical ideas (primarily the practice of doll therapy) that can enable people with dementia or Alzheimer's disease to assume responsibility. Direct communication and a reflective, sensitive consideration of each individual case are identified as important prerequisites for the inclusion of elderly people with dementia.