bluuebunny/crossref_metadata_2025 huggingface dataset:
Predisposition to Thrombosis in Experimental Cancer
Authors: Hilgard P.
Published: June 2019

In accordance with clinical findings in malignant diseases, the growth of allogeneic and autochthonous rat tumours induced characteristic changes of the clotting mechanism of the host: increased activity of various clotting factors and elevation of plasma fibrinogen levels, yet the presence of high amounts of serum FDP and an accelerated fibrinogen catabolism suggested increased intravascular degradation. Obviously, the impaired balance was still compensated since no evidence for organ deposition of fibrin was found. However, additional trigger mechanisms, which individually are not thrombogenic in the normal rat – hypercalcaemia and bacterial endotoxins – led to the development of thrombotic conditions in tumour bearing rats resulting in microangiopathic haemolytic anaemia or in the generalized Shwartzman reaction. Preventive anticoagulation was only effective if established prior to the second stimulus. In addition, the experiments suggested that rapid decomposition of tumour cells, disturbances in the functional state of the reticuloendothelial system, a decreased fibrinolytic potential and, possibly, leukocytosis are supplementary predisposing factors to thrombosis in malignant diseases. It is concluded that the low grade activation of the clotting mechanism in experimental cancer respresents the “hpyercoagulable state” which is at high risk to be converted into a thrombotic state.

* Supported by the “Deutsche Forschungsgemeinschaft”, Bonn-Bad Godesberg.
Calculation of Predictive Odds for Possible Carriers of Haemophilia
Authors: Forbes G. D. , McLaren A. D. , Prentice C. R. M.
Published: June 2019

The predictive odds for possible carriers of haemophilia have been calculated using data derived from normal and known carrier populations. For each individual the concentration of factor VII-related antigen (A) and factor VIII biological activity (B) was measured. The data has been studied by linear discriminant analysis linked to a Bayesian calculation of posterior odds using the predictive distributions of both the normal and obligatory carrier populations. The proportion of possible carriers assigned to the definite carrier group or control group is dependent on which betting odds are regarded as most suitable for counselling patients. For instance, if betting odds of 5 : 1 were given it was possible to assign 22 of 32 possible carriers (69 per cent) to control or carrier groups. Of this group of 22 possible carriers, 11 were thought to be normal and 11 were thought to be haemophilia carriers.
Factor-VIII Inhibitor in Less Severely Affected Haemophilic Patients
Authors: Tuddenham E. G. D. , Bloom A. L. , Giddings J. C. , Barrett C. A.
Published: June 2019

The occurrence of factor VIII inhibitor in five mild or moderately affected liaemophilic patients is described. In four patients the inhibitor inactivated endogenous factor VIII an dtemporarily converted them to severely affected haemophiliacs with factor VIII level of 0%. In the fifth patient, a brother of one of the others, the inhibitor although more potent did not inactivate the patient’s own factor VIII and did not completely inactivate normal factor VIII in vitro. This patient responded to treatment with factor-VIII concentrate but the in-vivo recovery was reduced. The patient’s plasma was tested against a panel of normal donors but it inactivated factor VIII in each to a similar extent and no evidence for normal factor-VIII groups was obtained. In the other patients the response to replacement treatment was also better than that usually seen in severely affected haemophilic patients with inhibitor. In the two related patients the inhibitors have so far persisted but in the unrelated patients the inhibitors eventually disappeared and did not always recur with subsequent therapy. The incidence of factor- VIII inhibitor in less severe haemophiliacs (factor VIII > 3% ) in this centre is 6% suggesting that the complication is more frequent in this type of patient than hitherto recognised.
Changes with age in Fibrinolytic Activity, Coagulation Factors and Lipids in an Industrial Population
Authors: Chakrabarti R. , Brozovic M. , Meade T. W. , North W. R. S. , Stirling Y.
Published: June 2019

Fibrinolytic activity, coagulation factors I, V, VII and VIII, blood cholesterol and triglyceride levels have been measured in a randomyl selected group of 650 men aged 17–64 and 350 women aged 17–59 working in an industrial population. Fibrinolytic activity (the reciprocal of the dilute blood clot lysis time in hours) decreases significantly (0.003 per annum) with advancing age in men; there is no significant change in women. Factors I and V increase significantly with age in both men and women at about the same rate (1.0% per annum for factor I and 0.6% for factor V), their mean levels in each group being very similar. Factor VIII also increases significantly with age in both sexes up to the age of about 50 years, after which levels continue to rise in men, but fall in women. Factor VII and blood cholesterol levels are lower in young women than in young men; they rise in both sexes, but significantly faster in women than in men (1.1% and 0.4%, respectively for factor VII, for example), so that in older women they are substantially higher than in older men. Triglyceride levels rise with age in both sexes, levels in men being hig er than those in women.
Significance of Platelet Size and Shape Changes in Man
Authors: Behrens W. E. von , Harker L. A.
Published: June 2019

Platelet volume, shape and diameter were measured by thrombocrit, light- and electron-microscopy and electronic techniques in over 500 selected patients with disorders of thrombopoiesis and haemosta-sis. Mean cell volumes (MCVs) estimated by these independent methods agreed well. Median MCV of 100 random control subjects was 10.3 fl (two GST) range 8.51–12.46 fl), count was 233,000/μ1 (1.60–3.40 × 105), thrombocrit was 0.25% (0.20–0.31%) and geometric standard deviation (GSD) of volumes was 1.61 (1.56–1.67). But selected healthy subjects had congenitally smaller or much larger platelets, reciprocal variation in count but normal thrombocrit as strikingly illustrated by a new thrombocrit method permitting microhematocrit packing of all platelets from 1 ml whole blood with morphometrically proven absence of plasma trapping. Extreme MCV deviations were rare and mainly congenital e.g. ≈ 50 fl, ≈ 35 fl and ≈ 20 fl in the Davidson (3) May Hegglin (2) and Mediteranean (> 20) macrothrombocytopenias ; 5 fl in Wiskott Aldrich (4); up to 30 fl in transient macrothrombocytopenia during severe infection or hypoxia (4) and up to 40 fl in dysthrombocytosis of the blast crisis of the myeloproliferative syndrome (3). Acute reversible disc-sphere transformation induced by EDTA in health was shown to be isovolumetric citrate platelets being discoid at 22° C with an axial ratio of 0.23 (0.18–0.27). In accord with Coulter theory effective electric volume of EDTA platelets exceeded that of citrate cells by a factor of 1.28 (1.181–1,382) – a measure of platelet shape differences termed E/C ratio. During lesser MCV deviations platelets appearance in blood films and during electronic sizing of citrate cells was dominated by shape heterogeneiety the E/C ratio correlating negatively (P < 10-3) with increased platelet turnover because citrate platelets show pseudopodial activation and sphering. For example in over 20 patients with acute ITP, ≈ 8-fold increase in platelet turnover, normal or only slight increase in both thrombocrit MCV and electronic size of EDTA platelets, electronic size and GSD of citrate platelets was increased, E/C ratio was consistently below 1.08 and many platelets were spread in blood films. In other acquired disorders MCV deviations were also usually minor.
Platelet Volume and Density in Relation to Aging: Myth or Reality
Authors: Boneu B. , Plante J. , Corberand J. , Biermé R.
Published: June 2019

Platelet volume and density distribution of three different patient groups were studied. Volumes were determined with a Coulter-Counter (Z BIC-Channelyser C 100) while the respectives densities were evaluated using a modified approach to the standard Booyse and Rafelson density assay method (ultracentrifugation on a linear sucrose gradient).

In the first group of patients schowing thrombocytemia following splenectomy, platelet volumes and densities were within the normal range both before and after splenectomy in spite of sudden platelet increase.

In the second group wit I.T.P. (platelets < 20,000/mm3) the gaussian distribution of log volumes was deviated towards a macrothrombocytosis; however, the dispersion of the values was significantly increased in spite of the homogeneity of platelet age. The platelet count was immediately normalised following splenectomy. The young platelets formed (age < 48 hours) presented a normal gaussian distribution of both log-volume and density.

In the third group of consumption coagulopathies with mild thrombocytopenia, there was evidence of macrothrombocytosis in all eases; yet, separation of platelet populations revealed an increase in the number of light platelets (class A and B of the Booyse and Rafelson classification).

Those findings strongly suggest that young platelets present normal volume and density-distributions. Only in those cases of intensive peripheral consumption do the mega-caryocytcs produce an abnormal platelet population with grater volume and dispersion as well as lower densities.
The Hemostatic Effect of 51Cr-Labelled Platelets
Authors: Björnson J. , Aursnes I.
Published: June 2019

In the interpretation of data obtained with 51Cr-labelled platelets it is vital to know whether they are functionally normal. Although survival of 51Cr-labelled platelets in vivo appears to be normal, platelet aggregability- has recently been shown to be reduced after the labelling procedure (Björnson, J., Sc and. J. Haemat. 13, 252–259).

The aim of the present study was to examine the hemostatic effect of labelled platelets. Rabbits were made thrombocytopenic (< 35,000/μ1) by whole body irradiation. Bleeding times were recorded after standardized cuts on the inner side of the ear, a method showing an acceptable reproducibility (< 3 min in normals). The animals were then transfused with labelled platelet concentrates, increasing the platelet levels to about 200,000/μ) blood. Bleeding times of more than 15 min before transfusion were almost normalized 1 and 4 hours after transfusion. In controls transfusion of PRP led to similar shortening of bleeing time.

It is concluded that platelets subjected to the 51Cr-labelling procedure to a large extent retain their hemostatic ability.
Management of Myasthenia Gravis
Authors: Venkataramaiah Sudhir , Kamath Sriganesh
Published: June 2019

Myasthenia gravis (MG) apart from Guillain–Barré syndrome is one of the most common disorders presenting as respiratory failure secondary to muscle weakness in the modern world. MG is also one of the most researched and reasonably well understood autoimmune disorder of mankind. From the description of early cases of MG to the current day understanding, the progress in the management and therapeutics has advanced significantly. Diagnosis of MG can be accurately done either with traditional tests such as the edrophonium test or by advanced nerve conduction studies. Presence of demonstrable circulating autoantibodies against the acetyl choline receptors, muscle-specific tyrosine kinase, involvement of B and T cells in the pathogenesis, and tomographic evidence of the enlarged thymus gland in certain patients have led to designing specific treatment strategies. Removal of the circulating autoantibodies as much as possible by plasmapheresis supported by anticholinesterases and immunosuppression are the mainstay of targeted therapy. The advent of newer immunosuppressant drugs such as rituximab which targets the CD20 protein present on the surface of B cells and tacrolimus which is an interleukin 2 inhibitor has improved the therapeutic armamentarium of the physician. These agents in combination with time tested medications such as steroids and antimetabolites have rendered faster remission rates and improved outcomes in MG crisis. This article outlines the basic pathophysiology, specific and supportive management strategies in patients presenting with MG with or without crisis.
Exact results on the large-scale stochastic transport of inertial particles including the Basset history term
Authors: Boi S.
Published: June 2019

The Maxey-Riley equation and its simplified versions represent the most widespread tool to investigate dynamics and dispersion of inertial small particles in turbulent flows. The numerical solution of such models is often very challenging, and some of their terms, such as the molecular diffusivity or the Basset history force, are often neglected to reduce the complexity upon suitable approximations. Here, we propose exact results with regard to the rate of transport on large time scales in random shear flows. These can be expediently used as a benchmark to develop and assess algorithms when solving this class of stochastic integrodifferential problems on large time scales.
On heat transport and energy partition in thermal convection with mixed boundary conditions
Authors: Nandukumar Yada , Chakraborty Suman , Verma Mahendra K. , Lakkaraju Rajaram
Published: June 2019

A two-dimensional square enclosure thermally insulated on the vertical walls and heated nonuniformly on the horizontal walls is numerically studied in comparison with the classical Rayleigh-Bénard (RB) convection in the range of Rayleigh number 105 ≤ Ra ≤ 109. Two possible configurations, namely, (1) HCCH and (2) HCHC, are studied in which a unit step function describes the conduction wall temperature as a combination of hot (H) and cold (C) temperatures. The first two letters (of HCCH or HCHC) represent the applied thermal conditions on the bottom wall and the last two letters represent those on the top wall. In the mentioned configurations, the average temperature difference between the bottom and top walls is zero, yet the complex convection state is observed. The diagonally aligned large-scale elliptic roll observed in the RB convection for the Rayleigh number Ra = 108 is found to be replaced by a circular roll in HCCH and a square roll in HCHC. The mean and fluctuating temperature fields in cases of HCCH and HCHC are significantly high as compared to the RB case. We found that heat transport is higher for HCCH and HCHC as compared to the RB convection in a range of 105 ≤ Ra < 108. The increase in heat transport is due to (1) an increase in the background potential energy in the case of HCCH and (2) an increase in the available potential energy in the case of HCHC, which is confirmed by using the global energy budget.
Syntopic Cystoseira taxa support different molluscan assemblages in the Gulf of Naples (southern Tyrrhenian Sea)
Authors: Chiarore Antonia , Bertocci Iacopo , Fioretti Sara , Meccariello Angela , Saccone Giuseppe , Crocetta Fabio , Patti Francesco Paolo
Published: June 2019

Brown macroalgae belonging to the genus Cystoseira (Fucales: Sargassaceae) are canopy-forming organisms the recent decline of which at a basin and local scale has been widely documented, which urgently calls for research to fill knowledge gaps and support new and effective measures for protection. We, hereby, characterised the molluscan assemblages associated with three Cystoseira taxa (C. amentacea, C. compressa and C. crinita) from Ischia Island (Italy, Tyrrhenian Sea), and tested whether different congeneric taxa may syntopically support a different biota. In particular, these assemblages were compared among three Cystoseira species, between two times of sampling (June–July 2015 and June–July 2016), and among six sites in terms of multivariate structure (identity and relative abundances of constituting taxa combined, and presence–absence composition), as well as for synthetic measures of diversity, including the total richness of taxa, the exponential Shannon index and the reciprocal Simpson index. In total, 24736 molluscan individuals were collected, overall belonging to 52 taxa. The majority of the identified species included micrograzers and filter feeders, which is in agreement with similar previous studies. The composition of associated molluscan assemblages, which was mainly represented by juvenile individuals, differed among the three Cystoseira species, suggesting that even congeneric taxa do not support an analogous benthic fauna. The present findings have shed light on the molluscan biota associated with Cystoseira taxa in the Gulf of Naples and strengthened the importance of such habitat-forming macroalgae in structuring the local infralittoral invertebrate biodiversity and as a nursery for species-specific associated molluscs.
“My life has changed forever!”
Authors: Vásquez Camilla
Published: June 2019

New parodic genres have emerged across diverse forms of digital media. Sometimes these parodies take the form of mock “narratives of personal experience,” with authors drawing on a range of discursive resources to perform particular identities and in doing so, to create texts written from imagined perspectives. In this article, I focus on parodies of user-generated product reviews on Amazon. For over a decade, Amazon users have contributed thousands of parodies of reviews written about real products. This analysis focuses on a sample from a data set of 100 parodic Amazon reviews written about five different products (which have become the targets of a large number of parody reviews), and demonstrates how authors perform self-disclosure to construct fictional personae. I demonstrate how these discursively-constructed narrative identities are central to the ensuing and improbable narrative events represented in the parodic texts.
“We are going to our Portuguese homeland!”
Authors: Simões Marques Isabelle , Koven Michèle
Published: June 2019

This article combines the study of online narratives as social practices and the linguistic anthropological study of imagined communities, to examine a set of non-canonical narrative practices in a Facebook group for the Portuguese diaspora in France. Instead of reports of individual members’ past experiences, these narratives function as invitations to other group members to co-tell typical, shared experiences. Specifically, we investigate how group members share vacation trips to Portugal with each other in ways that produce a sense of collective and simultaneous experience. They accomplish this through deictically-based narrative strategies that shift the social, spatial, and temporal perspectives of narrating and narrated frames in ways that link the following: individual I’s with collective we’s, one-time events with timeless event types, and co-presence online with co-presence on vacation. Through these strategies, participants connect Facebook narrations of vacations to the larger social project of diasporic longing for and return to Portugal.
Gill diseases in marine salmon aquaculture with an emphasis on amoebic gill disease.
Authors: Rozas-Serri M.
Published: June 2019

Gill diseases are a growing health challenge in salmon farming worldwide, but many gaps remain in our knowledge. Gill diseases are generally complex and multifactorial disorders, often with presumable spatial and temporal distribution patterns, but are highly difficult to effectively prevent and control. The term complex gill disease (CGD) includes a wide range of clinical disease presentations on the gills of farmed salmon; usually, CGD presents from the end of summer to early winter. The pathogens involved include
Neoparamoeba perurans
,
Tenacibaculum maritimum
, Candidatus
Piscichlamydia salmonis
, Candidatus
Branchiomonas cysticola
,
Desmozoon lepeophtherii
(syn.
Paranucleospora theridion
) and viruses, such as the Atlantic salmon paramyxovirus (ASPV) and salmon gill poxvirus (SGPV). Amoebic gill disease (AGD) is perhaps the most significant disease in terms of gill health and economic impact. AGD results in high mortality, reduced production performance and impaired fish welfare. This review summarizes and analyses CGD research, outbreaks and treatment, with a focus on AGD, as well as on knowledge gaps and avenues for future research.
The Infected Diabetic Foot: Re-evaluating the Infectious Diseases Society of America Diabetic Foot Infection Classification
Authors: Lavery Lawrence A , Ryan Easton C , Ahn Junho , Crisologo Peter A , Oz Orhan K , La Fontaine Javier , Wukich Dane K
Published: June 2019

Background

We provide evidence to revise the Infectious Diseases Society of America (IDSA) diabetic foot infection classification by adding a separate tier for osteomyelitis and evaluating if moderate and severe infection criteria improve the classification’s ability to direct therapy and determine outcomes.

Methods

We retrospectively evaluated 294 patients with moderate and severe infections. Osteomyelitis was confirmed by bone culture or histopathology. Soft tissue infection (STI) was based on negative bone culture, magnetic resonance imaging, or single-photon emission computed tomography. We stratified STI and osteomyelitis using IDSA criteria for moderate and severe infections and compared outcomes and complications.

Results

Osteomyelitis patients had greater antibiotic duration (32.5 ± 46.8 vs 63.8 ± 55.1 days; P < .01), surgery frequency (55.5% vs 99.4%; P < .01), number of surgeries (2.1 ± 1.3 vs 3.3 ± 2.3; P < .01), amputations (26.3% vs 83.4%; P < .01), reinfection (38.0% vs 56.7%; P < .01), and length of stay (14.5 ± 14.9 vs 22.6 ± 19.0 days; P < .01). There were no differences in moderate and severe STI outcomes except for infection readmissions (46.2% vs 25.0%; P = .02), and acute kidney injury (31.2% vs 50.0%; P = .03). There were no differences in moderate and severe osteomyelitis except the number of surgeries (2.8 ± 2.1 vs 4.1 ± 2.5; P < .01) and length of stay (18.6 ± 17.5 vs 28.2 ± 17.7; P < .01).

Conclusions

The IDSA classification better reflects outcomes if risk categories are stratified by STI or osteomyelitis and moderate and severe infections are not categorized separately.
Myocardial performance index by tissue Doppler echocardiography predicts adverse events in patients with atrial fibrillation
Authors: Dons Maria , Olsen Flemming Javier , de Knegt Martina Chantal , Fritz-Hansen Thomas , Mogelvang Rasmus , Alhakak Alia Saed , Jespersen Thomas , Gislason Gunnar , Biering-Sørensen Tor
Published: June 2019

Aims 

The prognostic value of myocardial performance index (MPI) has not yet been assessed in patients with atrial fibrillation (AF). The aim of this study was to evaluate the prognostic value of MPI by tissue Doppler imaging (TDI) M-mode in AF patients.

Methods and results 

Echocardiograms from 210 patients with AF during examination were analysed offline. Patients with known heart failure (HF) were excluded. Time intervals were measured using an M-mode line through the mitral valve leaflets to provide a colour diagram of the mitral leaflet movement so all time intervals could be measured from one cardiac cycle. MPI was calculated as the sum of isovolumic relaxation time and isovolumic contraction time divided by the ejection time [(IVRT+IVCT)/ET]. During a median follow-up of 2.4 years, 84 patients (40%) reached the combined endpoint of major adverse cardiovascular events (MACE), being all-cause mortality, HF, myocardial infarction, or stroke. Increasing MPI was significantly associated with an increased risk of MACE, and the risk increased with 20% per 0.1 increase in MPI [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.10–1.32; P < 0.001]. Increasing MPI was also significantly associated with a lower left ventricular ejection fraction (LVEF) (P < 0.001). Nevertheless, MPI remained an independent predictor even after adjustment for age, sex, diabetes mellitus, left atrial volume, and LVEF (HR 1.12, 95% CI 1.01–1.25; P = 0.038).

Conclusion 

Increasing MPI was significantly associated with increased risk of MACE and remained an independent predictor after multivariable adjustment. This demonstrates that the MPI obtained by TDI M-mode might be useful in assessing cardiac function in AF patients with ongoing arrhythmia during examination.
Exploring Wildfire-Prone Community Trust in Wildfire Management Agencies
Authors: Rasch Rebecca , McCaffrey Sarah
Published: June 2019

This research examines how trustworthy wildfire management agencies are perceived to be in five wildfire-prone communities. Trust was most often expressed in the context of agency abilities or competence (calculative trust), whereas distrust was framed in the context of intentions or the belief that the agency is not acting in the best interest of the community (relational trust). Five factors identified as closely tied to an individual’s trust in wildfire agencies are: communication from the agency; perceived relations among different management agencies, as well as between agencies and the public; experiences with wildfire agencies, particularly during wildfire events; experience with prescribed burns; and values or preferences for management actions. Managers hoping to build, maintain, or restore trust with communities may need to work on building a reputation of both competence and intention to act in the best interest of the community. Results indicate that level of trust in agencies varies considerably, both across and within communities, but that applied at the right scale, the wildfire community archetype framework, a method for rapidly identifying the level of adaptive capacity in wildfire-prone communities appears to be a relatively good indicator of the level of trust community members have in an agency’s abilities.
On the ancestry of woodrats
Authors: Martin Robert A , Zakrzewski Richard J
Published: June 2019

We evaluated the fossil record of extinct and extant woodrats, and generated a comprehensive phylogenetic hypothesis of woodrat origins and relationships based on these data. The galushamyinin cricetines are redefined and reclassified as a subtribe of the Neotomini, including Repomys, Miotomodon, Galushamys, Nelsonia, and a new extinct genus with two new species. The geographic distribution of Nelsonia, restricted to montane coniferous forests of western Mexico, suggests that this subtribe was mostly confined to western coniferous ecosystems or similar ecosystems at lower elevation during glacial advances. A second subtribe of the Neotomini includes a new archaic genus and species, Neotoma, Hodomys, and Xenomys. Lindsaymys, a possible neotominin from the late Clarendonian (late Miocene) of California, demonstrates an occlusal morphology consistent with ancestry for the Neotomini, but the presence of a fourth root on M1 is problematic and may preclude the known populations from filling that role. Molars identified as Neotoma sp. from the Hemphillian (latest Miocene or early Pliocene) Rancho el Ocote assemblage of Guanajuato, Mexico, may represent the earliest Xenomys. Extant Neotoma species with a bilobed m3 appear to have originated subsequent to about 2.0 Ma, whereas Hodomys alleni and Xenomys nelsoni likely originated earlier from one or more extinct ancestors with an S-shaped m3.
Mast Cell Degranulation and Fibroblast Activation in the Morphine-induced Spinal Mass
Authors: Yaksh Tony L. , Eddinger Kelly A. , Kokubu Shinichi , Wang Zhenping , DiNardo Anna , Ramachandran Roshni , Zhu Yuelian , He Yajun , Weren Fieke , Quang Daphne , Malkmus Shelle A. , Lansu Katherine , Kroeze Wesley K. , Eliceiri Brian , Steinauer Joanne J. , Schiller Peter W. , Gmeiner Peter , Page Linda M. , Hildebrand Keith R.
Published: June 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

As the meningeally derived, fibroblast-rich, mass-produced by intrathecal morphine infusion is not produced by all opiates, but reduced by mast cell stabilizers, the authors hypothesized a role for meningeal mast cell/fibroblast activation. Using the guinea pig, the authors asked: (1) Are intrathecal morphine masses blocked by opiate antagonism?; (2) Do opioid agonists not producing mast cell degranulation or fibroblast activation produce masses?; and (3) Do masses covary with Mas-related G protein-coupled receptor signaling thought to mediate mast cell degranulation?

Methods

In adult male guinea pigs (N = 66), lumbar intrathecal catheters connected to osmotic minipumps (14 days; 0.5 µl/h) were placed to deliver saline or equianalgesic concentrations of morphine sulfate (33 nmol/h), 2’,6’-dimethyl tyrosine-(Tyr-D-Arg-Phe-Lys-NH2) (abbreviated as DMT-DALDA; 10 pmol/h; μ agonist) or PZM21 (27 nmol/h; biased μ agonist). A second pump delivered subcutaneous naltrexone (25 µg/h) in some animals. After 14 to 16 days, animals were anesthetized and perfusion-fixed. Drug effects on degranulation of human cultured mast cells, mouse embryonic fibroblast activation/migration/collagen formation, and Mas-related G protein-coupled receptor activation (PRESTO-Tango assays) were determined.

Results

Intrathecal infusion of morphine, DMT-DALDA or PZM21, but not saline, comparably increased thermal thresholds for 7 days. Spinal masses proximal to catheter tip, composed of fibroblast/collagen type I (median: interquartile range, 0 to 4 scale), were produced by morphine (2.3: 2.0 to 3.5) and morphine plus naltrexone (2.5: 1.4 to 3.1), but not vehicle (1.2: 1.1 to 1.5), DMT-DALDA (1.0: 0.6 to 1.3), or PZM21 (0.5: 0.4 to 0.8). Morphine in a naloxone-insensitive fashion, but not PZM21 or DMT-DALDA, resulted in mast cell degranulation and fibroblast proliferation/collagen formation. Morphine-induced fibroblast proliferation, as mast cell degranulation, is blocked by cromolyn. Mas-related G protein-coupled receptor activation was produced by morphine and TAN67 (∂-opioid agonist), but not by PZM21, TRV130 (mu biased ligand), or DMT-DALDA.

Conclusions

Opiates that activate Mas-related G protein-coupled receptor will degranulate mast cells, activate fibroblasts, and result in intrathecal mass formation. Results suggest a mechanistically rational path forward to safer intrathecal opioid therapeutics.
Responsiveness of EQ-5D Youth version 5-level (EQ-5D-5L-Y) and 3-level (EQ-5D-3L-Y) in Patients With Idiopathic Scoliosis
Authors: Wong Carlos King Ho , Cheung Prudence Wing Hang , Luo Nan , Lin Jiaer , Cheung Jason Pui Yin
Published: June 2019

Study Design.

Prospective cohort study

Objective.

The aim of this study was to evaluate the responsiveness of EQ-5D Youth version (EQ-5D-Y) 5-level and 3-level in patients with idiopathic scoliosis

Summary of Background Data.

A new version of EQ-5D-Y increasing the number of response levels from 3 (3LY) to 5 (5LY) has been recently introduced. Although the validity and reliability of 5LY and 3LY for use in idiopathic scoliosis patients are compared, responsiveness of two questionnaires among children and adolescents is unknown.

Methods.

A total of 129 children or adolescents attending the spine clinics of a tertiary hospital in Hong Kong, China, completed 3LY and 5LY. At 3-month follow-up, 110 (85.2%) patients completed two EQ-5D-Y questionnaires, and the single-item Global Rating on Change Scale determining “worsened,”, “unchanged,”, or “improved” global health. Among those indicating “unchanged” in global health from baseline to follow-up, agreement in responses to each 3LY and 5LY item was examined. Mean changes in EQ-5D-Y scores during the past 3 months in patients with “worsened,” “unchanged,” and “improved” health were calculated.

Results.

Most patients (82.7%) reported no change in global health, whereas about 12.7% and 4.5% of them felt better and worse, respectively, compared to baseline. Among those reporting “unchanged health,” the “Looking after myself” item exhibited the largest proportion of agreement in responses (5LY: 96.36%; 3LY: 95.50%), followed by “Mobility” (5LY 90.91%; 3LY 90.99%), “Usual activities” (5LY 83.64%; 3LY 87.39%), “Pain/discomfort”(5LY 68.18%; 3LY 76.58%), and “Feeling worried/sad/unhappy” (5LY 66.36%; 3LY 72.07%). In the “improved” or “worsened” group, the 3-month follow-up 5LY and 3LY scores were higher or lower compared with baseline, respectively.

Conclusion.

The 5LY is demonstrated as responsive as the 3LY for patients with idiopathic scoliosis.

Level of Evidence: 2
The Role of Cross-Links in Posterior Spinal Fusion for Cerebral Palsy–Related Scoliosis
Authors: Usmani M. Farooq , Shah Suken A. , Yaszay Burt , Samdani Amer F. , Cahill Patrick J. , Newton Peter O. , Marks Michelle C. , Sponseller Paul D.
Published: June 2019

Study Design.

Retrospective review of a multicenter, prospective database.

Objective.

Our aim was to compare complication rates and maintenance of radiographic correction at 2 years after posterior spinal fusion (PSF) with or without cross-links in patients with cerebral palsy (CP)–related scoliosis.

Summary of Background Data.

Cross-links are frequently used in PSF to correct scoliosis in patients with CP because they are thought to increase the stiffness and torsional rigidity of the construct.

Methods.

We reviewed the records of patients with CP who underwent primary PSF with or without cross-links between August 2008 and April 2015. Inclusion criteria were minimum follow-up of 2 years, availability of complications data (implant failure, surgical site infection, revision), and pre- and postoperative measurements of the major curve (measured using the Cobb method). The 256 patients included in this analysis had a mean age of 14.1 ± 2.7 years. Ninety-four patients had cross-links (57% using one cross-link; 43% using two cross-links) and 162 patients did not have cross-links. P < 0.05 was considered statistically significant.

Results.

The two groups did not differ significantly with regard to sex, age at surgery, preoperative menarche status, Gross Motor Function Classification System level, major curve magnitude, pelvic obliquity, kyphosis, and lordosis angles. There were no significant differences between groups in the correction achieved or the maintenance of correction at 2 years for the major curve, pelvic obliquity, kyphosis, or lordosis (all P > 0.05). Complication rates were similar between the cross-link group (16%, N = 15) and the non–cross-link group (14%, N = 22).

Conclusion.

At 2 years after PSF to treat CP-related scoliosis, patients had no significant differences in the degree of correction achieved, the maintenance of correction, or the rate of complications between those whose fusion constructs used cross-links and those whose constructs did not.

Level of Evidence: 3
Drug causes of ischaemic stroke
Authors: Burrage Daniel R.
Published: June 2019

There is a wide range of drugs with the potential to cause ischaemic stroke. Whilst the absolute risk of stroke with commonly used drugs is low, a patient's background risk of stroke can increase their chance of stroke in combination with a particular drug. Careful decision-making is required when initiating and continuing treatment to ensure the risk-benefit profile of a drug is weighed appropriately on an individual patient basis.
Observation of Ground-level Enhancement Across Canada’s Fixed Point Surveillance Network During the 20 January 2005 Solar Event
Authors: Liu Chuanlei , Ungar Kurt , Zhang Weihua , Korpach Ed , Benotto Mike , Pellerin Eric
Published: June 2019

This paper presents the count rate enhancement observed across Canada’s Fixed Point Surveillance network during the solar event on 20 January 2005 and explores the feasibility and value of applying the Fixed Point Surveillance network’s long-term and continuous observations for space weather monitoring. The count rate, recorded in the high-energy channel of RS250 sodium iodide detectors, reflects the detector’s response to muonic and electromagnetic components of the cosmic ray shower. During the event peak time, simultaneous count rate increases have been observed across many Fixed Point Surveillance network stations at enhancements varying from 10% to 18%, 12- to 15-fold less than relative increases in neutron detector observations.
Sham surgeries for central and peripheral neural injuries persistently enhance pain-avoidance behavior as revealed by an operant conflict test
Authors: Odem Max A. , Lacagnina Michael J. , Katzen Stephen L. , Li Jiahe , Spence Emily A. , Grace Peter M. , Walters Edgar T.
Published: June 2019

Studies using rodent models of neuropathic pain use sham surgery control procedures that cause deep tissue damage. Sham surgeries would thus be expected to induce potentially long-lasting postsurgical pain, but little evidence for such pain has been reported. Operant tests of voluntary behavior can reveal negative motivational and cognitive aspects of pain that may provide sensitive tools for detecting pain-related alterations. In a previously described operant mechanical conflict test involving lengthy familiarization and training, rodents freely choose to either escape from a brightly lit chamber by crossing sharp probes or refuse to cross. Here, we describe a brief (2-day) mechanical conflict protocol that exploits rats' innate exploratory response to a novel environment to detect persistently enhanced pain-avoidance behavior after sham surgeries for 2 neural injury models: thoracic spinal cord injury and chronic constriction injury of the sciatic nerve. Pitting the combined motivations to avoid the bright light and to explore the novel device against pain from crossing noxious probes disclosed a conflicting, hyperalgesia-related reluctance to repeatedly cross the probes after injury. Rats receiving standard sham surgeries demonstrated enhanced pain-like avoidance behavior compared with naive controls, and this behavior was similar to that of corresponding chronic constriction injury or spinal cord injury rats weeks or months after injury. In the case of sham surgery for spinal cord injury, video analysis of voluntary exploratory behavior directed at the probes revealed enhanced forepaw withdrawal responses. These findings have important implications for preclinical investigations into behavioral alterations and physiological mechanisms associated with postsurgical and neuropathic pain.
Hepatocellular carcinoma recurrence after liver transplantation in a Brazilian multicenter study: clinical profile and prognostic factors of survival
Authors: Chagas Aline L. , Felga Guilherme E.G. , Diniz Marcio A. , Silva Renato F. , Mattos Angelo A. , Silva Rita C.M.A. , Boin Ilka F.S.F. , Garcia José H.P. , Lima Agnaldo S. , Coelho Julio C.U. , Bittencourt Paulo L. , Alves Venâncio A.F. , D’Albuquerque Luiz A.C. , Carrilho Flair J.
Published: June 2019

Background

Liver transplantation (LT) is the treatment of choice for patients with unresectable early hepatocellular carcinoma (HCC). Post-LT HCC recurrence rates range from 8 to 20% and still impact on overall survival (OS). The aim of our study was to evaluate the impact of HCC recurrence on post-LT survival and analyze prognostic factors among those patients with recurrence.

Patients and methods

We carried out a national, multicenter, retrospective cohort study in Brazil. Medical records of 1119 LT recipients with HCC were collected. Data from patients with post-LT HCC recurrence were analyzed and correlated with post-relapse survival.

Results

OS of the 1119 patients included in the study was 63% over 5 years. Post-LT HCC recurrence occurred in 86 (8%) patients. The mean time to recurrence was 12 months. Sites of recurrence were extrahepatic in 55%, hepatic in 27%, and both hepatic and extrahepatic in 18%. Recurrence treatment was performed in 50 (64%) cases, mostly with sorafenib. Post-relapse survival rates were 34% at 1 year and 13% at 5 years. Univariable analysis identified α-fetoprotein more than 1000 ng/ml at relapse, recurrence treatment, extrahepatic location, and time to recurrence more than 2 years as prognostic factors. In multivariable analysis, recurrence treatment, extrahepatic location, and time to recurrence more than 2 years were independent predictors of better survival.

Conclusion

In a large Brazilian cohort of LT recipients with HCC, post-LT HCC recurrence occurred in 8% and impacted significantly on the OS. Patients with early recurrence presented a worse prognosis. However, treatment of recurrence improved outcomes, highlighting the importance of early diagnosis.
Does Neoadjuvant Chemotherapy Change the Role of Regional Lymphadenectomy in Pancreatic Cancer Survival?
Authors: Macedo Francis Igor , Picado Omar , Hosein Peter J. , Dudeja Vikas , Franceschi Dido , Mesquita-Neto Jose Wilson , Yakoub Danny , Merchant Nipun B.
Published: June 2019

Objectives

The objective of this study was to evaluate the role of lymph node (LN) dissection and staging in outcomes of patients with pancreatic adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy (NAC).

Methods

National Cancer Database was queried for patients with stages I to III PDAC diagnosed between 2004 and 2014. Overall survival (OS) was derived from Kaplan-Meier methods, and Cox-regression model was used to evaluate associations between the number of LN examined, number of positive nodes, and LN ratio with OS.

Results

A total 35,599 patients were included, 3395 (9%) underwent NAC, 19,865 (56%) received adjuvant chemotherapy (AC), and 12,299 (35%) underwent surgery alone. Cox-regression showed superior OS in NAC compared with AC and surgery alone (26 vs 23 vs 14 months, P < 0.001). Minimum number of LN examined affecting OS was 8 LNs in NAC (23.8 vs 26.6 months, P = 0.029), and 12 LNs in AC group (22 vs 23.1 months, P = 0.028). Lymph node ratio cutoff of greater than 0.2 was associated with decreased OS (19.4 vs 24.4 months, P < 0.001).

Conclusions

Neoadjuvant chemotherapy is associated with improved survival in PDAC. Lymph node yield remains a significant prognostic factor after NAC, whereas the minimum number of harvested LNs associated with sufficient staging and survival is decreased.
Perceived Family Impact During Children’s Hospitalization for Treatment of Acute Lymphoblastic Leukemia
Authors: Lyu Qi-yuan , Wong Frances K.Y. , You Li-ming , Li Xian-wen
Published: June 2019

Background

Improved survival rates of acute lymphoblastic leukemia (ALL) in children are often associated with repeated and prolonged hospitalization, creating an immensely stressful situation for the family.

Objective

The aims of this study were to assess perceived family impact and coping during the child’s hospitalization for ALL treatment and identify potential predictors of perceived family impact.

Interventions/Methods

A total of 212 families with children hospitalized participated. The hospitalization impact and coping scales were used to assess perceived family impact and coping, respectively.

Results

The mean (SD) total score for perceived family impact was 88.11 (22.39); social impact received the highest average score. The mean (SD) total score for family coping was 39.02 (9.84). A significant decrease in family coping was associated with more readmissions. Predictors of perceived family impact were severity of the child’s illness, total days of all admissions, and coping, accounting for 37% of the observed variance.

Conclusions

Families were moderately affected by children’s hospitalizations; social functioning was most affected. Families’ perceived coping effectiveness decreased as the readmissions increased. The higher risk category a child’s diagnosis is, the longer a child’s hospitalization is, and the less perceived coping effectiveness, the higher family perceived impact.

Implications for Practice

The findings provide a direction for the development of family-centered supportive intervention programs. Nurses should be aware that the total days of admission and severity of a child’s illness are significant factors associated with perceived family impact and likely justify special attention. Family coping enhancement interventions could alleviate perceived family impact.
CLINICAL NURSE SPECIALIST PRACTICE INTERVENTIONS FOR SECOND VICTIMS OF ADVERSE PATIENT EVENTS
Authors: Bleazard Mark
Published: June 2019

Background:

Second-victim impact describes emotional suffering that occurs secondary to an adverse patient event and occurs in approximately half of all healthcare providers. Immediate intervention is needed to reduce consequences including nursing turnover, job absenteeism, repeat adverse events, professional burnout, and posttraumatic stress.

Purpose:

To provide clinical nurse specialists a summary of second-victim impact secondary to adverse patient events, a review of associated negative outcomes, and clinical nurse specialist practice recommendations.

Recommendations:

Clinical nurse specialist nursing interventions include implementation of validated screening tools, identification of healthcare providers at high risk of second-victim impact, recognition of signs of second-victim impact, facilitating supportive clinical debriefings, providing supporting dialogue, and mentorship through stages of recovery and the institutional response. Clinical nurse specialist organization/system interventions to reduce the consequences of second-victim impact include supporting a culture of safety, leading organizational improvement, as well as advocating for education and support for second victims on the national level.

Conclusions:

Clinical nurse specialists have the potential to mitigate the effects of second-victim impact associated with adverse patient events and secondary complications through use of evidence-based practice interventions.
Self-Reported History of Chlamydia or Gonorrhea Testing Among Heterosexual Women at High Risk of HIV Infection, National HIV Behavioral Surveillance, 2013
Authors: Johnson Jones Michelle L. , Kirkcaldy Robert D. , An Qian , Gorwitz Rachel , Bernstein Kyle , Paz-Bailey Gabriela
Published: June 2019

Background

The US Preventive Services Task Force recommends annual chlamydia and gonorrhea screening for sexually active women <25 and ≥25 years old with associated risk factors. We sought to determine self-reported chlamydia and gonorrhea testing and diagnosis rates in the past 12 months in a community-based sample of heterosexual women at high risk of HIV infection.

Methods

We used National HIV Behavioral Surveillance data from 2013 when surveillance was conducted in heterosexual adults with low social economic status. Our analysis was restricted to 18- to 44-year-old women who answered questions regarding chlamydia/gonorrhea testing and diagnosis in the previous 12 months. We calculated the percentage reporting testing and diagnosis. Poisson regressions with generalized estimating equations clustered on recruitment chain were used to assess factors associated with testing and diagnosis.

Results

Among 18- to 24-year-old women (n = 1017), 61.0% self-reported chlamydia testing and 57.6% gonorrhea testing in the past 12 months. Among 25- to 44-year-old women (n = 2322), 49.0% and 47.0% reported chlamydia and gonorrhea testing, respectively. Among the subset of 25- to 44-year-old women who met screening criteria, 51.2% reported chlamydia testing. Having seen a medical provider and HIV testing (past 12 months) were associated with chlamydia/gonorrhea testing in both age groups. Self-reported chlamydia (18–24 years, 21.4%; 25–44 years, 12.2%) and gonorrhea diagnoses (18–24 years, 8.4%; 25–44 years, 6.6%) were common.

Conclusions

A substantial number of eligible women may not have been screened for chlamydia/gonorrhea. Renewed efforts to facilitate screening may prevent sequelae and support disease control activities.