bluuebunny/crossref_metadata_2025 huggingface dataset:
Accurate diagnosis of degree of atypia in cholangiocarcinoma by peroral cholangioscopy‐guided probe‐based confocal endomicroscopy
Authors: Tanisaka Yuki , Ryozawa Shomei , Nonaka Kouichi
Published: November 2019

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Multimodality imaging of an aortic graft infection
Authors: Uslu Abdulkadir , Kup Ayhan , Güner Ahmet , Çelik Mehmet , Kahyaoglu Muzaffer , Güner Ezgi Gültekin , Uzun Fatih , Kahveci Gökhan
Published: November 2019

Aortic prosthetic vascular graft infections (PVGI) are rare complications of the aortic surgery, with an incidence of 0.5%‐6%. Although rare, they carry mortality rates as high as 25%‐88%. Improvement in diagnostic imaging modalities in the last two decades, together with early diagnosis, aortic PVGI associated mortality was reduced. These imaging methods include transesophageal echocardiography (TEE), computed tomography angiography (CTA), and 18F‐fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT). In this case report, we focus mainly on three imaging modalities as TEE, CTA, and 18F‐FDG PET/CT and showed their role in the assessment of aortic PVGI.
Violent outcomes in first‐episode psychosis: A clinical cohort study
Authors: Whiting Daniel , Lennox Belinda R. , Fazel Seena
Published: November 2019

Aim

Violence risk is an important part of a comprehensive clinical assessment in first‐episode psychosis. This study addresses limitations of previous violent outcome research in first‐episode psychosis, which has typically investigated selected cohorts or been restricted to violence occurring prior to service contact, with limited use of police data.

Methods

For individuals consecutively assessed by Early Intervention in Psychosis (EIP) services in two UK regions (n = 177), violent outcomes in the subsequent 12‐months were collected using electronic patient records, supplemented by police data.

Results

Of individuals accepted by EIP services (n = 109), electronic medical records indicated around 1 in 4 (n = 28, 25.7%) perpetrated any physical violence, and 1 in 10 (n = 10, 9.2%) were arrested or charged for violent offences in the 12‐months after first contact. Police data on all individuals assessed (n = 177) reported 1 in 7 (n = 26, 14.7%) were arrested or charged for violent offences in the 12‐months after first contact.

Conclusions

EIP services should consider integrating multi‐agency sources of data to evaluate violent outcomes. The potential role of violence risk management should be further examined.
Efficacy of a brief mindfulness intervention upon anxiety in early psychosis patients
Authors: Ernst Alycia F. , D'Mello Dale
Published: November 2019

Aim

To examine the efficacy of a brief mindfulness intervention in reducing anxiety in early psychosis patients, and to determine whether symptom burden mitigates therapeutic response.

Methods

Our study included patients who had experienced an initial episode of psychosis, with less than 30 months of antipsychotic exposure. First, the prescriber completed the COMPASS Clinician Rating Form (measuring symptom burden), and patients completed the POMS questionnaire (measuring anxiety). A 3‐minute mindfulness exercise was administered, and patients again completed the POMS scale. The differences between the pre‐ and postintervention anxiety scores were analysed using a paired t test.

Results

A total of 20 subjects participated. The mean Anxiety Subscale of the POMS scores decreased from 4.6 to 1.7. The change was statistically significant, and not influenced by symptom burden.

Conclusions

A brief mindfulness exercise, conducted in a routine office visit, produced a significant reduction in state anxiety for early psychosis patients, regardless of symptom burden.
Inhibition of PLK1 by capped‐dose volasertib exerts substantial efficacy in MDS and sAML while sparing healthy haematopoiesis
Authors: Dill Veronika , Kauschinger Johanna , Hauch Richard T. , Buschhorn Lars , Odinius Timo O. , Müller‐Thomas Catharina , Mishra Ritu , Kyncl Michele C. , Schmidt Burkhard , Prodinger Peter M. , Hempel Dirk , Bellos Frauke , Höllein Alexander , Kern Wolfgang , Haferlach Torsten , Slotta‐Huspenina Julia , Bassermann Florian , Peschel Christian , Götze Katharina S. , Waizenegger Irene C. , Höckendorf Ulrike , Jost Philipp J. , Jilg Stefanie
Published: November 2019

Introduction

Targeting the cell cycle machinery represents a rational therapeutic approach in myelodysplastic syndromes (MDS) and secondary acute myeloid leukemia (sAML). Despite substantial response rates, clinical use of the PLK inhibitor volasertib has been hampered by elevated side effects such as neutropenia and infections.

Objectives

The primary objective was to analyse whether a reduced dose of volasertib was able to limit toxic effects on the healthy haematopoiesis while retaining its therapeutic effect.

Methods

Bone marrow mononuclear cells (BMMNCs) of patients with MDS/sAML (n = 73) and healthy controls (n = 28) were treated with volasertib (1 μM to 1 nM) or vehicle control. Short‐term viability analysis was performed by flow cytometry after 72 hours. For long‐term viability analysis, colony‐forming capacity was assessed after 14 days. Protein expression of RIPK3 and MCL‐1 was quantified via flow cytometry.

Results

Reduced dose levels of volasertib retained high cell death‐inducing efficacy in primary human stem and progenitor cells of MDS/sAML patients without affecting healthy haematopoiesis in vitro. Interestingly, volasertib reduced colony‐forming capacity and cell survival independent of clinical stage or mutational status.

Conclusions

Volasertib offers a promising therapeutic approach in patients with adverse prognostic profile. RIPK3 and MCL‐1 might be potential biomarkers for sensitivity to volasertib treatment.
Spinning strands into aspects: Realism, idealism, and finite modes in Spinoza
Authors: Shein Noa
Published: November 2019

There is a long tradition of reading Spinoza as committed, perhaps unwillingly, to the non‐reality of finite modes. While acknowledging that Spinoza does seem to rely on the reality of modes in certain places, Michael Della Rocca has called attention to what he labels an “idealist strand.” As a concluding remark in “Steps Toward Eleaticism in Spinoza's Philosophy of Action,” he claims that faced with these two conflicting strands, which are genuinely to be found in the text, it is better to note both rather than artificially imposing a unity on the text. In this paper, I suggest that one need not admit two conflicting strands in Spinoza, on the one hand, nor arbitrarily disregard one strand, on the other. Rather, I argue for a unified view that diagnoses what gives rise to both seemingly conflicting strands. The key to this enterprise is recognizing that finite modes, paradoxically seeming perhaps at first, are not wholly finite. That is, a finite mode is determined by the totality of finite modes—wherein lies its finite aspect, but at the same time, and equally, partially actively determines this totality—wherein lies its infinite aspect.
Ecological effects of non‐native species in marine ecosystems relate to co‐occurring anthropogenic pressures
Authors: Geraldi Nathan R. , Anton Andrea , Santana‐Garcon Julia , Bennett Scott , Marbà Nuria , Lovelock Catherine E. , Apostolaki Eugenia T. , Cebrian Just , Krause‐Jensen Dorte , Martinetto Paulina , Pandolfi John M. , Duarte Carlos M.
Published: November 2019

Predictors for the ecological effects of non‐native species are lacking, even though such knowledge is fundamental to manage non‐native species and mitigate their impacts. Current theories suggest that the ecological effects of non‐native species may be related to other concomitant anthropogenic stressors, but this has not been tested at a global scale. We combine an exhaustive meta‐analysis of the ecological effects of marine non‐native species with human footprint proxies to determine whether the ecological changes due to non‐native species are modulated by co‐occurring anthropogenic impacts. We found that non‐native species had greater negative effects on native biodiversity where human population was high and caused reductions in individual performance where cumulative human impacts were large. On this basis we identified several marine ecoregions where non‐native species may have the greatest ecological effects, including areas in the Mediterranean Sea and along the northwest coast of the United States. In conclusion, our global assessment suggests coexisting anthropogenic impacts can intensify the ecological effects of non‐native species.
What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial
Authors: Skains Rachel M. , Kuppermann Nathan , Homme James L. , Kharbanda Anupam B. , Tzimenatos Leah , Louie Jeffrey P. , Cohen Daniel M. , Nigrovic Lise E. , Westphal Jessica J. , Shah Nilay D. , Inselman Jonathan , Ferrara Michael J. , Herrin Jeph , Montori Victor M. , Hess Erik P.
Published: November 2019

Objective

To test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust.

Methods

This was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy‐two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site.

Results

The decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint] = 0.14) or physician trust more in parents with low health literacy (Pint = 0.34). The decision aid decreased decisional conflict more in non‐white parents (decisional conflict scale, −8.14, 95% CI: −12.33 to −3.95; Pint = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35‐14.83; Pint = 0.04).

Conclusions

Use of the Head CT Choice decision aid resulted in less decisional conflict in non‐white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents.
Ballistic evaluation and damage characterization of 3‐D printed, alumina‐based ceramics for light armor applications
Authors: Jones Tyrone L. , Vargas‐Gonzalez Lionel R. , Scott Brian , Goodman Bill , Becker Benjamin
Published: November 2019

The goal of this work was to present results of mechanical characterization and ballistic investigation of 3‐D printed alumina (Al2O3)‐based armor plates, manufactured using two additive manufacturing‐based methods: pressurized spray deposition (PSD) and direct ink write (DIW), to determine the maturity of these additive‐based processes against the industry standard process. The DIW plates exhibited superior hardness, flexural strength, and density compared to the PSD plates, and in many respects, even eclipsed some of the properties of the commercial isopressed (IP) material. Plates (90 mm × 90 mm × 8 mm) of these composition were manufactured for ballistic analysis in accordance with established ballistic characterization procedures, using a 50.8‐mm‐thick Aluminum 6061 plate as backing and witness plates in the case of penetration or deformation. Six alumina plates were examined ballisitically (one shot per plate) against the 12.7 mm APM2 projectile (45.9 g) at an impact velocity of 840 m/second. The plates that were manufactured using the DIW method provided a higher impact resistance than the PSD method, however, both did not perform as well as the traditionally processed IP material, due to the presence of defects introduced due to the printing processes.
Inactivation of bacterial endospores on surfaces by plasma processed air
Authors: Kramer B. , Hasse D. , Guist S. , Schmitt-John T. , Muranyi P.
Published: November 2019

Aims

In case of biological hazards and pandemics, personal protective equipment of rescue forces is currently manually decontaminated with harmful disinfectants, primarily peracetic acid. To overcome current drawbacks regarding supply, handling and disposal of chemicals, the use of plasma processed air (PPA) represents a promising alternative for surface decontamination on site. In this study, the sporicidal efficiency of a portable plasma system, designed for field applications, was evaluated.

Methods and Results

The developed plasma device is based on a dielectric barrier discharge (DBD) and operated with ambient air as process gas. PPA from the plasma nozzle was flushed into a treatment chamber (volume: 300 l) and bacterial endospores (Bacillus subtilis and Bacillus atrophaeus) dried on different surfaces were treated under variable conditions. Reductions in spores by more than 4 log10 were found within 3 min of PPA exposure. However, the presence of endospores in agglomerates or in an organic matrix as well as the complexity of the respective surface microstructure negatively affected the inactivation efficiency. When endospores were embedded in a dried protein matrix, mechanical wiping with swabs during exposure to PPA increased the inactivation effect significantly. Gaseous ozone alone did not provide a sporicidal effect. Significant spore inactivation was only obtained when water vapour was injected into the PPA stream.

Conclusion

The results show that endospores dried on surfaces can be reduced by several orders of magnitude within few minutes in a treatment chamber which is flushed with PPA from of a DBD plasma nozzle.

Significance and Impact of the Study

Plasma processed air generated on site by DBD plasma nozzles could be a suitable alternative for the disinfection of various surfaces in closed rooms.
Production of bioactive recombinant human myeloid‐derived growth factor in Escherichia coli and its mechanism on vascular endothelial cell proliferation
Authors: Zhao Longwei , Feng Shuang , Wang Shen , Fan Miaojuan , Jin Wei , Li Xianjing , Wang Chen , Yang Yong
Published: November 2019

Myeloid‐derived growth factor (MYDGF) is a novel protein secreted by bone marrow cells that features important physiological functions. In recent years, MYDGF has gained considerable interest due to their extensive beneficial effect on cardiac repair and protects cardiomyocytes from cell death. However, its precise molecular mechanisms have not been well elucidated. The purpose of this study was to produce sufficient amount of biologically active recombinant human (rh) MYDGF more economically and effectively by using in vitro molecular cloning techniques to study its clinical application. The prokaryotic expression system of Escherichia coli was established for the preparation of rhMYDGF. Finally, a large amount of high biologically active and purified form of recombinant protein was obtained. Moreover, we investigated the potential mechanism of rhMYDGF‐mediated proliferation and survival in human coronary artery endothelial cells (HCAECs). Mechanistically, the results suggested that MAPK/STAT3 and the cyclin D1 signalling pathways are indispensable for rhMYDGF‐mediated HCAEC proliferation and survival. Therefore, this study successfully established a preparation protocol for biologically active rhMYDGF and it may be a most economical way to produce high‐quality active rhMYDGF for future clinical application.
CD8+ T cells exhaustion induced by myeloid‐derived suppressor cells in myelodysplastic syndromes patients might be through TIM3/Gal‐9 pathway
Authors: Tao Jinglian , Han Dong , Gao Shan , Zhang Wei , Yu Hong , Liu Pei , Fu Rong , Li Lijuan , Shao Zonghong
Published: November 2019

CD8+ T cells play a central role in antitumour immunity, which often exhibit ‘exhaustion’ in the setting of malignancy and chronic viral infection due to T cell immunoglobulin and mucin domain 3 (TIM3) and myeloid‐derived suppressor cells (MDSCs). Our team previously found that overactive MDSCs and exhausted TIM3+CD8+ T cells were observed in myelodysplastic syndromes (MDS) patients. However, it is not obvious whether MDSCs suppress CD8+ T cells through TIM3/Gal‐9 pathway. Here, Gal‐9, as the ligand of TIM3, was overexpressed in MDSCs. The levels of Gal‐9 in bone marrow supernatants, serum and culture supernatants of MDSCs from MDS patients were elevated. CD8+ T cells from MDS or normal controls produced less perforin and granzyme B and exhibited increased early apoptosis after co‐culture with MDSCs from MDS. Meanwhile, the cytokines produced by CD8+ T cells could be partially restored by TIM3/Gal‐9 pathway inhibitors. Furthermore, CD8+ T cells produced less perforin and granzyme B after co‐culture with excess exogenous Gal‐9, and the function of CD8+ T cells was similarly restored by TIM3/Gal‐9 pathway inhibitors. Expression of Notch1, EOMES (associated with perforin and granzyme B secretion), p‐mTOR and p‐AKT (associated with cell proliferation) was decreased in CD8+ T cells from MDS after co‐culture with excess exogenous Gal‐9. These suggested that MDSCs might be the donor of Gal‐9, and TIM3/Gal‐9 pathway might be involved in CD8+ T cells exhaustion in MDS, and that TIM3/Gal‐9 pathway inhibitor might be the promising candidate for target therapy of MDS in the future.
Opportunistic invasive fungal disease in patients with type 2 diabetes mellitus from Southern China: Clinical features and associated factors
Authors: Lao Minxi , Li Chen , Li Jin , Chen Dubo , Ding Meilin , Gong Yingying
Published: November 2019

Aims/Introduction

A retrospective study was carried out to investigate the clinical characteristics and associated factors for invasive fungal disease in patients with type 2 diabetes mellitus.

Materials and Methods

Demographic and clinical data were recorded. Associated factors were analyzed by logistic regression analysis.

Results

Invasive fungal disease was diagnosed in 120 patients with type 2 diabetes mellitus (prevalence, 0.4%). Yeast infection (56/120, 46.7%), including candidiasis (31/56, 55.4%) and cryptococcosis (25/56, 44.6%), was the most common. The urinary tract was mainly involved in candidiasis (12/31, 38.7%). More than half of the cryptococcosis (16/25, 64.0%) presented as pneumonia. Mold infection accounted for 40.8% of the cases, and predominantly involved the lung (34/49, 69.4%). A total of 15 (12.5%) patients had mixed fungal infection. Candida albicans (24/111, 21.6%), Cryptococcus neoformans (19/111, 17.1%) and Aspergillus fumigatus (14/111, 12.6%) were the leading agents. Co‐infection occurred in 58 (48.3%) patients, mainly presenting as pneumonia caused by Gram‐negative bacteria. The inpatient mortality rate of invasive fungal disease was 23.3% (28/120). Glycated hemoglobin levels were higher in non‐survivors than survivors (8.8 ± 2.5 vs 7.7 ± 2.1%, P = 0.02). Anemia (adjusted odds ratio, 3.50, 95% confidence interval 1.95–6.27, P < 0.001), hypoalbuminemia (adjusted odds ratio, 5.42, 95% confidence interval 3.14–9.36, P < 0.001) and elevated serum creatinine (adjusted odds ratio, 2.08, 95% confidence interval 1.07–4.04, P = 0.03) were associated with invasive fungal disease in type 2 diabetes mellitus patients.

Conclusions

Invasive fungal disease is a life‐threatening complication in type 2 diabetes mellitus patients. C. a albicans, C. neoformans, and A. fumigatus are the leading agents. Prolonged hyperglycemia results in unfavorable outcomes. Correction of anemia and hypoalbuminemia might improve prognosis.
No evidence that Y‐chromosome differentiation affects male fitness in a Swiss population of common frogs
Authors: Veltsos Paris , Rodrigues Nicolas , Studer Tania , Ma Wen‐Juan , Sermier Roberto , Leuenberger Julien , Perrin Nicolas
Published: November 2019

The canonical model of sex‐chromosome evolution assigns a key role to sexually antagonistic (SA) genes on the arrest of recombination and ensuing degeneration of Y chromosomes. This assumption cannot be tested in organisms with highly differentiated sex chromosomes, such as mammals or birds, owing to the lack of polymorphism. Fixation of SA alleles, furthermore, might be the consequence rather than the cause of recombination arrest. Here we focus on a population of common frogs (Rana temporaria) where XY males with genetically differentiated Y chromosomes (nonrecombinant Y haplotypes) coexist with both XY° males with proto‐Y chromosomes (only differentiated from X chromosomes in the immediate vicinity of the candidate sex‐determining locus Dmrt1) and XX males with undifferentiated sex chromosomes (genetically identical to XX females). Our study finds no effect of sex‐chromosome differentiation on male phenotype, mating success or fathering success. Our conclusions rejoin genomic studies that found no differences in gene expression between XY, XY° and XX males. Sexual dimorphism in common frogs might result more from the differential expression of autosomal genes than from sex‐linked SA genes. Among‐male variance in sex‐chromosome differentiation seems better explained by a polymorphism in the penetrance of alleles at the sex locus, resulting in variable levels of sex reversal (and thus of X‐Y recombination in XY females), independent of sex‐linked SA genes.
Psychometric properties of the SCREESCO questionnaire used in a colorectal cancer screening programme—A Rasch analysis
Authors: Jervaeus Anna , Fritzell Kaisa , Hultcrantz Rolf , Wengström Yvonne , Kottorp Anders
Published: November 2019

Introduction

Colorectal cancer (CRC) is one of the most common cancer diagnoses among both sexes. Sweden has not yet implemented any CRC screening programme, but a study, Screening of Swedish Colons (SCREESCO), is ongoing. The movement within the health care sector towards a more participatory perspective has led to the increased importance of shared decision making (SDM), and this is suggestively applied when deciding upon screening participation. There is no Swedish questionnaire for assessing the level of SDM in relation to CRC screening. Therefore, the CRC screening module of the National Survey of Medical Decisions was translated and culturally adapted into a Swedish context: the SCREESCO questionnaire.

Aim

The SCREESCO questionnaire requires further evaluation, and therefore, the aim, by using the Rasch approach, was to evaluate the psychometric properties of the SCREESCO questionnaire.

Methods

A Rasch partial credit model was chosen to investigate the psychometric properties. The sample consisted of individuals invited to the SCREESCO programme, who have answered the SCREESCO questionnaire.

Results

Rating scale structures indicated stability for the response structure used. Satisfactory evidence for validity of internal structure was also shown for the whole questionnaire and two of three concepts/subscales, after deletion of a few items. Validity in response processes indicated acceptable, or close to acceptable, findings, while the results for unidimensionality and differential item functioning (DIF) were somewhat mixed. Separation index revealed less satisfactory results, both for the whole questionnaire and the concepts/subscales.

Conclusion

This Rasch analysis of the SCREESCO questionnaire revealed that the questionnaire in its current form has difficulties to assess the level of SDM in relation to CRC screening. The achieved results will guide further evaluation and development with the long‐term goal of having a Swedish questionnaire, to be used in the health care sector, assessing the level of SDM in relation to CRC screening.
One‐step fiber post cementation and core build‐up in endodontically treated tooth: A clinical case report
Authors: Reis José Mauricio dos Santos Nunes , Oliveira Carlos R. de Moura , Reis Erica G. J. , Mascaro Bruno A. , Abi‐Rached Filipe de Oliveira
Published: November 2019

Objective

This clinical case report addresses the step‐by‐step of the application of a core‐and‐post system that uses a single resin composite material to fiber post cementation and core build‐up in a maxillary left central incisor.

Clinical considerations

The literature reports several materials and methods for the restoration of endodontically treated teeth with coronal destruction that require an intra‐radicular fiber post for the core build‐up. The present case report describes a core‐and‐post or “monoblock” technique. A dual resin composite (Core‐X Flow; Dentsply DeTrey) highly filled material and cement was used for luting the fiber post (Blue X‐Post) and build‐up the core structure in an easy application.

Conclusions

The “core‐and‐post” technique that uses a single material system protocol minimizes the material interfaces, steps of procedures, and chair‐time in comparison to conventional techniques.

Clinical Significance

The use of different materials for post cementation and core build‐up requires more steps, which increases the chair‐time and number of interfaces among the materials. Since the “monoblock” technique uses only one material, it can streamline the clinical procedures, thus, saving time and materials. Moreover, techniques based on core‐and‐post systems are easily applied, versatile, and esthetics, and can be applicable to posterior and anterior teeth.
Long‐term outcomes of thalidomide in pediatric Crohn's disease
Authors: Wang Lin , Xue Aijuan , Zheng Cuifang , Zhou Ying , Wang Yuhuan , Huang Ying
Published: November 2019

Background and Aim

In this largest pediatric cohort to date in Asian population, we aimed to report our long‐term real‐life experience with thalidomide treatment in pediatric Crohn's disease (CD).

Methods

A retrospective single‐center analysis of pediatric CD patients treated by thalidomide was conducted. The clinical characteristics and outcomes were extracted. Primary outcomes were clinical response and remission rate at different time points, especially comparing the difference between monogenic and non‐monogenic mutation patients. We also evaluated the long‐term safety of thalidomide.

Results

A total of 62 patients met the inclusion criteria. The median follow‐up period was 30.5 months. Among all, 19 patients (30.6%) were diagnosed with monogenic mutation during treatment. Clinical remission rate was 53.2% (33/62) at 6 months, 54.8% (34/62) at 12 months, and 33.9% (21/62) at the end of follow‐up. Clinical remission rates between non‐monogenic and monogenic groups at the end were statistically different (44.2% [19/43] vs 10.5% [2/19], P < 0.05). At 12 months, 66.7% (30/45) were with normalized C‐reactive protein level. Most patients (95.4%, 21/22) discontinued steroids with a median time of 4.4 months. Twelve patients relapsed, but no risk factor was identified to be significantly associated with relapse. A total of 45.2% (28/62) patients experienced an adverse event, in which 22 patients stopped thalidomide due to safety concern. Cumulative dose was not associated with abnormal electromyography but with the occurrence of adverse events.

Conclusions

Thalidomide was clinically efficacious and safe among pediatric CD. Our results suggest that it is an alternative therapy in monogenic mutation patients.
Progression of pancreatic cystic lesions without any risk features is associated with initial cyst size and obesity
Authors: Park Hye Won , Lee Jong Soo , Park Seo Young , Kim Tae Hyup , Lee Ji Young , Koo Ja Eun , Bae Suh Eun , Choe Jaewon , Chang Hye‐Sook , Park Do Hyun , Bae Inyoung , Park Sungwon
Published: November 2019

Background and Aim

The clinical significance of incidental pancreatic cystic lesions (PCLs) remains unclear in those that are not accompanied by worrisome features or high‐risk stigmata. We aimed to investigate the natural course of PCLs without any risk features and examine the clinical factors associated with their progression.

Methods

We conducted a retrospective cohort study of 427 patients with PCLs, which were incidentally detected by computed tomography between January 2003 and December 2012. Progression of PCLs without any risk features and the clinical factors associated with their progression were investigated. The length of time to significant growth was also evaluated.

Results

Ninety‐four (22.0%) of the 427 patients had asymptomatic PCLs that showed significant growth after a median surveillance period of 5.3 years; approximately 27.7% of the patients showed significant size changes in the first 5 years, while the remaining 72.3% showed significant changes after 5 years. The cumulative rate of patients with significant growth was associated with initial cyst size and high body mass index. In the growth group, additional treatments were required for 12 patients, one of whom developed malignancy. Four patients in the stable group underwent additional treatment and showed no malignant change.

Conclusions

One‐fifth of the asymptomatic PCLs significantly increased in size after a long‐term follow‐up period, which was associated with initial cyst size and obesity. The size of PCLs mostly increased after 5 years; although the malignancy risk of PCLs was low, it was still a concern.
Automatic detection of blood content in capsule endoscopy images based on a deep convolutional neural network
Authors: Aoki Tomonori , Yamada Atsuo , Kato Yusuke , Saito Hiroaki , Tsuboi Akiyoshi , Nakada Ayako , Niikura Ryota , Fujishiro Mitsuhiro , Oka Shiro , Ishihara Soichiro , Matsuda Tomoki , Nakahori Masato , Tanaka Shinji , Koike Kazuhiko , Tada Tomohiro
Published: November 2019

Background and Aim

Detecting blood content in the gastrointestinal tract is one of the crucial applications of capsule endoscopy (CE). The suspected blood indicator (SBI) is a conventional tool used to automatically tag images depicting possible bleeding in the reading system. We aim to develop a deep learning‐based system to detect blood content in images and compare its performance with that of the SBI.

Methods

We trained a deep convolutional neural network (CNN) system, using 27 847 CE images (6503 images depicting blood content from 29 patients and 21 344 images of normal mucosa from 12 patients). We assessed its performance by calculating the area under the receiver operating characteristic curve (ROC‐AUC) and its sensitivity, specificity, and accuracy, using an independent test set of 10 208 small‐bowel images (208 images depicting blood content and 10 000 images of normal mucosa). The performance of the CNN was compared with that of the SBI, in individual image analysis, using the same test set.

Results

The AUC for the detection of blood content was 0.9998. The sensitivity, specificity, and accuracy of the CNN were 96.63%, 99.96%, and 99.89%, respectively, at a cut‐off value of 0.5 for the probability score, which were significantly higher than those of the SBI (76.92%, 99.82%, and 99.35%, respectively). The trained CNN required 250 s to evaluate 10 208 test images.

Conclusions

We developed and tested the CNN‐based detection system for blood content in CE images. This system has the potential to outperform the SBI system, and the patient‐level analyses on larger studies are required.
Sequential Helicobacter pylori eradication therapy in Myanmar; a randomized clinical trial of efficacy and tolerability
Authors: Myint Nan Phyu Sin Toe , Zaw Thet Tun , Sain Kyauk , Waiyan Soe , Danta Mark , Cooper David , Aung Ne Myo , Kyi Mar Mar , Hanson Josh
Published: November 2019

Background and Aim

There is little published research to examine the best approach to the management of Helicobacter pylori in Myanmar. This study aimed to determine the relative efficacy and tolerability of sequential eradication therapy compared to Myanmar's current recommendation of a concomitant four drug regimen.

Methods

Patients were screened for H. pylori using monoclonal Stool Antigen Testing (SAT). Those testing positive were randomized 1:1 to receive receive Myanmar's first‐line regimen of 14 days of concomitant rabeprazole, clarithromycin, amoxycillin and tinidazole (140 pills, cost US$23) or 10 days of sequential rabeprazole, clarithromycin, amoxycillin and tinidazole (60 pills, cost US$10). Adherence and adverse effects were recorded, and the efficacy of the regimens assessed with repeat SAT.

Results

Of the 1011 patients screened for H. pylori infection, 313 (31%) tested positive. There was no statistical difference in the cure rates of the two regimens in either intention‐to‐treat: 128/157 (82%; 95% confidence interval (CI): 75–87%) receiving sequential therapy versus 123/156 (79%; 95% CI: 72–85%) receiving concomitant therapy (P = 0.55) or per‐protocol analysis: 125/131 (95%; 95% CI: 90–98) receiving sequential therapy versus 121/130 (93%; 95% CI: 87–96) receiving concomitant therapy (P = 0.42). Side effects of therapy were reported in 54/157 (47%) patients taking sequential therapy compared with 62/156 (53%) taking concomitant therapy, but this difference did not reach statistical significance (P = 0.33).

Conclusions

In this high‐burden, resource‐poor setting, less expensive sequential therapy was as effective and as well tolerated as the currently recommended concomitant four drug regimen for eradication of H. pylori.
Metabolic fingerprints discriminating severity of acute ischemia using in vivo high‐field 1H magnetic resonance spectroscopy
Authors: Lepore Mario G. , Buscemi Lara , Hirt Lorenz , Lei Hongxia
Published: November 2019

Despite the improving imaging techniques, it remains challenging to produce magnetic resonance (MR) imaging fingerprints depicting severity of acute ischemia. The aim of this study was to evaluate the potential of the overall high‐field 1H MR Spectroscopy (1H‐MRS) neurochemical profile as a metabolic signature for acute ischemia severity in rodent brains. We modeled global ischemia with one‐stage 4‐vessel‐occlusion (4VO) in rats. Vascular structures were assessed immediately by magnetic resonance angiography. The neurochemical responses in the bilateral cortex were measured 1 h after stroke onset by 1H‐MRS. Then we used Partial‐Least‐Squares discriminant analysis on the overall neurochemical profiles to seek metabolic signatures for ischemic severity subgroups. This approach was further tested on neurochemical profiles of mouse striatum 1 h after permanent middle cerebral artery occlusion, where vascular blood flow was monitored by laser Doppler. Magnetic resonance angiography identified successful 4VO from controls and incomplete global ischemia (e.g., 3VO). 1H‐MR spectra of rat cortex after 4VO showed a specific metabolic pattern, distinct from that of respective controls and rats with 3VO. Partial‐Least‐Squares discriminant analysis on the overall neurochemical profiles revealed metabolic signatures of acute ischemia that may be extended to mice after permanent middle cerebral artery occlusion. Fingerprinting severity of acute ischemia using neurochemical information may improve MR diagnosis in stroke patients.

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Nucleus accumbens volume is related to obesity measures in an age‐dependent fashion
Authors: García‐García Isabel , Morys Filip , Dagher Alain
Published: November 2019

Motivation theories of obesity suggest that one of the brain mechanisms underlying pathological eating and weight gain is the dysregulation of dopaminergic circuits. Although these dysregulations likely occur at the microscopic level, studies on grey matter volume report macroscopic differences associated with obesity. One region suggested to play a key role in the pathophysiology of obesity is the nucleus accumbens (NAcc). We performed a meta‐analysis of findings regarding NAcc volume and overweight/obesity. We additionally examined whether grey matter volume in the NAcc and other mesolimbic areas depends on the longitudinal trajectory of obesity, using the UK Biobank dataset. To this end, we analysed the data using a latent growth model, which identifies whether a certain variable of interest (eg, NAcc volume) is related to another variable's (body mass index [BMI]) initial values or longitudinal trajectories. Our meta‐analysis showed that, overall, NAcc volume is positively related to BMI. However, further analyses revealed that the relationship between NAcc volume and BMI is dependent on age. For younger individuals, such a relationship is positive, whereas, for older adults, it is negative. This was corroborated by our analysis in the UK Biobank dataset, which includes older adults, where we found that a higher BMI was associated with a lower NAcc and thalamus volume. Overall, the present study suggests that increased NAcc volume at a young age might be a vulnerability factor for obesity, whereas, at an older age, decreased NAcc volume with increased BMI might be an effect of prolonged influences of neuroinflammation on the brain.
Emotional Labor Strategies, Stress, and Burnout Among Hospital Nurses: A Path Analysis
Authors: Kim Ji‐Soo
Published: November 2019

Purpose

This study aimed to examine the associations among emotional labor strategies, stress from emotional labor, and burnout in nurses.

Design

We employed a descriptive cross‐sectional design. Data were collected from May to November 2018 in South Korea using structured questionnaires. Participants were 303 nurses from 27 hospitals, who were recruited by convenience sampling.

Methods

Emotional labor strategies (surface acting, deep acting, and expression of naturally felt emotions), stress, and burnout were self‐reported. A path analysis using structural equation modeling was performed to examine the associations among the study variables.

Findings

Bivariate analyses revealed that surface acting was positively correlated with stress and burnout, deep acting was negatively correlated with burnout, and naturally felt emotions were negatively correlated with stress and burnout. The path analysis revealed that surface acting was positively associated with stress, naturally felt emotions were negatively associated with burnout, and the stress from emotional labor was positively associated with burnout. Although surface acting was not directly associated with burnout, it was indirectly associated through stress.

Conclusions

Surface acting involves regulation and suppression of one’s felt emotions. The findings of this study suggest that hospitals need to reduce expectations for surface acting to reduce nurses’ stress and burnout. Organizational efforts to provide interventions that improve nurses’ ability to manage their emotions in interactions with patients might effectively foster nurses’ well‐being.

Clinical Relevance

Surface acting might contribute to nurses’ burnout, and naturally felt emotions might reduce nurses’ burnout. Nurse managers should thus provide opportunities to discuss the utilized emotional labor strategies and encourage appropriate responses depending on the patient context. Programs that promote emotional competence may reduce the adverse effects associated with nurses’ emotional labor and foster effective coping strategies.
Optimal social security claiming behavior under lump sum incentives: Theory and evidence
Authors: Maurer Raimond , Mitchell Olivia S. , Rogalla Ralph , Schimetschek Tatjana
Published: November 2019

Many Americans claim Social Security benefits early, though this leaves them with lower monthly payments throughout retirement. We build a lifecycle model that closely tracks claiming patterns under current rules, and we use it to predict claiming delays if, by delaying benefits, people were to receive a lump sum instead of an annuity. We predict that current early claimers would defer claiming by a year given actuarially fair lump sums, and the predictions conform with respondents' answers to a strategic survey about the lump sum. In other words, such a reform could provide an avenue for encouraging delayed retirement without benefit cuts or tax increases. Moreover, many people would still defer claiming even for smaller lump sums.
Immigration and the pursuit of amenities
Authors: Albouy David , Cho Heepyung , Shappo Mariya
Published: November 2019

Immigrants to the United States live disproportionately in metropolitan areas where nominal wages are high, but real wages are low. This sorting behavior may be due to preferences toward certain quality‐of‐life amenities. Relative to U.S.‐born inter‐state migrants, immigrants accept lower real wages to locate in cities that are coastal, larger, and offer deeper immigrant networks. They sort toward cities that are hillier and also larger and networked. Immigrants come more from coastal, cloudy, and safer countries—conditional on income and distance. They choose cities that resemble their origin in terms of winter temperature, safety, and coastal proximity.
Application of health behaviour theory to sleep health improvement
Authors: Mead Michael P. , Irish Leah A.
Published: November 2019

Although sleep hygiene is often used for broad sleep health promotion efforts, sleep hygiene education programmes are largely ineffective. These programmes are limited by their lack of a theoretical foundation. Health behaviour theory (HBT) has been used for decades to successfully predict and modify many health behaviours, but its use in the study of sleep health is rare. The purpose of this review is threefold. First, four dominant HBTs will be introduced. Second, the brief literature on HBT and sleep health will be reviewed. Lastly, a translational research agenda will be proposed. The present review concludes that HBT shows potential in both the prediction and modification of sleep health, and that there are several short‐ and long‐ term research goals to advance these efforts.
Review of cobalamin status and disorders of cobalamin metabolism in dogs
Authors: Kather Stefanie , Grützner Niels , Kook Peter H. , Dengler Franziska , Heilmann Romy M.
Published: November 2019

Disorders of cobalamin (vitamin B12) metabolism are increasingly recognized in small animal medicine and have a variety of causes ranging from chronic gastrointestinal disease to hereditary defects in cobalamin metabolism. Measurement of serum cobalamin concentration, often in combination with serum folate concentration, is routinely performed as a diagnostic test in clinical practice. While the detection of hypocobalaminemia has therapeutic implications, interpretation of cobalamin status in dogs can be challenging. The aim of this review is to define hypocobalaminemia and cobalamin deficiency, normocobalaminemia, and hypercobalaminemia in dogs, describe known cobalamin deficiency states, breed predispositions in dogs, discuss the different biomarkers of importance for evaluating cobalamin status in dogs, and discuss the management of dogs with hypocobalaminemia.
Caution at choosing a particular colony-forming unit from faecal Escherichia coli: it may not represent the sample profile
Authors: Maciel J.F. , Gressler L.T. , da Silveira B.P. , Dotto E. , Balzan C. , Matter L.B. , Siqueira F.M. , de Vargas A.P.C.
Published: November 2019

Data about phylogenetic classification of Escherichia coli colonizing calves, lambs and foals are routinely neglected and restricted to outdated methodologies, even in the context of antimicrobial susceptibility (AS) testing. Thus, the aim of this study was to determine the phylogenetic diversity and the AS profile of E. coli colony-forming units (CFUs) from faecal samples of healthy animals. Five CFUs of E. coli were randomly selected from each faecal culture of calves (n = 13), foals (n = 13) and lambs (n = 13), totalizing 195 CFUs phylo-typed by quadruplex PCR. The AS profile of five CFUs from 15 samples (five from each animal species; n = 75 isolates) against nine drugs was determined by agar diffusion test. We found E. coli belonging to all phylo-groups already described, except D group, with the predominance of B1 (65% CFUs; 126/195) in the three-animal species sampled. Most faecal samples of calves (77%; 10/13) and foals (69%; 9/13) harboured both pathogenic and nonpathogenic E. coli. All faecal samples showed CFUs with diverse AS profile, highlighting the ineffectiveness of tetracycline, sulphonamide and ampicillin. As a key point, our data reinforce the importance to select at least four E. coli CFUs for AS testing.

Significance and Impact of the Study

This study provides relevant data about the high phylogenetic and antimicrobial susceptibility diversity observed in Escherichia coli colony-forming units (CFUs) from a bacteriological culture of faeces from healthy calves, foals and lambs. The selection pressure exerted by the herd treatment may directly impact the intestinal microflora of animals that have never been treated. Finally, we emphasize the importance of Clinical Laboratory Standards Institute guidelines and we recommended to analyse at least four E. coli CFUs to determine, in particular, the antimicrobial susceptibility profile of faecal isolates, independent of the animal’s health status.
Clinicopathological features of Bu Gu Zhi‐induced liver injury, a long‐term follow‐up cohort study
Authors: Wang Lan , Wang Yan , Wee Aileen , Soon Gwyneth , Gouw Annette S. H. , Yang Ruiyuan , Tian Qiuju , Liu Liwei , Ma Hong , Zhao Xinyan
Published: November 2019

Background & Aims

Bu Gu Zhi (BGZ) is a Chinese herb consumed mainly for osteoporosis treatment. Only small case series of BGZ‐induced liver injury (BGZILI) have been reported. We describe the clinicopathological features and clinical course of BGZILI.

Methods

Patients diagnosed with drug‐induced liver injury (DILI) at Beijing Friendship Hospital from 2005 to 2017 were reviewed. Clinical and follow‐up data were analysed.

Results

Of the 547 DILI patients, 40 cases (7.3%) were attributed to BGZILI. About 34/40 (85.0%) patients were females with a median age of 63 (range, 54‐70) years. The median latency period was 45 (range, 29‐90) days. Patients commonly presented with loss of appetite (57.5%), dark urine (57.5%) and fatigue (55.0%). The median level of alanine aminotransferase and aspartate aminotransferase at BGZILI onset was 673.5 and 423.0 U/L respectively. Total bilirubin (TB) and direct bilirubin (DB) were 59.0 and 39.4 µmol/L respectively. The biochemical liver injury pattern was hepatocellular (92.5%), cholestatic (5.0%) and mixed (2.5%). They were categorized into ‘mild’ (N = 23, 57.5%), ‘moderate’ (6, 15.0%) or ‘severe’ (11, 27.5%) according to severity assessment by DILI network. The main histological injury pattern in 9/40 patients with liver biopsy was acute hepatitis with/without cholestasis. Median duration of follow‐up was 26.3 months with recovery in 37 patients within 6 months. No patients died or required transplantation.

Conclusions

BGZ‐induced liver injury manifested more often as a hepatocellular injury pattern with mild to moderate hepatocellular damage. Most patients recovered after cessation of BGZ within 6 months, and none developed end‐stage liver disease or died.