bluuebunny/crossref_metadata_2025 huggingface dataset:
Study on the time taken for patients to achieve the ability to self‐care their new stoma
Authors: Goldblatt Joshua , Buxey Ken , Paul Eldho , Foot‐Connolly Rebecca , Leech Tristan , Bell Stephen
Published: October 2017

Background

Stoma formation in colorectal surgery is a recognized independent cause of prolonged hospital stay. It has been shown that preoperative stoma education and siting leads to a reduction in the length of hospital stay. Despite this, the length of time to independent stoma management and the variables that affect this has not been well studied. We conducted a prospective case series to analyse this.

Methods

A total of 107 consecutive colorectal surgery patients undergoing stoma formation at two separate large metropolitan hospitals, one private funded and the other government funded, were enrolled in a prospective case series. The primary outcome evaluated was independent management of stoma at discharge from hospital. Logistic regression analysis was performed to determine the factors associated with achieving independent stoma management at discharge.

Results

The median length of stay was 9 days (range: 4–71). In our study, 71% of patients achieved self‐care at the time of discharge from hospital (76/107 patients). The median length of time taken to achieve independent management of a stoma was 7 days (interquartile range: 6–9). Factors associated with increased chance of independent management of stoma at discharge included younger age, male, preoperative siting and treatment in a public hospital.

Conclusion

Our study supports that preoperative stoma education in combination with post‐operative stoma education is superior to post‐operative stoma education alone. Interestingly, treatment in a private hospital is associated with a higher likelihood of failure to achieve independent stoma management at discharge. This is unexpected and not explained by our data.
Serum complement factor 5a levels are associated with nonalcoholic fatty liver disease in obese children
Authors: Hu Wei , Wang Min , Yin Chunyan , Li Shuangshaung , Liu Yuesheng , Xiao Yanfeng
Published: October 2017

Aim

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of progressive and chronic liver injury. Complement factor 5a (C5a) may be involved in many inflammation disorders. This study investigated levels of systemic C5a in patients with and without NAFLD and lean controls.

Methods

A cross‐sectional study was conducted from July 2012 to June 2013 among 96 Chinese children, aged 6–17 years, recruited from the Pediatric Department of the Second Affiliated Hospital of Xi'an Jiao Tong University: 40 obese children with NAFLD, 31 obese children without NAFLD and 25 lean controls. Anthropometric parameters, clinical data and circulating C5a levels were measured.

Results

Obese children had higher serum concentrations of complement factor C5a compared with lean controls, especially in obese children with NAFLD. C5a was positively correlated with body mass index (BMI), waist circumference, diastolic blood pressure (BP), triglycerides and homoeostasis model of insulin resistance, independent of their body mass index standard deviations score and age. Of the well‐known risk factors, C5a was a significant predictor of NAFLD in obese children.

Conclusion

Serum C5a was elevated in obese children, especially in those with NAFLD and it may be proposed as a novel marker to predict advanced disease.
Incidence and predictors of osteoporotic fractures in patients with Barrett's oesophagus: a population‐based nested case‐control study
Authors: Kumar S. , Drake M. T. , Schleck C. D. , Johnson M. L. , Alexander J. A. , Katzka D. A. , Iyer P. G.
Published: October 2017

Background

Proton pump inhibitors (PPI) are inconsistently associated with osteoporotic fractures. Barrett's oesophagus (BO) patients are treated with high PPI doses for prolonged periods, but there are limited data on the incidence of osteoporosis and fractures in this group pf patients.

Aim

To estimate the incidence of (and risk factors for) low bone mass (osteoporosis and/or osteopenia) related fractures in a population‐based BO cohort.

Methods

All subjects with BO and a diagnosis of osteoporosis and fractures were identified using Rochester Epidemiology Project resources. The incidence rates of all and osteoporotic fractures in these subjects were compared to an age‐ and gender similar population in Olmsted County to determine standardised incidence ratios (SIR). Predictors were assessed using Cox proportional hazards models.

Results

Five hundred and twenty‐one patients were included (median [IQR] age 61 [52, 72] years; 398 [76%] men) of whom 113 (21.7%) had fractures, and 46 (8.8%) had osteoporotic fractures. The incidence of all fractures and osteoporotic fractures was comparable to that of an age‐ and gender‐matched population (SIR 1.09; 95% CI 0.92‐1.29: SIR 1.05; 95% CI 0.85‐1.29). PPI use, dose or duration of use was not associated with osteoporotic fracture risk (HR 0.87; 95% CI 0.12‐6.39). Independent risk factors for osteoporotic fractures included older age, female gender and higher co‐morbidity index.

Conclusions

The incidence of osteoporotic fractures was not increased in BO patients compared to the general population. In addition, PPI use was not associated with increased fracture risk regardless of the duration of therapy or dose.
Endoscopic surgery in Japan: The 12th national survey(2012–2013) by the Japan Society for Endoscopic Surgery
Authors: Bandoh Toshio , Shiraishi Norio , Yamashita Yuichi , Terachi Toshiro , Hashizume Makoto , Akira Shigeo , Morikawa Toshiaki , Kitagawa Yuko , Yanaga Katsuhiko , Endo Shunsuke , Onishi Kiyoshi , Takiguchi Shuji , Tamaki Yasuhiro , Hasegawa Toru , Mimata Hiromitsu , Tabata Minoru , Yozu Ryohei , Inomata Masafumi , Matsumoto Sumio , Kitano Seigo , Watanabe Masahiko
Published: October 2017

In Japan, the first endoscopic surgery, a laparoscopic cholecystectomy, was performed in 1990. Since then, operative procedures have been standardized, and the safety and usefulness of endoscopic surgery have been evaluated. With the acceptance of endoscopic surgery as less invasive than open surgery, the number of the endoscopic procedures continues to increase in all surgical domains. The Japan Society for Endoscopic Surgery (JSES) has had an important role in the development of endoscopic surgery in Japan. For example, JSES established a technical skills certification system for physicians to train instructors to teach safe endoscopic surgery. Additionally, JSES has performed a national survey every 2 years. In 2013, 178 084 patients underwent endoscopic surgery in all surgical domains, including abdominal, thoracic, mammary and thyroid gland, cardiovascular, obstetrics and gynecology, urologic, orthopedic, and plastic surgery. The development and current status of laparoscopic surgery are reported here based on the results of the most recent questionnaire survey conducted by JSES.
Systematic review of behaviour change techniques to promote participation in physical activity among people with dementia
Authors: Nyman Samuel R. , Adamczewska Natalia , Howlett Neil
Published: October 2017

Purpose

The objective of this study was to systematically review the evidence for the potential promise of behaviour change techniques (BCTs) to increase physical activity among people with dementia (PWD).

Methods

PsychINFO, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched 01/01/2000–01/12/2016. Randomized controlled/quasi‐randomized trials were included if they recruited people diagnosed/suspected to have dementia, used at least one BCT in the intervention arm, and had at least one follow‐up measure of physical activity/adherence. Studies were appraised using the Cochrane Collaboration Risk of Bias Tool, and BCTs were coded using Michie et al., 2013, Annals of Behavioral Medicine, 46, 81. taxonomy. Intervention findings were narratively synthesized as either ‘very promising’, ‘quite promising’, or ‘non‐promising’, and BCTs were judged as having potential promise if they featured in at least twice as many very/quite promising than non‐promising interventions (as per Gardner et al., 2016, Health Psychology Review, 10, 89).

Results

Nineteen articles from nine trials reported physical activity findings on behavioural outcomes (two very promising, one quite promising, and two non‐promising) or intervention adherence (one quite promising and four non‐promising). Thirteen BCTs were used across the interventions. While no BCT had potential promise to increase intervention adherence, three BCTs had potential promise for improving physical activity behaviour outcomes: goal setting (behaviour), social support (unspecified), and using a credible source.

Conclusions

Three BCTs have potential promise for use in future interventions to increase physical activity among PWD.

Statement of contribution

What is already known on this subject?

While physical activity is a key lifestyle factor to enhance and maintain health and wellbeing amongst the general population, adults rarely participate in sufficient levels to obtain these benefits.

Systematic reviews suggest that specific behaviour change techniques can increase physical activity, although one review suggested that self‐regulatory techniques may be counterproductive when promoting physical activity among older people.

Until now, no systematic review has been conducted to assess which behaviour change techniques may be associated with greater participation in physical activity among people with dementia.

What does this study add?

Interventions showed mixed promise for increasing physical activity and little effect on participant adherence.

Goal setting (behaviour), social support (unspecified), and using a credible source are promising approaches.

No technique showed promise for increasing adherence to physical activity interventions among people with dementia.
The longitudinal effects of emotion regulation on physical and psychological health: A latent growth analysis exploring the role of cognitive fusion in inflammatory bowel disease
Authors: Trindade Inês A. , Ferreira Cláudia , Pinto‐Gouveia José
Published: October 2017

Objective

This study thus aims to test differences between patients with inflammatory bowel disease (IBD) regarding IBD symptomatology, cognitive fusion, and psychological and physical health, as well as to explore whether the maladaptive emotion regulation process of cognitive fusion longitudinally impacts on the baseline and evolution of these outcomes over a period of 18 months.

Design and methods

Participants include 116 IBD patients with a mean age of 36.76 (SD = 11.39) of both genders (69.83% females) that completed the self‐report measures of interest in three different times, equally spaced 9 months apart, over a period of 18 months. Latent growth curve models were conducted using structural equation modelling to estimate the growth trajectory of the variables in study.

Results

Inflammatory bowel disease symptomatology and cognitive fusion's levels were negatively associated with psychological health and physical health's baseline levels. Furthermore, IBD symptomatology did not influence the growth of psychological health, while cognitive fusion did (β = .30, p = .007). The same result was found for physical health (β = .26, p = .024). These findings indicate that individuals with higher levels of cognitive fusion present lower levels of psychological health and physical health that tend to further decrease over the time through the effects of this maladaptive emotion regulation process.

Conclusions

This study implies that it is of crucial importance to include psychotherapeutic interventions in the health care of patients with IBD. If successful, these interventions could represent decreases in the cost of IBD treatment and in the use of drugs with adverse side effects, in addition to improving patients’ mental health and quality of life. Further implications for clinical and research work are discussed.

Statement of contribution

What is already known on this subject?

Research has demonstrated the impact of emotion regulation on both physical and mental health.

Nevertheless, the longitudinal effects of the specific emotion regulation process of cognitive fusion on physical and psychological health have never been explored.

Additionally, no study has yet examined the causal role of emotion regulation in evolution of physical health in inflammatory bowel disease (IBD).

What does this study add?

Cognitive fusion longitudinally impacted on IBD patients’ physical and mental health.

These variables were measured over a period of 18 months.

Treatment for IBD should include interventions aiming to diminish maladaptive emotion regulation.
Neural stem cells and adult brain fatty acid metabolism: Lessons from the 3xTg model of Alzheimer's disease
Authors: Hamilton Laura K. , Fernandes Karl J. L.
Published: October 2017

Neural stem cell (NSC) activity and adult neurogenesis are physiologically relevant regulators of adult brain structure, function and repair. Given these roles, the NSC impairments observed in a wide range of neurodegenerative and psychiatric conditions likely factor into the overall cognitive dysfunction in these conditions. We investigated NSC regulation in the context of Alzheimer's disease (AD) using the well‐characterised triple transgenic (3xTg) model of AD. In this review, we describe our recent findings that link 3xTg‐AD neurogenesis impairments to AD‐associated abnormalities in brain fatty acid metabolism. Notably, we identified an accumulation of triglycerides rich in oleic acid, a mono‐unsaturated fatty acid, within the forebrain NSC niche in AD. Inhibiting the local conversion of saturated to mono‐unsaturated fatty acids within the brain was sufficient to counteract the loss of NSC activity in 3xTg‐AD mice (Hamilton et al., 2015). We place these findings within the context of recent evidence that dynamic changes in lipid metabolism occur during the transition from NSC quiescence to activation. The picture that emerges is that the critical NSC quiescence‐to‐activation decision is sensitive to the local levels of specific fatty acids and can be impaired by a disease‐associated shift in brain fatty acid balance.
Incidence and risk factors for parastomal bulging in patients with ileostomy or colostomy: a register‐based study using data from the Danish Stoma Database Capital Region
Authors: Andersen R. M. , Klausen T. W. , Danielsen A. K. , Vinther A. , Gögenur I. , Thomsen T.
Published: October 2017

Aim

The aim was to investigate the incidence and risk factors for parastomal bulging, a clinically important complication, in patients with an ileostomy or colostomy.

Method

The Danish Stoma Database Capital Region prospectively collects data on patients with a stoma up to a year after surgery. Stoma care nurses clinically assessed the main outcome, parastomal bulging. We linked data from the Stoma Database to data from the Danish Anaesthesia Database. Cumulative incidence of parastomal bulging over the first year was calculated with death and stoma reversal as competing risks. Risk factors were investigated using an exploratory approach.

Results

In a study population of 5019, the cumulative incidence (with competing risks) of parastomal bulging was 36.2% at 400 days after surgery. Age, colostomy, male gender, alcohol consumption and laparoscopy were associated with an increased risk of parastomal bulging. Compared with cancer, inflammatory bowel disease was associated with a lower risk of parastomal bulging, and diverticulitis was associated with a higher risk. Peristomal mesh and stomas placed through a separate incision were associated with a reduction in risk. There was neither increased nor decreased risk of parastomal bulging for body mass index, American Society of Anesthesiologists score, smoking status, emergency surgery and preoperative stoma site marking.

Conclusion

Parastomal bulging is a common complication affecting one in three patients within 1 year of surgery. Along with previous findings, there is now considerable evidence for age and colostomy as being risk factors for parastomal bulging.
Incidence of venous thromboembolic events in enhanced recovery after surgery for colon cancer: a retrospective, population‐based cohort study
Authors: Vendler M. M. I. , Haidari T. A. , Waage J. E. , Kleif J. , Kristensen B. , Gögenur I. , Bertelsen C. A. ,   the Copenhagen cOmplete Mesocolic Excision Study group (COMES)
Published: October 2017

Aim

Both the Danish and the National Institute of Clinical Excellence (NICE) guidelines recommend prolonged thromboprophylaxis (PT) with low‐molecular‐weight heparin (LMWH) for 28 days postoperatively after elective surgery for colon cancer. The evidence relies on data from two randomized clinical trials (RCTs) that included not only colon cancers but also other abdominal cancers or benign colorectal diseases. Neither of those studies investigated the risk of venous thromboembolism (VTE) under enhanced recovery after surgery (ERAS). We aim to describe the risk of VTE and estimate the cost of preventing one case of VTE by PT under ERAS.

Method

This was a retrospective study of 2230 patients undergoing elective surgery for colon cancer Stage I‐III in the Capital Region of Denmark, 1 June 2008 to 31 December 2013. Patients who were discharged on postoperative day 28 or later, died during admission or were discharged with a vitamin K antagonist, novel oral anticoagulants or LMWH were excluded. Patients with rectal cancer only were not included. End‐points were symptomatic VTE diagnosed within 60 days postoperatively.

Results

Three‐hundred and thirty patients were excluded. For the remaining 1893, the median length of stay (LOS) was 4 [interquartile range (IQR): 3–5] days. Of these 1893 patients, four (0.20%) experienced a nonfatal symptomatic VTE. All four patients had other postoperative complications before the VTE. The cost of each symptomatic VTE prevented is estimated to be between £63 709 and £111 455 when medication and home‐care nursing are included.

Conclusion

The risk of symptomatic VTE after uncomplicated, elective surgery for colon cancer with ERAS seems negligible and the cost‐effectiveness of PT to prevent one symptomatic VTE seems questionable.
Defektdeckung am Nasenflügel durch die kaudolateral gedrehte Transpositionslappenplastik und ihre Varianten
Authors: Felcht Moritz
Published: October 2017

Defekte am Nasenflügel können für den Dermatochirurgen eine Herausforderung darstellen. Unterschiedliche Methoden der Defektdeckung wurden in der Vergangenheit entwickelt, allerdings sind diese teilweise kompliziert zu erlernen und durchzuführen. Der Dermatochirurg Andreas Lösler aus der Fachklinik für Dermatologie Hornheide, hat kürzlich die kaudolateral gedrehte Transpositionslappenplastik zur Deckung von Defekten am Nasenflügel entwickelt und publiziert. Diese zeigt eine sehr geringe Komplikationsrate. Da sie noch relativ neu ist, ist diese Technik den meisten Dermatochirurgen noch nicht bekannt und bisher auch nicht in den Standardwerken der Dermatochirurgie erwähnt. In dieser Übersichtsarbeit wird die Technik der kaudolateral gedrehten Transpositionslappenplastik beschrieben und zwei Varianten vorgestellt, die es erlauben, auch große Defekte und lateral gelegene Defekte im Bereich des Nasenflügels zu decken. Der kaudolateral gedrehte Transpositionslappen wird mit den beiden häufigsten Lappenplastiken zur Defektdeckung im Bereich des Nasenflügels, dem zweifach gestielten Lappen (bilobed flap) und der melolabialen Transpositionslappenplastik verglichen.
S1 guidelines for the diagnosis and treatment of ichthyoses – update
Authors: Oji Vinzenz , Preil Marie‐Luise , Kleinow Barbara , Wehr Geske , Fischer Judith , Hennies Hans Christian , Hausser Ingrid , Breitkreutz Dirk , Aufenvenne Karin , Stieler Karola , Tantcheva‐Poór Illiana , Weidinger Stefan , Emmert Steffen , Hamm Henning , Perusquia‐Ortiz Ana Maria , Zaraeva Irina , Diem Anja , Giehl Kathrin , Fölster‐Holst Regina , Kiekbusch Kirstin , Höger Peter , Ott Hagen , Traupe Heiko
Published: October 2017

Ichthyoses are a group of rare genetic skin disorders that pose numerous clinical challenges, in particular with respect to the correct diagnosis and appropriate management. The present update of the German ichthyosis guidelines addresses recent diagnostic advances that have resulted in the Sorèze consensus classification. In this context, we provide an updated diagnostic algorithm, taking into account clinical features as well as the molecular genetic basis of these disorders. Moreover, we highlight current therapeutic approaches such as psychosocial support, balneotherapy, mechanical scale removal, topical therapy, and systemic retinoid therapy. General aspects such as the indication for physical therapy, ergotherapy, or genetic counseling are also discussed. The present update was consented by an interdisciplinary consensus conference that included dermatologists, pediatricians, human geneticists, and natural scientists as well as representatives of the German patient support organization Selbsthilfe Ichthyose e. V.
Stress test to STEMI: Utility of coronary CTA in the diagnosis and management of anomalous right coronary artery from the left coronary cusp
Authors: Das Anshuman , Joseph Ajay , Jolly Neeraj , Kalra Dinesh K.
Published: October 2017

A 42‐year‐old woman presented to the emergency department with chest pain. Acute coronary syndrome was ruled out. During dobutamine stress echocardiography (DSE), she developed chest pain and inferior ST elevation. Emergent coronary angiography revealed no culprit lesions but did show an anomalous right coronary artery (RCA). Coronary CT angiography (CCTA) confirmed an anomalous RCA arising from the left coronary cusp with a slit‐like ostium and interarterial course (ARCA‐LCC‐IA). Herein, we review the extant literature on ARCA‐LCC‐IA, its clinical presentation, the vital role of CTA and MRI in its diagnosis, as well as challenges and controversies surrounding management.
Prosthetic mitral inflow mimicking severe aortic regurgitation (revisited). An echocardiographic challenge
Authors: Battisha Ayman , Abdelhaleem Ahmed , Srialluri Swetha , Arisha Mohammed J. , Farhoud Adel A. , Kamel Hassan , Mahmoud Mohamed S. , Tageldin Omar , Salama Ahmed Y. , Ibeche Bashar , Nanda Navin C.
Published: October 2017

Assessing aortic regurgitation (AR) severity in patients with mitral valve prosthesis may pose an echocardiographic challenge. We present a case of mild AR in whom difficulty occurred in judging its severity due to eccentric mitral prosthetic inflow signals filling practically completely the proximal left ventricular outflow tract in diastole mimicking severe AR. Frame‐by‐frame analysis of two‐dimensional transthoracic echocardiographic images using a small sector depth and width was helpful in clarifying the true severity of AR.
Polypoidal choroidal vasculopathy treatment options: A meta‐analysis
Authors: Qian Tianwei , Li Xinxin , Zhao Mengya , Xu Xun
Published: October 2017

Background

Combined treatment with intravitreal anti‐vascular endothelial growth factor (anti‐VEGF) and verteporfin photodynamic therapy (PDT) is widely used for patients with polypoidal choroidal vasculopathy (PCV), although clinical evidence regarding the therapeutic efficacy and safety of such treatment remains lacking.

Design/Methods

We performed a meta‐analysis of previously reported studies comparing combination treatment, PDT monotherapy, and anti‐VEGF monotherapy. Primary outcome measures included changes in best‐corrected visual acuity (BCVA) and central retinal thickness (CRT). The proportion of patients with polyp regression was regarded as the secondary outcome measure.

Results

Twenty studies (three RCTs and 19 retrospective studies) involving 1,178 patients with PCV were selected. Significant differences in the proportion of patients with polyps were observed between the PDT and anti‐VEGF monotherapy groups at 3 and ≥6 months (P < .00001; and P = .0001, respectively). Significantly greater reductions in CRT were observed in the anti‐VEGF than in the PDT group at the 3‐month follow‐up (P = .04). Significantly greater improvements in BCVA were observed in the combined therapy group than in the PDT monotherapy group at 3, 6, 12, and 24 months (P = .03; P = .005; P = .02; and P < .00001, respectively). Combined treatment also resulted in significantly greater improvements in BCVA than monotherapy with anti‐VEGF at 6 and 24 months (P = .001; P < .00001, respectively), and significantly greater polyp regression than that observed following anti‐VEGF treatment at 3 and ≥6 months (P < .00001; P < .0001, respectively).

Conclusions

Combined therapy involving anti‐VEGF agents and PDT may be more effective in improving long‐term outcomes for patients with PCV than monotherapy.
Brain and heart magnetic resonance imaging/spectroscopy in duchenne muscular dystrophy
Authors: Mavrogeni Sophie , Pons Roser , Nikas Ioannis , Papadopoulos George , Verganelakis Dimitrios A. , Kolovou Genovefa , Chrousos George P.
Published: October 2017

Duchenne muscular dystrophy (DMD) is an X‐linked muscle disorder characterized by progressive and irreversible loss of muscular function. As muscular disease progresses, the repair mechanisms cannot compensate for cellular damage, leading inevitably to necrosis and progressive replacement by fibrous and fatty tissue. Cardiomyopathy and respiratory failure are the main causes of death in DMD. In addition to the well‐described muscle and heart disease, cognitive dysfunction affects around 30% of DMD boys. Myocardial fibrosis, assessed by late gadolinium enhancement (LGE), using cardiovascular magnetic resonance imaging (CMR), is an early marker of heart involvement in both DMD patients and female carriers. In parallel, brain MRI identifies smaller total brain volume, smaller grey matter volume, lower white matter fractional anisotropy and higher white matter radial diffusivity in DMD patients. The in vivo brain evaluation of mdx mice, a surrogate animal model of DMD, showed an increased inorganic phosphate (P(i))/phosphocreatine (PCr) and pH. In this paper, we propose a holistic approach using techniques of magnetic resonance imaging, spectroscopy and diffusion tensor imaging as a tool to create a “heart and brain imaging map” in DMD patients that could potentially facilitate the patients’ risk stratification and also future research studies in the field.
Foreign direct investment and inequality in developing countries: Does sector matter?
Authors: Bogliaccini Juan A. , Egan Patrick J. W.
Published: October 2017

Scholars have studied the relationship between inward foreign direct investment (FDI) and within‐country income inequality in cross‐national contexts, but have not empirically investigated how FDI in different sectors might affect inequality in different ways. We use error correction models to analyze sectoral FDI data compiled from UNCTAD investment reports in 60 middle‐income countries from 1989 to 2010, arguing that FDI in services is more likely to be associated with inequality than FDI in other sectors. We argue that skill biases and changes in employment patterns associated with service sector investments can help explain these findings.
Between discretion and control: Reflections on the institutional position of the Commission within the European citizens' initiative process
Authors: Vogiatzis Nikos
Published: October 2017

This article considers the institutional position of the Commission within the European citizens' initiative (ECI) process, with particular emphasis on its decision regarding the admissibility/registration of a proposed ECI, and its final decision on the outcome of an ECI which has met the necessary levels of support. The purpose of this contribution is to juxtapose the case‐law of the Court on the Commission's discretion and the relevant provisions of the Treaties with the evolution of European integration and, more specifically, the evolution of the Commission's role therein. Viewed under this prism, the Commission's powers at the registration stage (which in any event clearly fall under the scope of judicial review) are compatible with the constitutionalisation of the Union, whereas the Commission's width of discretion at the follow‐up stage, while compatible with the Commission's prerogatives, cannot easily be reconciled, nonetheless, with the Commission's limited legitimacy when compared to that of the co‐legislators, the fact that it may not always represent the Union interest, and the latter's pragmatic losses within the EU institutional balance.
Prediction of fracture loads in PMMA U‐notched specimens using the equivalent material concept and the theory of critical distances combined criterion
Authors: Cicero S. , Torabi A.R. , Madrazo V. , Azizi P.
Published: October 2017

This paper provides a methodology for the prediction of fracture loads in notched materials that combines the equivalent material concept with the theory of critical distances. The latter has a linear‐elastic nature and requires material calibration in those cases where the non‐linear material behaviour is significant. The calibration may be performed by fracture testing on notched specimens or a combination of fracture testing and simulation. The proposed methodology sets out to define an equivalent linear‐elastic material on which the theory of critical distances may be applied through its basic formulation and without any previous fracture testing and/or simulation. It has been applied to PMMA single edge notch bending specimens containing U‐notches, providing accurate predictions of fracture loads.
A novel approach for modeling retained austenite transformations during rolling contact fatigue
Authors: Morris D. , Sadeghi F. , Chen Y.‐C. , Wang C. , Wang B.
Published: October 2017

Retained austenite (RA) transformation in martensitic steels subjected to rolling contact fatigue (RCF) is a well‐established phenomenon. In this investigation, a novel approach is developed to predict martensitic transformations of RA in steels subjected to RCF. In order to achieve the objectives, a 2‐dimensional finite element model was developed to determine subsurface stresses due to rolling contact. These stresses are utilized within a continuum damage mechanics framework to determine RA transformations as a function of depth and cycles. Phase transformations were determined by comparing the required thermodynamic driving force for transformations to the energy dissipation of the microstructure. The results obtained from the combined FEA and continuum damage mechanics model were corroborated to the experimental results for RA decomposition as a function of depth and cycle for SAE 52100 steel. The results obtained are in good agreement with observed RA decomposition and DER formation as compared with the experimental results.
Occipital Nerve Stimulation for Medically Refractory Chronic Paroxysmal Hemicrania
Authors: Miller Sarah , Lagrata Susie , Watkins Laurence , Matharu Manjit
Published: October 2017

Objective

To describe the outcome of a patient with refractory chronic paroxysmal hemicrania (CPH) to occipital nerve stimulation (ONS).

Background

CPH is a primary headache disorder exquisitely sensitive to indomethacin. In patients unable to tolerate indomethacin, the therapeutic options are limited. ONS is a promising therapy for other refractory headache conditions. We report the first patient with medically refractory CPH treated with ONS.

Methods

Following implantation of the occipital nerve stimulator in 2006, the patient kept prospective headache diaries. Outcome was assessed by daily attack frequency.

Results

After a follow‐up of over 10 years, the patient reported a sustained efficacy of more than 50% reduction in attack frequency and was pain‐free at final follow‐up. The patient was able to stop indomethacin completely. The patient had three successful pregnancies during follow‐up. One system revision was undertaken alongside an expected battery replacement to treat unequal paresthesia and pain over the electrodes.

Conclusion

ONS may offer an effective long‐term treatment for CPH in patients where indomethacin cannot be tolerated.
Comparison of performance and abnormal cell flagging of two automated hematology analyzers: Sysmex XN 3000 and Beckman Coulter DxH 800
Authors: Genc S. , Dervisoglu E. , Erdem S. , Arslan O. , Aktan M. , Omer B.
Published: October 2017

Introduction

The purpose was to evaluate the analytical performances of Sysmex XN 3000 and UniCel DxH 800 comparing the obtained results with manual counting and between each other. Also flagging capabilities of abnormal cells were compared for both analyzers.

Methods

Two thousand one hundred and forty‐two whole‐blood samples were analyzed for evaluation. The samples flagged due to blast, atypical lymphocyte (AL), immature granulocyte (IG), or nucleated red blood cells (NRBC) were microscopically reviewed (n=102).

Results

The within‐run and between‐day coefficient of variations (CV%) of XN 3000 for hemoglobin, RBC, MCV, WBC, and platelets were lower than 5% and for WBC differentials lower than 10% except monocytes which was 15.6% at low level. The precision results of DxH 800 were also lower than 5.0% except platelets (9.5%) and monocytes (45%) at low level. The comparison of analyzers revealed good agreement (R>.86), except monocytes and basophils. The flagging sensitivities of XN 3000 were higher for IGs, blasts, and ALs than those of DxH 800 and almost similar for NRBC.

Conclusion

The XN 3000 and DxH 800 are accurate, highly precise systems and can be used effectively in high‐volume laboratories. The flagging sensitivity of XN 3000 was higher in detecting blasts, IGs, and ALs than that of DxH 800. The detection of abnormal cells with high sensitivity may improve laboratory workflow with a reduced slide review and accelerated turnaround time.
Impact of four direct oral anticoagulants on rotational thromboelastometry (ROTEM)
Authors: Seyve L. , Richarme C. , Polack B. , Marlu R.
Published: October 2017

Introduction

Rotational Thromboelastometry (ROTEM) is a point of care method used to monitor coagulation during surgery and to guide transfusion strategies in patients presenting with severe bleeding. The aim of our study was to determine the impact of four direct oral anticoagulants (DOACs) on 3 commonly used ROTEM tests.

Methods

Whole blood samples from 20 healthy donors were spiked in vitro with apixaban, edoxaban, rivaroxaban or dabigatran at 5 different plasma concentrations (0‐1000 ng/mL). EXTEM, INTEM and FIBTEM tests were systematically performed.

Results

There was a linear relationship between the increase in clotting time (CT) and plasma DOAC concentrations in both the EXTEM and INTEM tests. We found that the DOAC concentration required to double EXTEM CT was 1042 ± 225 ng/mL for apixaban, 134 ± 38 ng/mL for edoxaban, 176 ± 26 ng/mL for rivaroxaban and 284 ± 73 ng/mL for dabigatran. INTEM CT was less sensitive than EXTEM CT whatever the anticoagulant. EXTEM CT was above the normal range for 5 of 5 spiked samples when the plasma concentrations were ~1000 ng/mL for apixaban, ~100 ng/mL for edoxaban, ~200 ng/mL for rivaroxaban and ~200 ng/mL for dabigatran. Maximum Clot Firmness in EXTEM, INTEM and FIBTEM tests was not affected whatever the DOAC or its concentration.

Conclusion

This study found a DOAC dose‐dependent increase in ROTEM CTs. ROTEM tests were only poorly impacted by low levels of edoxaban, rivaroxaban or dabigatran. Apixaban had only a low effect even at high concentrations.
Synthesis and thermophysical properties of RETa3O9 (RE = Ce, Nd, Sm, Eu, Gd, Dy, Er) as promising thermal barrier coatings
Authors: Chen Lin , Jiang YeHua , Chong XiaoYu , Feng Jing
Published: October 2017

Thermal barrier coatings (TBCs) are one of the most important materials in gas turbine to protect the high temperature components. RETa3O9 compounds have a defect‐perovskite structure, indicating that they have low thermal conductivity, which is the critical property of TBCs. Herein, dense RETa3O9 bulk ceramics were fabricated via solid‐state reaction. The crystal structure was characterized by X‐ray diffraction (XRD) and Raman Spectroscope. Scanning electron microscope (SEM) was used to observe the microstructure. The thermophysical properties of RETa3O9 were studied systematically, including specific heat, thermal diffusivity, thermal conductivity, thermal expansion coefficients, and high‐temperature phase stability. The thermal conductivities of RETa3O9 are very low (1.33‐2.37 W/m·K, 373‐1073 K), which are much lower than YSZ and La2Zr2O7; and the thermal expansion coefficients range from 4.0 × 10−6 K−1 to 10.2×10−6 K−1 (1273 K), which is close to La2Zr2O7 and YSZ. According to the differential scanning calorimetry (DSC) curve there is not phase transition at the test temperature. Due to the high melting point and excellent high‐temperature phase stability with these oxides, RETa3O9 ceramics were promising candidate materials for TBCs.
Dielectric relaxation and electrical conduction in (BixNa1−x)0.94Ba0.06TiO3 ceramics
Authors: Li Xiaojuan , Jing Qi , Xi Zengzhe , Liu Peng , Long Wei , Fang Pinyang
Published: October 2017

The dielectric relaxation and electrical conduction were investigated in (BixNa1−x)0.94Ba0.06TiO3 (Abb. xBNBT6, x = 0.5, 0.495, 0.485, and 0.475) ceramics prepared by solid state reaction. With a decrease in x, the dielectric properties of the ceramics decreased, whereas the electrical conduction increased, resulting in a transition from insulator to oxide‐ions conductor. When x = 0.475, the ceramics exhibited large conductivity (~10−3 S cm−1 at 575°C) and low activation energy (~0.45 eV), indicating their potential application in solid oxide fuel cells. A mixed conduction mechanism with oxide‐ions, electrons, and holes was proposed. With a decrease in x from 0.495 to 0.475, it was found that the p‐type conduction was switched to n‐type conduction. The dielectric relaxation of the x = 0.495 sample was associated with short‐range hopping of oxygen vacancies. However, the dielectric properties of the x = 0.485 and 0.475 samples can be explained by Maxwell‐Wagner interface relaxation.
Molecular mechanisms in the reversible regulation of morphology, proliferation and collagen metabolism in hepatic stellate cells by the three‐dimensional structure of the extracellular matrix
Authors: SENOO HARUKI , IMAI KATSUYUKI , MATANO YOSHIKAZU , SATO MITSURU
Published: October 2017

Hepatic stellate cells (vitamin A‐storing cells, lipocytes, interstitial cells, fat‐storing cells, Ito cells) exist in the perisinusoidal space of the hepatic lobule and store 80% of the body's retinoids as retinyl palmitate in lipid droplets in the cytoplasm. Under physiological conditions, these cells play pivotal roles in the regulation of retinoid homeostasis; they express specific receptors for retinol‐binding protein (RBP), a binding protein specific for retinol, on their cell surface, and take up the complex of retinol and RBP by receptor‐mediated endocytosis. However, in pathological conditions such as liver fibrosis, these cells lose retinoids and synthesize a large amount of extracellular matrix (ECM) components including collagen, proteoglycan and adhesive glycoproteins. The morphology of these cells also changes from star‐shaped stellate cells to that of fibroblasts or myofibroblasts. The three‐dimensional structure of ECM components was found to regulate reversibly the morphology, proliferation and functions of hepatic stellate cells. Molecular mechanisms in the reversible regulation of stellate cells by ECM imply cell surface integrin binding to ECM components followed by signal transduction processes and then cytoskeleton assembly.
Tissue inhibitors of metalloproteinases, hepatic stellate cells and liver fibrosis
Authors: ARTHUR MICHAEL JP , MANN DEREK A , IREDALE JOHN P
Published: October 2017

Hepatic stellate cells (HSC) play a central role in the pathogenesis of liver fibrosis. Following liver injury, these cells proliferate and are activated to a profibrogenic myofibroblastic phenotype. In addition to increased matrix protein synthesis, there is evidence to indicate that these cells are able to regulate matrix degradation. In the early phases of their cellular activation, HSC release matrix metalloproteinases with the ability to degrade the normal liver matrix. When HSC are fully activated, there is a net down‐regulation of matrix degradation mediated by increased synthesis and extracellular release of tissue inhibitors of metalloproteinase (TIMP)‐1 and ‐2. These studies in cell culture have been complemented by in vivo studies of hepatic TIMP‐1 and TIMP‐2 gene expression. In advanced human liver disease of various aetiologies, there is increased TIMP‐1‐mRNA and protein and increased TIMP‐2‐mRNA in fibrotic liver compared with control liver. Temporal studies of progressive rat liver fibrosis caused by bile duct ligation or by carbon tetrachloride, indicate an important role for increased TIMP‐1 and TIMP‐2 expression in pathogenesis. Moreover, in a rat model of reversible liver fibrosis, matrix remodelling and resolution of liver fibrosis is closely associated, temporally, with a marked decrease in TIMP‐1 and TIMP‐2 expression. These combined cell culture and in vivo findings have led us to investigate the mechanisms of regulation of TIMP‐1 gene expression in hepatic stellate cells. Our recent data indicate that transcriptional regulation of TIMP‐1 gene expression in HSC is mediated via a mechanism which differs considerably from that previously identified in skin fibroblasts. We conclude that increased TIMP‐1 and TIMP‐2 expression by HSC plays an important role in the pathogenesis of liver fibrosis. This may represent an important therapeutic target in the design of anti‐fibrotic strategies for chronic liver disease.
Growth and maturation of small hepatocytes
Authors: MITAKA TOSHIHIRO , MIZUGUCHI TORU , SATO FUMIHIKO , MOCHIZUKI CHIHIRO , MOCHIZUKI YOHICHI
Published: October 2017

Proliferation of adult rat hepatocytes is observed in serum‐free Dulbecco's modified Eagle's medium (DMEM) supplemented with 10 mmol/L nicotinamide and 10 ng/mL epidermal growth factor (EGF). The proliferating cells are mainly mononucleate and form small cell colonies surrounded by mature hepatocytes. Although these cells in focal colonies have a less‐differentiated appearance, immunocytochemically and ultrastructurally they possess hepatic characteristics. The size of small hepatocytes is one‐third to half that of mature hepatocytes. Therefore, we call the cells forming a colony, small hepatocytes. The small hepatocytes can be subcultured for several passages. Furthermore, the cells are rich in the supernatant following 50 g centrifugation for 1 min after collagenase liver perfusion. When the cells are cultured in DMEM supplemented with 10% foetal bovine serum, 10 mmol/L nicotinamide, 1 mmol/L ascorbic acid 2‐phosphate, 10 ng/mL EGF and 1% dimethyl sulphoxide, each small hepatocyte can clonally proliferate for more than 3 months. A small hepatocyte divides to form a colony and the number of cells reaches more than 100 within 20 days. With time in culture, cells with a large cytoplasm appear within a colony. They have many mitochondria and large peroxisomes with crystalline nucleoids and are typical, mature hepatocytes. Immunoreactivity to connexin 32 and well‐developed bile canaliculus structures are often observed in the cell‐cell borders. Thus, we suggest that small hepatocytes may be considered to be ‘committed progenitor cells’ that can further differentiate into mature hepatocytes.
Effects of different methods of reflection on nurses' gaze and judgement in a task using a touch panel
Authors: Nishimura Ayako
Published: October 2017

Aims and objectives

To clarify the effects of different methods of reflection on nurses' gaze and judgement in a task using a touch panel, written and oral methods of reflection were compared.

Background

Recently, with the development of ICT, nursing education and learning with ICT have spread. However, there are few studies that have analysed the objective effects of learning with ICT and the effects of different methods of learning.

Design

This study was a randomised controlled trial comparing writing and oral reflection groups.

Methods

Forty‐one nurses were divided into two groups as follows: 21 nurses in the writing group and 20 nurses in the oral group. Eye movements were recorded as subjects performed a task on a touch panel. A still photograph of the hospital room was displayed on the touch panel, and the subjects touched the panel according to the instructions provided. Statistical analyses were performed using the Mann–Whitney test to compare the results between the two groups.

Results

In an observation task using a touch panel of a setting requiring environmental improvement, we found no observable differences between the two reflection methods with regard to gaze and judgement in the overall setting. However, with respect to the items in the setting, the writing group judged with gazing after reflection, whereas the oral group judged without gazing.

Conclusions

Oral reflection as well as reflective writing had positive effects on observation for tasks requiring overall gaze and judgement. On the other hand, reflective writing promoted the visual verification of items requiring observation in the hospital setting.

Relevance to clinical practice

Reflective writing promotes visual verification in nurses in a clinical setting while performing a task using a touch panel.
RETRACTED: Effects of melatonin on fatty liver disease: The role of NR4A1/DNA‐PKcs/p53 pathway, mitochondrial fission, and mitophagy
Authors: Zhou Hao , Du Wenjuan , Li Ye , Shi Chen , Hu Nan , Ma Sai , Wang Weihu , Ren Jun
Published: October 2017

Mitochondrial dysfunction has been implicated in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) through poorly defined mechanisms. Melatonin supplementation has been found to protect liver function in diabetes and obesity. Here, we intensively explored the role and mechanism of melatonin in the development of NAFLD. We demonstrated that the onset of diet‐induced NAFLD greatly caused NR4A1 upregulation in hepatocytes, leading to the activation of DNA‐PKcs and p53. On the one hand, p53 aided Drp1 migration in the mitochondria and consequently drove mitochondrial fission. On the other hand, p53 repressed Bnip3 transcription and expression, resulting in mitophagy arrest. The excessive fission and deficient mitophagy dramatically mediated mitochondrial dysfunction, including extensive mPTP opening, reduction in mitochondrial potential, oxidative stress, calcium overload, mitochondrial respiratory collapse, and ATP shortage. However, genetic deletion of NR4A1 or DNA‐PKcs could definitively reverse NAFLD progression and the mitochondrial dysfunction. Similarly, melatonin supplementation could robustly reduce the damage to liver and mitochondrial structure and function in NAFLD. Mechanistically, melatonin halted fission but recovered mitophagy via blockade of NR4A1/DNA‐PKcs/p53 pathway, finally improving mitochondrial and liver function in the setting of NAFLD. Our results identify NR4A1/DNA‐PKcs/p53 pathway as the novel molecular mechanism underlying the pathogenesis of NAFLD via regulation of Drp1‐mediated mitochondrial fission and Bnip3‐related mitophagy. Meanwhile, we also confirm that melatonin has the ability to cut off the NR4A1/DNA‐PKcs/p53 pathway, which confers a protective advantage to hepatocytes and mitochondria. The manipulation of NR4A1/DNA‐PKcs/p53 pathway by melatonin highlights a new entry point for treating NAFLD.