bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delirium in ICU patients following cardiac surgery: An observational study
Authors: Simeone Silvio , Pucciarelli Gianluca , Perrone Marco , Teresa Rea , Gargiulo Gianpaolo , Guillari Assunta , Castellano Gaetano , Tommaso Luigi Di , Niola Massimo , Iannelli Gabriele 
Published: March 2018

Aims and objectivesTo observe the clinical and structural factors that can be associated with the post‐operative onset of delirium in patients who have undergone heart surgery.BackgroundSeveral risk factors could contribute to the development of delirium, such as the use of some sedative drugs and a patient's history with certain types of acute chronic disease. However, in the literature, there is little knowledge about the association between delirium in patients who have undergone cardiac surgical intervention and their clinical and environmental predictors.DesignWe used an observational design.MethodsWe enrolled 89 hospitalised patients in the ICU. Patients were first evaluated using the Richmond Agitation Sedation Scale and subsequently using the Confusion Assessment Method for the ICU. A linear model of regression was used to identify the predictors of delirium in patients.ResultsThe patients had an average age of 89 years (SD = 6.9), were predominantly male (84.3%) and were mostly married (79.8%). The majority of patients had been subjected to bypass (80.9%), while 19.1% had undergone the intervention of endoprosthesis. The logistic regression model showed that patient age, the duration of mechanically assisted ventilation, continuous exposure to artificial light and the presence of sleep disorders were predictors of the onset of delirium.ConclusionThis study further confirms that clinical aspects such as insomnia and one's circadian rhythm as well as structural elements such as exposure to artificial light are variables that should be monitored in order to prevent and treat the onset of severe post‐operative delirium.Relevance to clinical practiceIdentifying the possible factors that predispose a patient to the onset of delirium during intensive therapy following cardiac surgery, it is fundamental to implement interventions to prevent this syndrome.
Knowing how to get things done: Nurse consultants as clinical leaders
Authors: Giles Michelle , Parker Vicki , Conway Jane , Mitchell Rebecca 
Published: March 2018

BackgroundClinical leaders drive healthcare performance in the provision of safe, high‐quality patient care by influencing others and augmenting change. Clinical leadership features strongly in nurse consultant roles and holds potential to strengthen the nurse consultant's place in healthcare teams, making their contribution as clinical leaders more recognisable. This study explores how clinical leadership is enacted through the nurse consultant role, providing understanding of the elements that influence their effectiveness as clinical leaders.DesignThis study presents qualitative findings from a larger sequential mixed‐method study conducted in a large Local Health District in New South Wales, Australia.MethodsFocus groups were held with nurse consultants, managers and other stakeholders from a variety of context including acute, primary and community care settings across metropolitan and rural locations. An online discussion forum was provided for nurse consultants unable to attend focus groups. Transcript data were analysed using iterative theming techniques.ResultsA total of 26 nurse consultants, 20 managers and 16 other stakeholders participated in focus groups and 22 nurse consultants contributed to the discussion forum. The role of the nurse consultant as clinical leader was a dominant feature, manifested through the following four themes: knowing and being known, being a collaborator, being a utility player and working across and within.ConclusionsNurse consultants are cogent clinical leaders, recognised and valued for their contribution to interprofessional teams and service delivery. The nurse consultant role is seen as having a broad sphere of influence and is able to action change through clinical leadership.Relevance to clinical practiceFindings give organisational leaders and other healthcare professional's greater understanding of nurse consultants as clinical leaders. This informs how nurse consultants are appointed and positioned and how they can be supported in fulfilling their clinical leadership potential.
Nurses' role in recognising and responding to clinical deterioration in surgical patients
Authors: Mohammmed Iddrisu Suad , Hutchinson Ana F , Sungkar Yasmin , Considine Julie 
Published: March 2018

Aim and objectivesTo explore nurse’ role in recognising and responding to deteriorating post‐operative patients.BackgroundClinical deterioration is a significant problem in acute care settings. Nurses play a vital role in post‐operative patient monitoring; however, there is limited understanding of the nurses’ role in recognising and responding to clinical deterioration in surgical patients.MethodsThis qualitative exploratory study was conducted at a metropolitan teaching hospital in Melbourne, Australia. Data were collected through focus groups from 1 September to 31 October 2014. Four focus groups of 2–5 surgical nurses (n = 14) were conducted to explore the nurses’ perception of their role in managing deterioration over the first 72 hr postoperatively. Qualitative data were recorded, transcribed and key themes identified.ResultsNurses demonstrated a high level of awareness of their role in recognising and responding to early signs of deterioration. The themes that arose from the focus group interviews were “struggling with blood pressure,” and “we know our patient is sick.” The nurses were confident about the clinical indicators of deterioration and the appropriate channels to use to escalate care. Using track and trigger observation charts enabled nurses to identify deteriorating patients prior to the patient fulfilling rapid response system escalation criteria.ConclusionsThese findings highlight the importance of a collective team approach to preventing, recognising and responding to clinical deterioration across the whole patient journey. Initiatives to ensure accurate written and verbal communication between medical and nursing staff warrants further assessment.Relevance to clinical practiceNurses working in acute surgical wards are highly engaged in the process of recognising and responding to clinical deterioration in post‐operative patients. Many nurses reported being able to anticipate deterioration occurring but are required by current organisational frameworks to escalate care to rapid response systems. How nurses anticipate and manage deterioration prior to the patient fulfilling rapid response system criteria warrants further investigation.
Growth and protein‐rich food intake in infancy is associated with fat‐free mass index at 2–3 years of age
Authors: Smith‐Brown Paula , Morrison Mark , Krause Lutz , Newby Ruth , Davies Peter SW 
Published: March 2018

AimThe reduction of infant protein intake and associated growth velocity is a recommended public health strategy for reducing the risk of childhood obesity. This study tests the hypothesis that infants’ growth and protein‐rich food (dairy, meat, fish and egg) intake influences childhood body size and composition at 2–3 years of age.MethodsThirty‐six children were studied from the Feeding Queensland Babies Study Cohort, which prospectively collected data on infant growth and diet. Body composition was estimated using the deuterium oxide dilution technique at 2–3 years of age.ResultsFat‐free mass index Z score at 2–3 years of age was positively associated with animal protein food (dairy, meat, fish and egg) intake at 12 months of age (r = 0.58, P = 0.002, false discovery rate corrected P value = 0.008) and negatively associated with weight‐for‐length growth velocity from 6 to 12 months of age (r = −0.75, P = 0.019, false discovery rate corrected P value = 0.038), which in turn was negatively associated with growth velocity from 0 to 6 months of age (r = −0.790, P = 0.007).ConclusionThis study suggests that strategies to reduce protein intake and growth velocity in early life may limit fat‐free mass growth, potentially predisposing to increased adiposity in later life.
The enhanced effect of tetrahydrocurcumin on radiosensitivity of glioma cells
Authors: Zhang Xingzhen , Peng Lei , Liu Anchang , Ji Jianbo , Zhao Lixia , Zhai Guangxi 
Published: March 2018

Abstract

Objectives
To evaluate the effects of tetrahydrocurcumin (THC) on the radiosensitivity of glioma cells and the possible molecular mechanism.

Methods
MTT assay, colony forming and wound healing assays were performed to detect the proliferation, radiosensitivity and migration of cells with various treatments. Cell apoptosis, cell cycle and GHS level were determined for exploring potent sensitization mechanism of THC. Meanwhile, protein expressions of cyclin D1 and PCNA were also measured. Furthermore, both orthotopic C6 mouse models and C6 subcutaneously grafted mouse models were established to test the tumour inhibitory effects of combined treatment in vivo.

Key findings
Cells treated with combined THC and radiation demonstrated lower cell viability and higher apoptosis rate as compared to radiation group. Moreover, the intracellular GSH was also decreased in the THC co-treated C6 cells. More importantly, combinatorial treatment group significantly induced G0/G1 cell cycle arrest and a decrease in the S phase cell through the down-regulation of cyclin D1 and PCNA. The in-vivo therapeutic efficacy assay indicated that the growth of tumour was greatly inhibited in combinatorial group.

Conclusions
Tetrahydrocurcumin can synergistically enhance the radiosensitivity of glioma cells by inhibiting the expressions of cyclin D1 and PCNA.
Carcass characteristics, chemical and fatty acid composition and oxidative stability of meat from broiler chickens fed black cumin (Nigella sativa) seeds
Authors: Kumar P. , Patra A. K. , Mandal G. P. , Debnath B. C. 
Published: March 2018

SummaryA study was conducted to investigate the dietary supplementation of black cumin seeds (BCS) on carcass characteristics, chemical and fatty acid (FA) composition and antioxidant properties of thigh and breast meat of broiler chickens at 42 days of age. Three hundred sixty 1‐day‐old broiler chickens were allocated to five dietary treatment groups (each group containing eight replicate pens with each pen containing nine broiler chickens): basal diet (control; CON), CON + 0.05 g/kg of bacitracin methylene disalicylate (AB), CON + 5 g/kg of BCS (low dose of BCS), CON + 10 g/kg of BCS (medium dose of BCS) and CON + 20 g/kg of BCS (high dose of BCS). Weight (g) of slaughtered birds (p = .03), hot carcass (p = .007), breast (p = .03), thigh (p < .001), wing (p = .06), neck (p = .01), liver (p = .09), abdominal fat (p = .01) and total edible parts (p = .01) increased or tended to increase due to BCS supplementation compared with the CON. The concentrations of dry matter, crude protein and ether extract in chicken thigh and breast meat increased (p = .038 to <.001) with increasing doses of BCS in diets. The ferric reducing antioxidant activity in blood and meat increased linearly with increasing doses of BCS in the diets. However, peroxide values in meat were not affected by BCS and AB on both days 1 and 7 of storage at 4°C. Supplementation of BCS increased the concentrations of C14:1, C18:3n‐6, C20:1, C20:2 FA and PUFA linearly (p < .05) and tended to increase (p = .098) the concentration of C18:2cis linearly. However, the concentrations of C16:0 and C16:1 FA decreased linearly with increasing doses of BCS in the diets. In conclusion, dietary supplementation of BCS at 20 g/kg diet may improve slaughter body weight, beneficial FA concentrations and antioxidant properties of broiler chicken meat.
Evolutionary trends in Tetrastigma (Vitaceae): Morphological diversity and taxonomic implications
Authors: Habib Sadaf , Dang Viet‐Cuong , Ickert‐Bond Stefanie M. , Wen Jun , Chen Zhi‐Duan , Lu Li‐Min 
Published: March 2018

AbstractTetrastigma (Miq.) Planch. (Vitaceae) is a genus with ca. 100 species showing great morphological diversity. Previous molecular phylogenetic studies suggested that traditional classification systems are not consistent with the molecular phylogeny, and Tetrastigma is undergoing further systematic investigation. We traced the evolutionary trends of 20 morphological characters within a robust phylogenetic framework. Our results revealed that many morphological characters show either multiple transitions or few state changes, however, some characters show distinct variation. The two subgenera in Tetrastigma (subgen. Tetrastigma and subgen. Palmicirrata) based on unbranched/bifurcate versus digitately branched tendrils are not supported because subgen. Tetrastigma is paraphyletic. However, the unbranched versus bifurcate/digitately branched tendril is of taxonomic utility to characterize some of the major clades. Inflorescences in Tetrastigma appear axillary, but are leaf‐opposed on a compressed axillary shoot. We found most of the species in Tetrastigma retained the ancestral compound dichasial inflorescence, except those of clade IV that have derived pseudo‐umbellate inflorescences. Other characters including habit, leaf organization, and berry shape provide additional morphological support for the major clades. Our morphological analysis and recent molecular study suggest each of the five major clades within Tetrastigma be treated as distinct taxonomic sections (five sections in the genus).
Complement system activation in obstructive sleep apnea
Authors: Horvath Peter , Tarnoki David L. , Tarnoki Adam D. , Karlinger Kinga , Lazar Zsofia , Losonczy Gyorgy , Kunos Laszlo , Bikov Andras 
Published: March 2018

SummaryThe complement system may play a role in the systemic inflammation characterising obstructive sleep apnea; however, this has not been investigated before. We aimed to study the involvement of effector complement elements in obstructive sleep apnea, namely C3a, C5a and SC5b‐9. Venous blood was collected in 50 patients with obstructive sleep apnea and 26 control subjects in the evening and the following morning. Plasma complement proteins were analysed with ELISA. Complement factor levels were compared between the two groups and correlated with clinical variables. Plasma C3a concentration was elevated in obstructive sleep apnea both in the evening (84.1 [0–338.5] ng ml−1) and in the morning (85.5 [0–247.8] ng ml−1) compared with controls (30.3 [0–176.8] ng ml−1 and 36.3 [0–167.1] ng ml−1, evening and morning, respectively, both p < 0.05). On the contrary, C5a and SC5b‐9 levels were comparable between patients and controls at each time point (p > 0.05). There was no change in complement factors from evening to morning in either group (p > 0.05), except for C5a that decreased from evening to morning in obstructive sleep apnea (from 11.6 [1.6–47.4] ng ml−1 to 9.3 [0–46.4] ng ml−1, p = 0.01). Elevated C3a levels were directly related to obstructive sleep apnea severity, and were significantly associated with male gender, weight, body mass index, hypertension, high C‐reactive protein and low high‐density lipoprotein cholesterol (p < 0.05). The complement system is activated in obstructive sleep apnea, which is correlated with disease severity. Our findings highlight the potential role of complement system in the pathophysiology of obstructive sleep apnea, thus facilitating further research.
Treatment efficiency and stability of skeletal Class III malocclusion with a surgery‐first approach
Authors: Lian Y. K. , Hsieh A. M. C. , Tsai M. S. , Jiang H. R. , Yen C. Y. , Hsia Y. J. , Lee S. Y. 
Published: March 2018

Structured AbstractObjectivesTo compare treatment duration in skeletal Class III malocclusion patients managed with a 2‐step treatment (surgery‐first approach, SFA) and conventional 3‐step treatment, and to compare stability of surgical outcomes between segmentation and non‐segmentation in the 2‐step treatment group.Setting and Sample PopulationThe sample population consisted of 37 patients who completed orthognathic surgery (OGS) and orthodontic correction at the Charm Aesthetic Surgery Clinic (Taipei, Taiwan) between 2012 and 2015. Of these, 26 received 2‐step treatment and 11 received 3‐step treatment.Materials and MethodsTo compare treatment efficiency and stability, three time points were analysed: T0, before treatment (before OGS in the 2‐step group and before orthodontic treatment in the 3‐step group); T1, after OGS but before orthodontic correction (cone beam computed tomography (CBCT) was obtained within 2 weeks of OGS); and T2, after orthodontic correction (CBCT was obtained on the day of bracket removal). The post‐OGS (T1) CBCT items were individually superimposed on the pre‐treatment (T0) CBCT items to determine the distance of B point migration.ResultsA significant difference was found in treatment times between 2‐step treatment and conventional 3‐step treatment. In addition, no significant difference was found when comparing B‐X (mm) and B‐Y (mm) at T2‐T1 for the segmentation and non‐segmentation groups.ConclusionsUsing SFA for skeletal Class III malocclusions saves approximately 6 months of treatment time over 3‐step treatment; the stability of the segmentation group was comparable to that of the non‐segmentation group, a result that is possibly associated with the fixation of 2 miniplates.
Simplified procedures to treat periodontal intraosseous defects in esthetic areas
Authors: Trombelli Leonardo , Simonelli Anna , Minenna Luigi , Vecchiatini Renata , Farina Roberto 
Published: March 2018

AbstractSuccessful treatment of deep intraosseous defects in esthetic areas implies clinical improvement of the lesion consistent with long‐term tooth survival as well as the preservation (or improvement) of esthetics. It is hoped that such treatment end points may be reached through procedures (which we have termed as ‘simplified’) that, on the one hand can be easily and successfully applied by the majority of clinicians, and, on the other hand, are well tolerated by patients in terms of postsurgical pain and discomfort, adverse events and cost. In this review, we describe the technical aspects of the simplified procedures currently available (i.e. nonsurgical therapy and the single flap approach and its variants). Also, we analyze the effect of such procedures on clinical parameters and patient‐centered outcomes. While nonsurgical therapy seems to be appropriate per se in lesions with a probing depth of < 7 mm and a limited intraosseous component, severe intraosseous defects can be successfully treated using simplified surgical procedures. Overall, data support the effectiveness of simplified surgical procedures and indicate that they result in minimal esthetic impairment (i.e. post‐treatment recession) and a more tolerable postoperative course when compared with conventional surgical (double flap) approaches. In particular, the single flap approach was shown to be at least as effective as traditional papilla‐preservation techniques when evaluated either as a stand‐alone protocol or in combination with regenerative devices. Bioactive agents have shown the most appropriate regenerative technology when used in association with simplified surgical procedures.
Nuclear parameters and chromatin remodeling in epithelial cells and lymphocytes from the palpebral conjunctiva of dogs with keratoconjunctivitis sicca
Authors: dos Santos Daniela Moura , Aldrovani Marcela , Filezio Marcella Rosa , Abreu Thais Guimarães Morato , Balthazar da Silveira Camila Pinho , Cruz Nathan Rocha das Neves , Laus José Luiz 
Published: March 2018

AbstractObjectiveTo study parameters related to nuclear morphology and chromatin remodeling in epithelial cells and lymphocytes from the inferior palpebral conjunctiva of dogs with and without keratoconjunctivitis sicca (KCS).Animals studiedThirty‐two dogs (64 eyes) were included in the study. Based on the tear production measured by Schirmer tear test 1, the dogs were distributed into control and KCS groups.ProceduresEpithelial cells and lymphocytes were collected by conjunctival brush cytology, fixed on glass slides, and subjected to the Feulgen reaction, a topochemical method specific for DNA/chromatin. Feulgen‐stained cells were studied by microscopy and video image analysis to establish nuclear size (area and perimeter) and shape (relative nuclear roundness factor = RNRF), DNA content (ploidy), and compaction and texture of chromatin.ResultsConjunctival samples in the KCS group showed infiltration of inflammatory and immune cells. Micronuclei, snake‐like chromatin, aberrant chromosomes, and goblet cells were not detected. Compared with the controls, cells on the conjunctival surface of dogs with KCS showed altered nuclei. Conjunctival epithelial cells were more affected by KCS (changes in nuclear size, shape, DNA content, and chromatin compaction) than lymphocytes (changes in chromatin compaction, only). Significant chromatin decompaction was observed in both conjunctival epithelial cells and lymphocytes.ConclusionsOur results show that KCS promotes chromatin remodeling in epithelial cells and lymphocytes on the conjunctival surface of dogs. The changes described in this study are different from those reported for conjunctival cell nuclei of human KCS patients.
ATP increases [Ca2+]iand activates a Ca2+‐dependent Cl−current in rat ventricular fibroblasts
Authors: Hatano Noriyuki , Ohya Susumu , Imaizumi Yuji , Clark Robert B. , Belke Darrell , Giles Wayne R. 
Published: March 2018

New FindingsWhat is the central question of this study?Although electrophysiological and biophysical characteristics of heart fibroblasts have been studied in detail, their responses to prominent paracrine agents in the myocardium have not been addressed adequately. Our experiments characterize changes in cellular electrophysiology and intracellular calcium in response to ATP.What is the main finding and its importance?In rat ventricular fibroblasts maintained in cell culture, we find that ATP activates a specific subset of Ca2+‐activated Cl−channels as a consequence of binding to P2Y purinoceptors and then activating phospholipase C. This response is not dependent on [Ca2+]obut requires an increase in [Ca2+]iand is modulated by the type of nucleotide that is the purinergic agonist.AbstractEffects of ATP on enzymatically isolated rat ventricular fibroblasts maintained in short‐term (36–72 h) cell culture were examined. Immunocytochemical staining of these cells revealed that a fibroblast, as opposed to a myofibroblast, phenotype was predominant. ATP, ADP or uridine 5′‐triphosphate (UTP) all produced large increases in [Ca2+]i. Voltage‐clamp studies (amphotericin‐perforated patch) showed that ATP (1–100 μm) activated an outwardly rectifying current, with a reversal potential very close to the Nernst potential for Cl−. In contrast, ADP was much less effective, and UTP produced no detectable current. The non‐selective Cl−channel blockers niflumic acid, DIDS and NPPB (each at 100 μm), blocked the responses to 100 μmATP. An agonist for P2Y purinoceptors, 2‐MTATP, activated a very similar outwardly rectifying C1−current. The P2Y receptor antagonists, suramin and PPADS (100 μmeach), significantly inhibited the Cl−current produced by 100 μmATP. ATP was able to activate this Cl−current when [Ca2+]owas removed, but not when [Ca2+]iwas buffered with BAPTA‐AM. In the presence of the phospholipase C inhibitor U73122, this Cl−current could not be activated. PCR analysis revealed strong signals for a number of P2Y purinoceptors and for the Ca2+‐activated Cl−channel, TMEM16F (also denoted ANO6). In summary, these results demonstrate that activation of P2Y receptors by ATP causes a phospholipase C‐dependent increase in [Ca2+]i, followed by activation of a Ca2+‐dependent Cl−current in rat ventricular fibroblasts.