bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nonalcoholic fatty liver disease in chronic obstructive pulmonary disease
Authors: Viglino Damien , Jullian-Desayes Ingrid , Minoves Mélanie , Aron-Wisnewsky Judith , Leroy Vincent , Zarski Jean-Pierre , Tamisier Renaud , Joyeux-Faure Marie , Pépin Jean-Louis 
Published: June 2017

Nonalcoholic fatty liver disease (NAFLD) is independently linked to cardiometabolic morbidity and mortality. Low-grade inflammation, oxidative stress and ectopic fat, common features of chronic obstructive pulmonary disease (COPD), might contribute to the development of NAFLD.We aimed to investigate the prevalence of NAFLD and to evaluate the relationship between various types of liver damage and COPD severity, comorbidities and circulating inflammatory cytokines. Validated noninvasive tests (FibroMax: SteatoTest, NashTest and FibroTest) were used to assess steatosis, nonalcoholic steatohepatitis (NASH) and liver fibrosis. Patients underwent an objective assessment of COPD comorbidities, including sleep studies. Biological parameters included a complete lipid profile and inflammatory markers.In COPD patients the prevalence of steatosis, NASH and fibrosis were 41.4%, 36.9% and 61.3%, respectively. In multivariate analysis, SteatoTest and FibroTest were significantly associated with sex, body mass index (BMI), untreated sleep apnoea and insulin resistance, and, in addition, COPD Global Initiative for Chronic Obstructive Lung Disease stage for SteatoTest. Patients with steatosis had higher tumour necrosis factor-α levels and those with NASH or a combination of liver damage types had raised leptin levels after adjustment for age, sex and BMI.We concluded that NAFLD is highly prevalent in COPD and might contribute to cardiometabolic comorbidities.
Pedobarography as a clinical tool in the management of diabetic feet in New Zealand: a feasibility study
Authors: Gurney Jason K. , Kersting Uwe G. , Rosenbaum Dieter , Dissanayake Ajith , York Steve , Grech Roger , Ng Anthony , Milne Bobbie , Stanley James , Sarfati Diana 
Published: June 2017

AbstractBackgroundThe peripheral complications of diabetes mellitus remain a significant risk to lower‐limb morbidity. In New Zealand, risk of diabetes, comorbidity and lower‐limb amputation are highly‐differential between demographic groups, particularly ethnicity. There is growing and convincing evidence that the use of pedobarography – or plantar pressure measurement – can usefully inform diabetic foot care, particularly with respect to the prevention of re‐ulceration among high‐risk patients.MethodsFor the current feasibility study, we embedded pedobarographic measurements into three unique diabetic foot clinic settings in the New Zealand context, and collected pedobarographic data from n = 38 patients with diabetes using a platform‐based (Novel Emed) and/or in‐shoe‐based system (Novel Pedar). Our aim was to assess the feasibility of incorporating pedobarographic testing into the clinical care of diabetic feet in New Zealand.Results and ConclusionsWe observed a high response rate and positive self‐reported experience from participants. As part of our engagement with participants, we observed a high degree of lower‐limb morbidity, including current ulceration and chronic foot deformities. The median time for pedobarographic testing (including study introduction and consenting) was 25 min. Despite working with a high‐risk population, there were no adverse events in this study. In terms of application of pedobarography as a clinical tool in the New Zealand context, the current feasibility study leads us to believe that there are two avenues that deserve further investigation: a) the use of pedobarography to inform the design and effectiveness of offloading devices among high‐risk diabetic patients; and b) the use of pedobarography as a means to increase offloading footwear and/or orthoses compliance among high‐risk diabetic patients. Both of these objectives deserve further examination in New Zealand via clinical trial.
Aerosolized Vasodilators for the Treatment of Pulmonary Hypertension in Cardiac Surgical Patients: A Systematic Review and Meta-analysis
Authors: Elmi-Sarabi Mahsa , Deschamps Alain , Delisle Stéphane , Ased Hosham , Haddad François , Lamarche Yoan , Perrault Louis P. , Lambert Jean , Turgeon Alexis F. , Denault André Y. 
Published: June 2017

BACKGROUND:
In cardiac surgery, pulmonary hypertension is an important prognostic factor for which several treatments have been suggested over time. In this systematic review and meta-analysis, we compared the efficacy of inhaled aerosolized vasodilators to intravenously administered agents and to placebo in the treatment of pulmonary hypertension during cardiac surgery. We searched MEDLINE, CENTRAL, EMBASE, Web of Science, and clinicaltrials.gov databases from inception to October 2015. The incidence of mortality was assessed as the primary outcome. Secondary outcomes included length of stay in hospital and in the intensive care unit, and evaluation of the hemodynamic profile.

METHODS:
Of the 2897 citations identified, 10 studies were included comprising a total of 434 patients.

RESULTS:
Inhaled aerosolized agents were associated with a significant decrease in pulmonary vascular resistance (−41.36 dyne·s/cm5, P= .03) and a significant increase in mean arterial pressure (8.24 mm Hg, P= .02) and right ventricular ejection fraction (7.29%, P< .0001) when compared to intravenously administered agents. No significant hemodynamically meaningful differences were observed between inhaled agents and placebo; however, an increase in length of stay in the intensive care unit was shown with the use of inhaled aerosolized agents (0.66 days, P= .01). No other differences were observed for either comparison.

CONCLUSIONS:
The administration of inhaled aerosolized vasodilators for the treatment of pulmonary hypertension during cardiac surgery is associated with improved right ventricular performance when compared to intravenously administered agents. This review does not support any benefit compared to placebo on major outcomes. Further investigation is warranted in this area of research and should focus on clinically significant outcomes.
Cardiorespiratory Alterations Following Acute Normovolemic Hemodilution in a Pediatric and an Adult Porcine Model: A Prospective Interventional Study
Authors: Albu Gergely , Sottas Cédric , Dolci Mirko , Walesa Magali , Peták Ferenc , Habre Walid 
Published: June 2017

BACKGROUND:
Acute normovolemic hemodilution (ANH) is considered as a blood-sparing intervention during the perioperative management. We aimed at comparing the cardiopulmonary consequences of ANH between adult pigs and weaned piglets to establish the effects of lowering hematocrit in these age groups, and thereby testing the hypothesis that difference in the age-related physiological behavior will be reflected in the cardiorespiratory changes following ANH.

METHODS:
ANH was achieved in anesthetized, mechanically ventilated adult minipigs and 5-week-old weaned piglets by stepwise blood withdrawal (10 mL/kg) with crystalloids replacement. Cardiorespiratory assessments consisted of measuring airway resistance, respiratory tissue elastance, effective lung volume, extravascular lung water, mean arterial pressure, pulmonary blood flow, and cardiac output. Respiratory and hemodynamic measurements were made at control conditions and following each ANH condition obtained with 5 to 7 steps.

RESULTS:
ANH induced immediate and progressive increases in airway resistance and tissue elastance in both groups, with more pronounced worsening in adults despite the similar decreases in hematocrit. The increases in extravascular lung water were significantly greater in the adult population with the differences in mean (DM) of 25.1% (95% confidence interval [CI], 5.3%–44.9%). Progressive ANH led to significant decreases in the DM of pulmonary blood flow (45.3%; 95% CI, 19.8%–70.8%) and mean arterial pressure (36.3%; 95% CI, 18.7%–53.9%) only in adults, whereas cardiac output increased significantly only in the piglets (DM, 51.6; 95% CI, 14.2%–89.0%).

CONCLUSIONS:
While ANH led to mild detrimental cardiorespiratory changes in weaned piglets, gradual developments of bronchoconstriction, lung tissue extravasation and stiffening, and deteriorations in systemic and pulmonary hemodynamics were observed in adults. ANH may exert age-dependent cardiorespiratory effect.
The use of modern dressings in managing split-thickness skin graft donor sites: a single-centre randomised controlled trial
Authors: Kazanavičius M. , Cepas A. , Kolaityte V. , Simoliuniene R. , Rimdeika R. 
Published: June 2017

Objective: To identify the most appropriate, most suitable and most efficient dressing for split-thickness skin graft (STSG) donor sites. Comparing the wound healing rate, pain severity and duration, as well as the dressing change frequency in four randomised patient groups. Methods: A single-centre non-blinded randomised controlled trial was carried out during 2010–2014. All patients treated for skin defects/lesions (due to burns, trauma or ulcers) using STSG were included in the study. All patients were randomly allocated in four different donor site treatment groups; polyurethane (PU group, Mepilex); polyurethane with silicone membrane (PUSM group; Mepilex border,); transparent, breathable film (TBF group; Mepitel film) and cotton gauze dressings (CG group) using Excel 2007. We evaluated: wound healing time, pain severity and duration, the frequency of dressing change, donor site re-epithelialisation, donor site complications (signs of inflammation or infection). Patients were assessed on postoperative days: 1, 3, 6, 9, 12, 15, 18 and 21. Results: After random allocation of study participants the number of patients in each group were: PU group n=25; PUSM group n=24; TBF group n=24; CG group n=25. The groups were homogenous according to gender, age, main pathology, donor site area and wound size. The STSG donor site healing time varied from 9 to 21 days. The mean healing time in the CG group was 14.76 days, whereas in the PU, PUSM, and TBF group it was significantly shorter; 12.25 days, 11.63 days and 10 days, respectively. Patients in the TBF group demonstrated the most rapid healing time with 66.7% of STSG donor sites healed by postoperative day 9. The pain duration interval in modern dressing groups (PU, PUSM and TBF groups) was 0–9 days, whereas it was 6–18 day in the CS group. Pain intensity mean on postoperative day 1 was 2.21 in the PU group; 1.67 in the PUSM group; 1.46 in the TBF group and 3.04 in the CG group. The average pain duration in Group PU, PUSM, and TBF was 4.08 days; 2.5 days; 2.29 days, respectively. The average number of times each dressing was changed in each group was, 2.83 times in the PU group and PUSM group and 1.46 times in the TBF group. The CG dressing group were changed once when the donor site wound re-epithelialised. There was one patient in the PU group who experienced signs of infection, was treated accordingly and excluded from the study. Conclusion: The fastest healing time was demonstrated by patients in the TBF group. The pain was not as severe and for a shorter period of time in modern dressing study groups. However, the pain was lightest and felt shortest in TBF dressing group. The modern dressings PU and PUSM had to be changed more frequently than TBF.
The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK
Authors: Guest J. F. , Vowden K. , Vowden P. 
Published: June 2017

Objective: To estimate the patterns of care and related resource use attributable to managing acute and chronic wounds among a catchment population of a typical clinical commissioning group (CCG)/health board and corresponding National Health Service (NHS) costs in the UK. Method: This was a sub-analysis of a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) database. Patients' characteristics, wound-related health outcomes and health-care resource use were quantified for an average CCG/health board with a catchment population of 250,000 adults ≥18 years of age, and the corresponding NHS cost of patient management was estimated at 2013/2014 prices. Results: An average CCG/health board was estimated to be managing 11,200 wounds in 2012/2013. Of these, 40% were considered to be acute wounds, 48% chronic and 12% lacking any specific diagnosis. The prevalence of acute, chronic and unspecified wounds was estimated to be growing at the rate of 9%, 12% and 13% per annum respectively. Our analysis indicated that the current rate of wound healing must increase by an average of at least 1% per annum across all wound types in order to slow down the increasing prevalence. Otherwise, an average CCG/health board is predicted to manage ~23,200 wounds per annum by 2019/2020 and is predicted to spend a discounted (the process of determining the present value of a payment that is to be received in the future) £50 million on managing these wounds and associated comorbidities. Conclusion: Real-world evidence highlights the substantial burden that acute and chronic wounds impose on an average CCG/health board. Strategies are required to improve the accuracy of diagnosis and healing rates.
Pressure ulcers prevention efficacy of an alternating pressure air mattress in elderly patients: E²MAO a randomised study
Authors: Sauvage P. , Touflet M. , Pradere C. , Portalier F. , Michel J-M. , Charru P. , Passadori Y. , Fevrier R. , Hallet-Lezy A-M. , Beauchêne F. , Scherrer B. 
Published: June 2017

Objective: Our aim was to compare Axtair One, an alternating pressure air mattress (APAM), with a viscoelastic foam mattress (VFM) in elderly patients at moderate to high risk of developing pressure ulcers (PUs). Method: A randomised, controlled, superiority, parallel-group, open-label, multicentre study, was conducted, between February 2012 and March 2015, in nine French, medium- and long-term stay facilities. Eligible patients were aged 70 and over, had no PUs on enrolment, were bedridden for at least 15 hours per day, had reduced mobility, an absent or minimal positioning capability, a Braden score <14, a nutritional status score >12 and a Karnofsky score <40%. The primary endpoint was the appearance of PUs over a 30-day monitoring period. The primary objective was to demonstrate a 50% reduction in instantaneous risk of PUs in the APAM versus the VFM group. Secondary objectives were to determine if preventive care was less frequent in the APAM group, the instantaneous relative risk of PUs (hazard ratio) was constant over time and the comfort experienced was higher in the APAM group and to verify the uniformity of the preventive benefit of an APAM, regardless of the level of exposure to major risk factors for PUs. Results: We randomised 76 patients (39 in the APAM group and 37 in the VFM group). The groups were comparable on enrolment and throughout the study. The cumulative risk of PUs was estimated at 6.46% [95% confidence interval (CI): 1.64; 23.66] in the APAM group and at 38.91% [95% CI: 24.66; 57.59] in the VFM group, p=0.001 (log-rank test). The adjusted hazard ratio according to the Cox model with four prognostic factors for the appearance of PUs was 7.57 [95% CI: 1.67; 34.38, p=0.009]. Preventive care proved to be equivalent in both groups. The only risk factor significantly associated with an increased risk of PUs was the type of mattress (VFM). The comfort and tolerance perceived by the patients were both high and similar in the two groups. The constancy over time of the preventive benefit of an APAM could not be verified because of the lack of a sufficient number of events (appearance of PUs) in the APAM group. Conclusion: The APAM was superior to a VFM for preventing PUs in elderly patients, bedridden for more than 15 hours per day, severely dependent, at moderate-to high-risk of PUs, with an instantaneous risk for the appearance of PUs 7.57 times greater in the VFM group than in the APAM group. This study provides descriptive information and evidence for practice.
Efficacy of arginine-enriched enteral formulas for the healing of pressure ulcers: a systematic review
Authors: Liu P. , Shen W-Q , Chen H-L 
Published: June 2017

Objective:Arginine improves healing and modulates inflammation and the immune response. This systematic review aimed to assess the effect of arginine-enriched enteral formulas in pressure ulcer (PU) healing.Method:Systematic computerised searches of PubMed, Web of Knowledge, Scopus, ENTRAL and CINAHL databases were performed from their inception to 20 January 2016. Randomised controlled trials (RCTs) were included in this systematic review. We used the Jadad scale as a quality assessment tool.Results:There were seven RCTs with 369 patients included in this systematic review; four RCTs assessed healing by PU area reduction. All of them reported arginine-enriched enteral nutrition led to a significant improved PU healing compared with standard hospital diet in 2–12 weeks follow-up. Among these four RCTs, one enrolled malnourished patients, one enrolled non-malnourished patients, and the other two studies did not restrict the nutritional status of the patients. Using the Pressure Ulcer Scale for Healing (PUSH) four RCTs assessed healing of PU, all reporting arginine-enriched enteral nutrition resulted in a significant PUSH score improvement compared with control at follow-up. Using the Pressure Sore Status Tool (PSST) one RCT assessed healing of PUs, finding patients receiving arginine had the lowest PSST scores compared with controls. An RCT compared healing with two doses of arginine (4.5g versus 9g), but no difference was found between the doses.Conclusion:Evidence showed that arginine-enriched enteral nutrition led to a significant improvement in PU healing. It was effective not only in malnourished patients, but also in non-malnourished patients.
Of Presidents, High Representatives and European Commissioners – the external representation of the European Union seven years after Lisbon
*

*
Dr Iur, Professor at the Free University, Brussels. Email: frank.hoffmeister@ec.europa.eu. For the case studies on Iran and the Ukraine in section 4, I would like to warmly thank Mrs Charlotte Berends for extensive research and analysis. Important details from the practice of the EU’s environmental diplomacy I owe to the Academic Director of the Institute for European Studies (Brussels), Prof Sebastian Oberthür. The article also benefited from a couple of interviews held with the former Trade Commissioner Karel De Gucht and high EEEAS officials on matters touched upon in this article.
Authors: Frank Hoffmeister 
Published: June 2017

The article reviews the external representation of the European Union. Hoffmeister first analyses the rules established by the Lisbon Treaty (2007). He emphasizes the division between the Common Foreign and Security Policy (CFSP) and non-CFSP and the importance of the diplomatic level. Moreover, he interprets recent case law in which the European Court of Justice has given guidance to the Council and the Commission about their respective roles in policy-making and representation. The author then provides extensive case studies on Iran, Ukraine, trade negotiations and environmental negotiations to track down relevant practice of the last seven years. He concludes that Europe continues to operate a multi-layered system of external representation, where supra-national elements with a strong role of the Commission in important areas are combined with inter-governmental traits of a principal–agent relationship between the Council and its President or the High Representative.
Immobilization of lactic acid bacteria and application of bacteriocin for preservation of fruit juices and bacteriocin production
Authors: . Divya , Xavier J. R. , Gopalan Natarajan , Ramana K. V. 
Published: June 2017

<p>Lactic acid bacteria are generally recognized as safe (GRAS) organisms producingbacteriocins that help in inhibiting foodborne pathogens. However, its narrow spectrum activity is a major limitation for food applications. Thus, a combination of different methods were attemptedto broaden the antimicrobial spectrum of bacteriocins produced using lactic acid bacteria. Initially, the antimicrobial activity of bacteriocin from various combinations of mixed lactic acid bacteria and single culture were determined after 56 hours at 35ºC to select the desirable combination with maximum antimicrobial activity. Combination of bacteriocin produced by <em>Lactobacillus plantarum </em>DFR4<em>, Enterococcus faecalis </em>DFR4 and<em> E.Faecalis </em>DFRP1 showed maximumactivity against <em>Listeria monocytogenes</em> with zone of 31.24±0.33 mm in agar disc diffusion assay. The specific activity and purification of bacteriocins produced by these isolates werefound to be highest in gel permeation chromatography whereas, the yield was highest in 80 percent acetone precipitation. The partially purified bacteriocins were further investigated for the effect of pH, enzymes and temperature stability and were found to be thermostableand active at pH range of 3 to 5. Proteolytic enzymes such as protease and papain inactivedthe bacteriocinswhile amylase had no inhibitory effect. The antimicrobial activity of bacteriocin produced from bamboo (<em>Bambusa vulgaris</em>) fibre immobilized <em>Lactobacillus plantarum</em> DFR4 was found to be more (zone size=20.91±0.35 mm) in comparison to free cells (zone size=8.52±0.26 mm) after 24 h of incubation at 37°C. Further, immobilization of <em>Lactobacillus plantarum </em>DFR4<em>, Enterococcus faecalis </em>DFR4 and<em> E. Faecalis </em>DFRP1 using bamboo fibre aided in faster production of bacteriocins in 24 h.Mosambi juice (<em>Citrus limetta</em>) supplemented with bacteriocins (produced from mixed bacterial isolates) had a shelf life of 26 days at 5ºC. </p>
Quality Aspects and Storage Evaluation of Freeze Dried Probiotic Pineapple Lassi Powder
Authors: Tabassum Aisha , Shiby V. K. , Pandey M. C. 
Published: June 2017

<p>Freeze dried probiotic pineapple <em>lassi</em> powder was developed using <em>Bifidobacterium bifidum</em> (NCDC 235). Quality aspects were determined in terms of physico-chemical parameters, vitamin composition and probiotic viability. Storage changes were monitored at 25±2<sup>0</sup>C and -18±2<sup>0</sup>C for 1 year. The reconstituted <em>lassi</em> has carbohydrate content of 22.2%, thiamin 2mg which meets 2/3<sup>rd</sup> of suggested micronutrient intake goal for those working either in cold or at high altitudes. The niacin content in the product is 2.27mg, riboflavin 0.375 mg and pyridoxine 67.5mg. An increasing trend in ΔE values 0 to 6.06 was observed at 25±2°C while no significant difference (p&lt;0.05) was observed at -18±2<sup>0</sup>C. pH decreased from 4.71 to 4.1 at 25±2°C and to 4.3 at -18°C±2°C after 12 months. Browning in terms of absorbance increased significantly (p&lt;0.05) from 0.015 to 0.061 at 25±2°C. <em>Bifidobacterium bifidum</em> count decreased from 9.55 log<sub>10 </sub>cfu.ml<sup>-1</sup> to 8.87 log<sub>10 </sub>cfu.ml<sup>-1 </sup>and 8.95 log<sub>10 </sub>cfu.ml<sup>-1</sup> after 12 months at 25±2°C and -18°C±2°C respectively. Probiotic viability did not change significantly throughout the storage period at both the temperatures. This instant powder can also be utilised as a health drink mix with reduced bulk suitable for combat conditions and in high altitudes to overcome logistic problems.</p><p> </p>