Feasibility of implementing oral health guidelines in residential care settings: views of nursing staff and residential care workers.

Feasibility of implementing oral health guidelines in residential care settings: views of nursing staff and residential care workers.

Appl Nurs Res. 2016 May;30:194-203

Authors: Hilton S, Sheppard JJ, Hemsley B

Abstract
PURPOSE: To determine the views of nurses and on the feasibility of implementing current evidence-based guidelines for oral care, examining barriers and facilitators to implementation.
RESULTS: This mixed-methods study involved an online survey of 35 nurses and residential care workers, verified and expanded upon by one focus group of six residential care workers. Results reflected that nurses and residential care workers (a) have little or no training in recommended oral care techniques, and (b) lack access to the equipment and professional supports needed to provide adequate oral care. Basic oral care might be performed less than once per day in some settings and patients with problematic behaviours, dysphagia, or sensitivities associated with poor oral health might be less likely to receive oral care. While lack of time was highlighted as a barrier in the survey findings, focus group members considered that time should not be a barrier to prioritising oral care practices on a daily basis in residential care settings.
CONCLUSION: There are several important discrepancies between the recommendations made in evidence-based guidelines for oral care and the implementation of such practices in residential care settings. Nursing and residential care staff considered adequate oral care to be feasible if access, funding and training barriers are removed and facilitators enhanced.

PMID: 27091278 [PubMed - in process]

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[Course of rehabilitation in early neurological/neurosurgical rehabilitation. Results of a2014 multi-center evaluation in Germany].

[Course of rehabilitation in early neurological/neurosurgical rehabilitation. Results of a 2014 multi-center evaluation in Germany].

Nervenarzt. 2016 Apr 18;

Authors: Pohl M, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak DA, Platz T, Rollnik JD, Scheidtmann K, Thomas R, von Rosen F, Wallesch CW, Woldag H, Peschel P, Mehrholz J

Abstract
BACKGROUND: In Germany, neurological-neurosurgical early rehabilitation is well established in the treatment of severe neurological diseases. To develop quality standards, knowledge of the current rehabilitation course is required.
PATIENTS AND METHODS: A retrospective analysis was performed on the course of rehabilitation from patients in an early neurological/neurosurgical rehabilitation program in 16 centers from 10 German states. The odds for a good or poor outcome were investigated using a multivariate logistic regression model.
RESULTS: Seven hundred and fifty-four patients were included in the study. The average age of the patients was 68 ± 15 years. Of the patients studied, 26 % were on mechanical ventilation commencing their neurological rehabilitation. The average duration of stay was 56 ± 51 days. Weaning rate from mechanical ventilation was 65 % and the rate of weaning from tracheal cannula was 54 %. Mean improvement in the Barthel Index of 17 points, significant reduction of dysphagia (from 62 to 30 %) and depended walking (from 99 to 82 %), and the achievement of phase C (the next stage of rehabilitation) in 38 % can still be counted as signs of successful rehabilitation. During their course of stay, near 10 % of the patients died. Of these, 67 % received solely palliative care. In the multivariate logistic models, the absence of the factor "necessity for mechanical ventilation on admission" (odds ratio 0.61; 95 % confidence interval (CI): 0.42 … 0.89) increased the chance for good outcome and the presence of this factor the risk of dying with an odds ratio of 8.07 (95 % CI: 4.54-14.34).
DISCUSSION: In spite of the severity of neurological deficits, significant functional progress has been made. These results could be interpret as positive proof of the efficacy of neurological/neurosurgical early rehabilitation programs.

PMID: 27090897 [PubMed - as supplied by publisher]

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Swallowing Disorders in Severe Brain Injury in the Arousal Phase.

Swallowing Disorders in Severe Brain Injury in the Arousal Phase.

Dysphagia. 2016 Apr 18;

Authors: Bremare A, Rapin A, Veber B, Beuret-Blanquart F, Verin E

Abstract
The objective of this study was to determine the clinical characteristics of swallowing disorders in severe brain injury in the arousal phase after coma. Between December 1, 2013 and June 30, 2014, eleven patients with severe acquired brain injury who were admitted to rehabilitation center (Male 81.8 %; 40.7 ± 14.6 years) were included in the study. Evaluation of swallowing included a functional examination, clinical functional swallowing test, and naso-endoscopic swallowing test. All patients had swallowing disorders at admission. The first functional swallowing test showed oral (77.8 %) and pharyngeal (66.7 %) food bolus transport disorders; and alterations in airway protection mechanisms (80 %). Swallowing test under endoscopic control showed a disorder in swallowing coordination in 55.6 % of patients tested. Seven (63.6 %) patients resumed oral feeding within an average of 6 weeks after admission to rehabilitation center and 14 weeks after acquired brain injury. Six (85.7 %) of these seven patients continued to require modified solid and liquid textures. Swallowing disorders are a major concern in severe brain injury in the arousal phase. Early bedside assessment of swallowing is essential for detection of swallowing disorders to propose appropriate medical rehabilitation care to these patients in a state of altered consciousness.

PMID: 27090424 [PubMed - as supplied by publisher]

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Alterations in Oropharyngeal Sensory Evoked Potentials (PSEP) with Parkinson's disease.

Alterations in Oropharyngeal Sensory Evoked Potentials (PSEP) with Parkinson's disease.

Respir Physiol Neurobiol. 2016 Apr 15;

Authors: Pitts T, Wheeler-Hegland K, Sapienza CM, Bolser DC, Davenport PW

Abstract
Movement of a food bolus from the oral cavity into the oropharynx activates pharyngeal sensory mechanoreceptors. Using electroencephalography, somatosensory cortical-evoked potentials resulting from oropharyngeal mechanical stimulation (PSEP) have been studied in young healthy individuals. However, limited information is known about changes in processing of oropharyngeal afferent signals with Parkinson's disease (PD). To determine if sensory changes occurred with a mechanical stimulus (air-puff) to the oropharynx, two stimuli (S1-first; S2-second) were delivered 500ms apart. Seven healthy older adults (HOA; 3 male and 4 female; 72.2+/- 6.9 years of age), and thirteen persons diagnosed with idiopathic Parkinson's disease (PD; 11 male and 2 female; 67.2+/- 8.9 years of age) participated. Results demonstrated PSEP P1, N1, and P2 component peaks were identified in all participants, and the N2 peak was present in 17/20 participants. Additionally, the PD participants had a decreased N2 latency and gated the P1, P2, and N2 responses (S2/S1 under 0.6). Compared to the HOAs, the PD participants had greater evidence of gating the P1 and N2 component peaks. These results suggest that persons with PD experience changes in sensory processing of mechanical stimulation of the pharynx to a greater degree than age-matched controls. In conclusion, the altered processing of sensory feedback from the pharynx may contribute to disordered swallow in patients with PD.

PMID: 27090350 [PubMed - as supplied by publisher]

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The Efficacy of Corticosteroids in the Treatment of Peritonsillar Abscess: A Meta-Analysis.

The Efficacy of Corticosteroids in the Treatment of Peritonsillar Abscess: A Meta-Analysis.

Clin Exp Otorhinolaryngol. 2016 Apr 19;

Authors: Lee YJ, Jeong YM, Lee HS, Hwang SH

Abstract
Despite widespread use of antibiotics and surgical procedures for treating peritonsillar abscess (PTA), symptoms of severe inflammation such as pain and trismus during treatment result in patient dissatisfaction. The goal of this study was to perform a systematic review and meta-analysis of the efficacy of systemic steroids on the clinical course of PTA. Two reviewers independently searched the databases (MEDLINE, Scopus, and the Cochrane Database) from inception to December 2014. Studies comparing systemic administration of steroids (steroid group) with placebo (placebo group), where the outcomes of interest were pain, body temperature, hospitalization, and oral intake during the posttreatment period, were included. Baseline study characteristics, study quality data, numbers of patients in the steroid and control groups, and outcomes were extracted. Sufficient data for meta-analysis were retrieved for 3 trials with a total of 153 patients. Pain-related parameters (patient-reported scores and trismus), body temperature, and dysphagia during the first 24 hours after treatment were significantly improved in the steroid group compared with placebo group. The discharge rate during the first 5 days of the posttreatment period was significantly higher in the steroid group than the control group. However, although more patients in the steroid group returned to normal activities and dietary intake at 24 hours after treatment, the differences between the groups were not significant and disappeared after 48 hours. In the treatment of PTA, systemic administration of steroids with antibiotics could reduce pain-related symptoms, as well as provide a benefit with respect to the clinical course. However, further trials with well-designed research methodologies should be conducted to confirm our results.

PMID: 27090283 [PubMed - as supplied by publisher]

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[Detection and management of the neurologic dysphagia].

[Detection and management of the neurologic dysphagia].

Rev Med Suisse. 2016 Mar 2;12(508):467-71

Authors: Leemann B, Sergi S, Sahinpasic L, Schnider A

Abstract
Neurologic dysphagia is frequent and has consequences which can be severe, such as, denutrition andpneumonia. In most cases, it can be detected with a clinical exam. The management includes some general measures, an adaptation of textures, specific rehabilitation, and nutritional assessment to judge whether complementary enteral nutrition is needed.

PMID: 27089605 [PubMed - in process]

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Collis-Nissen gastroplasty for short oesophagus.

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Collis-Nissen gastroplasty for short oesophagus.

Multimed Man Cardiothorac Surg. 2015;2015

Authors: Mattioli S, Lugaresi M, Ruffato A, Daddi N, Di Simone MP, Perrone O, Brusori S

Abstract
The Collis-Nissen procedure is performed for the surgical treatment of 'true short oesophagus'. When this condition is strongly suspected radiologically, the patient is placed in the 45° left lateral position on the operating table with the left chest and arm lifted to perform a thoracostomy in the V-VI space, posterior to the axillary line. The hiatus is opened and the distal oesophagus is widely mobilized. With intraoperative endoscopy, the position of the oesophago-gastric junction in relationship to the hiatus is determined and the measurement of the length of the intra-abdominal oesophagus is performed to decide either to carry out a standard anti-reflux procedure or to lengthen the oesophagus. If the oesophagus is irreversibly short ('true short oesophagus'), the short gastric vessels are divided and the gastric fundus is mobilized. An endostapler is introduced into the left chest. The left thoracoscopic approach is suitable to control effectively the otherwise blind passage of the endostapler into the mediastinum and upper abdomen (if a second optic is not used). The tip of the stapler is clearly visible while 'walking' on the left diaphragm. The Collis gastroplasty is performed over a 46 Maloney bougie. A floppy Nissen fundoplication and the hiatoplasty complete the procedure.

PMID: 26585969 [PubMed - indexed for MEDLINE]

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Posterior Cologastric Anastomosis: An Effective Antireflux Mechanism in Colonic Replacement of the Esophagus.

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Posterior Cologastric Anastomosis: An Effective Antireflux Mechanism in Colonic Replacement of the Esophagus.

Ann Thorac Surg. 2016 Jan;101(1):266-73

Authors: AbouZeid AA, Zaki AM, Safoury HS

Abstract
BACKGROUND: The colon may be used to replace a portion of the esophagus in pediatric patients, but prevention of gastrocolic reflux is a concern. We report our experience with the retrosternal colon bypass, and the effect of combining the procedure with a posterior cologastric anastomosis on prevention of gastrocolic reflux.
METHODS: The study included 35 consecutive pediatric patients who underwent retrosternal colon bypass during the period of 2010 through 2014. In standard practice, the cologastric anastomosis is performed at the anterior gastric wall. Lately, we modified our technique by shifting the cologastric anastomosis to the back of the stomach away from the anterior adhesions around the gastrostomy. In follow-up, a gastrogram was performed to check for gastrocolic reflux.
RESULTS: The indication for esophageal replacement was postcorrosive esophageal stricture in 19 patients and long gap esophageal atresia in 16 patients. Their mean ages were 51 and 16 months, respectively. No gastrocolic reflux was detected with the posterior cologastric anastomosis, whereas reflux was always present with the anterior cologastric anastomosis. We had two mortalities and one major morbidity (hematemesis and failure to thrive) that were related to regurgitation of gastric contents into the colonic conduit. The last patient was successfully managed by transferring the cologastric anastomosis from the front to the back of the stomach, with marked symptomatic and radiologic improvement.
CONCLUSIONS: After colonic replacement of the esophagus, the gastrocolic reflux represents a functional problem that may lead to serious complications. Combining a posterior cologastric anastomosis with retrosternal colon bypass is an effective way to avoid this problem.

PMID: 26377064 [PubMed - indexed for MEDLINE]

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Gastroesophageal Reflux Disease in Children with Cystic Fibrosis.

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Gastroesophageal Reflux Disease in Children with Cystic Fibrosis.

Adv Exp Med Biol. 2015;873:1-7

Authors: Dziekiewicz MA, Banaszkiewicz A, Urzykowska A, Lisowska A, Rachel M, Sands D, Walkowiak J, Radzikowski A, Albrecht P

Abstract
Previously published studies have indicated that gastroesophageal reflux (GER) disease is common in pediatric patients with cystic fibrosis. The aim of the present study was to get insight into the incidence of GER and to characterize the nature of reflux episodes in children with cystic fibrosis. This was a multicenter, prospective study of children with cystic fibrosis older than 18 months. Forty four consecutive patients (22 boys, mean age 10.4 ± 3.6, range 3.0-17.8 years) were enrolled into the study. All patients underwent 24 h pH-impedance monitoring. GER were classified according to the widely recognized criteria as an acid, weakly acid, weakly alkaline, or proximal. The pH-impedance trace was considered abnormal when acid exposure was >6 %. GER was diagnosed in 24/44 (54.5 %) children. A total of 1585 (median 35, range 7-128) reflux episodes were detected; 1199 (75.6 %) were acidic, 382 (24.1 %) weakly acidic, and 4 (0.3 %) weakly alkaline. Six hundred and ninety-one (43.6 %) reflux episodes reached the proximal esophagus. In 14/44 patients typical GER symptoms were present. We conclude that the incidence of GER in children with cystic fibrosis is very high. In the majority of patients typical GER symptoms are absent. Therefore, diagnostic procedures should be considered, regardless of lacking symptoms. Although acid reflux episodes predominate in children with cystic fibrosis, classical pH-metry may not constitute a sufficient diagnostic method in this population because of a relatively high number of proximal reflux episodes. Such episodes also indicate an increased risk for aspiration. The pH-impedance diagnostic measurement is advocated when suspecting GER in children with cystic fibrosis.

PMID: 26285611 [PubMed - indexed for MEDLINE]

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Causes of Chronic Cough in Non-smoking Patients.

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Causes of Chronic Cough in Non-smoking Patients.

Adv Exp Med Biol. 2015;873:25-33

Authors: Dąbrowska M, Grabczak EM, Arcimowicz M, Domeracka-Kołodziej A, Domagała-Kulawik J, Krenke R, Maskey-Warzęchowska M, Tarchalska B, Chazan R

Abstract
Chronic cough is a common medical problem. The aim of the study was to analyze chronic cough causes in non-smoking patients and to search for demographic factors associated with different cough reasons. The etiology of cough was determined by medical history, diagnostic tests and response to specific treatment. Patients with significant abnormalities in the chest radiograph or spirometry were not included. The study included 131 non-smoking patients; median age 54 years, 77 % female. The most frequent causes of cough were gastroesophageal reflux disease (GERD) (62 %) and upper airway cough syndrome (UACS) (46 %). Cough variant asthma and non-asthmatic eosinophilic bronchitis (NAEB) were diagnosed in 32 (25 %) and 19 (15 %) patients, respectively. Other cough causes were found in 27 patients (21 %). Asthma was a significantly more common cause of chronic cough in women than in men (31 % vs. 3 %, p = 0.005). A reverse relationship was demonstrated for UACS (39 % vs. 67 %, p = 0.01). Patients with chronic cough aged >50 yrs were more likely to be diagnosed with less common cough causes. In conclusion, the most common chronic cough reasons are GERD and UACS. Asthma-related cough is diagnosed more frequently in females, while UACS-related cough is more frequent in males.

PMID: 26285610 [PubMed - indexed for MEDLINE]

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The effect of position on esophageal structure and function determined with solid-state high-resolution manometry.

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The effect of position on esophageal structure and function determined with solid-state high-resolution manometry.

J Dig Dis. 2015 Jun;16(6):350-6

Authors: Zhang XJ, Xiang XL, Tu L, Xie XP, Hou XH

Abstract
OBJECTIVE: To investigate the influence of posture on the anatomy and function of esophageal sphincters using solid-state high-resolution manometry.
METHODS: Fifty individuals underwent esophageal manometry with a 36-channel solid-state catheter in the supine and upright positions. The length and pressure of the esophageal sphincters, as well as the esophageal and intra-abdominal lengths of lower esophageal sphincter (LES), were recorded. The residual pressure of the upper esophageal sphincter (UES) and the 4-s integrated relaxation pressure were also measured when the participants swallowed 10 consecutive servings of water (5 mL each). The Bland-Altman plot was used to assess agreement between these parameters in the supine and upright positions.
RESULTS: The LES resting pressure was significantly decreased in the upright position compared with the supine position (13.85 ± 5.90 mmHg vs 18.09 ± 7.80 mmHg, P = 0.000). Weaker integrated relaxation pressures were observed when the participants were in the upright position (5.66 ± 3.33 mmHg vs 7.80 ± 3.25 mmHg, P = 0.000). Compared with the supine position, the upright esophageal length was longer (P = 0.004) and the upper border of the LES was lower (P = 0.050) when the individuals were in the upright position. The agreement between the two positions was acceptable for the esophageal length, LES upper border location and LES pressure measurements.
CONCLUSIONS: Body position exerts a greater influence on the LES than on the UES. Thus, it is necessary to establish normal values for the LES basal pressure and residual pressure in different positions.

PMID: 25940059 [PubMed - indexed for MEDLINE]

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Gastroesophageal reflux in laparoscopic sleeve gastrectomy: hiatal findings and their management influence outcome.

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Gastroesophageal reflux in laparoscopic sleeve gastrectomy: hiatal findings and their management influence outcome.

Surg Obes Relat Dis. 2015 May-Jun;11(3):530-7

Authors: Lyon A, Gibson SC, De-loyde K, Martin D

Abstract
BACKGROUND: Sleeve gastrectomy (SG) has become a definitive treatment for morbid obesity. There is conflicting evidence on the effects of SG on gastroesophageal reflux disease (GERD).
OBJECTIVE: The objective of this study was to assess whether taking an aggressive approach to managing hiatal weakness in patients undergoing SG results in an alteration in GERD symptoms.
SETTING: Tertiary public hospital and private hospital, Sydney, Australia.
METHODS: Patients undergoing laparoscopic extended (beginning within 2 cm from pylorus) SG were included. If evidence of weakness was present, an anterior hiatal dissection and tight suture repair was performed. If a hiatus hernia was present, formal repair was undertaken. Patients were questioned and scored on preoperative and postoperative reflux symptom frequency and severity, proton pump inhibitor (PPI) usage, current weight, and satisfaction.
RESULTS: A continuous cohort of 262 patients experienced a significant reduction in heartburn frequency (P = .035) and severity (P = .017). Moderate/severe preoperative reflux (Visick score 3 and 4) often improved whether there was a defect requiring repair or not (no repair P = .02, hiatal suture P = .001, hiatus hernia repair P<.001). The severity of symptoms also improved (no repair P = 0.005, hiatal suture P<.001, hiatus hernia repair P< .001).
CONCLUSION: Moderate or severe preexisting gastroesophageal reflux improved for most of our obese patients undergoing an extended SG when hiatal defects were routinely repaired. Moderate to severe preoperative reflux also improved in the average obese patient when there was no hiatal defect to repair.

PMID: 25863531 [PubMed - indexed for MEDLINE]

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Association between individual response to food taste and gastroesophageal symptoms.

Related Articles

Association between individual response to food taste and gastroesophageal symptoms.

J Dig Dis. 2015 Jun;16(6):337-41

Authors: Shibata T, Nakamura M, Omori T, Tahara T, Ichikawa Y, Okubo M, Ishizuka T, Nakagawa Y, Nagasaka M, Nakamura M, Arisawa T, Hirata I

Abstract
OBJECTIVE: Taste is an important element in food preferences. Gastroesophageal reflux disease (GERD) is related to lifestyles including eating habits. We aimed to investigate the relationship between responses to specific tastes and GERD.
METHODS: Altogether 280 patients including 170 men with a mean age of 58.6 years were included in the study to determine the relationship between their liking for specific tastes and GERD using a new self-administered questionnaire (responses to various tastes and participants' sensitivity to taste and hot food and on the frequency of stomatitis). Another self-administrated questionnaire was administrated for a diagnosis of GERD (the frequency scale for the symptoms of GERD cut-off score of 10). Furthermore, 142 of 280 patients who had received esophagogastroduodenoscopy (EGD) were investigated on the association between endoscopic esophagitis and their favorite tastes.
RESULTS: In the association analyses between responses to specific tastes and GERD, the group liking salty food and the group with a high frequency of stomatitis had a significantly higher incidence of GERD (salty food: odds ratio [OR] 2.059, 95% confidence interval [CI] 1.215-3.488, P = 0.0073; stomatitis: OR 2.861, 95% CI 1.558-5.253, P = 0.0007, respectively). In association analyses with endoscopic esophagitis, the groups liking salty and sour food had a significantly higher incidence rate of endoscopic esophagitis (salty: OR 2.718, 95% CI 1.330-5.555, P = 0.0061; sour: OR 3.267, 95% CI 1.491-7.160, P = 0.0031, respectively).
CONCLUSIONS: Sensitivity and response to specific food taste were associated with GERD. The results of a preference to hot or salty food and endoscopic esophagitis suggest that physical stimuli are important for esophageal injuries.

PMID: 25762126 [PubMed - indexed for MEDLINE]

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Guiding cell migration with microscale stiffness patterns and undulated surfaces

Publication date: Available online 19 April 2016
Source:Acta Biomaterialia
Author(s): Jonathan T. Pham, Longjian Xue, Aránzazu del Campo, Marcelo Salierno
By placing stiff structures under soft materials, prior studies have demonstrated that cells sense and prefer to position themselves over the stiff structures. However, an understanding of how cells migrate on such surfaces has not been established. Many studies have also shown that cells readily align to surface topography. Here we investigate the influence of these two aspects in directing cell migration on surfaces with 5 and 10 μm line stiffness patterns (a cellular to subcellular length scale). A simple approach to create flat, stiffness-patterned surfaces by suspending a thin, low modulus polydimethylsiloxane (PDMS) film over a high modulus PDMS structure is presented, as well as a route to add undulations. We confirm that cells are able to sense through the thin film by observation of focal adhesions being positioned on stiff regions. We examine migration by introducing migration efficiency, a quantitative parameter to determine how strongly cells migrate in a certain direction. Notably, we found that cells have a preference to align and migrate along stiffness patterns while the addition of undulations boosts this effect, significantly increasing migration efficiency in either case. Interestingly, we found speed to play little role in the migration efficiency and to be mainly influenced by the top layer modulus. Our results demonstrate that both stiffness patterns and surface undulations are important considerations when investigating the interactions of cells with biomaterial surfaces.Statement of significanceTwo common physical considerations for cell-surface interactions include patterned stiffness and patterned topography. However, their relative influences on cell migration behavior have not been established, particularly on cellular to subcellular scale patterns. For stiffness patterning, it has been recently shown that cells tend to position themselves over a hard structure that is placed under a thin flat layer. By quantifying the directional migration efficiency on such surfaces with and without undulations, we show that migration can be manipulated by flat stiffness patterns, although surface undulations also play a strong role. Our results offer insight on the effect of cellular scale stiffness and topographical patterns on cell migration, which is critical for the development of fundamental cell studies and engineered implants.

Graphical abstract

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The Design of Antimicrobial LL37-Modified Collagen-Hyaluronic Acid Detachable Multilayers

Publication date: Available online 19 April 2016
Source:Acta Biomaterialia
Author(s): Margaret E. Cassin, Andrew J. Ford, Sophia M. Orbach, Scott E. Saverot, Padmavathy Rajagopalan
The design of antimicrobial membranes and thin films are critical for the design of biomaterials that can combat bacterial contamination. Since the long-term use of conventional antibiotics can result in bacterial resistance, there is a critical need to incorporate natural antimicrobial peptides (AMPs) that not only prevent a wide range of pathogens from causing infections but can also promote many beneficial outcomes in wounded tissues. We report the design and antimicrobial properties of detachable collagen (COL)/hyaluronic acid (HA) polyelectrolyte multilayers (PEMs) modified with LL-37, a naturally occurring human AMP. LL-37 was physically adsorbed and chemically immobilized on the surface of PEMs. The antimicrobial and cytotoxic properties of PEMs were tested with Gram-negative Escherichia coli (E. coli, strain DH10B) and primary rat hepatocytes, respectively. The ability to prevent bacterial adhesion and to neutralize an E. coli layer was investigated as a function of LL-37 concentration. An interesting trend was that even unmodified PEMs exhibited a 40% reduction in bacterial adhesion. When LL-37 was physically adsorbed on PEMs, bacterial adhesion was significantly lower on the surface of the films as well as in the surrounding broth. Immobilizing LL-37 resulted in less than 3% bacterial adhesion on the surface due to the presence of the peptide. LL-37 modified PEMs did not result in any cytotoxicity up to input concentrations of 16 μM. More importantly, urea and albumin secretion by hepatocytes were unaffected even at high LL-37 concentrations. The COL/HA PEMs can serve as antimicrobial coatings, biological membranes and as in vitro platforms to investigate pathogen-tissue interactions.Statement of SignificanceAntimicrobial peptides (AMPs) are emerging as an alternative to conventional antibiotics. We report the antimicrobial properties of detachable collagen (COL)/hyaluronic acid (HA) polyelectrolyte multilayers (PEMs) modified with LL-37, a human AMP. The antimicrobial and cytotoxic properties were tested with gram-negative Escherichia coli (E. coli, strain DH10B) and primary rat hepatocytes, respectively. Unmodified PEMs exhibited a 40% reduction in bacterial adhesion. When LL-37 was physically adsorbed on PEMs, the sustained release of the active peptide killed planktonic bacteria. Immobilizing LL-37 resulted in resulted in less than 3% bacterial adhesion. LL-37 modified PEMs did not result in cytotoxicity up to input concentrations of 16μM. The COL/HA PEMs can serve as antimicrobial coatings and to investigate pathogen-cell interactions.

Graphical abstract

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An Alginate-based Platform for Cancer Stem Cell Research

Publication date: Available online 19 April 2016
Source:Acta Biomaterialia
Author(s): Shu-pei Qiao, Yu-fang Zhao, Chun-feng Li, Yan-bin Yin, Qing-yuan Meng, Feng-Huei Lin, Yi Liu, Xiao-lu Hou, Kai Guo, Xiong-biao Chen, Wei-ming Tian
As the primary determinants of the clinical behaviors of human cancers, the discovery of cancer stem cells (CSCs) represents an ideal target for novel anti-cancer therapies [1]. Notably, CSCs are difficult to propagate in vitro, which severely restricts the study of CSC biology and the development of therapeutic agents. Emerging evidence indicates that CSCs rely on a niche that controls their differentiation and proliferation, as is the case with normal stem cells (NSCs). Replicating the in vivo CSC microenvironment in vitro using three-dimensional (3D) porous scaffolds can provide means to effectively generate CSCs, thus enabling the discovery of CSC biology. This paper presents our study on a novel alginate-based platform for mimicking the CSC niche to promote CSC proliferation and enrichment. In this study, we used a versatile mouse 4T1 breast cancer model to independently evaluate the matrix parameters of a CSC niche– including the material's mechanical properties, cytokine immobilization, and the composition of the extracellular matrix's (ECM's) molecular impact – on CSC proliferation and enrichment. On this basis, the optimal stiffness and concentration of hyaluronic acid (HA), as well as epidermal growth factor and basic fibroblast growth factor immobilization, were identified to establish the platform for mimicking the 4T1 breast CSCs (4T1 CSCs) niche. The 4T1 CSCs obtained from the platform show increased expression of the genes involved in breast CSC and NSC, as compared to general 2D or 3D culture, and 4T1 CSCs were also demonstrated to have the ability to quickly form a subcutaneous tumor in homologous Balb/c mice in vivo. In addition, the platform can be adjusted according to different parameters for CSC screening. Our results indicate that our platform offers a simple and efficient means to isolate and enrich CSCs in vitro, which can help researchers better understand CSC biology and thus develop more effective therapeutic agents to treat cancer.Statement of significanceAs the primary determinants of the clinical behaviors of human cancers, the discovery of cancer stem cells (CSCs) represents an ideal target for novel anti-cancer therapies. However, CSCs are difficult to propagate in vitro, which severely restricts the study of CSC biology and the development of therapeutic agents. Emerging evidence indicates that CSCs rely on a niche that controls their differentiation and proliferation, as is the case with normal stem cells (NSCs). Replicating the in vivo CSC microenvironment in vitro using three-dimensional (3D) porous scaffolds can provide means to effectively generate CSCs, thus enabling the discovery of CSC biology. In our study, a novel alginate-based platform were developed for mimicking the CSC niche to promote CSC proliferation and enrichment.

Graphical abstract

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Cell Recruiting Chemokine-Loaded Sprayable Gelatin Hydrogel Dressings for Diabetic Wound Healing

Publication date: Available online 19 April 2016
Source:Acta Biomaterialia
Author(s): Dong Suk Yoon, Yunki Lee, Hyun Aae Ryu, Yeonsue Jang, Kyoung-Mi Lee, Yoorim Choi, Woo Jin Choi, Moses Lee, Kyung Min Park, Ki Dong Park, Jin Woo Lee
In this study, we developed horseradish peroxidase (HRP)-catalyzed sprayable gelatin hydrogels (GH) as a bioactive wound dressing that can deliver cell-attracting chemotactic cytokines to the injured tissues for diabetic wound healing. We hypothesized that topical administration of chemokines using GH hydrogels might improve wound healing by inducing recruitment of the endogenous cells. Two types of chemokines (Interleukin-8; IL-8, macrophage inflammatory protein-3α; MIP-3α) were simply loaded into GH hydrogels during in situ cross-linking, and then their wound-healing effects were evaluated in streptozotocin-induced diabetic mice. The incorporation of chemokines did not affect hydrogels properties including swelling ratio and mechanical stiffness, and the bioactivities of IL-8 and MIP-3α released from hydrogel matrices were stably maintained. In vivo transplantation of chemokine-loaded GH hydrogels facilitated cell infiltration into the wound area, and promoted wound healing with enhanced re-epithelialization/neovascularization and increased collagen deposition, compared with no treatment or the GH hydrogel alone. Based on our results, we suggest that cell-recruiting chemokine-loaded GH hydrogel dressing can serve as a delivery platform of various therapeutic proteins for wound healing applications.Statement of SignificanceDespite development of materials combined with therapeutic agents for diabetic wound treatment, impaired wound healing by insufficient chemotactic responses still remain as a significant problem. In this study, we have developed enzyme-catalyzed gelatin (GH) hydrogels as a sprayable dressing material that can deliver cell-attracting chemokines for diabetic wound healing. The chemotactic cytokines (IL-8 and MIP-3α) were simply loaded within hydrogel during in situ gelling, and wound healing efficacy of chemokine-loaded GH hydrogels was investigated in STZ-induced diabetic mouse model. These hydrogels significantly promoted wound-healing efficacy with faster wound closure, neovascularization, and thicker granulation. Therefore, we expect that HRP-catalyzed in situ forming GH hydrogels can serve as an injectable/sprayable carrier of various therapeutic agents for wound healing applications.

Graphical abstract

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Fabrication and characteristics of dual functionalized vascular stent by spatio-temporal coating

Publication date: Available online 19 April 2016
Source:Acta Biomaterialia
Author(s): Seong Min Kim, Kwang-Sook Park, Eugene Lih, Young Joon Hong, Jong Hee Kang, Ik Hwan Kim, Myung Ho Jeong, Yoon Ki Joung, Dong Keun Han
Stent implantation with balloon angioplasty is a widely used treatment for coronary artery diseases. Stents have been developed from bare metal stent (BMS) to advanced forms such as drug-eluting stent (DES). However, modern DES still causes thrombosis and/or in-stent restenosis as long-term outcomes. For effective prevention of these problems, we fabricated a dual functionalized stent using spatio-temporal coating, which has two different surfaces, as a novel type of DES. Hyaluronic acid conjugated with dopamine (HA-DA) was applied to a bare cobalt-chromium (CC) stent prior to abluminal coating of sirolimus (SRL)-in-polymer such as poly(D,L-lactide). The SRL-in-polymer (P+S) coated on the abluminal surface of the HA-DA modified stent showed highly stable coating layer and prevented the crack formation after ballooning. In the blood- and cyto-compatibility tests, HA-DA coating displayed suppressive effects on adhesion and activation of platelets and maintained the cell viability and proliferation of human coronary artery endothelial cells even under the existence of SRL. In in vivo study using porcine restenosis model, the neointimal area and inflammation score of the dual functionalized stent with HA-DA and P+S were significantly reduced than those of BMS. It is expected that this novel type of DES can be effectively applied to utilize diverse anti-proliferative drugs and bioactive polymers.Statement of SignificanceStents have been developed from bare metal stent to advanced forms such as drug-eluting stents (DESs). However, even DESs can still cause in-stent restenosis as long-term outcomes. This paper demonstrated a novel DES using spatio-temporal coating by dopamine-mediated hyaluronic acid coating (HA-DA) before asymmetric coating of sirolimus-in-poly(D,L-lactide) (P+S). It showed stable coating surface and prevented crack formation after ballooning. HA-DA coating also had an inhibitive effect on adhesion of platelets and maintained cell viability of endothelial cells even under the existence of sirolimus. Additionally, in vivo neointima area and inflammation score of HA-DA/P+S stent significantly decreased than those of BMS. We expected that this novel type of DES can be effectively applied to introduce diverse anti-proliferative drugs and bioactive molecules.

Graphical abstract

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Exploration of the conditioning electrical stimulation frequencies for induction of long-term potentiation-like pain amplification in humans

Abstract

Spinal nociceptive long-term potentiation (LTP) can be induced by high- or low-frequency conditioning electrical stimulation (CES) in rodent preparations in vitro. However, there is still sparse information on the effect of different conditioning frequencies inducing LTP-like pain amplification in humans. In this study, we tested two other paradigms aiming to explore the CES frequency effect inducing pain amplification in healthy humans. Cutaneous LTP-like pain amplification induced by three different paradigms (10, 100, and 200 Hz CES) was assessed in fifteen volunteers in a crossover design. Perceptual intensity ratings to single electrical stimulation at the conditioned site and to mechanical stimuli (pinprick and light stroking) in the immediate vicinity were recorded; superficial blood flow was also measured. The short form of the McGill Pain Questionnaire (SF-MPQ) was used for characterizing the perception induced by CES. Compared with the control session, pain perception to pinprick stimuli and area of allodynia significantly increased after all three CES paradigms. In the 10 and 200 Hz sessions, the superficial blood flow 10 min after CES was significantly higher than in the control session reaching a plateau after 20 and 10 min, respectively; for the 100 Hz paradigm, a stable level was found without significant differences compared with CES and control sessions. 10 Hz CES caused a lower SF-MPQ score than 100 Hz. High-frequency (200 Hz) and low-frequency (10 Hz) paradigms can induce heterotopic pain amplification similar to the traditional 100 Hz paradigm. The 10 Hz paradigm can be an appealing alternative paradigm in future studies due to its specific association with low-level discharging of C-fibers during inflammation.

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Action perception in infancy: the plasticity of 7-month-olds attention to grasping actions

Abstract

The present study investigates the plasticity of 7-month-old infants' orienting of attention during their perception of grasping actions. Previous research has shown that when infants observe a grasping hand, they shift their attention in line with the grasping direction, which is indicated by a reliable priming effect in this direction. The mechanisms behind this priming effect are largely unknown, and it is unclear how malleable this priming effect is with respect to a brief exposure to novel action-target contingencies. In a spatial-cueing paradigm, we presented a series of training trials prior to a series of test trials. These training sequences significantly modulated infants' attention. This suggests that action perception, when assessed through shifts of attention, is not solely based on the infants' grasping experience but quickly adapts to context-specific observed regularities.

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The neural mechanisms of re-experiencing physical fatigue sensation: a magnetoencephalography study

Abstract

It has been hypothesized that fatigue sensation impairs the ability and efficiency to perform activities and can be a cause of fatigue itself. As such, it is important to clarify the neural mechanisms of fatigue sensation. The re-experiencing of mental fatigue sensation involves brain regions including Brodmann's area (BA) 40, BA 39, and the pulvinar nucleus. In the present study, we examined neural activity caused by re-experiencing a physical fatigue sensation that had been experienced. Fifteen healthy male volunteers participated in fatigue and control experiments in a crossover fashion. In the fatigue experiment, participants performed a handgrip task for 10 min to induce a physical fatigue sensation and then re-experienced the physical fatigue sensation during magnetoencephalography (MEG) session. In the control experiment, they did not perform the handgrip task but re-experienced the sensation without physical fatigue in an MEG session. Neural activity related to re-experiencing physical fatigue sensations of the right hand (right condition), left hand (left condition), and related to listening to the auditory cues (sound condition) was assessed using spatial filtering analyses of the MEG data. Changes in oscillatory band power in some brain regions, including BA 40, were common between the right and left conditions. A part of the neural activity related to the re-experiencing physical fatigue sensation, such as the decrease in alpha (8–13 Hz) band power in the BA 40, was also observed in the sound condition. These findings may help to understand the neural mechanisms related to intentionally and unintentionally re-experiencing physical fatigue sensation.

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The Flexibility of P2O7 Dimers in Soft Structures: M2CdP2O7 (M = Rb Cs)

Abstract

Two new congruent-melting alkali metal diphosphates, Rb₂CdP₂O₇ and Cs₂CdP₂O₇, were synthesized by conventional solid-state reactions. Single-crystal X-ray structural analyses showed that M₂CdP₂O₇ (M = Rb, Cs) feature two-dimensional [CdP₂O₇]^2– layers that are composed of CdO₅ pyramids and P₂O₇ dimers. The Rb⁺ and Cs⁺ cations ions fill the interlayers. The flexible P₂O₇ dimers could be bent and distorted if the Cs⁺ ion was substituted by the Rb⁺ ion, which led to crystallization of the Rb₂CdP₂O₇ compound in the lower symmetry monoclinic space group P2₁/c (No. 14) and crystallization of the Cs₂CdP₂O₇ compound in the high-symmetry orthorhombic space group Pnma (No. 53). Thermal analyses showed that the two compounds melt congruently and that the melting point of Rb₂CdP₂O₇ compound is lower than that of the Cs₂CdP₂O₇ compound owing to distortion of the P₂O₇ dimers. IR spectroscopy and UV/Vis–near-IR diffuse reflectance spectroscopy were performed on the reported compounds.

Distortion of the P₂O₇ dimer in the Rb₂CdP₂O₇ compound leads to a lower melting point than that of the Cs₂CdP₂O₇ compound. It is found that the soft structures of Rb and Cs compounds can crystallize in different space groups.

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CyclopentadienylSilsesquioxane Titanium Catalysts: Factors Affecting Their Formation and Activity in Olefin Epoxidation with Aqueous Hydrogen Peroxide

Abstract

The reaction of titanium chlorosilyl-substituted cyclopentadienyl (Cp) complexes, Ti(η⁵-C₅H₃R′SiMe₂Cl)Cl₃ (R′ = H, 1b; SiMe₃, 1c), with 1 equiv. of various silsesquioxane trisilanols, R₇Si₇O₉(OH)₃ (R = iBu, 2a; Ph, 2b), affords either corner-capped Cp derivatives, Ti(η⁵-C₅H₃R′SiMe₂Cl)(R₇Si₇O₁₂-κ³O₃) (R′ = H, R = iBu, 5a, Ph, 5b; R′ = SiMe₃, R = iBu, 7a, Ph, 7b), or cyclopentadienyl–silsesquioxane complexes, Ti(η⁵-C₅H₄SiMe₂OR₇Si₇O₁₁-κ²O₂)Cl (R′ = H, R = iBu, 6a, Ph, 6b; R′ = SiMe₃, R = iBu, 8a, Ph, 8b), depending on the reaction conditions. In any case, upon heating, kinetic products 5 and 7 are transformed into the corresponding thermodynamic products 6 and 8, respectively. The electron-donating ability of the Cp ring is a relevant controlling parameter: a strong π-donor character facilitates the isomerization process. In addition, the nature of the silicon substituents in the silsesquioxane framework, the type of solvent, and the reaction temperature are also factors that significantly affect this process. Cyclopentadienyl–silsesquioxane complexes 6b and 8b are efficient and selective catalysts for epoxidation with aqueous hydrogen peroxide under mild conditions. Such a catalytic efficiency is attributed to the hydrophobic environment generated about the titanium atom by the Cp ring incorporated into the cyclopentadienyl–silsesquioxane ligand.

A set of efficient catalysts based on titanium cyclopentadienyl–silsesquioxane derivatives for olefin epoxidation with aqueous hydrogen peroxide has been prepared. The modification of the electronic and steric properties of the Cp ring entails important differences in the chemical and catalytic behavior of such compounds

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Reverse mathematics well-quasi-orders and Noetherian spaces

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Only standard Dutch in the second language classroom? Consequences for newcomers

Newcomers settling in Flanders experience a strong contract between the standard language advocated in policy and education on the one hand and the multitude of non-standard language use and other languages they encounter in daily interaction on the other hand: (1) Flemish integration and language-in-education policy documents propagate Standard Dutch as the only acceptable language variety. In line with a European trend (Pulinx e.a. 2014), mastering the national language is increasingly considered to be a conditio sine qua non for successful participation in Flemish society (De Wilde e.a. to appear; Jaspers 2012). The importance attached to Dutch language competence goes hand in hand with the preference and perceived superiority of Standard Dutch, the official language variety in Flanders (see Jaspers & Van Hoof 2013 on the standard language climate). As a consequence, Dutch as a second language classes are tailored to the instruction of Standard Dutch. (2) However, the insistence on Standard Dutch in education differs strongly from everyday spoken encounters where Standard Dutch is rarely attested (De Caluwe 2009). On an intralingual level, Flanders is characterised by abundant non-standard language use: either, but less and less, dialect, or tussentaal, an often used umbrella term for language use situated between Standard Dutch and the dialects. Next to intralingual language variation, Flanders also has a strong presence of other languages (e.g. French, to name but one). During my talk I will elaborate on the impact of this contrast between policy and language use for L2 learners of Dutch. In specialist and non-specialist literature, indications are given that learners do not understand native speakers (Bolten 2004), that they often lack the appropriate language proficiency for the job market (Jaspers 2012) and that they are not prepared for the receptive demands of academic studies (Deygers to appear). Teachers in and outside the Dutch language area are confronted with unsatisfied students who are giving their teachers the impression they are teaching them 'the wrong language' (cf. Diepeveen & Hüning 2013 on the importance of 'tussentaal' in preparing their students for a stay in Belgium). I will critically discuss the discourse on second language education, and I will end my talk with a plea not to overlook the impact of the contrast between policy and language use on L2 learners.

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Ambiguity and Explanation

This paper presents evidence that 'because' is importantly ambiguous between two closely related senses covering what are usually called causal explanations, on the one hand, and grounding or metaphysical explanations, on the other hand. To this end, it introduces the lexical categories of monosemy, polysemy, and homonymy; describes a test for polysemy; and discusses the results of the test when applied to 'because'. It also shows how to understand so-called hybrid explanations in light of the semantic facts established by the analysis.

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Les 'beaux hasards' de Patrick Deville: Kampuchéa et la terreur

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Solving stable matching problems using answer set programming

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The Causal Metaphor Account of Metaphysical Explanation

This paper argues that the semantic facts about 'because' are best explained via a metaphorical treatment of metaphysical explanation that treats causal explanation as explanation par excellence. Along the way, it defends a commitment to a unified causal sense of 'because' and offers a proprietary explanation of grounding skepticism. With the causal metaphor account of metaphysical explanation on the table, an extended discussion of the relationship between conceptual structure and metaphysics ends with a suggestion that the semantic facts about 'because' tell against grounding-causation unity.

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Manuscript and memory in religious communities in the Medieval Low Countries: an introduction

The special issue 'Manuscript and Memory in Religious Communities in the Medieval Low Countries' aims at critically questioning how memory practices, developed through and shaped by the medieval manuscript culture, contributed to strengthening religious communal life between the tenth and the early sixteenth centuries. The introductory article discusses the research traditions that have informed this collection of essays. There is, on the one hand, the tradition of memory studies, which since the late 1980s has become increasingly important in many humanities disciplines, particularly in medieval studies with its significant interest in the impact of the religiously-inspired memoria culture on medieval society. On the other hand, since the 1990s the same field of medieval studies has also been marked by the rise of material philology, which has not only fuelled many theoretical debates about the way in which our textual heritage should be understood and edited, but has also resulted in a renewed appreciation of the study of manuscripts themselves as meaningful bearers of medieval textual traditions. The introductory article subsequently explains how combining these two research traditions compels us to critically reconsider the role of manuscripts (cartularies, miscellanies, collections of sermons…) and the deployment of genres (annals, charters, lives, necrologia, treatises…) in the actual study of the culture of memoria in medieval religious communities.

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Hepatitis C virus cell entry: a target for novel antiviral strategies to address limitations of direct acting antivirals

Hepatology International

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Concentrations of adalimumab and infliximab in mothers and newborns and effects on infection

Gastroenterology

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Transjugular intrahepatic portosystemic shunt creation and variceal coil or plug embolization ineffectively attain gastric variceal decompression or occlusion: results of a 26-patient retrospective study

Journal of Vascular and Interventional Radiology

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Vitamin B2 intake and colorectal cancer risk: Results from the Nurses' Health Study and the Health Professionals Follow-up Study cohort

International Journal of Cancer

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High-quality bowel preparation is required for detection of sessile serrated polyps

Clinical Gastroenterology and Hepatology

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Lamivudine monotherapy-based cART is efficacious for HBV treatment in HIV/HBV coinfection when baseline HBV DNA <20000 IU/mL

Journal of Acquired Immune Deficiency Syndromes

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Acinar cell cystadenoma of the pancreas: a retrospective analysis of ten-year experience from a single academic institution

Pancreatology

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No differences in achieving hepatitis C virus care milestones between patients identified by birth cohort vs risk-based screening

Clinical Gastroenterology and Hepatology

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Single- versus triple-drug chemoembolization for hepatocellular carcinoma: comparing outcomes by toxicity imaging response and survival

Journal of Vascular and Interventional Radiology

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Folic Acid Supplementation in Postpolypectomy Patients in a Randomized Controlled Trial Increases Tissue Folate Concentrations and Reduces Aberrant DNA Biomarkers in Colonic Tissues Adjacent to the Former Polyp Site

The Journal of Nutrition

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Role of serial EUS-guided FNA on pancreatic cystic neoplasms: a retrospective analysis of repeat carcinoembryonic antigen measurements

Gastrointestinal Endoscopy

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Management of inflammatory bowel disease during pregnancy

Digestive Diseases and Sciences

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Aspirin for the primary prevention of cardiovascular disease and colorectal cancer: A decision analysis for the U.S. preventive services task force

Annals of Internal Medicine

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Lubiprostone is effective in the treatment of chronic idiopathic constipation and irritable bowel syndrome

Mayo Clinic Proceedings

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B cell-activating factor as a new potential marker in inflammatory bowel disease

Digestive Diseases and Sciences

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Oropharyngeal pH testing does not predict response to proton pump inhibitor therapy in patients with laryngeal symptoms

The American Journal of Gastroenterology

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Evaluation of the risk of cardiovascular events with clarithromycin using both propensity score and self-controlled study designs

British Journal of Clinical Pharmacology

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Correlations of survival with progression-free survival response rate and disease control rate in advanced biliary tract cancer: a meta-analysis of randomised trials of first-line chemotherapy

British Journal of Cancer

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Gastrointestinal mucosal barrier function and diseases

Journal of Gastroenterology

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The macrophage activation marker sCD163 combined with markers of the Enhanced Liver Fibrosis (ELF) score predicts clinically significant portal hypertension in patients with cirrhosis

Alimentary Pharmacology and Therapeutics

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