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Purpose: This paper aims to quantify the impact of environmental contamination on farmland valuation. It applies data fusion and hedonic pricing approaches to quantify the contribution of nitrogen and phosphorus loading on farmland sales transactions. It further suggests approaches to improve internalization of environmental cost in valuation approaches using shadow pricing. The work informs the field of environmental, social and governance (ESG) investing by fusing environmental data with financial transactions. Design/methodology/approach: This paper is an empirical study implementing hedonic pricing of farmland in the Lake Huron major drainage area. Data sources and fusion were derived from AcreValue, the United States Department of Agriculture's Gridded Soil Survey Geographic database (gSSURGO) and the United States Geological Survey's Spatially Referenced Regression on Watershed Attributes database (SPARROW). Findings: The results suggest that environmental contamination has statistically significant positive determination power on farmland prices such that prices increase with contamination. Conventional metrics such as percentage of cultivated land in the parcel, root zone depth, whether the parcel is designated by the Natural Resource Conservation Service as prime farmland, and the size of the farmland parcel contribution to farmland value as well. The results indicate that environmental impacts are not accurately accounted for in farmland transactions. Research limitations/implications: This paper points to inaccurate valuation of environmental contamination in farmland value. While geocoding allowed for positioning of farmland sales transactions relative to modeled areas of contaminant loading in the Lake Huron drainage area, the interpretation indicates that value is driven by cultivation. Hence, generalization to other areas needs a cautious approach. Empirical testing across locations and drainage areas with diverse farmland features will serve to verify the modeled data used in this study. Practical implications: The lack of integration of externalities in land valuation has implications on lending and disclosure practices, as financial service providers increasingly seek to account for ESG risk on their loan books and broader investment portfolios. The impact of farmland accounting practices for contamination such as shadow pricing may impact land valuation based on future cash flows, and may serve to inform sustainability-linked lending practices to farm operations. Originality/value: This is the first paper to fuse data from AcreValue, gSSURGO and SPARROW to discover the explanatory power of nutrient contamination in farmland value in the Lake Huron major drainage area. [ABSTRACT FROM AUTHOR]

Background and Aims: A variety of auto‐antibody assays are available as part of the clinical care of patients with liver disease. We sought to better understand the clinical utility of immune serological testing in patients with primary biliary cholangitis (PBC). Methods: We retrospectively analysed data from 2846 patients investigated for liver disease at a UK liver centre between 2001 and 2017. A total of 499 patients with PBC were identified. Immune serology results were examined for their diagnostic utility and prognostic significance to predict transplant‐free survival. Results: Antimitochondrial antibodies (AMAs) were specific (94.5%) and sensitive (85.6%) for PBC; antinuclear antibodies (ANAs) against glycoprotein 210 (gp210) and sp100 were specific (>98%) but not sensitive (<25%). The disease‐specific ANAs were detectable in 29.6% of AMA‐negative patients. Anti‐gp210 auto‐antibodies were significantly associated with elevated serum aminotransferase activity, bilirubin and liver stiffness at presentation (P <.010). Anti‐gp210 auto‐antibodies predicted non‐response to ursodeoxycholic acid (UDCA) by GLOBE criteria (39.3% vs 16.7%, P =.005). Moreover, anti‐gp210 was independently associated with death or liver transplantation (HR 3.22, 95% CI 1.49‐6.96; P =.003), after accounting for other significant baseline determinants of outcome. Serologic finding of anti‐gp210 antibodies conferred an independent risk of death or transplantation (HR 4.13, 95% CI 1.85‐9.22; P =.001) after accounting for treatment response. Conclusion: In our single‐centre cohort of patients with PBC, the presence of anti‐gp210 was associated with an adverse presenting phenotype, predicted treatment non‐response and independently predicted reduced transplant‐free survival. [ABSTRACT FROM AUTHOR]

Aim: Urodynamic study is a functional assessment of the lower urinary tract. It has an essential role in the evaluation of paediatric patients with lower urinary tract symptoms, be it due to neurogenic or nonneurogenic causes. Since 2013, we have introduced wireless ambulatory form of the study. In the present study, we performed a baseline review of our paediatric urodynamic service within a 6‐year period to determine its indications, outcomes and complications. Patients and Methods: A retrospective review of all urodynamic studies performed between August 2011 and April 2017 in patients <18 years of age was performed. Demographics, including age and sex, and indications were collected. Urodynamic parameters, including type of catheter used, presence of detrusor overactivity, bladder compliance, end‐fill detrusor pressure, maximum voiding detrusor pressure, postvoid residual bladder volume and bladder emptying efficiency, were collected. Complications from either catheter insertion or the urodynamic study itself were documented. Results: Sixty‐seven studies were done between the study period in 55 patients (16 females and 39 males). Fifty‐eight ambulatory studies with natural and conventional fill were performed since 2013. The median age at study was 2.1 years (range 0.1–17 years). Indications included myelodysplasia (61 per cent, n = 41 studies), bilateral high‐grade vesicoureteric reflux (18 per cent, n = 12), dysfunctional voiding (15 per cent, n = 10) and patient with posterior urethral valve (6 per cent, n = 4). Suprapubic catheters were used in 62 studies in patients with urethral sensation, and transurethral catheters were used in five studies. Overall, 53 studies were considered abnormal (79.1 per cent). No complications resulted from suprapubic catheter insertion or urodynamic studies. Conclusion: Ambulatory urodynamic studies using our unit’s protocol remain safe and child friendly, with minimal complications and high patient and parent satisfaction. [ABSTRACT FROM AUTHOR]

Objective: Vesicoureteral reflux (VUR) is a common condition associated with childhood urinary tract infection (UTI), which may lead to chronic renal failure and hypertension. Different antireflux approaches were advocated with differences in morbidity and success. The aim of this study is to review and analyze the surgical outcomes of pneumovesicoscopic ureteral reimplantation and endoscopic injection of dextranomer/hyaluronic acid (Dx/HA) in three tertiary centers.Materials and Methods: The medical records of 215 patients (159 boys and 56 girls) for a total of 323 ureters underwent surgical interventions for primary VUR from February 2002 to August 2014 were reviewed. Data on baseline demographics, preoperative symptoms, radiological imaging studies, and postoperative outcomes were analyzed. VUR resolution was defined as when no VUR was detected by micturating cystourethrogram at 3 months or later after the intervention. Independent t-test, Mann-Whitney U test, Fisher's Exact test, and Chi-Square test were used for different parameters. All results with P value ≤.05 were regarded as statistically significant.Results: The mean age at operation was 3.33 and 4.63 for reimplantation and Dx/HA injection respectively. A total of 234 ureters underwent Dx/HA injection and 92 ureters underwent pneumovesicoscopic ureteral reimplantation with mean preoperative VUR grading of 3.1 and 4.2 respectively (P = .0001). The overall VUR downgrading and resolution rates were both significantly higher in reimplantation than Dx/HA injection (97.8% versus 78.6% P = .0001 and 84.3% versus 65% P = .0011). Further subgroup analyses across the different VUR gradings showed higher downgrading and resolution rates in reimplantation group than Dx/HA injection for grade 4 (100% versus 81% P = .0147 and 82.4% versus 63% P = .0411) and grade 5 VUR (97.3% versus 50% P = .0022 and 81.6% versus 40% P = .0256). Dx/HA injection was associated with shorter operation time (41.5 minutes versus 147.5 minutes, P < .001), less postoperative analgesic usage (P = .049), and shorter hospital stay (1.06 days versus 4.44 days P < .0001). No major complications were identified in both groups. The mean follow-up time was significantly longer in reimplantation group than Dx/HA group (57.25 months versus 37.85 months, P = .002). There was no significant difference in the rate of subsequent UTI development during follow-up (P = .8).Conclusions: Both Dx/HA injection and pneumovesicoscopic ureteral reimplantation are safe and effective treatments for VUR. Reimplantation is associated with significantly higher VUR downgrading and resolution rates than Dx/HA injection especially in the higher grade VUR while Dx/HA injection has significantly shorter operation time, lower postoperative analgesic usage, and shorter hospital stay. Dx/HA injection can be considered as the first line surgical treatment especially for lower grade VUR. Pneumovesicoscopic ureteral reimplantation can be used for higher grade reflux or those who failed Dx/HA treatments. [ABSTRACT FROM AUTHOR]

Benzotriazole (BT) and 5-methyl-1H-benzotriazole (5-MeBT) are broadly used in industrial applications, such as anti-icing fluids and dishwashing detergent, and act as the primary building blocks for UV absorbers and photostabilizers. This study examined the occurrence of these two compounds in the environment and their unique photochemical behavior affecting photosensitizers and other micro-organic pollutants in aqueous environments. BT and 5-MeBT were detected in all river water samples from the major rivers in Taipei City in the concentration ranges of 147 to 1560 ng/L and 22 to 235 ng/L, respectively, and both compounds persisted through a conventional wastewater treatment plant. The direct photolysis half-lives of BT and 5-MeBT were 56.9 and 14.0 h, respectively. The half-life of photolysis in river water for BT was 44.2 h, whereas the half-life of 5-MeBT was 24.7 h. The long half-lives in real-water matrices resulted in their prevalence in water bodies, and these compounds were also found to minimize the photosensitizing ability of nitrate and dissolved organic matter (DOM) and increase the persistence of other micro-organic pollutant. With BT present, the production of ·OH in nitrate photolysis was reduced, the degradation of DOM under sunlight was hindered, and the photodegradation of pharmaceutical residues in surface water, such as methotrexate, was completely impeded. This study suggests that in cases in which BT and 5-MeBT are highly concentrated, the effectiveness of natural attenuation process, i.e., photodegradation, in the aqueous environment is diminished, which increases the persistence of the pollutants as well as the risk of exposure. [ABSTRACT FROM AUTHOR]

Aim Localized intravascular coagulopathy (LIC) has been described in adults with venous malformation (VM) but rarely reported in children. This study aims to determine the prevalence of LIC in children with VM and associated risk factors. Methods Patients younger than 18 years with VM from 2010 to 2014 were reviewed. Diagnosis was confirmed by Doppler ultrasound and/or magnetic resonance imaging. Demographics data and VM characteristics including volume, site, extension, painful symptoms, and palpable phleboliths were studied. Plasma D-dimer level of greater than 500 ng/mL was considered as abnormal. Results Total 24 children were included, of whom 8 were boys. Median age of presentation was 9 months (range: 0-12 years). Head-and-neck VM occurred in 17 (70.8%) patients and 3 (12.5%) had multifocal lesions. Seven (29.2%) patients had VM volume greater than 10 mL. Five (20.8%) patients had painful symptoms. Palpable phleboliths were found in two patients. Plasma D-dimer was raised in eight cases (33.3%). One patient with Klippel-Trenaunay syndrome (KTS) had D-dimer level of 5,000 ng/mL. Raised D-dimer was found in 23.5% of small VM (volume < 10 mL) and 57.1% of large VM (p = 0.167). D-dimer was significantly raised in multifocal VM (p = 0.028) and showed increasing trend in lesions with palpable phleboliths (p = 0.101). All patients had sclerotherapy performed with indications (cosmesis 41.7%, enlarging lesion 29.2%, pain 20.8%, bleeding 8.3%). Perioperatively, bolus intravenous fluid and mannitol were given to selected patients. All patients had VM volume reduction after sclerotherapy. There were no major thromboembolic complications. Conclusion LIC with raised D-dimer level occurred in one-third of pediatric VM. It was more common in large, multifocal VM and in those with palpable phleboliths or KTS. [ABSTRACT FROM AUTHOR]

Aim: Transanal endorectal pull-through (TEPT) operation is one the most popular operations for Hirschsprung's disease. This aim of the present study was to evaluate its outcome by clinical and manometric assessments. Patients and Methods: This study was a multicentred study involving all three paediatric surgical centres under the Hospital Authority in Hong Kong. All patients, over the age of 3 years, who had undergone primary TEPT operation for more than 1 year, were included in the present study. Clinical evaluation with bowel function score (BFS) and anorectomanometry were carried out. A BFS > 18 and sphincter resting pressure between 30 mmHg and 60 mmHg were considered normal. Those with concomitant anorectal/neurological anomaly or who could not cooperate were excluded. Results: A total of 37 patients were enrolled in this study. The median age was 60 months (range: 36-144 months), and the median age at the time of operation was 3 months (range: 0.5-60 months). With respect to functional outcomes, six patients (16.2 per cent) suffered from constipation, but more than two-thirds of patients had satisfactory stool consistency, as well as frequency. Sixteen patients (43.2 per cent) had no report of any soiling. For the BFS, 26 patients had a BFS above 18, with the median value being 16 (range: 7-20). Manometric assessment revealed that 27 patients (72.9 per cent) had sphincteric resting pressure within the normal value, and the median value was 45 mmHg (range: 14-79 mmHg). Rectoanal inhibitory reflex was present in six patients (16.2 per cent), and the median value for the volume of air to elicit the first anal sensation was 41 mL (range: 18-126 mL). Using univariate analysis, long segment disease was identified as a risk factor for developing soiling of more than two times per week [relative risk (RR): 1.87, 95 per cent confidence interval (CI):1.03-2.22, P = 0.05], whereas the creation of stoma (RR: 1.69, 95 per cent CI: 1.41-2.14, P = 0.04) and occurrence of postoperative enterocolitis (RR: 1.58, 95 per cent CI: 1.36-1.0, P = 0.04) were risk factors for abnormal bowel function score. There was no significant risk factor identified for abnormal manometric results. Lastly, patients with abnormal sphincter resting pressure detected in the anorectomanometry study were also more likely to have an abnormal BFS. Conclusion: Most patients have satisfactory clinical and manometric outcomes after primary TEPT operation. Anorectomanometry findings can predict clinical outcomes. Patients with long segment disease, development of enterocolitis and stoma creation before operation will need more attention, as they are prone to develop abnormal bowel function. Early interventions, such as manometric assessment and proper bowel management, are recommended in order to correct bowel dysfunction, as well enabling patients to have a better quality of life. [ABSTRACT FROM AUTHOR]

Background Stroke, a common cerebrovascular accident, usually results in various extents of functional disability. Extensive studies have shown that ocular and visual problems are common in patients with stroke. Unfortunately, current stroke rehabilitation programs rarely address stroke-related ocular and visual problems in Hong Kong. Methods To examine how visual impairment (for example, deterioration in visual acuity and restriction in visual field) affects the stroke population in Hong Kong, vision screening was conducted for post-stroke patients attending in-patient and out-patient stroke clinics at two hospitals. Results One hundred and thirteen stroke patients were recruited. The percentage of various aspects of visual problems in Hong Kong post-stroke patients was generally lower than that reported in Western countries; however, a high percentage of patients had deficits in oculomotor (53.1 per cent) and vergence functions (11.5 per cent), restrictions in binocular visual field (11.5 per cent) and impairment in visual acuity (worse than 0.30 log MAR, 29.8 per cent). Conversely, only a small proportion of patients noticed problems with their vision (for example, diplopia and blurry vision) through subjective reports. This revealed that many post-stroke patients had undetected or undiagnosed ocular and visual problems. Appropriate referral was given to patients with visual problems for further evaluation and treatment. Conclusion Neglecting visual problems may impose deteriorating effect on patients' stroke rehabilitation and functional independence and lead to increased incidents of injury. To address this potential hindrance in rehabilitation, formal screening for visual problems in stroke patients in a rehabilitation setting is essential. [ABSTRACT FROM AUTHOR]

Aim Image-guided sclerotherapy is becoming the preferred treatment for low-flow vascular malformations in head and neck region. The authors review the management protocol for this condition and evaluate its clinical outcomes. Methods Children with low-flow vascular malformations in head and neck region undergoing sclerotherapy from 2010 to 2013 were reviewed. All patients were assessed by pediatric surgeons and interventional radiologists in the multidisciplinary vascular anomalies clinic. Ultrasonography and intravenous contrast enhanced magnetic resonance imaging were performed preoperatively. Under general anesthesia with endotracheal intubation, sclerotherapy were performed with ultrasonographic and fluoroscopic guidance. Sodium tetradecryl sulfate (STS) foam or ethanolamine was used for venous malformation and doxycycline for lymphatic malformations as primary sclerosants, whereas 98% ethanol was reserved as an adjuvant sclerosant in selected cases of repeated procedures. Perioperative dexamethasone 0.2 mg/kg thrice daily was administered to decrease postsclerotherapy swelling and single dose intravenous mannitol 0.5 g/kg was given to minimize thromboembolic complications. Postoperatively, patients were admitted to intensive care unit for mechanical ventilation under deep sedation for airway protection. Results Overall 13 children (8 male and 5 female) with a mean age of 25 months (range, 2 mo-11 y) underwent a total of 25 sessions of image-guided staged sclerotherapy. There were five venous and eight lymphatic malformations. Location wise there were eight cervical, one lingual, one parotid, one lip, one facial, and one palatal lesions. Six patients had obstructive airway symptoms. Five patients required staged sclerotherapies from two to six sessions. There were no airway and thromboembolic complications. One patient had bleeding while another had recurrent swelling following sclerotherapy for lymphatic malformations and they were treated by aspiration. Significant size reductions of more than 50% volume were achieved in all patients. All patients with obstructive symptoms showed improvement. Conclusion Sclerotherapy is a safe and effective treatment for head and neck vascular malformations in children. Routine perioperative protocol is essential to reduce airway and thromboembolic complications. Size reduction and functional improvement occurred in all patients undergoing sclerotherapy. [ABSTRACT FROM AUTHOR]

We investigate the prevalence of contralateral patent processus vaginalis (CPPV) in children presenting with symptomatic unilateral inguinal hernia under diagnostic laparoscopy and its implication on contralateral surgery. Over a 24-month period, 79 children (66 boys, 13 girls) aged 1 month to 8 years with symptomatic unilateral inguinal hernia underwent laparoscopic hernia repair. Twenty-nine patients (36.7%) were under 24 months of age and 45 (57.0%) presented with right inguinal hernia. The contralateral internal inguinal ring was evaluated for CPPV. Bilateral repairs were carried out if CPPV was present. The overall prevalence of asymptomatic CPPV was 39.2% in children who presented with unilateral inguinal hernia. The prevalence of asymptomatic CPPV was 48.3% for children aged under 24 months old and 26.0% in children above 24 months old ( P = 0.044). CPPV was present in 52.9% of left-side hernia under laparoscopy and in 28.9% of right-side hernia ( P = 0.030). The prevalence of asymptomatic CPPV under laparoscopy is nearly twice the reported incidence of symptomatic contralateral hernia development after conventional unilateral herniotomy. Further studies on the natural history of CPPV are necessary to determine the indications for repair of asymptomatic CPPV. [ABSTRACT FROM AUTHOR]

Glioblastoma multiforme (GBM) remains refractory to conventional therapy. CD133+ GBM cells have been recently isolated and characterized as chemo-/radio-resistant tumor-initiating cells and are hypothesized to be responsible for post-treatment recurrence. In order to explore the molecular properties of tumorigenic CD133+ GBM cells that resist treatment, we isolated CD133+ GBM cells from tumors that are recurrent and have previously received chemo-/radio-therapy. We found that the purified CD133+ GBM cells sorted from the CD133+ GBM spheres express SOX2 and CD44 and are capable of clonal self-renewal and dividing to produce fast-growing CD133− progeny, which form the major cell population within GBM spheres. Intracranial injection of purified CD133+, not CD133− GBM daughter cells, can lead to the development of YKL-40+ infiltrating tumors that display hypervascularity and pseudopalisading necrosis-like features in mouse brain. The molecular profile of purified CD133+ GBM cells revealed characteristics of neuroectoderm-like cells, expressing both radial glial and neural crest cell developmental genes, and portraying a slow-growing, non-differentiated, polarized/migratory, astrogliogenic, and chondrogenic phenotype. These data suggest that at least a subset of treated and recurrent GBM tumors may be seeded by CD133+ GBM cells with neural and mesenchymal properties. The data also imply that CD133+ GBM cells may be clinically indolent/quiescent prior to undergoing proliferative cell division (PCD) to produce CD133− GBM effector progeny. Identifying intrinsic and extrinsic cues, which promote CD133+ GBM cell self-renewal and PCD to support ongoing tumor regeneration may highlight novel therapeutic strategies to greatly diminish the recurrence rate of GBM. [ABSTRACT FROM AUTHOR]

Background. The recovery rate of upper limb function after stroke is poor when compared with independent walking. Therefore, effective methods are warranted for upper limb rehabilitation. Objective. The aim of this study was to investigate the effectiveness of functional electric stimulation (FES) with bilateral activities training on upper limb function. Methods. This study was a double-blinded randomized controlled trial. Twenty patients were recruited 6 months after the onset of stroke and completed 15 training sessions. Participants were randomly assigned to the FES group or to the control group. Each session consisted of stretching activities (10 minutes), FES with bilateral tasks (20 minutes), and occupational therapy treatment (60 minutes). The participants used a self-trigger mechanism, with an accelerometer as a motion detector, for generating an electric stimulation pattern that was synchronized with the bilateral upper limb activities during the training. The participants in the control group received the same duration of stretching and occupational therapy training except that they just received placebo stimulation with the bilateral tasks. The outcome measures included Functional Test for the Hemiplegic Upper Extremity (FTHUE), Fugl-Meyer Assessment (FMA), grip power, forward reaching distance, active range of motion of wrist extension, Functional Independence Measure, and Modified Ashworth Scale. Results. At baseline comparison, there was no significant difference in both groups. After 15 training sessions, the FES group had significant improvement in FMA (P = .039), FTHUE (P = .001), and active range of motion of wrist extension (P = .020) when compared with the control group. Conclusions. Bilateral upper limb training with FES could be an effective method for upper limb rehabilitation of stroke patients after 15 training sessions. [ABSTRACT FROM AUTHOR]

The surface of an indwelling medical device can be colonized by human pathogens that can form biofilms and cause infections. In most cases, these biofilms are resistant to antimicrobial therapy and eventually necessitate removal or replacement of the device. An engineered surface microtopography based on the skin of sharks, Sharklet AF™, has been designed on a poly(dimethyl siloxane) elastomer (PDMSe) to disrupt the formation of bacterial biofilms without the use of bactericidal agents. The Sharklet AF™ PDMSe was tested against smooth PDMSe for biofilm formation of Staphylococcus aureus over the course of 21 days. The smooth surface exhibited early-stage biofilm colonies at 7 days and mature biofilms at 14 days, while the topographical surface did not show evidence of early biofilm colonization until day 21. At 14 days, the mean value of percent area coverage of S. aureus on the smooth surface was 54% compared to 7% for the Sharklet AF™ surface (p<0.01). These results suggest that surface modification of indwelling medical devices and exposed sterile surfaces with the Sharklet AF™ engineered topography may be an effective solution in disrupting biofilm formation of S. aureus. [ABSTRACT FROM AUTHOR]