bluuebunny/crossref_metadata_2025 huggingface dataset:
Angiosarcoma of the Scalp Treated with Mohs Micrographic Surgery
Authors: GOLDBERG DAVID J. , KIM Y. ALYSSA
Published: June 2013

The idiopathic type of angiosarcoma most commonly occurs on the face and scalp of elderly persons. This rare tumor can be highly aggressive; however, if the diagnosis is made at an early stage, while the tumor is still localized and has a size that is less than 10 cm, surgical excision is the treatment of choice. We report a case whereby Mohs micrographic surgery was used to treat angiosarcoma of scalp.
Terminating the Physician‐Patient Relationship
Authors: Torres Abel , Wagner Richard , Proper Steven
Published: June 2013

background. This continues our series of articles addressing the many medicolegal aspects that impact the practice of dermatology. Because the physician‐patient relationship is the cornerstone of every medical malpractice action, the proper termination of that relationship is very important.

methods. A format of an initial discussion of legal concepts followed by hypothetical and a review of actual cases was chosen to enhance interactive learning. The subject matter is based on a review of medicolegal literature and actual recorded case law.

results. Once a physician‐patient relationship has been established, improper termination of that relationship may constitute abandonment.

conclusion. Any termination of the physician‐patient relationship must be reasonable in view of the patients' access to alternate medical care and medical problems and should be properly communicated to the patient.
The Fibrel Mechanism of Action Study
Authors: GOLD MICHAEL H.
Published: June 2013

background. Fibrel is a medical implant device that has demonstrated use in the correction of cutaneous depressions from acne scars and wrinkles, OBJECTIVE. Mechanisms of actions have been proposed that have theorized the production of new collagen over time as a result of the Fibrel implant. The present study utilized human volunteers to study the histologic response of Fibrel over time.

methods. Fibrel was injected into tattoo sites behind the ears of human volunteers; skin biopsies were taken at various time intervals and studied histologically by a clinical pathologist.

results. An overall increase over time was noted with regard to production of collagen and inflammatory response. No change in elastic tissue was found.

conclusions. Fibrel does promote new collagen synthesis and inflammatory response and thus is useful to correct cutaneous depressions via soft tissue augmentation.
Immunohistochemical Margin Control Applied to Mohs Micrographic Surgical Excision of Dermatofibrosarcoma Protuberans
Authors: JIMENEZ FRANCISCO JAVIER , GRICHNIK JAMES MICHAEL , BUCHANAN MARK DEWAINE , CLARK ROBERT EARL
Published: June 2013

background. Surgical treatment of dermatofibrosarcoma protuberans has a high rate of recurrence presumably secondary to persistent residual tumor. Recently an antigenic marker, CD34, has demonstrated specificity for this tumor.

objective. To improve the microscopic detection of dermatofibrosarcoma protuberans tumor elements in Mohs micrographic surgical sections by incorporating immunohistologic staining.

methods. Standard Mohs micrographic surgical technique was used, coupled with standard immunohistochemical procedures using an antibody to the CD34 antigen.

results. Immunohistochemical staining with anti‐CD34 of Mohs micrographic sections clearly delineated the extent of the tumor elements.

conclusions. We anticipate that the application of this immunohistochemical‐modified Mohs surgical technique will further enhance the detection of insidious portions of tumor thereby enhancing removal and reducing recurrence.
Basal Cell Carcinoma on the Lower Extremity
Authors: CARLSON KEITH C. , CONNOLLY SUZANNE M. , WINKELMANN R. K.
Published: June 2013

From 1987 to 1990, 21 of 648 patients with basal cell carcinomas (BCCs) had their lesion located on the leg. Basal cell carcinomas in this location are uncommon. Women outnumbered men by 1.6:1. The majority of patients had types I and II skin. Most reported residence in the southwestern United States for many years. Recreational sun exposure was extensive and dominated by activities in which exposure of the legs was common. Most lesions were recognized clinically and located on the anterior lower leg. The most frequent histologic description was superficial BCC. Treatment was with electrodesiccation and curettage or excision.
Rapid Staining with Carcinoembryonic Antigen Aids Limited Excision of Extramammary Paget's Disease Treated by Mohs Surgery
Authors: HARRIS D.W.S. , KIST D.A. , BLOOM K. , ZACHARY C.B.
Published: June 2013

Extensive extramammary Paget's (EMPD) disease of the perineum in a 68‐year‐old man was treated by Mohs surgery. To facilitate identification of involved tissue a rapid staining carcinoembryonic antigen was used. This technique proved a useful adjunct to conventional hemotoxylin‐eosin (H&E) stains. It was especially useful in highlighting involvement in areas of marked dysplasia/artifact where discrimination is often difficult. It is recommended that such a technique offers considerable benefits over H&E staining when confronted by such tissue morphology.
Gingival Metastasis as First Sign of an Undifferentiated Carcinoma of the Lung
Authors: PERIS KETTY , CERRONI LORENZO , PAOLONI MAURO , MARGIOTTA VALERIO , CHIMENTI SERGIO
Published: June 2013

background
. Metastases of internal tumors to the oral cavity are unusual and involve in most cases maxilla and mandible. Metastases to the gingival soft tissue are extremely rare.

objective
. To report a case of gingival metastasis from undifferentiated carcinoma of the lung.

methods
. The lesion was removed and hematoxylin and eosin sections were performed. Immunohistochemical investigations were performed with a standard three‐step immunoperoxidase technique on formalin‐fixed, paraffin‐embedded tissue sections using anti‐CEA, anti‐S‐100, HMB45, and anti‐LCA antibodies.

results
. Based on clincopathologic findings, a diagnosis of metastasis from undifferentiated carcinoma of the lung was established. Further investigations revealed a primary undifferentiated carcinoma of the lung.

conclusions
. Metastasis from internal neoplasms should be considered among other differential diagnoses in the evaluation of gingival tumors. In the present case, onset of oral lesion preceded detection of the primary lung tumor. Complete screening of the patient should therefore follow a diagnosis of gingival neoplasm of unknown origin.
Allergic Reactions to Polidocanol for Vein Sclerosis
Authors: FEIED CRAIG F. , JACKSON JOYCE J. , BREN TERESA S. , BOND OLIVER B. , FERNANDO C. ERNEST , YOUNG VINCENT C.Y. , HASHEMIYOON ROBERT B.
Published: June 2013

background. Polidocanol is a sclerosing solution that is highly valued by clinicians and patients for its painlessness, high efficacy, excellent safety profile, low incidence of side effects, and for the rarity of its allergic reactions. Previous estimates of the incidence of allergic reactions have ranged from 0 to 0.06%.

objective. Improved recognition of systemic allergy to polidocanol is desirable for both clinicians and for patients. We have attempted to describe two cases recently observed in our population and to provide an improved upper‐bounds estimate for the true population incidence of allergy to polidocanol.

results. We report two recent cases of mild systemic allergic reaction to polidocanol in a population of 689 exposed patients, for an observed incidence of 0.3% in our patient population. We have calculated a 95% confidence upper‐bound estimate of 0.91% for the incidence of polidocanol allergy in the general population.

conclusion. Allergy to polidocanol may be more common than previously recognized. Careful questioning of previously treated patients and more prolonged observation of patients after treatment may yield a larger number of recognized cases.
Oral Transmucosal Fentanyl Citrate Premedication in Patients Undergoing Outpatient Dermatologie Procedures
Authors: GERWELS JOHN W. , BEZZANT JOHN L. , LE MAIRE LEON , PAULEY LYNNE F. , STREISAND JAMES B.
Published: June 2013

background. Oral transmucosal fentanyl citrate (OTFC) is a novel lozenge dosage form of fentanyl used for premedication. Many dermatology patients undergoing surgical procedures could benefit from such a medication.

objective. The study compared the safety and efficacy of 400‐ vs 800‐ μg dosage forms for their sedative and anxiolytic effects in adults undergoing a variety of dermatologic outpatient surgical procedures.

methods. Patients received OTFC 30 minutes before the procedura. Vital signs, oxygen Saturation, sedation, and anxiety scores were measured before OTFC administration and every 15 minutes thereafter.

results. Significant sedation and anxiolysis developed in both dosage groups. No clinically significant changes in respiratory rate, heart rate, or blood pressure occurred during the study period. Common drug‐induced side effects included dizziness, nausea, pruritus, and vomiting.

conclusion. OTFC is safe and effective for outpatient dermatologic procedures; however, the risk of opioid‐related side effects must be carefully weighed against the benefits when deciding to use OTFC in an outpatient setting.
Repair of the Soft Triangle of the Nose
Authors: ZITELLI JOHN ALBERT
Published: June 2013

background. Notching of the soft triangle is a complication of excisional and some reconstructive surgery that is difficult to repair.

objective. This article provides a simple single‐stage procedure to correct the complication of notching of the soft triangle.

methods. A detailed description of a turnover flap from the inferior tip covered with a full‐thickness skin graft is provided.

results. The method described has provided uniformly satisfactorily results based on the author's experience.

conclusion. This simple method is the treatment of choice for a one‐stage repair of a soft triangle notch.
Cryosurgery of Varicose Veins
Authors: GARDE CLAUDE
Published: June 2013

background. It is impossible to treat all varicose veins employing the same method. Cryosurgery offers a new modality for the destraction of the long and short saphenous vein deletion.

objective. To describe the technique, its indications, potential complications, and cosmetic results.

methods. We followed 800 patients over 6 years. The study allows evaluation of the results of and the best indications for this method. With a follow up of five years, we have analyzed: 1) the immediate complications, and 2) middle‐term results.

results. The results of cryosurgery of varicose veins were generally comparable to those obtained using classical surgery (stripping).

conclusion. Cryosurgery of varicose veins is a fast and safe method for selected varicose disorders, exhibiting good cosmetic results.
The Glycolic Acid Trichloroacetic Acid Peel
Authors: III WILLIAM P. COLEMAN , FUTRELL JOSEPHINE M.
Published: June 2013

background. Chemical peeling has become increasingly popular. Technique is more critical in medium depth peeling than with deeper peels because of variable penetration of the trichloroacetic acid,

objective. This article describes a novel use of two caustic agents, glycolic acid and trichloroacetic acid, to effect a predictable approach to medium depth peeling,

methods. Without other skin preparation, 70% glycolic acid was applied to the entire face and diluted with water after 2 minutes. Then, 35% trichloroacetic acid was applied over the same areas. Biopsies were done on selected patients after 24 hours and 30, 60, and 90 days,

results. Both clinically and histologically the glycolic trichloroacetic acid peel resulted in medium depth injury. Improvement in pigmentary dyschromias and actinic damage was impressive,

conclusion. The GA‐TCA peel provides a consistent approach to medium depth peeling to add to the armamentarium of the dermatologic surgeon,
Dear Sir
Authors: Champkin Julian
Published: June 2013

When the Queen knights a scientist, do his letters get answered more quickly? Julian Champkin finds statistical egalitarianism.
Transcranial Laser Therapy for Acute Ischemic Stroke: A Pooled Analysis of NEST-1 and NEST-2
Authors: Huisa Branko N. , Stemer Andrew B. , Walker Michael G. , Rapp Karen , Meyer Brett C. , Zivin Justin A. ,   for the NEST-1 and −2 investigators
Published: June 2013

Background

NeuroThera Effectiveness and Safety Trials (NEST) 1 and 2 have demonstrated safety of transcranial laser therapy (TLT) for human treatment in acute ischemic stroke. NEST 1 study suggested efficacy of TLT but the following NEST 2, despite strong signals, missed reaching significance on its primary efficacy endpoint. In order to assess efficacy in a larger cohort, a pooled analysis was therefore performed.

Methods

The two studies were first compared for heterogeneity, and then a pooled analysis was performed to assess overall safety and efficacy, and examined particular subgroups. The primary endpoint for the pooled analysis was dichotomized modified Rankin scale (mRS) 0–2 at 90 days.

Results

Efficacy analysis for the intention-to-treat population was based on a total of 778 patients. Baseline characteristics and prognostic factors were balanced between the two groups. The TLT group ( n = 410) success rate measured by the dichotomized 90-day mRS was significantly higher compared with the sham group ( n = 368) ( P = 0·003, OR: 1·67, 95% CI: 1·19–2·35). The distribution of scores on the 90-day mRS was significantly different in TLT compared with sham ( P = 0·0005 Cochran–Mantel–Haenszel). Subgroup analysis identified moderate strokes as a predictor of better treatment response.

Conclusions

This pooled analysis support the likelihood that transcranial laser therapy is effective for the treatment of acute ischemic stroke when initiated within 24 h of stroke onset. If ultimately confirmed, transcranial laser therapy will change management and improve outcomes of far more patients with acute ischemic stroke.
The In Vitro Efficacy of Antimicrobial Agents Against the Pathogenic Free‐Living Amoeba Balamuthia mandrillaris
Authors: Ahmad Arine F. , Heaselgrave Wayne , Andrew Peter W. , Kilvington Simon
Published: June 2013

The free‐living amoeba Balamuthia mandrillaris causes usually fatal encephalitis in humans and animals. Only limited studies have investigated the efficacy of antimicrobial agents against the organism. Assay methods were developed to assess antimicrobial efficacy against both the trophozoite and cyst stage of B. mandrillaris (ATCC 50209). Amphotericin B, ciclopirox olamine, miltefosine, natamycin, paromomycin, pentamidine isethionate, protriptyline, spiramycin, sulconazole and telithromycin had limited activity with amoebacidal levels of > 135–500 μM. However, diminazene aceturate (Berenil®) was amoebacidal at 7.8 μM and 31.3–61.5 μM for trophozoites and cysts, respectively. Assays for antimicrobial testing may improve the prognosis for infection and aid in the development of primary selective culture isolation media.
Dietary patterns, anthropometric status, prevalence and risk factors for anaemia among school children aged 5–11 years in Central Uganda
Authors: Turyashemererwa F. M. , Kikafunda J. , Annan R. , Tumuhimbise G. A.
Published: June 2013

Background

To determine the dietary patterns, anthropometric status, prevalence and risk factors for anaemia among school children aged 5–11 years in a peri‐urban area of Central Uganda.

Methods

A cross‐sectional study involving both qualitative and quantitative methods was used. Anthropometric data were taken using standardised equipment, whereas haemoglobin was assessed using a haemoglobin meter. Food intake was assessed using a food frequency questionnaire. One hundred and twenty‐two primary school children, aged 5–11 years, and their carers were recruited in the study.

Results

The proportion of anaemic children (haemoglobin <12 g/dl) was 37.7%; 36.9% of these had mild and 0.8% had moderate anaemia. The unadjusted odds ratio (OR) showed that children who never consumed fish had a nine‐fold increased odds of being anaemic [OR = 9.0, 95% confidence interval (CI) = 1.6–50.7; P = 0.018], whereas those who had fewer meals (1–2 per day) had a 27.0% increased risk (OR = 3.7, 95% CI = 1.1–12.6; P = 0.021). The adjusted OR showed number of meals per day as the only independent predictor of anaemia (OR = 3.5, 95% CI = 1.1–11.8; P = 0.031). The proportion of malnutrition (<−2 SD) for wasting (body mass index for age) was 3.3%, being underweight was 5.8% and stunting was 6.6%. Children aged >8 years were associated with wasting (P = 0.041) and stunting (P = 0.034). One main dietary pattern was identified explaining approximately 20.4% of the variability of intake in the population. However, scores of this pattern were not significantly associated with child haemoglobin levels.

Conclusions

Anaemia but not macronutrient malnutrition in this cohort of school children is high. Patterns of the dietary intake observed did not explain nutritional status in this population.
Classroom vs. Extramural English: Teachers Dealing with Demotivation
Authors: Sundqvist Pia , Olin‐Scheller Christina
Published: June 2013

The present article explores challenges facing EFL classrooms in Sweden due to new informal out‐of‐school language learning settings created by the current media landscape. A recent Swedish national evaluation identifies that a problematic situation in secondary school EFL classrooms has emerged. EFL teachers find it difficult to bridge the gap (cf. Olsson 2011) between the English used in school and the English used outside of school, extramural English (Sundqvist 2009). As a consequence, the pupils (aged 13–16) become discouraged and demotivated. Based on experiences from language teaching methodology in‐service training programs and a small‐scale survey, the article discusses the problem with demotivation, the empowerment of EFL teachers, and the development of teaching practices in order to meet the new challenges. The article argues that the challenges that Swedish EFL teachers currently meet can be viewed as an early indication that similar challenges are likely to emerge also in EFL classrooms elsewhere.
GSA‐1/ARG1 protects root gravitropism in Arabidopsis under ammonium stress
Authors: Zou Na , Li Baohai , Chen Hao , Su Yanhua , Kronzucker Herbert J. , Xiong Liming , Baluška František , Shi Weiming
Published: June 2013

Gravitropism plays a critical role in plant growth and development, plant stability and acclimation to changes in water and nutrient availability. Ammonium (NH4+) is well known to have profound effects on root growth, but its impacts on gravitropism are poorly understood.

To determine which genes are essential for the maintenance of root gravitropism under NH4+ stress, we isolated and identified an NH4+‐sensitive mutant, gsa‐1 (gravitropism sensitive to ammonium‐1), in Arabidopsis thaliana, using an agar plate root reorientation assay.

We found that, under NH4+ stress, gsa‐1 displayed increased loss of root gravitropism. Gene cloning and sequencing revealed that gsa‐1 contains a G to C transversion mutation at the highly conserved 5′‐GT splice position of intron 10 of ARG1 (ALTERED RESPONSE TO GRAVITY1), known to participate in the transduction of the root gravity signal. Genetic complement tests established the locus of GSA‐1/ARG1 and its role in resistance to NH4+ inhibition on root gravitropism. GSA‐1/ARG1 is required for normal AUX1 expression and basipetal auxin transport in root apices. In addition, PIN‐FORMED2 (PIN2) is proposed as a target in the reduction of root gravitropism under NH4+ stress, a response which can be antagonized by the GSA‐1/ARG1‐dependent pathway.

These results suggest that GSA‐1/ARG1 protects root gravitropism in Arabidopsis thaliana under ammonium stress.
Trends in overweight by educational level in 33 low‐ and middle‐income countries: the role of parity, age at first birth and breastfeeding
Authors: Lopez‐Arana S. , Burdorf A. , Avendano M.
Published: June 2013

This study examined trends in overweight among women of reproductive age by educational level in 33 low‐ and middle‐income countries, and estimated the contribution of parity, age at first birth and breastfeeding to these trends. We used repeated cross‐sectional Demographic Health Surveys of 255,828 women aged 25–49 years interviewed between 1992 and 2009. We applied logistic regression to model overweight (>25 kg m−2) as a function of education, reproductive variables and time period by country and region. The prevalence of overweight ranged from 3.4% in South and Southeast Asia to 73.7% in North Africa West/Central Asia during the study period. The association between education and overweight differed across regions. In North Africa West/Central Asia and Latin American, lower education was associated with higher overweight prevalence, while the inverse was true in South/Southeast Asia and Sub‐Saharan Africa. In all regions, there was a consistent pattern of increasing overweight trends across all educational groups. Older age at first birth, longer breastfeeding and lower parity were associated with less overweight, for differences by educational level in overweight prevalence and trends.
Correlation analysis of nuclear morphology, cytokeratin and Ki‐67 expression of urothelial carcinoma cells
Authors: Shuto Masayo , Warigaya Kenji , Watanabe Hiroshi , Shimizu Michio , Fukuda Toshio , Murata Shin‐ichi
Published: June 2013

We aimed to delineate the morphogenesis of aberrant nuclear features of urothelial carcinoma (UC) cells in association with cytokeratin (CK) expression patterns and cell proliferation activity. Correlation analysis of the nuclear area by morphometry and the expression patterns of CK5, CK20 and Ki‐67 by triple immunofluorescence analysis was applied to 1699 cells from five low‐grade and seven high‐grade cases of UC. The majority of UC cells showed aberrant cellular differentiation represented by abnormal CK expression patterns of CK5(+)/CK20(+) (40.5%) or CK5(−)/CK20(+) (56.0%). CK5(+)/CK20(−) cells, a phenotype of cancer stem/progenitor cells, represented a very small population (1.9%) and showed a low proliferation activity. Ki‐67(+) cells showed a significantly different CK expression pattern compared with that of Ki‐67(−) cells. The nuclear areas of CK5(−)/CK20(+) cells (71.3 ± 25.9 μm2) were significantly larger than those of CK5(+)/CK20(+) cells (66.6 ± 25.5 μm2). Negativity for CK5 was related to the grade of UC and an increased number of CK5(−)/CK20(+)/Ki‐67(+) cells was related to a higher malignant potential. We conclude the nuclear morphology is related to cell differentiation represented by CK expression and cell proliferative activity.
Gastric adenocarcinoma of the fundic gland type shares common genetic and phenotypic features with pyloric gland adenoma
Authors: Kushima Ryoji , Sekine Shigeki , Matsubara Akiko , Taniguchi Hirokazu , Ikegami Masahiro , Tsuda Hitoshi
Published: June 2013

Gastric adenocarcinoma of the fundic gland type (GAFG) and pyloric gland adenoma (PGA) have recently been recognized as rare types of neoplasia. We performed comparative immunohistochemical and genetic analyses of 3 GAFGs and 12 PGAs. All of the 3 GAFGs were diffusely positive for pepsinogen‐I, MIST1 and MUC6, indicating the predominantly chief cell/mucous neck cell differentiation of these tumors. A small number of H.K‐ATPase‐positive parietal cells were also scattered. PGAs invariably exhibited diffuse MUC6 and TFF2 expression, consistent with the pyloric gland differentiation of these tumors. Ten of the 12 PGAs also unexpectedly exhibited focal expression of pepsinogen‐I and MIST1, suggesting that PGAs often show focal chief cell differentiation and phenotypically resemble mucous neck cells rather than pyloric glands. The mutation analyses revealed activating GNAS mutations, which have been reported to be frequently detected in PGAs, in two of the GAFGs. While GAFGs and PGAs are morphologically distinct lesions, our observations showed their partially overlapping immunohistochemical profiles and shared presence of GNAS mutations, in addition to their common occurrence in the fundic gland mucosa. Based on these observations, we suggest that both GAFGs and PGAs are closely related lesions characterized by a mucous neck cell/chief cell lineage phenotype.
Optimal R&D Policy and Managerial Delegation Under Vertically Differentiated Duopoly
Authors: Wang Ya‐Chin
Published: June 2013

The paper investigates the optimal research and development (R&D) policy in a vertically differentiated market with managerial delegation. We consider not only discriminatory R&D policy but uniform R&D policy as well. It shows that R&D policy can vary depending on the regulator's objective: social welfare, consumer surplus or producer surplus; however, the outcomes are invariant to the nature of market competition. Undoubtedly, the relative‐performance contract plays a crucial role for elaborating policy effects. The government prefers discriminatory R&D policy to uniform policy under a consumer‐oriented objective. On the contrary, under a producer‐oriented objective, the government would prefer to choose uniform R&D policy rather than discriminatory policy.
Measuring Exchange Market Pressure and Its Contagion in the East African Community
Authors: Hegerty Scott W.
Published: June 2013

As the members of the East African Community seek to further integrate their economies, issues of compatibility arise. How interlinked are these countries' exchange markets, and which currencies are most likely to influence their neighbours? This study constructs monthly indices of exchange market pressure (EMP) for Burundi, Kenya, Rwanda, Tanzania and Uganda over the past decade. Two methods of constructing these indices are shown to exhibit large differences. Vector autoregressive approaches are then applied to the main EMP series and a set of global stock price proxies. Kenya, the dominant economy, is shown to have the largest effect on the region but is not itself affected by other regional currencies. Foreign stock price declines increase EMP for all countries except Tanzania, which is also the least integrated in terms of trade. This suggests that financial integration in the region is uneven – with implications for a successful common currency.
Profile of cognitive deficits and associations with depressive symptoms and intelligence in chronic early‐onset schizophrenia patients
Authors: Jepsen Jens Richardt Møllegaard , Fagerlund Birgitte , Pagsberg Anne Katrine , Christensen Anne Marie Raaberg , Nordentoft Merete , Mortensen Erik Lykke
Published: June 2013

Cognitive deficits in several domains have been demonstrated in early‐onset schizophrenia patients but their profile and relation to depressive symptoms and intelligence need further characterization. The purpose was to characterize the profile of cognitive deficits in chronic, early‐onset schizophrenia patients, assess the potential associations with depressive symptom severity, and examine whether cognitive deficits within several domains reflect intelligence impairments. This study compared attention, visual‐construction, aspects of visual and verbal memory, and executive functions in chronic, early‐onset schizophrenia patients (mean age = 20.7 years) (N = 18) and healthy controls (N = 38). Schizophrenia diagnoses were established at the time of the patients' first clinical presentation during childhood or adolescence and were confirmed five years later. In the chronic phase of early‐onset schizophrenia, significant deficits were observed in all specific cognitive functions. The profile of cognitive deficits was jagged, and visual‐construction, attention, and one aspect of verbal memory (verbal stories recall) were differentially impaired. Deficits of visual recall, visual recognition, and executive functions were accounted for by deficits in intelligence, while this was not the case for deficits of verbal recall of stories or attention. No significant associations were observed between the severity of cognitive deficits and that of depressive symptoms. Chronic, early‐onset schizophrenia is characterized by a broad and jagged profile of cognitive deficits. Deficits of attention and verbal recall of stories appear not to be accounted for by deficits in intelligence, and the severity of cognitive deficits seems independent from that of depressive symptoms
Interleukin‐28B genetic variations and spontaneous clearance of hepatitis C antibody–positive blood donors in China
Authors: Liu Yu , Ma Hongli , Chen Shanhua , Wang Jingxing , Liu Gui , Xu Min , Ke Ling , He Miao
Published: June 2013

Background

Single‐nucleotide polymorphisms (SNPs) near the interleukin (IL)28B gene have been shown to be associated with spontaneous clearance of hepatitis C virus (HCV) infection in western populations. Anti‐HCV–reactive and HCV RNA–negative samples were often found in Chinese blood donors. This study was to determine whether the IL28B gene variant is also associated with the natural outcome of HCV infection in Chinese blood donors.

Study Design and Methods

A total of 111 anti‐HCV–negative blood donors and 100 anti‐HCV–reactive subjects were enrolled in this study. HCV‐infected blood donors were classified into spontaneous clearance group and chronic infection group through HCV RNA detection. IL28B genetic variations (rs8099917 and rs12979860) were genotyped by polymerase chain reaction and direct sequencing.

Results

A total of 24 (24.0%) donors spontaneously cleared HCV. The rs12979860 C allele frequency was 90.3% and the rs8099917 T allele frequency was 96.7% in our study. The rs12979860 CC genotype was strongly associated with spontaneous HCV clearance. Female blood donors had a higher rate of spontaneous HCV clearance than male donors (15/42 [35.7%] vs. 9/58 [15.5%], p = 0.02).

Conclusions

The rs12979860 CC variant upstream of IL28B gene is associated with spontaneous clearance of HCV in Chinese blood donors and female donors are more likely to clear HCV infection than male donors.
Intensive red blood cell transfusions and risk of alloimmunization
Authors: Zalpuri Saurabh , Middelburg Rutger A. , Schonewille Henk , de Vooght Karen M.K. , le Cessie Saskia , van der Bom Johanna G. , Zwaginga Jaap Jan
Published: June 2013

Background

Exposure to allogenic red blood cells (RBCs) may lead to formation of antibodies against nonself‐antigens in transfused patients. While alloimmunization rates are known to increase with the number of transfusions, the transfusion course in patients can vary from receiving multiple units during a single transfusion event or getting them dispersed over a long(er) period. In this study we compared the immunization risk between different transfusion intensities.

Study Design and Methods

An incident new‐user cohort study was conducted among consecutive transfused patients at two university medical centers. All patients who received their first RBC transfusion within the study period from January 2005 to December 2011 were eligible. Intensive transfusions were defined as at least 5, at least 10, and at least 20 RBC units within 48 hours. Alloimmunization hazard ratios (HRs), comparing patients receiving intensive transfusions to patients never receiving intensive transfusions, were estimated.

Results

The study cohort was composed of 5812 patients who had received a median of 7 (interquartile range, 4‐12) units. RBC alloantibodies were formed by 156 patients. The adjusted Cox regression HRs for alloimmunization, with number of units as the time covariate and adjusted for patient age, sex, and follow‐up time after first transfusion, ranged from 0.8 to 1.2 (95% confidence interval, 0.4‐2.6).

Conclusion

The occurrence of RBC alloimmunization in patients receiving intensive transfusions did not differ significantly from patients receiving nonintensive transfusions.
Respiration‐phase‐matched digital tomosynthesis imaging for moving target verification: A feasibility study
Authors: Zhang You , Ren Lei , Ling C. Clifton , Yin Fang‐Fang
Published: June 2013

Purpose:

To develop a respiration‐phase‐matched digital tomosynthesis (DTS) technique to monitor moving targets, and to evaluate its accuracy for various imaging parameters and anatomical characteristics.

Methods:

Previously developed 3D‐DTS techniques, registering onboard DTS (OB‐DTS, reconstructed from onboard projections) to reference DTS (R‐DTS, reconstructed from DRRs of 3D reference CT), are inadequate to monitor moving targets. The authors’ proposed respiration‐phase‐matched DTS technique registers OB‐DTS to R‐DTS reconstructed from DRRs generated by the same phase images of 4D reference CT as the corresponding onboard projections. To evaluate the improved accuracy of the author's technique, the authors performed thoracic phantom studies using (1) simulation with the 4D digital extended‐cardiac‐torso (XCAT) phantom, and (2) experiments with an anthropomorphic motion phantom. The studies were performed for various: respiratory cycle (RC), scan angle, and fraction of RC contained therein. Also, the authors assessed the accuracy of their technique relative to target size/location, and respiration inconsistencies from the R‐DTS to OB‐DTS.

Results:

In both simulation and experimental studies, the respiration‐phase‐matched DTS technique is significantly more accurate in determining moving target positions. For 324 different scenarios simulated by XCAT, the respiration‐phase‐matched DTS technique localizes the 3D target position to errors of 1.07 ± 0.57 mm (mean ± S.D.), as compared to (a) 2.58 ± 1.37 and (b) 7.37 ± 4.18 mm, for 3D‐DTS using 3D reference CT of (a) average intensity projection and (b) free‐breathing CT. For 60 scenarios evaluated through experimental study, the uncertainties corresponding to those above are 1.24 ± 0.87, 2.42 ± 1.80, and 5.77 ± 6.45 mm, respectively. For a given scan angle, the accuracy of respiration‐phase‐matched DTS technique is less dependent on RC and the fraction of RC included in the scan. Increasing scan angle improves its accuracy. For different target locations, the targets near the chest wall or in the middle of lung provide higher registration accuracy compared to those near the mediastinum and diaphragm. Larger targets provide higher registration accuracy than small targets. Different respiratory cycle inconsistencies from R‐DTS to OB‐DTS minimally affect the registration accuracy. Increasing the respiratory amplitude inconsistencies will decrease the accuracy.

Conclusions:

The respiration‐phase‐matched DTS is more accurate and robust in determining moving target positions than 3D‐DTS. It has potential application in pretreatment setup, post‐treatment analysis, and intrafractional target verification.
Tracing a Translocation's Impact
The Philadelphia Chromosome
A Mutant Gene and the Quest to Cure Cancer at the Genetic Level

by Jessica Wapner

The Experiment, New York, 2013. 327 pp. $25.95. ISBN 9781615190676.
Authors: Nadkarni Aditi
Published: June 2013

Wapner's narrative follows developments from the recognition of a chromosomal abnormality in cancer cells to the production of a targeted drug against what had been a lethal leukemia.

[Also see Perspective by
Rowley
]
Performance of the Vitek MS v2.0 System in Distinguishing Streptococcus pneumoniae from Nonpneumococcal Species of the Streptococcus mitis Group
Authors: Branda John A. , Markham Rachelle P. , Garner Cherilyn D. , Rychert Jenna A. , Ferraro Mary Jane
Published: June 2013

The Vitek MS v2.0 matrix-assisted laser desorption ionization–time of flight mass spectrometry system accurately distinguishedStreptococcus pneumoniaefrom nonpneumococcalS. mitisgroup species. Only 1 of 116 nonpneumococcal isolates (<1%) was misidentified asS. pneumoniae. None of 95 pneumococcal isolates was misidentified. This method provides a rapid, simple means of discriminating among these challenging organisms.
Accuracy of Species-Level Identification of Yeast Isolates from Blood Cultures from 10 University Hospitals in South Korea by Use of the Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry-Based Vitek MS System
Authors: Won Eun Jeong , Shin Jong Hee , Lee Kyungwon , Kim Mi-Na , Lee Hye Soo , Park Yeon-Joon , Joo Min Young , Kim Soo Hyun , Shin Myung Geun , Suh Soon Pal , Ryang Dong Wook
Published: June 2013

We assessed the accuracy of yeast bloodstream isolate identification performed over a 1-year period at 10 South Korean hospitals, using the matrix-assisted laser desorption ionization–time of flight (MALDI-TOF)-based Vitek MS system. The overall phenotypic misidentification rate was 3.4% (18/533), with considerable variation between hospitals (0.0% to 19.0%), compared to 1.1% (6/533) for the Vitek MS system.
Two Atypical Cases of Kingella kingae Invasive Infection with Concomitant Human Rhinovirus Infection
Authors: Basmaci Romain , Ilharreborde Brice , Doit Catherine , Presedo Ana , Lorrot Mathie , Alison Marianne , Mazda Keyvan , Bidet Philippe , Bonacorsi Stéphane
Published: June 2013

We describe two atypical cases of
Kingella kingae
infection in children diagnosed by PCR, one case involving a soft tissue abscess and one case a femoral Brodie abscess. Both patients had concomitant human rhinovirus infection.
K. kingae
strains, isolated from an oropharyngeal swab, were characterized by multilocus sequence typing and
rtxA
sequencing.
Distinct Roles of Kaposi's Sarcoma-Associated Herpesvirus-Encoded Viral Interferon Regulatory Factors in Inflammatory Response and Cancer
Authors: Baresova Petra , Pitha Paula M. , Lubyova Barbora
Published: June 2013

Kaposi's sarcoma-associated herpesvirus (KSHV) is the etiologic agent associated with Kaposi's sarcoma (KS), primary effusion lymphoma (PEL), and multicentric Castleman disease (MCD). Similar to other herpesviruses, KSHV has two life cycles, latency and lytic replication. In latency, the KSHV genome persists as a circular episome in the nucleus of the host cell and only a few viral genes are expressed. In this review, we focus on oncogenic, antiapoptotic, and immunomodulating properties of KSHV-encoded homologues of cellular interferon regulatory factors (IRFs)—viral IRF1 (vIRF1) to vIRF4—and their possible role in the KSHV-mediated antiviral response, apoptosis, and oncogenicity.
Unilateral parotid mass as an unusual presentation of lupus erythematosus profundus
Authors: Jayaram Rahul , de Souza Michelle C , Manisali Mehmet
Published: June 2013

Unilateral parotid swelling or mass in the lupus erythematosus profundus person is a rare or under reported clinical scenario in existing literature. This is a case of a 49-year-old man with such presentation for whom medical management of the underlying condition led to the resolution of the swelling. Lupus erythematosus profundus must be considered as a differential diagnosis of unexplained parotid swelling to prevent incorrect diagnosis, unnecessary surgical intervention (eg, parotidectomy) and the morbidity that comes with it (eg, facial nerve weakness, Frey's syndrome etc).
A localised soft tissue and bone enlargement in an infant mandible
Authors: Sen Subhalakshmi , Kamath Abhay , Gupta Mukund , Radhakrishnan Raghu
Published: June 2013

A 4-month-old infant was referred by a paediatrician for a rapidly growing swelling on the right side of the mandible of 1.5 months duration. His medical and family history was unremarkable. Palpation divulged a firm and tender enlargement with the overlying soft tissue showing no significant alteration in colour. CT scan revealed cortical irregularity involving the ramus on the right side along with right masseter muscle hypertrophy. Routine haematological investigation yielded values within normal limits except for a raised erythrocyte sedimentation rate. Histopathological examination of the tissue submitted following an open biopsy procedure showed reactive lamellar bone and trabeculae with fibrous marrow exhibiting inflammation. The final diagnosis of infantile cortical hyperostosis was clinched based on the clinicopathological correlation. A rare reactive bone dystrophy which could pose a certain diagnostic dilemma is addressed herewith.
Drug-induced gastrointestinal disorders
Authors: Philpott H L , Nandurkar S , Lubel J , Gibson P R
Published: June 2013

Drug-induced gastrointestinal disorders can mimic conditions, such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) and, hence, recognition can prevent unnecessary investigations and treatment. While the knowledge and awareness relating to the adverse gastrointestinal effects of some medications, such as non-steroidal anti-inflammatory drugs are well established, other commonly prescribed drugs, such as antipsychotics, antidepressants and metformin are less well understood and warrant further study. This review attempts to integrate recent information regarding adverse drug reactions and place this in a useful clinical context.
Pre- or post-treatment with aminoguanidine attenuates a renal distal acidification defect induced by acute ureteral obstruction in rats
Authors: Moosavi S. Mostafa , Bagheri Zohreh , Gheitasi Izadpanah , Roozbeh Jamshid
Published: June 2013

Acute unilateral ureteral obstruction (UUO) impairs distal nephron acid secretion and stimulates expression of inducible nitric oxide synthase (iNOS) in post-obstructed kidney (POK). This study investigated the influence of pre- or post-treatment with aminoguanidine as a selective iNOS inhibitor on UUO-induced renal functional disturbances. To induce acute UUO, the left ureter in rats was ligated and released after 24 h. Then, a 3 h clearance period followed by bicarbonate loading and thereafter a 30 min clearance period were allocated. Aminoguanidine was administered either prior to the UUO induction or after release of the obstruction in the different rat groups, while untreated and sham groups received normal saline. During the first clearance period, fractional bicarbonate excretion and urinary pH increased markedly in the POK of the untreated group compared with the left kidney of sham group, and a large drop in the difference between urine and blood pCO2(U–B pCO2) was observed after bicarbonate loading; all of these parameters were ameliorated in the pre-treated and post-treated groups. However, the UUO-induced decreases in creatinine clearance, sodium reabsorption, urine osmolality, and free-water reabsorption in the POK were attenuated only in the post-treated group. Therefore, the in vivo application of a selective iNOS inhibitor partially improved the acute UUO-induced distal nephron acidification defect, while post-treatment but not pre-treatment with aminoguanidine ameliorated decrements of glomerular filtration, sodium reabsorption, and urine-concentrating ability.
REALIZABILITY ASSESSMENT OF PROBABILISTIC QUANTUM CNOT GATE BASED ON EXPERIMENTAL IMPLEMENTATION
Authors: CHATTA RIHAB , GUEDDANA AMOR , ATTIA MOEZ
Published: June 2013

Generalized behavior of a nondeterministic CNOT gate based on physical implementation is subject of this work. We define an abstract probabilistic model of the CNOT gate and describe a general proposition of realizability assessment based on experimental features. Theoretical results are directly confronted to experimental realization. Two CNOT models are brought out for this purpose.
THE ROLE OF STANDARDIZATION IN THE SHAPING OF A VISION FOR NANOTECHNOLOGY
Authors: DELEMARLE AURÉLIE , THRONE-HOLST HARALD
Published: June 2013

Nanotechnologies are considered as emerging technologies. However, there are already products in the market that claim to incorporate them. This has contributed to the growing interest in the regulation of this field. In this paper, we first introduce the question of regulation in nanotechnologies, and then describe the standardization process and ISO more specifically. This introduction is followed by the main point of the paper: We show, the specific role that the ISO TC 229 plays in the beginning of the shaping of a collective vision for nanotechnologies. We point to the organization and re-organization of TC 229 that allows actors to build a collective representation of the evolving field and build legitimacy at the global level. We argue that beyond the production of standards, this aspect is central in an emerging field that will impact regulators as they design new rules.
Electroacupuncture modulation of reflex hypertension in rats: role of cholecystokinin octapeptide
Authors: Li Min , Tjen-A-Looi Stephanie C. , Guo Zhi-Ling , Longhurst John C.
Published: June 2013

Acupuncture or electroacupuncture (EA) potentially offers a nonpharmacological approach to reduce high blood pressure (BP). However, ∼70% of the patients and animal subjects respond to EA, while 30% do not. EA acts, in part, through an opioid mechanism in the rostral ventrolateral medulla (rVLM) to inhibit sympathoexcitatory reflexes induced by gastric distention. CCK-8 opposes the action of opioids during analgesia. Therefore, we hypothesized that CCK-8 in the rVLM antagonizes EA modulation of sympathoexcitatory cardiovascular reflex responses. Male rats anesthetized with ketamine and α-chloralose subjected to repeated gastric distension every 10 min were examined for their responsiveness to EA (2 Hz, 0.5 ms, 1–4 mA) at P5-P6 acupoints overlying median nerve. Repeated gastric distension every 10 min evoked consistent sympathoexcitatory responses. EA at P5-P6 modulated gastric distension-induced responses. Microinjection of CCK-8 in the rVLM reversed the EA effect in seven responders. The CCK1 receptor antagonist devazepide microinjected into the rVLM converted six nonresponders to responders by lowering the reflex response from 21 ± 2.2 to 10 ± 2.9 mmHg (first vs. second application of EA). The EA modulatory action in rats converted to responders with devazepide was reversed with rVLM microinjection of naloxone ( n = 6). Microinjection of devazepide in the absence of a second application of EA did not influence the primary pressor reflexes of nonresponders. These data suggest that CCK-8 antagonizes EA modulation of sympathoexcitatory cardiovascular responses through an opioid mechanism and that inhibition of CCK-8 can convert animals that initially are unresponsive to EA to become responsive.
Sildenafil attenuates placental ischemia-induced hypertension
Authors: George Eric M. , Palei Ana C. , Dent Edward A. , Granger Joey P.
Published: June 2013

Preeclampsia is a complication of pregnancy that is marked by hypertension, proteinuria, and maternal endothelial dysfunction. A central factor in the etiology of the disease is the development of placental hypoxia/ischemia, which releases pathogenic soluble factors. There is currently no effective treatment for preeclampsia, but the phosphodiesterase-5 (PDE-5) inhibitor sildenafil has been suggested, as PDE-5 is enriched in the uterus, and its antagonism could improve uteroplacental function. Here, we report in the reduced uterine perfusion pressure (RUPP) rat model that administration of oral sildenafil is effective in attenuating placental ischemia-induced hypertension during gestation. RUPP animals have significantly elevated arterial pressure compared with control animals (132 ± 3 vs. 100 ± 2 mmHg; P < 0.05). Administration of oral sildenafil (45 mg·kg−1·day−1) had no effect on blood pressure in control rats but decreased pressure in RUPP rats (115 ± 1 mmHg; P < 0.05). RUPP induced changes in placental sFlt-1, and vascular endothelial growth factor (VEGF) was unaffected by sildenafil administration, as was the decrease in free plasma VEGF. RUPP animals had a significant increase in medullary PDE-5/β-actin ratio (1 ± 0.14 vs. 1.63 ± 0.18; P < 0.05) expression with a resulting reduction in renal medullary cGMP (1.5 ± 0.15 vs. 0.99 ± 0.1 pmol/μg protein, P < 0.05) compared with controls. Although sildenafil had no effect on renal medullary cGMP in control animals, it significantly increased cGMP in RUPP animals (1.3 ± 0.1 pmol/μg protein; P < 0.05). These data suggest that sildenafil might provide an effective therapeutic option for the management of hypertension during preeclampsia.