bluuebunny/crossref_metadata_2025 huggingface dataset:
The Economic Burden of Otitis Media in Korea, 2012: A Nationally Representative Cross-Sectional Study
Authors: Kim Young-Eun , Lee Ye-Rin , Park So-Youn , Lee Kyung Suk , Oh In-Hwan
Published: September 2016

Background. Otitis media (OM) is a common communicable disease that is associated with a substantial economic burden. However, no Korean studies have evaluated OM-related trends after the introduction of the pneumococcal conjugate vaccines.Purpose. This study aimed to estimate the prevalence and economic burden of OM in Korea using nationally representative data.Methods. The burden of OM was estimated nationally representative data such as national health insurance claims data from 2012, based on the prevalence approach and the societal perspective.Results. In 2012, 1,788,303 patients visited medical institutions for treatment of OM, and the prevalence and burden of OM were 3.5% and 497.35 million US dollars, respectively. Patients who were 0–9 years old accounted for 59.7% of the cases and 55.2% of the total cost. Among adults, the total and perpatient costs were highest among 50–59-year-old adults. Direct medical costs and outpatient costs accounted for large proportions of the total cost (86.3% and 88.3%, resp.).Conclusion. The economic burden of OM decreased after the introduction of the pneumococcal conjugate vaccines. However, OM is still associated with a relatively large burden, especially among adults, and interventions are needed to reduce the burden of OM in this population.
Fabrication and Investigation of Two-Component Film of 2,5-Diphenyloxazole and Octafluoronaphthalene Exhibiting Tunable Blue/Bluish Violet Fluorescence Based on Low Vacuum Physical Vapor Deposition Method
Authors: Zhai Xiaoyu , Li Siqi , Ding Yufeng , Pan Liangliang , Yang Hejia , Jiang Bingyin , Yan Dongpeng , Meng Qingyun
Published: September 2016

Organic luminescent materials play an important role in the fields of light-emitting diodes and fluorescent imaging. Moreover, new synthetic approaches towardsπ-conjugated molecular systems with high fluorescence quantum efficiency are highly desired. Herein, different 2,5-diphenyloxazole-octafluoronaphthalene (DPO-OFN) films with tunable fluorescence have been prepared by Low Vacuum Physical Vapor Deposition (LVPVD) method. DPO-OFN films showed some changed properties, such as molecular vibration and fluorescence. All films exhibited blue/bluish violet fluorescence and showed blue shift, in comparison with pristine DPO. This work introduced a new method to fabricate two-component molecular materials with tunable blue/bluish violet luminescence properties and provided a new perspective to prepare organic luminescent film materials, layer film materials, cocrystal materials, and cocrystal film materials. Importantly, these materials have potential applications in the fields of next generation of photofunctional materials.
Depressive Symptoms among Latino Sexual Minority Men and Latina Transgender Women in a New Settlement State: The Role of Perceived Discrimination
Authors: Sun Christina J. , Ma Alice , Tanner Amanda E. , Mann Lilli , Reboussin Beth A. , Garcia Manuel , Alonzo Jorge , Rhodes Scott D.
Published: September 2016

Background.Little is known about the role of discrimination on depression among Latino sexual and gender identity minorities. This manuscript examined the relationship between ethnic/racial discrimination and sexual discrimination on clinically significant depressive symptoms among Latino sexual minority men (i.e., gay and bisexual men and other men who have sex with men) and Latina transgender women.Methods.A community-based participatory research partnership recruited participants (N= 186; 80.6% cisgender men) in North Carolina to a social network-based HIV intervention. Using baseline data, we quantified the amount of perceived discrimination and conducted mixed-effects logistic regression analyses to examine correlates of clinically significant depressive symptoms.Results.A high percentage of participants reported ethnic/racial discrimination (73.7%) and sexual discrimination (53.8%). In the multivariable models, ethnic/racial discrimination, sexual discrimination, masculinity, fatalism, and social support were significantly associated with clinically significant depressive symptoms.Discussion.Improving mental health requires multilevel interventions that address pertinent individual, interpersonal, and system level factors.
Sliding Mode Real-Time Control of Photovoltaic Systems Using Neural Estimators
Authors: Ramos-Hernanz J. A. , Barambones O. , Lopez-Guede J. M. , Zamora I. , Eguia P. , Farhat M.
Published: September 2016

The maximum power point tracking (MPPT) problem has attracted the attention of many researchers, because it is convenient to obtain the maximum power of a photovoltaic module regardless of the weather conditions and the load. In this paper, a novel control for a boost DC/DC converter has been introduced. It is based on a sliding mode controller (SMC) that takes a current signal as reference instead of a voltage, which is generated by a neuronal reference current generator. That reference current indicates the current (IMPP) at the maximum power point (MPP) for given weather conditions. In order to test the designed control system, a photovoltaic module model based on a second artificial neuronal network (ANN) has been obtained from experimental data gathered during 18 months in the Faculty of Engineering Vitoria-Gasteiz (Spain). We have analyzed the performance of such model and we found that it is very accurate (MSE = 0.062 A andR= 0.991 with test dataset). We also have tested the performance of the overall SMC design with both simulated and real tests, concluding that it guarantees that the power in the output of the converter is very close to the power of the photovoltaic module output.
Immunomodulatory Effects of 1,25-Dihydroxyvitamin D3on Dendritic Cells Promote Induction of T Cell Hyporesponsiveness to Myelin-Derived Antigens
Authors: Lee Wai-Ping , Willekens Barbara , Cras Patrick , Goossens Herman , Martínez-Cáceres Eva , Berneman Zwi N. , Cools Nathalie
Published: September 2016

While emerging evidence indicates that dendritic cells (DC) play a central role in the pathogenesis of multiple sclerosis (MS), their modulation with immunoregulatory agents provides prospect as disease-modifying therapy. Our observations reveal that 1,25-dihydroxyvitamin D3(1,25(OH)2D3) treatment of monocyte-derived DC results in a semimature phenotype and anti-inflammatory cytokine profile as compared to conventional DC, in both healthy controls and MS patients. Importantly, 1,25(OH)2D3-treated DC induce T cell hyporesponsiveness, as demonstrated in an allogeneic mixed leukocyte reaction. Next, following a freeze-thaw cycle, 1,25(OH)2D3-treated immature DC could be recovered with a 78% yield and 75% viability. Cryopreservation did not affect the expression of membrane markers by 1,25(OH)2D3-treated DC nor their capacity to induce T cell hyporesponsiveness. In addition, the T cell hyporesponsiveness induced by 1,25(OH)2D3-treated DC is antigen-specific and robust since T cells retain their capacity to respond to an unrelated antigen and do not reactivate upon rechallenge with fully mature conventional DC, respectively. These observations underline the clinical potential of tolerogenic DC (tolDC) to correct the immunological imbalance in MS. Furthermore, the feasibility to cryopreserve highly potent tolDC will, ultimately, contribute to the large-scale production and the widely applicable use of tolDC.
A Case ofMycobacterium riyadhensein an Acquired Immune Deficiency Syndrome (AIDS) Patient with a Suspected Paradoxical Response to Antituberculosis Therapy
Authors: Al-Ammari Maged Omar , Badreddine Samar Assem , Almoallim Hani
Published: September 2016

A 30-year-old male patient with acquired immune deficiency syndrome (AIDS) on highly active antiretroviral therapy (HAART) presented with clinical picture suggestive of pulmonary tuberculosis. He was commenced on antituberculosis therapy (ATT) with signs of improvement. Then he developed cervical lymph node abscess which was drained. Steroid was started for presumed paradoxical response to ATT which results in clinical regression. The culture result revealedMycobacterium riyadhense. This report addresses the rarity of this bacteria in medical literature. It reviews clinical presentations and medical treatment particularly in the setting of coinfections.
Reliability of Using Retinal Vascular Fractal Dimension as a Biomarker in the Diabetic Retinopathy Detection
Authors: Huang Fan , Dashtbozorg Behdad , Zhang Jiong , Bekkers Erik , Abbasi-Sureshjani Samaneh , Berendschot Tos T. J. M. , ter Haar Romeny Bart M.
Published: September 2016

The retinal fractal dimension (FD) is a measure of vasculature branching pattern complexity. FD has been considered as a potential biomarker for the detection of several diseases like diabetes and hypertension. However, conflicting findings were found in the reported literature regarding the association between this biomarker and diseases. In this paper, we examine the stability of the FD measurement with respect to (1) different vessel annotations obtained from human observers, (2) automatic segmentation methods, (3) various regions of interest, (4) accuracy of vessel segmentation methods, and (5) different imaging modalities. Our results demonstrate that the relative errors for the measurement of FD are significant and FD varies considerably according to the image quality, modality, and the technique used for measuring it. Automated and semiautomated methods for the measurement of FD are not stable enough, which makes FD a deceptive biomarker in quantitative clinical applications.
Spontaneous Septic Arthritis of Pubic Symphysis in an Elite Athlete
Authors: Smits F. Jasmijn , Frima Herman , Schaeffeler Christoph , Sommer Christoph
Published: September 2016

Septic arthritis of the pubic symphysis is a potentially severe disease. Athletes are at risk of this form of spontaneous arthritis, as inflammation of the pubic bone due to muscular stress is relatively common. Oedema due to inflammation might predispose to infection through bacteraemia or local bacterial translocation. Suspicion should be raised when an athlete complains of groin pain and has signs of infection (i.e., fever, elevated white blood cell count, and elevated C-reactive protein). Diagnosis is made by imaging showing signs of inflammation combined with positive (blood) cultures. Broad spectrum antibiotics should be started upon suspicion and adjusted according to cultures. An abscess causing clinical deterioration under antibiotic treatment is an indication for invasive intervention (i.e., surgical or image-guided drainage). This is the first case of spontaneous septic arthritis of the pubic symphysis in an athlete requiring surgical and additional image-guided drainage.
Wandering Spleen and Organoaxial Gastric Volvulus after Morgagni Hernia Repair: A Case Report and Review of the Literature
Authors: Cantone Noemi , Gulia Caterina , Miele Vittorio , Trinci Margherita , Briganti Vito
Published: September 2016

Wandering spleen and gastric volvulus are two rare entities that have been described in association with congenital diaphragmatic hernia. The diagnosis is difficult and any delay can result in ischemia and necrosis of both organs. We present a case of a 13-year-old girl, previously operated on for anterior diaphragmatic hernia and intrathoracic gastric volvulus, that presented to our service for a subdiaphragmatic gastric volvulus recurrence associated with a wandering spleen. In this report we reviewed the literature, analyzing the clinical presentation, diagnostic assessment, and treatment options of both conditions, in particular in the case associated with diaphragmatic hernia.
Advanced Hemodynamic Management in Patients with Septic Shock
Authors: Saugel Bernd , Huber Wolfgang , Nierhaus Axel , Kluge Stefan , Reuter Daniel A. , Wagner Julia Y.
Published: September 2016

In patients with sepsis and septic shock, the hemodynamic management in both early and later phases of these “organ dysfunction syndromes” is a key therapeutic component. It needs, however, to be differentiated between “early goal-directed therapy” (EGDT) as proposed for the first 6 hours of emergency department treatment by Rivers et al. in 2001 and “hemodynamic management” using advanced hemodynamic monitoring in the intensive care unit (ICU). Recent large trials demonstrated that nowadays protocolized EGDT does not seem to be superior to “usual care” in terms of a reduction in mortality in emergency department patients with early identified septic shock who promptly receive antibiotic therapy and fluid resuscitation. “Hemodynamic management” comprises (a) making the diagnosis of septic shock as one differential diagnosis of circulatory shock, (b) assessing the hemodynamic status including the identification of therapeutic conflicts, and (c) guiding therapeutic interventions. We propose two algorithms for hemodynamic management using transpulmonary thermodilution-derived variables aiming to optimize the cardiocirculatory and pulmonary status in adult ICU patients with septic shock. The complexity and heterogeneity of patients with septic shock implies that individualized approaches for hemodynamic management are mandatory. Defining individual hemodynamic target values for patients with septic shock in different phases of the disease must be the focus of future studies.
Dynamics of an Anisotropic Universe inf(R,T)Theory
Authors: Mishra B. , Tarai Sankarsan , Tripathy S. K.
Published: September 2016

Dynamics of an anisotropic universe is studied inf(R,T)gravity using a rescaled functionalf(R,T), whereRis the Ricci Scalar andTis the trace of energy-momentum tensor. Three models have been constructed assuming a power law expansion of the universe. Physical features of the models are discussed. The model parameters are constrained from a dimensional analysis. It is found from the work that the anisotropic Bianchi typeVIh(BVIh) model in the modified gravity generally favours a quintessence phase when the parameterhis either-1or0. We may not get viable models in conformity with the present day observation forh=1.
Influence of Expendable Current Profiler Probe on Induced Electric Field of Ocean Currents
Authors: Zhang Qisheng , Zhao Xiao , Zhang Xinyue , Jing Jianen , Liu Shenghui , Li Shuhan , Yuan Zhenzhong
Published: September 2016

The expendable current profiler (XCP) is a new instrument that is internationally used to rapidly monitor ocean currents in marine environments. The most crucial part of this instrument is the XCP probe. Since the probe is of high electrical resistance, it acts almost like an insulator with respect to seawater. Placing it into the induced electric field (IEF) of seawater therefore yields a certain level of influence over the electric field. Therefore, in order to improve the accuracy of XCP measurements, the conditions associated with this influence can be used to guide the design of XCP probes; at the same time, these can also serve as reference points in order to provide technical support for the processing of XCP data on ocean currents. To this end, computer-based numerical simulations and laboratory-based physical simulations are used in this study. The results showed that after an XCP probe (diameter: 5 cm; length: 52 cm) was inserted into seawater, the voltage difference of ocean currents at both ends of the electric field sensor placed above the XCP probe increased by a factor of 1.85 (as compared to the case in which there is no influence from the probe).
Pharmacological Inhibition of Centrosome Clustering by Slingshot-Mediated Cofilin Activation and Actin Cortex Destabilization
Authors: Konotop Gleb , Bausch Elena , Nagai Tomoaki , Turchinovich Andrey , Becker Natalia , Benner Axel , Boutros Michael , Mizuno Kensaku , Krämer Alwin , Raab Marc Steffen
Published: September 2016

Centrosome amplification is a hallmark of virtually all types of cancers, including solid tumors and hematologic malignancies. Cancer cells with extra centrosomes use centrosome clustering (CC) to allow for successful division. Because normal cells do not rely on this mechanism, CC is regarded as a promising target to selectively eradicate cells harboring supernumerary centrosomes. To identify novel inhibitors of CC, we developed a cell-based high-throughput screen that reports differential drug cytotoxicity for isogenic cell populations with different centrosome contents. We identified CP-673451 and crenolanib, two chemically related compounds originally developed for the inhibition of platelet-derived growth factor receptor β (PDGFR-β), as robust inhibitors of CC with selective cytotoxicity for cells with extra centrosomes. We demonstrate that these compounds induce mitotic spindle multipolarity by activation of the actin-severing protein cofilin, leading to destabilization of the cortical actin network, and provide evidence that this activation is dependent on slingshot phosphatases 1 and 2 but unrelated to PDGFR-β inhibition. More specifically, we found that although both compounds attenuated PDGF-BB–induced signaling, they significantly enhanced the phosphorylation of PDGFR-β downstream effectors, Akt and MEK, in almost all tested cancer cell lines under physiologic conditions. In summary, our data reveal a novel mechanism of CC inhibition depending on cofilin-mediated cortical actin destabilization and identify two clinically relevant compounds interfering with this tumor cell–specific target. Cancer Res; 76(22); 6690–700. ©2016 AACR.
Blood Product Supply in Germany: The Impact of Apheresis and Pooled Platelet Concentrates
Authors: Berger Karin , Schopohl Dorothee , Wittmann Georg , Schramm Wolfgang , Ostermann Helmut , Rieger Christina
Published: September 2016

Background: In Germany, about 60% of all produced platelet concentrates (PCs) are apheresis PCs (APCs). Ongoing discussions on APC reimbursement and costs might lead to a potential shift in pooled PC (PPC)/APC production. Objective of this analysis was to build a comprehensive model from the societal perspective to evaluate consequences associated with shifts in platelet supply and demand. Methods: Literature search, desktop researches on platelet supply and demand. Model calculations, time horizon one year: model input from the Paul-Ehrlich-Institute, data 2013. Base case: 19.2% of annual whole blood donations (WBDs) were used for production of 38.5% PPCs, decay of 46,218 PCs (8.0%). Scenarios calculated: variation in PPC proportion of 10-100%. Results: Base case: during PPC production 41,957-83,913 red blood cell concentrates (RBCCs) are estimated to be lost, which corresponds to 1-2% of annual RBCCs in Germany. Scenarios were calculated for a production of 60-100% PPCs: loss is estimated to be 1.5-5.0% of annual RBCCs (65,430-218,099), decay 54,189-69,022 PCs (9.4-12.0%). Conclusion: Production of different blood components is interlinked and sensitive to unidimensional decisions. Increasing PPC proportion has negative impact on the RBCC production and on the antigen-matched APC donor pool. Completion of the model calculations to predict the optimal PPC/APC proportion would require evidence on the number of refractory patients, donor pool sizes, and incidences of diseases requiring platelet transfusions.
Ca2+ Entry, Oxidative Stress, Ceramide and Suicidal Erythrocyte Death Following Diosgenin Treatment
Authors: Mischitelli Morena , Jemaà Mohamed , Almasry Mustafa , Faggio Caterina , Lang Florian
Published: September 2016

Background/Aims: The bioactive steroid sapogenin diosgenin is considered for a wide variety of applications including treatment of malignancy. The substance counteracts tumor growth in part by stimulating apoptosis of tumor cells. Similar to apoptosis of nucleated cells, erythrocytes may enter suicidal death or eryptosis, which is characterized by cell shrinkage and cell membrane scrambling with phosphatidylserine translocation to the erythrocyte surface. Signaling involved in the stimulation of eryptosis includes increase of cytosolic Ca2+ activity ([Ca2+]i), oxidative stress and ceramide. The present study explored, whether diosgenin induces eryptosis and, if so, to decipher cellular mechanisms involved. Methods: Flow cytometry was employed to estimate phosphatidylserine exposure at the cell surface from annexin-V-binding, cell volume from forward scatter, [Ca2+]i from Fluo3-fluorescence, ROS formation from DCF dependent fluorescence, and ceramide abundance utilizing specific antibodies. Hemolysis was quantified by determination of haemoglobin concentration in the supernatant. Results: A 48 hours exposure of human erythrocytes to diosgenin significantly increased the percentage of annexin-V-binding cells (≥ 5 µM), significantly decreased forward scatter (15 µM), significantly increased Fluo3-fluorescence (≥ 10 µM), significantly increased DCF fluorescence (15 µM), significantly increased ceramide abundance (15 µM) and significantly increased hemolysis (15 µM). The effect of diosgenin (15 µM) on annexin-V-binding was significantly blunted but not abolished by removal of extracellular Ca2+. Conclusions: Diosgenin stimulates eryptosis with erythrocyte shrinkage and phospholipid scrambling of the erythrocyte cell membrane, an effect paralleled by and at least in part due to Ca2+ entry, oxidative stress and ceramide.
Triggering of Suicidal Erythrocyte Death by Fascaplysin
Authors: Mischitelli Morena , Jemaà Mohamed , Almasry Mustafa , Faggio Caterina , Lang Florian
Published: September 2016

Background/Aims: The bis-indole alkaloid Fascaplysin is effective against malignancy, an effect at least partially due to stimulation of tumor cell apoptosis. Similar to apoptosis of nucleated cells, erythrocytes could enter suicidal erythrocyte death or eryptosis, characterized by cell shrinkage and cell membrane scrambling with phosphatidylserine translocation to the erythrocyte surface. Triggers of eryptosis include increase of cytosolic Ca2+ activity ([Ca2+]i), oxidative stress and ceramide. The present study explored, whether Fascaplysin induces eryptosis and, if so, to shed light on the cellular mechanisms involved. Methods: Flow cytometry was employed to estimate phosphatidylserine exposure at the cell surface from annexin-V-binding, cell volume from forward scatter, [Ca2+]i from Fluo3-fluorescence, ROS formation from DCFDA dependent fluorescence, and ceramide abundance utilizing specific antibodies. Hemolysis was quantified from the hemoglobin concentration in the supernatant. Results: A 48 hours exposure of human erythrocytes to Fascaplysin (≥ 5 µM) significantly increased the percentage of annexin-V-binding cells, significantly decreased forward scatter, and significantly increased Fluo3-fluorescence, DCFDA fluorescence as well as ceramide abundance. The effect of Fascaplysin on annexin-V-binding and forward scatter was significantly blunted but not abolished by removal of extracellular Ca2+. Conclusions: Fascaplysin triggers cell shrinkage and phospholipid scrambling of the erythrocyte cell membrane, an effect at least in part due to Ca2+ entry, oxidative stress and ceramide.
Differential Lipotoxic Effects of Palmitate and Oleate in Activated Human Hepatic Stellate Cells and Epithelial Hepatoma Cells
Authors: Hetherington Alexandra M. , Sawyez Cynthia G. , Zilberman Emma , Stoianov Alexandra M. , Robson Debra L. , Borradaile Nica M.
Published: September 2016

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) progression to fibrosis, cirrhosis and hepatocellular carcinoma, alters the cellular composition of this organ. During late-stage NAFLD, fibrotic and possibly cancerous cells can proliferate and, like normal hepatocytes, are exposed to high concentrations of fatty acids from both surrounding tissue and circulating lipid sources. We hypothesized that primary human activated hepatic stellate cells and epithelial hepatoma (HepG2) cells respond differently to lipotoxic conditions, and investigated the mechanisms involved. Methods: Primary activated hepatic stellate cells and HepG2 cells were exposed to pathophysiological concentrations of fatty acids and comparative studies of lipid metabolic and stress response pathways were performed. Results: Both cell types remained proliferative during exposure to a combination of palmitate plus oleate reflective of the general saturated versus unsaturated fatty acid composition of western diets. However, exposure to either high palmitate or high oleate alone induced cytotoxicity in activated stellate cells, while only palmitate caused cytotoxicity in HepG2 cells. mRNA microarray and biochemical comparisons revealed that stellate cells stored markedly less fatty acids as neutral lipids, and had reduced capacity for beta-oxidation. Similar to previous observations in HepG2 cells, palmitate, but not oleate, induced ER stress and actin stress fiber formation in activated stellate cells. In contrast, oleate, but not palmitate, induced the inflammatory signal TXNIP, decreased cytoskeleton proteins, and decreased cell polarity preceding cell death in activated stellate cells. Conclusions: Palmitate-induced lipotoxicity was associated with ER stress pathways in both primary activated hepatic stellate cells and epithelial hepatoma cells, whereas high oleate caused lipotoxicity only in activated stellate cells, possibly through a distinct mechanism involving disruption of cytoskeleton components. This may have implications for optimal dietary fatty acid compositions during various stages of NAFLD.
Photoreceptor Integrity Predicts Response to Anti-VEGF Treatment
Authors: Achiron Asaf , Kydyrbaeva Ayana , Man Vitaly , Lagstein Oded , Burgansky Zvia , Blumenfeld Oren , Bar Asaf , Bartov Elisha
Published: September 2016

Purpose: Assessing changes in foveal photoreceptor microstructure (FPM) following intravitreal anti-VEGF treatment may serve as a prognostic marker in patients with macular edema (ME). Methods: Sixteen eyes belonging to newly diagnosed patients with ME were included in this prospective longitudinal study. FPM integrity was evaluated at baseline and at the end of a series of anti-VEGF injections. Results: Treatment led to a significant improvement in mean visual acuity (VA) and central macular thickness. A larger FPM defect was associated with lower VA, both before and after treatment. Patients with larger FPM defects at baseline had smaller VA improvements, and the improvement in FPM integrity was associated with VA improvement (every 100-µm FPM recovery contributed to a gain of 0.04 logMAR). Conclusions: Recovery of FPM after anti-VEGF treatment was significantly associated with a VA improvement. Direct measurement of photoreceptor integrity might provide an additional tool for the assessment of retinal function and treatment response in patients newly diagnosed with ME.
Mesenchymal Stem Cells from Human Amniotic Membrane and Umbilical Cord Can Diminish Immunological Response in an in vitro Allograft Model
Authors: Dabrowski Filip A. , Burdzinska Anna , Kulesza Agnieszka , Chlebus Marcin , Kaleta Beata , Borysowski Jan , Zolocinska Aleksandra , Paczek Leszek , Wielgos Miroslaw
Published: September 2016

Background/Aim: Mesenchymal stem cells (MSCs) are gaining rising interest in gynecology and obstetrics. MSCs immunomodulatory properties are suitable enough to reduce perinatal morbidity caused by inflammation in premature neonates. The aim of this study was to evaluate and compare the ability to inhibit allo-activated lymphocytes proliferation by MSCs derived from different sources: amniotic membrane (AM), umbilical cord (UC) and adipose tissue (AT). Methods: MSCs were isolated from AM (n = 7) and UC (n = 6) and AT (n = 6) of healthy women. Cells were characterized by flow cytometry and differentiation assay. To evaluate the potential of fetal and adult MSCs to diminish immunological response, mixed lymphocytes reaction (MLR) was performed. Results: Amnion and UC-derived cells displayed typical MSCs characteristics. Addition of MSCs to MLR significantly inhibited the proliferation of stimulated lymphocytes. The effect was observed regardless of the MSCs type used (p < 0.01 in all groups). Comparative analysis revealed no significant differences in this action between tested MSCs types. Additionally, no type of MSCs significantly stimulated allogeneic lymphocytes. Conclusion: The results prove the immunosuppressive capacities of fetal-derived MSCs in vitro. In the future, they may be potentially used to treat premature newborn as well as in immunomodulation in post-transplant therapy.
Does Gastric Surgery (Such as Bariatric Surgery) Impact the Risk of Intestinal Inflammation?
Authors: Gero Daniel , Gutschow Christian A. , Bueter Marco
Published: September 2016

Background: The prevalence of morbid obesity and inflammatory bowel disease (IBD) is on the rise in association with a Western lifestyle. Both conditions are characterized by chronic inflammation. Bariatric surgery (BS) is a recommended and widely used approach to address severe obesity and its related comorbidities. Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) are the most frequently performed procedures worldwide. Evidence is scarce on outcomes of BS in IBD patients. Summary: Systemic and adipose-tissue inflammation seems to decrease following BS. Different studies observed decreased serum levels of inflammatory markers (CRP, IL-6, MCP-1, and TNF-α) along with a reduction of insulin resistance both after RYGBP and SG. Several authors documented postbariatric improvement of concomitant chronic inflammatory diseases (rheumatoid arthritis, systemic lupus erythematosus, gout, and psoriasis). There are only few retrospective case series on outcomes of BS in IBD patients. These studies reported safety and feasibility of BS and improvement in IBD status, manifested by prolonged disease remission and decreased use of pharmacotherapy. Weight loss outcomes were excellent and similar to those of non-IBD patients. The preferred surgical approach for morbidly obese IBD patients is SG in order to avoid potential drawbacks of RYGBP, such as malabsorption, intestinal manipulation, and augmentation of technical difficulties for future IBD surgery. Seven cases of newly diagnosed IBD after BS have been reported, which are more likely to result from postoperative intestinal microbial dysbiosis than from directly induced inflammation. Key Messages: This review summarizes the outcomes of BS in IBD patients. SG is the preferable technique for morbidly obese IBD patients, who have potentially a double benefit from BS: weight loss and IBD remission. Further research is necessary to clarify the common pathophysiology of chronic inflammation in morbid obesity and in IBD. Postbariatric changes in gut microbiota should also be assessed to understand whether they promote IBD development or not.
Increased Expression of the Receptor for Advanced Glycation End-Products (RAGE) Is Associated with Advanced Breast Cancer Stage
Authors: Nankali Maryam , Karimi Jamshid , Goodarzi Mohammad T. , Saidijam Massoud , Khodadadi Iraj , Razavi Amir N. Emami , Rahimi Farzaneh
Published: September 2016

Background: The receptor for advanced glycation end-products (RAGE) is a multiligand transmembrane receptor that is overexpressed in various pathological conditions including cancers. However, the expression pattern of RAGE in breast cancer tumors is still not completely clear. Methods: In this study, we investigated the expression levels of RAGE in 25 fresh-frozen breast cancer samples and corresponding noncancerous tissue samples collected from breast cancer patients, by real-time polymerase chain reaction (PCR). Additionally, we performed immunohistochemistry on breast cancer specimens. Results: The results indicate a high expression of the RAGE-encoding gene in the cancerous tissues. RAGE expression at the mRNA and protein levels was statistically significantly up-regulated in advanced-stage and triple-negative breast tumors and node-positive tissues compared with other tissues (p < 0.001). A significant association between RAGE expression and tumor size was observed (p = 0.029). Conclusions: Overexpression of RAGE in advanced-stage tumors may be a useful biomarker for diagnosis and the prediction of breast cancer progression.
Exploring unmet needs in venous and arterial thromboembolism with rivaroxaban
Authors: Cappato Riccardo , Welsh Robert
Published: September 2016

The vast clinical research programme for the direct, oral factor Xa inhibitor rivaroxaban has generated a wealth of data since the first rivaroxaban approval in 2008 for the prevention of venous thrombo embolism (VTE) in patients undergoing elective hip or knee replacement surgery. While rivaroxaban is widely used across a spectrum of seven indications, there is continuous commitment to investigating its wider benefits in new indications and attempts to refine current evidence. Key data from recently completed randomised controlled trials (RCTs) have shown that rivaroxaban is a feasible anticoagulation option for patients with non-valvular atrial fibrillation (NVAF) undergoing cardioversion or catheter ablation. Now, a number of Phase II and III RCTs are underway that seek to uncover further roles for rivaroxaban in patients at risk of thrombosis and aim to improve quality of life. This article will introduce and provide context for these RCTs in the contemporary management of arterial and venous thromboembolism in the following underserved areas: Patients with both NVAF and acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI); patients with embolic stroke of undetermined source (ESUS); patients who require transcatheter aortic valve replacement (TAVR); patients with acute or chronic coronary artery disease (CAD; including those with heart failure [HF]); those at risk of or suffering from cancer-associated thrombosis (CAT) and those requiring long-term anticoagulation. It is hoped that this collection of studies provides clarity around the use of rivaroxaban as a fundamental component of antithrombotic therapy in an array of clinical situations.
Spotlight on advances in VTE management: CALLISTO and EINSTEIN CHOICE
Authors: Bach Miriam , Bauersachs Rupert
Published: September 2016

Venous thromboembolism (VTE) is associated with numerous complications and high mortality rates. Patients with cancer are at high risk of developing cancer-associated thrombosis (CAT), and VTE recurrence is common. Evidence supporting use of non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) in patients with cancer is lacking – direct comparisons between NOACs and low-molecular-weight heparin (LMWH) are needed, along with patient-reported outcomes. Cancer Associated thrombosis – expLoring soLutions for patients through Treatment and Prevention with RivarOxaban (CALLISTO) is an international research programme exploring the potential of the direct, oral factor Xa inhibitor rivaroxaban for the prevention and treatment of CAT, supplementing existing data from EINSTEIN DVT and EINSTEIN PE. Here, we focus on four CALLISTO studies: A Study to Evaluate the Efficacy and Safety of Rivaroxaban Venous Thromboembolism Prophylaxis in Ambulatory Cancer Participants receiving Chemotherapy (CASSINI), Antico-agulation Therapy in SELECTeD Cancer Patients at Risk of Recurrence of Venous Thromboembolism (SELECT-D), Rivaroxaban in the Treatment of Venous Thromboembolism in Cancer Patients – a Randomized Phase III Study (CONKO-011) and a database analysis. Optimal anticoagulation duration for VTE treatment has always been unclear. Following favourable results for rivaroxaban 20 mg once-daily (Q. D.) for secondary VTE prevention (EINSTEIN EXT), EINSTEIN CHOICE is assessing rivaroxaban safety and (20 mg Q. D. or 10 mg Q. D.) vs acetylsalicylic acid (ASA), and will investigate whether an alternative rivaroxaban dose (10 mg Q. D.) could offer long-term VTE protection. It is anticipated that results from these studies will provide important answers and expand upon current evidence for rivaroxaban in VTE management.
ОРГАНІЗАЦІЙНО-МЕТОДИЧНІ ПІДХОДИ ВПРОВАДЖЕННЯ EMR-СИСТЕМ В ОХОРОНІ ЗДОРОВ’Я УКРАЇНИ
Authors: Semenets A. V.
Published: September 2016

Wide implementation of information and communication technologies combined with organizational changes in medical education will significantly increase the effectiveness and quality of medical care and education. An alternative approaches of the implementation of software applications in medical practice and education are displayed. These approaches include the proprietary software purchase, open-source software adaptation and specialized software development. A common problems and errors occurred during the process of the implementation of information systems in hospitals are presented. Examples of the open-source software development and adaption in the Ternopil State Medical University by I.Ja. Horbachevsky are also shown.
УДОСКОНАЛЕННЯ СИСТЕМИ ІНФОРМУВАННЯ ПРО РИЗИКИ ДЛЯ ЗДОРОВ’Я НАСЕЛЕННЯ ЧЕРЕЗ ЗАБРУДНЕННЯ АТМОСФЕРНОГО ПОВІТРЯ
Authors: Horova A. I. , Buchavyy Yu. V. , Kolesnyk V. Ye.
Published: September 2016

Every member of society has the right to adequate and objective information on the relative levels of the health risks caused by the influence of anthropogenic factors on the environment [1]. A lot of works devoted to risks assessment on the certain territory due to the influence of anthropogenic factors are held both Ukrainian and foreign scientist [2-4]. However, the results of their research are usually not available or not enough informative for ordinary citizens. Thus, there is a need for new approaches to informing the public about the risks of pollution.
Recovery of Serum Cholesterol Predicts Survival After Left Ventricular Assist Device Implantation
Authors: Vest Amanda R. , Kennel Peter J. , Maldonado Dawn , Young James B. , Mountis Maria M. , Naka Yoshifumi , Colombo Paolo C. , Mancini Donna M. , Starling Randall C. , Schulze P. Christian
Published: September 2016

Background—

Advanced systolic heart failure is associated with myocardial and systemic metabolic abnormalities, including low levels of total cholesterol and low-density lipoprotein. Low cholesterol and low-density lipoprotein have been associated with greater mortality in heart failure. Implantation of a left ventricular assist device (LVAD) reverses some of the metabolic derangements of advanced heart failure.

Methods and Results—

A cohort was retrospectively assembled from 2 high-volume implantation centers, totaling 295 continuous-flow LVAD recipients with ≥2 cholesterol values available. The cohort was predominantly bridge-to-transplantation (67%), with median age of 59 years and 49% ischemic heart failure cause. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride levels all significantly increased after LVAD implantation (median values from implantation to 3 months post implantation 125–150 mg/dL, 67–85 mg/dL, 32–42 mg/dL, and 97–126 mg/dL, respectively). On Cox proportional hazards modeling, patients achieving recovery of total cholesterol levels, defined as a median or greater change from pre implantation to 3 months post-LVAD implantation, had significantly better unadjusted survival (hazard ratio, 0.445; 95% confidence interval, 0.212–0.932) and adjusted survival (hazard ratio, 0.241; 95% confidence interval, 0.092–0.628) than those without cholesterol recovery after LVAD implantation. The continuous variable of total cholesterol at 3 months post implantation and the cholesterol increase from pre implantation to 3 months were also both significantly associated with survival during LVAD support.

Conclusions—

Initiation of continuous-flow LVAD support was associated with significant recovery of all 4 lipid variables. Patients with a greater increase in total cholesterol by 3 months post implantation had superior survival during LVAD support.
Predictors of Rehospitalization Among Adults With Congenital Heart Disease Are Lesion Specific
Authors: Cedars Ari M. , Burns Sara , Novak Eric L. , Amin Amit P.
Published: September 2016

Background—

Readmission is responsible for a large proportion of inpatient care costs in adult congenital heart disease. There are, however, few data available to identify at-risk patients or to suggest strategies for intervention to prevent rehospitalization.

Methods and Results—

We conducted an analysis of admissions in patients over the age of 18 years with a 3-digit
International Classification of Diseases
-Ninth Revision code of 745 to 747 from the State Inpatient Databases of Arkansas (2008–2010), California (2003–2012), Florida (2005–2012), Hawaii (2006–2010), Nebraska (2003–2011), and New York (2005–2012). We investigated index admission diagnoses most commonly associated with 1-year readmission and the most common reasons for readmission. We then selected variables we thought would be associated with increased rates of 1-year readmission and constructed multivariable regression models grouping patients by congenital lesion, to examine the relative contribution of the specified variables to readmission risk for each lesion. A total of 64 420 patients were included in the final analysis. Thirty-nine percent of patients experienced a readmission within 12 months of an index admission. Compared with those who did not experience a readmission, those who did were more likely to have had a primary diagnosis of congestive heart failure at the time of index admission, and the most common diagnoses at the time of readmission were congestive heart failure and arrhythmia. There is lesion-specific heterogeneity in risk factors for readmission.

Conclusions—

Patients with adult congenital heart disease have high rates of readmission, predominantly for congestive heart failure and arrhythmia. Predictors of readmission are lesion specific, and future strategies aimed at decreasing readmission rate will likely need to be individualized.
Health Insurance Trajectories and Long-Term Survival After Heart Transplantation
Authors: Tumin Dmitry , Foraker Randi E. , Smith Sakima , Tobias Joseph D. , Hayes Don
Published: September 2016

Background—

Health insurance status at heart transplantation influences recipient survival, but implications of change in insurance for long-term outcomes are unclear.

Methods and Results—

Adults aged 18 to 64 receiving first-time orthotopic heart transplants between July 2006 and December 2013 were identified in the United Network for Organ Sharing registry. Patients surviving >1 year were categorized according to trajectory of insurance status (private compared with public) at wait listing, transplantation, and 1-year follow-up. The most common insurance trajectories were continuous private coverage (44%), continuous public coverage (27%), and transition from private to public coverage (11%). Among patients who survived to 1 year (n=9088), continuous public insurance (hazard ratio =1.36; 95% confidence interval 1.19, 1.56;
P
<0.001) and transition from private to public insurance (hazard ratio =1.25; 95% confidence interval 1.04, 1.50;
P
=0.017) were associated with increased mortality hazard relative to continuous private insurance. Supplementary analyses of 11 247 patients included all durations of post-transplant survival and examined post-transplant private-to-public and public-to-private transitions as time-varying covariates. In these analyses, transition from private to public insurance was associated with increased mortality hazard (hazard ratio =1.25; 95% confidence interval 1.07, 1.47;
P
=0.005), whereas transition from public to private insurance was associated with lower mortality hazard (hazard ratio =0.78; 95% confidence interval 0.62, 0.97;
P
=0.024).

Conclusions—

Transition from private to public insurance after heart transplantation is associated with worse long-term outcomes, compounding disparities in post-transplant survival attributed to insurance status at transplantation. By contrast, post-transplant gain of private insurance among patients receiving publicly funded heart transplants was associated with improved outcomes.
Associations Between Macrophage Colony‐Stimulating Factor and Monocyte Chemotactic Protein 1 in Plasma and First‐Time Coronary Events: A Nested Case–Control Study
Authors: Schiopu Alexandru , Bengtsson Eva , Gonçalves Isabel , Nilsson Jan , Fredrikson Gunilla Nordin , Björkbacka Harry
Published: September 2016

Background

Myeloid cells play a central role in atherosclerosis. We investigated the associations between the plasma levels of growth factors and chemokines that regulate myeloid cell homeostasis and function and the risk of first‐time acute coronary events in middle‐aged persons.

Methods and Results

We measured baseline plasma levels of macrophage colony‐stimulating factor; monocyte chemotactic protein 1; C‐C motif chemokine ligands 3, 4, and 20; C‐X‐C motif chemokine ligands 1, 6, and 16; and C‐X3‐C motif chemokine ligand 1 in 292 participants who had a coronary event during follow‐up and 366 controls matched for age, sex, and time of inclusion who remained event free. Study participants were recruited from the Malmö Diet and Cancer Study population cohort and had no previous history of coronary artery disease. We found a strong independent negative association between macrophage colony‐stimulating factor and incident coronary events in a forward stepwise Cox proportional hazards model including all biomarkers alongside the classic Framingham risk factors (age, sex, smoking, total cholesterol, high‐density lipoprotein cholesterol, systolic blood pressure), diabetes mellitus, and medication. Conversely, monocyte chemotactic protein 1 had the strongest independent positive association with the outcome. The addition of macrophage colony‐stimulating factor and monocyte chemotactic protein 1 significantly improved the predictive ability of a model including traditional risk factors alone (C statistic 0.81 [95%
CI
0.78–0.84] versus 0.67 [95%
CI
0.63–0.71]; net reclassification index 0.52 [0.42–0.62];
P
<0.001). The combined model led to a 54% net downclassification of participants who did not have a coronary event during follow‐up and was particularly effective in the intermediate‐risk group.

Conclusions

High levels of macrophage colony‐stimulating factor and low levels of monocyte chemotactic protein 1 in plasma characterize middle‐aged persons at low risk to develop clinically manifested coronary artery disease.
Urine Albumin/Creatinine Ratio Below 30 mg/g is a Predictor of Incident Hypertension and Cardiovascular Mortality
Authors: Sung Ki‐Chul , Ryu Seungho , Lee Jong‐Young , Lee Sung Ho , Cheong EunSun , Hyun Young‐Youl , Lee Kyu‐Beck , Kim Hyang , Byrne Christopher D.
Published: September 2016

Background

Microalbuminuria is associated with cardiovascular disease (
CVD
) mortality, but whether lower levels of urine albumin excretion similarly predict
CVD
is uncertain. We investigated associations between urine albumin:creatinine ratio (
UACR
) <30 mg/g, and incident hypertension, incident diabetes mellitus, and all‐cause and
CVD
mortality, during a maximum of 11 years of follow‐up.

Methods and Results

Individuals (37 091) in a health screening program between 2002 and 2012 with baseline measurements of
UACR
were studied. Cox proportional hazards models were used to estimate hazard ratios (
HR
s) and 95% CIs for incident hypertension, incident diabetes mellitus, and mortality outcomes (lowest
UACR
quartile as reference) at follow‐up. For linear risk trends, the quartile rank was used as a continuous variable in regression models. Nine‐hundred sixty‐three cases of incident hypertension, 511 cases of incident diabetes mellitus, and 349 deaths occurred during follow‐up. In the fully adjusted models, there was a significant
HR
for the association between
UACR
and incident hypertension (highest
UACR
quartile
HR
1.95 [95%
CI
1.51, 2.53],
P
‐value for trend across
UACR
quartiles
P
<0.001). In contrast, the association between
UACR
and incident diabetes mellitus was not significant (highest
UACR
quartile,
HR
1.15 [95%
CI
0.79, 1.66],
P
‐value for trend
P
=0.20). For
CVD
mortality, with increasing
UACR
quartiles, there was a significant increase in
HR
across quartiles,
P
=0.029, (for all‐cause mortality,
P
=0.078).

Conclusions

Low levels of albuminuria,
UACR
below 30 mg/g, are associated with increased risk of incident hypertension and
CVD
mortality at follow‐up, but are not associated with increased risk of incident diabetes mellitus.