bluuebunny/crossref_metadata_2025 huggingface dataset:
The Christian Schism in Jewish History and Jewish Memory
Authors: Burns Joshua Ezra
Published: March 2016

How did Jews perceive the first Christians? By what means did they come to appreciate Christianity as a religion distinct from their own? In The Christian Schism in Jewish History and Jewish Memory, Professor Joshua Ezra Burns addresses those questions by describing the birth of Christianity as a function of the Jewish past. Surveying a range of ancient evidences, he examines how the authors of Judaism's earliest surviving memories of Christianity speak to the perspectives of rabbinic observers who were conditioned by the unique circumstances of their encounters with Christianity to recognize its adherents as fellow Jews. Only upon the decline of the Church's Jewish demographic were their successors compelled to see Christianity as something other than a variation of Jewish cultural expression. The evolution of thought in the classical Jewish literary record thus offers a dynamic account of Christianity's separation from Judaism counterbalancing the abrupt schism attested in contemporary Christian texts.
Emergencies in Public Law
Authors: Loevy Karin
Published: March 2016

Debates about emergency powers traditionally focus on whether law can or should constrain officials in emergencies. Emergencies in Public Law moves beyond this narrow lens, focusing instead on how law structures the response to emergencies and what kind of legal and political dynamics this relation gives rise to. Drawing on empirical studies from a variety of emergencies, institutional actors, and jurisdictional scales (terrorist threats, natural disasters, economic crises, and more), this book provides a framework for understanding emergencies as long-term processes rather than ad hoc events, and as opportunities for legal and institutional productivity rather than occasions for the suspension of law and the centralization of response powers. The analysis offered here will be of interest to academics and students of legal, political, and constitutional theory as well as to public lawyers and social scientists.
Shakespeare and the Eighteenth-Century Novel
Authors: Rumbold Kate
Published: March 2016

The eighteenth century has long been acknowledged as a pivotal period in Shakespeare's reception, transforming a playwright requiring 'improvement' into a national poet whose every word was sacred. Scholars have examined the contribution of performances, adaptations, criticism and editing to this process of transformation, but the crucial role of fiction remains overlooked. Shakespeare and the Eighteenth-Century Novel reveals for the first time the prevalence, and the importance, of fictional characters' direct quotations from Shakespeare. Quoting characters ascribe emotional and moral authority to Shakespeare, redeploy his theatricality, and mock banal uses of his words; by shaping in this way what is considered valuable about Shakespeare, the novel accrues new cultural authority of its own. Shakespeare underwrites, and is underwritten by, the eighteenth-century novel, and this book reveals the lasting implications for both of their reputations.
Fundamentals of Mobile Data Networks
Authors: Miao Guowang , Zander Jens , Sung Ki Won , Ben Slimane Slimane
Published: March 2016

This unique text provides a comprehensive and systematic introduction to the theory and practice of mobile data networks. Covering basic design principles as well as analytical tools for network performance evaluation, and with a focus on system-level resource management, you will learn how state-of-the-art network design can enable you flexibly and efficiently to manage and trade-off various resources such as spectrum, energy, and infrastructure investments. Topics covered range from traditional elements such as medium access, cell deployment, capacity, handover, and interference management, to more recent cutting-edge topics such as heterogeneous networks, energy and cost-efficient network design, and a detailed introduction to LTE (4G). Numerous worked examples and exercises illustrate the key theoretical concepts and help you put your knowledge into practice, making this an essential resource whether you are a student, researcher, or practicing engineer.
Gerrymandering in America
Authors: McGann Anthony J. , Smith Charles Anthony , Latner Michael , Keena Alex
Published: March 2016

This book considers the political and constitutional consequences of Vieth v. Jubelirer (2004), where the Supreme Court held that partisan gerrymandering challenges could no longer be adjudicated by the courts. Through a rigorous scientific analysis of US House district maps, the authors argue that partisan bias increased dramatically in the 2010 redistricting round after the Vieth decision, both at the national and state level. From a constitutional perspective, unrestrained partisan gerrymandering poses a critical threat to a central pillar of American democracy, popular sovereignty. State legislatures now effectively determine the political composition of the US House. The book answers the Court's challenge to find a new standard for gerrymandering that is both constitutionally grounded and legally manageable. It argues that the scientifically rigorous partisan symmetry measure is an appropriate legal standard for partisan gerrymandering, as it logically implies the constitutional right to individual equality and can be practically applied.
International Pecking Orders
Authors: Pouliot Vincent
Published: March 2016

In any multilateral setting, some state representatives weigh much more heavily than others. Practitioners often refer to this form of diplomatic hierarchy as the 'international pecking order'. This book is a study of international hierarchy in practice, as it emerges out of the multilateral diplomatic process. Building on the social theories of Erving Goffman and Pierre Bourdieu, it argues that diplomacy produces inequality. Delving into the politics and inner dynamics of NATO and the UN as case studies, Vincent Pouliot shows that pecking orders are eminently complex social forms: contingent yet durable; constraining but also full of agency; operating at different levels, depending on issues; and defined in significant part locally, in and through the practice of multilateral diplomacy.
Forensic Analysis of Landslide Reveals Rocky Secrets
Authors: Wendel JoAnna
Published: March 2016

Scientists used drones, seismic data, and eyewitness accounts to figure out what unleashed an unthinkably large landslide on a spring day in Colorado.
Layered hydrogels accelerate iPSC-derived neuronal maturation and reveal migration defects caused by MeCP2 dysfunction
Authors: Zhang Zhen-Ning , Freitas Beatriz C. , Qian Hao , Lux Jacques , Acab Allan , Trujillo Cleber A. , Herai Roberto H. , Nguyen Huu Viet Anh , Wen Jessica H. , Joshi-Barr Shivanjali , Karpiak Jerome V. , Engler Adam J. , Fu Xiang-Dong , Muotri Alysson R. , Almutairi Adah
Published: March 2016

Significance

Three-dimensional systems enable the formation of tissue-mimetic architectures and promote more realistic physiological responses than conventional 2D systems. Here we report a previously unidentified layered 3D culture system to assay migration and maturation of human induced pluripotent stem cell (iPSC)-derived neural progenitor cells (NPCs) and reveal a genotype-specific effect of methyl-CpG-binding protein-2 (MeCP2) dysfunction on iPSC-derived neuronal migration and maturation in 3D layered hydrogels. Using this platform, we identified a migration defect in MeCP2-mutant iPSC-derived NPCs and confirmed previous observations that neurons derived from these cells have reduced neurite outgrowth and fewer synapses. Meanwhile, 3D hydrogel culture accelerates neuronal differentiation of iPSC-derived NPCs.
Tudor Humanists, London Printers, and the Status of Women: The Struggle over Livy in theQuerelle des Femmes
Authors: Philo John-Mark
Published: March 2016

This essay discusses a novel contribution to the Renaissance debate over women. In 1551, William Thomas translated a brief but significant moment from Livy’sHistory of Romeconcerning the repeal of the Lex Oppia, a sumptuary law targeting women in particular. Thomas thereby adapted one of the most arresting examples of women’s engagement in Roman politics. The episode shows the women of Rome taking to the streets to demand the law’s repeal, forcing senators and tribunes alike to acknowledge their protest. By contextualizing Thomas’s translation amid Quattrocento debates over female apparel and contemporary, female-centric works printed by Thomas Berthelet, Thomas’s translation emerges as a clear though hitherto-unacknowledged intervention in the Englishquerelle des femmes.
The Hunt in the Performance of Archducal Rule: Endurance and Revival in the Habsburg Netherlands in the Early Seventeenth Century
Authors: Duerloo Luc
Published: March 2016

After decades of civil war, the archdukes Albert and Isabella drew on the princely hunt to consolidate their regime in the Habsburg Netherlands. In essence a performance of dominion, the hunt served to enact their exalted birth and the return to peace and order. Attempts to unify the hunting laws of their possessions were, however, frustrated by provincial liberties. As a result the archducal hunt had to derive its prestige from where it was held, rather than from the species that were hunted. Appropriating the cult of Saint Hubertus and patronizing artistic representations further enhanced the prestige of these locations.
Fictions of Abundance in Early Modern Madrid: Hospitality, Consumption, and Artistic Identity in the Work of Juan van der Hamen y León
Authors: Ripollés Carmen
Published: March 2016

This article examines how still-life painting contributed to the creation of a distinct urban aristocratic culture in seventeenth-century Madrid. Focusing on a group of paintings by Juan van der Hamen, the article situates these images within the context of the picture gallery and the practice of aristocratic hospitality. By giving visual form to this new urban mode of magnificence, Van der Hamen’s still lifes created a fiction of abundance that glossed over Madrid’s economic realities. At the same time, Van der Hamen concealed signs of manual craftsmanship and commercial interest in order to advance and ennoble his own artistic identity.
Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury
Authors: Algarra Nelson N. , Lele Abhijit V. , Prathep Sumidtra , Souter Michael J. , Vavilala Monica S. , Qiu Qian , Sharma Deepak
Published: March 2016

Background:

Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographic scan, intracranial pressure (ICP), and escalation of care within 24 hours of surgery.

Materials and Methods:

We reviewed medical records of TBI patients 18 years and above with Glasgow Coma Scale score <13 who underwent single orthopedic surgery within 2 weeks of TBI. Secondary insults examined were: systemic hypotension (systolic blood pressure<90 mm Hg), intracranial hypertension (ICP>20 mm Hg), cerebral hypotension (cerebral perfusion pressure<50 mm Hg), hypercarbia (end-tidal CO2>40 mm Hg), hypocarbia (end-tidal CO2<30 mm Hg in absence of intracranial hypertension), hyperglycemia (glucose>200 mg/dL), hypoglycemia (glucose<60 mg/dL), and hyperthermia (temperature >38°C).

Results:

A total of 78 patients (41 [18 to 81] y, 68% male) met the inclusion criteria. The most common intraoperative secondary insults were systemic hypotension (60%), intracranial hypertension and cerebral hypotension (50% and 45%, respectively, in patients with ICP monitoring), hypercarbia (32%), and hypocarbia (29%). Intraoperative secondary insults were associated with worsening of head computed tomography, postoperative decrease of Glasgow Coma Scale score by ≥2, and escalation of care. After Bonferroni correction, association between cerebral hypotension and postoperative escalation of care remained significant (P<0.001).

Conclusions:

Intraoperative secondary insults were common during orthopedic surgery in patients with TBI and were associated with postoperative escalation of care. Strategies to minimize intraoperative secondary insults are needed.
Pediatric pelvic pyomyositis: initial MRI can be misleading
Authors: Chotai Pranit N. , Hsiao Mark S. , Pathak Indu , Banh Diem , Abdou Marwa , Abdelgawad Amr A.
Published: March 2016

Pelvic pyomyositis is an infection of the skeletal muscles around the hip joint. Fever, hip pain, limp, and leukocytosis are common; however, the clinical picture is often vague. MRI is the current gold-standard imaging for pyomyositis. No studies in the current literature have reported an unremarkable initial MRI in a patient with symptomatic pyomyositis. An adolescent female presented with symptomatic pelvic pyomyositis, but admission MRI was normal. A follow-up MRI indicated development of pelvic pyomyositis. The patient was successfully managed nonoperatively. The initial MRI in pyomyositis can be misleading. Patients should be admitted and MRI should be repeated, as indicated clinically.
Spontaneous improvement of cervical kyphosis in eosinophilic granuloma: a case report
Authors: Takano Hiromitsu , Yonezawa Ikuho , Shimamura Yukitoshi , Yoshikawa Kei , Sato Tatsuya , Okuda Takatoshi , Kaneko Kazuo
Published: March 2016

We describe the case of a spontaneous improvement of the cervical kyphosis in eosinophilic granuloma with long-term follow-up. A collapse of the C5 vertebral body was confirmed by cervical spine radiography and computed tomography. The patient wore a sterno-occipitalmandibular immobilizer brace for 6 months, and remodeling of the vertebral body was confirmed 18 months after onset. Seven years have passed since the onset of symptoms, and the patient’s cervical spine has maintained normal alignment. Management of eosinophilic granuloma of the pediatric cervical spine is still controversial. Conservative treatment suffices as adequate management of cervical eosinophilic granuloma, even with kyphotic deformity.
Factors in Surgical Decision Making for Thoracolumbar/Lumbar AIS: It’s About More Than Just the Curve Magnitude
Authors: Souder Christopher , Newton Peter O. , Shah Suken A. , Lonner Baron S. , Bastrom Tracey P. , Yaszay Burt
Published: March 2016

Study Design:

A retrospective review of prospective data

Objective:

The purpose of this study was to compare operative and nonoperative patients with similar curve magnitudes to determine motivating factors associated with surgical correction in “smaller” curves.

Summary of Background Data:

Despite traditional treatment recommendations on major curve angle measurements, many patients with thoracolumbar/lumbar (TH/L) curves of smaller magnitudes are unhappy and desire correction.

Methods:

A prospectively enrolled multicenter adolescent idiopathic scoliosis database was queried. Patients with major TH/L curves <50 degrees and low risk of progression (Risser 3, 4, and 5) were identified and grouped based on their treatment (operative vs. nonoperative). Preoperative demographic, radiographic, Scoliosis Research Society (SRS) outcome scores, and trunk shape values were compared.

Results:

A total of 126 patients undergoing surgical intervention and 17 patients pursuing nonoperative treatment were analyzed. The average lumbar curve of the operative group was 43 degrees (range, 35 to 49 degrees) and for the nonoperative group was 39 degrees (range, 26 to 49 degrees). The operative group was significantly younger, had larger lumbar major curve angles, lower thoracic to lumbar curve ratio, increased TH/L apical translation, and greater trunk shift (P<0.05). Only lumbar curve (P=0.018, OR=1.19) and trunk shift (P=0.01, OR=3.22) remained significant predictors of surgery in a multivariate regression analysis. SRS scores were significantly lower in the operative group for pain, self-image, function, mental health, and total (P<0.05). When SRS total score was entered into the regression, it was the only significant predictor of surgical intervention (P=0.004, OR=0.03).

Conclusions:

Many patients with smaller lumbar curves have clinical deformities that are more consistent with larger curves. These smaller curves can produce similar coronal imbalance and trunk shift, with lower SRS domains that may drive patients to seek surgical treatment. What is unclear is the reason for this greater degree of imbalance in this select group of patients and whether the natural history is different for a more balanced TH/L curve.

Level of Evidence:

Level II—Prognostic.
Early-stage Uterine Pure and Mixed Clear Cell Carcinoma
Authors: Chang-Halpenny Christine N. , Natarajan Sathima , Hwang-Graziano Julie M.
Published: March 2016

Objective:

Clear cell carcinoma (CCC) of the uterus is a rare but aggressive histology for which the role of adjuvant therapy for stage I-II disease is unclear. Our study investigated outcomes and patterns of failure in these patients.

Methods:

We found 64 cases of CCC, including 26 of pure CCC, 22 mixed with endometrioid adenocarcinoma, and 16 mixed with uterine papillary serous carcinoma. Adjuvant treatment was given to 55%.

Results:

Median follow-up was 51.9 months. By Kaplan-Meier estimate, 5-year vaginal recurrence-free survival (RFS) was 91.3%, pelvic RFS was 92.6%, distant metastasis RFS was 81.6%, disease-free survival was 79.6%, and overall survival was 79.7%. Median time to recurrence was 20.7 months (range, 2 to 40.5 mo). Patients treated adjuvantly had higher proportion of stage II disease (40% vs. 6.9% observed, P=0.0031) and 20% (7/35) recurred. There were no significant differences in outcomes by histologic subtypes but numerically more recurrences with uterine papillary serous involvement. By univariate analysis, higher stage, presence of lymphovascular invasion, and lack of lymph node dissection were predictive of worse overall survival. Age 65 years and above was predictive of worse cancer-specific survival. Of 12 who progressed, only 1 was salvaged and 11 died of disease. Of progressors, 10 had documented distant metastasis. Median time from recurrence to death was 4.5 months (range, 0.2 to 21.2 mo).

Conclusions:

Given aggressive and often unsalvageable nature of recurrence, consideration of adjuvant treatment (including chemotherapy and radiation) is warranted for early-stage CCC, particularly for stage II or those with poor prognostic factors.
Recombinant Human Alpha-1 Antitrypsin-Fc Fusion Protein Reduces Mouse Myocardial Inflammatory Injury After Ischemia–Reperfusion Independent of Elastase Inhibition
Authors: Toldo Stefano , Mauro Adolfo G. , Marchetti Carlo , Rose Scott W. , Mezzaroma Eleonora , Van Tassell Benjamin W. , Kim Soohyun , Dinarello Charles A. , Abbate Antonio
Published: March 2016

Background:

Alpha-1-antitrypsin (AAT) is an abundant plasma protein with neutrophil elastase-inhibiting activity, and AAT is available as a plasma-derived therapeutic (pAAT). In experimental myocardial infarction, pAAT reduced acute inflammatory injury because of ischemia–reperfusion. The aim of the present study was to assess the properties of a recombinant protein composed of human AAT fused to the human immunoglobulin (Ig) G1 Fc fragment (rhAAT-Fc) in experimental myocardial infarction.

Methods:

Ten-week-old CD1 male mice underwent transient occlusion (30 minutes) of the left anterior coronary artery. rhAAT-Fc (2 mg/kg) or pAAT (60 mg/kg) were administered upon reperfusion. We used human plasma-derived Ig (2 mg/kg) or a matching volume of NaCl 0.9% as control solutions. After 24 hours, infarct size and caspase-1 activity were quantified. The left ventricular ejection fraction (LVEF) was measured by echocardiography at 24 hours and 7 days. A variant of rhAAT-Fc lacking elastase inhibition activity, rhAAT-Fc[E−], was also tested.

Results:

The rhAAT-Fc induced a significant reduction in infarct size (P < 0.01 vs. all controls, P > 0.05 vs. pAAT). Caspase-1 activity was reduced to the same degree with rhAAT-Fc and pAAT (−70%; P < 0.05; P > 0.05 rhAAT-Fc vs. pAAT). The effects on infarct size after a single administration were reflected by preservation of LVEF at 24 hours and 7 days (all P < 0.05). rhAAT-Fc without elastase inhibiting activity, rhAAT-Fc[E−], conferred comparable effects on infarct size, caspase-1 activity, and LVEF (P > 0.2 vs. rhAAT-Fc).

Conclusions:

The pAAT and recombinant human AAT-Fc reduce the acute myocardial inflammatory injury after ischemia–reperfusion in the mouse leading to preservation of viable myocardium and systolic function, independent on the effects on neutrophil elastase.
Impact of Peripheral Field Loss on the Execution of Natural Actions: A Study With Glaucomatous Patients and Normally Sighted People
Authors: Dive Stéphanie , Rouland Jean F. , Lenoble Quentin , Szaffarczyk Sebastien , McKendrick Allison M. , Boucart Muriel
Published: March 2016

Purpose:

We investigated the visuomotor behavior of people with reduced peripheral field due to glaucoma while they accomplished natural actions.

Methods:

Twelve participants with glaucoma and 13 normally sighted controls were included. Participants were asked to accomplish a familiar sandwich-making task and a less familiar model-building task with a children’s construction set while their eye movements were recorded. Both scene layouts contained task-relevant and task-irrelevant objects. There was no time constraint.

Results:

Participants with glaucoma were slower to perform the task than were the normal observers, but the slower performance was confined to the unfamiliar model-building task. Patients and controls were equally efficient in the more familiar sandwich-making task. On initial exposure, before the first reaching movement was initiated, patients scanned the objects longer than did controls, particularly in the unfamiliar model-building task, and controls fixated irrelevant objects less than did patients. During the working phase fixations were on average longer for patients than for controls and patients made more saccades than did controls. Patients did not grasp more irrelevant objects compared with controls.

Conclusions:

The results provide evidence that, although slower than controls, patients with glaucoma were able to accomplish natural actions efficiently even when the task required discrimination of small structurally similar objects (nuts and screws in the model-building task). Their difficulties were reflected in longer fixation times and more head and eye movements compared with controls, presumably to compensate for lower visibility when objects fell in the part of their visual field where sensitivity was reduced.
Anterior-Chamber Angle and Axial Length Measurements in Normal Chinese Children
Authors: Jin Peiyao , Li Meili , He Xiangui , Lu Lina , Zhu Jianfeng , Chang Ta Chen , Zou Haidong
Published: March 2016

Purpose:

To establish the physiological distribution of anterior-chamber angle parameters and axial length (AL) in a randomly sampled cohort of Chinese children.

Patients and Methods:

This was a prospective, cross-sectional study on randomly sampled Chinese children ages 7 to 15 years. Complete ophthalmologic examination was carried out on all participants; anterior-segment parameters and ALs were measured using Fourier-domain optical coherence tomography and automated biometers. Associations between the age, the sex, the refractive error, the iris thickness, the AL, and anterior-chamber depth (ACD) and angle measurements were analyzed using multiple correlation and regression tests. The relationship between the AL and other factors was studied by a linear regression analysis. Only the right eye data were analyzed for statistical purpose.

Results:

A total of 541 children were enrolled in this study. There were no differences in angle parameters between sexes (P>0.05), but boys had a longer AL (P<0.01). The AL increased logarithmically with age in children (P<0.01,R2=0.5552,b=6.18). Although the magnitude of myopia also increased with AL, this association was less robust (P<0.05,R2=0.0917,b=−0.88). A multiple regression test indicated that the age and the ACD were independently associated with the increase in angle width (b=0.37 to 0.50 and 0.51 to 0.60, respectively;P<0.001).

Conclusions:

All angle measurements increased with age and were positively correlated with the ACD in children 7 to 15 years of age. The AL increased logarithmically with age.
Bilateral Same-day Laser Peripheral Iridotomy in the Philadelphia Glaucoma Detection and Treatment Project
Authors: Waisbourd Michael , Shafa Anousheh , Delvadia Radha , Sembhi Harjeet , Molineaux Jeanne , Henderer Jeffery , Pizzi Laura T. , Myers Jonathan S. , Hark Lisa A. , Katz L. Jay
Published: March 2016

Purpose:

To report the outcomes of bilateral, same-day laser peripheral iridotomy (LPI) in the Philadelphia Glaucoma Detection and Treatment Project.

Methods:

The Philadelphia Glaucoma Detection and Treatment Project was a community-based initiative aimed to improve detection, management, treatment, and follow-up care of individuals at high risk for glaucoma. This novel project performed LPI, where 2 eyes received laser therapy on the same day. Of the 1649 patients examined between January 1, 2013 and May 31, 2014, patients who underwent bilateral, same-day LPI were included in our analysis. Main outcome measures were visual acuity, intraocular pressure (IOP), and postoperative complication rates.

Results:

A total of 132 eyes of 66 patients underwent bilateral, same-day LPI. Mean visual acuity remained unchanged following treatment (P=0.85). Eight patients (12.1%) had IOP spikes >5 mm Hg following treatment, and 4 patients (6.1%) spiked >10 mm Hg. IOP returned to normal in all but 1 patient, who was diagnosed with chronic angle-closure glaucoma. Hyphema was reported in 2 patients (3%) and glare in 1 patient (1.5%). Thirteen patients (19.7%) had repeat LPI treatment. All patients successfully tolerated LPI treatment without serious complications.

Conclusions:

Performing bilateral, same-day LPI was well tolerated in a large community-based, glaucoma detection and treatment project. Applying this treatment strategy may be considered in similar settings, where patients’ access to eye care is limited and it may be a cost-effective strategy.
Bilateral Primary Mucinous Carcinoma of the Eyelid
Authors: Burris Christopher K. H. , Raven Meisha L. , Rodriguez Maria E. , Potter Heather D. , Lucarelli Mark J. , Albert Daniel M.
Published: March 2016

The aim of this study is to report a case of bilateral primary mucinous carcinoma of the eyelids. This is a case report and literature review. A 71-year-old female presented with primary mucinous carcinoma of the left upper eyelid, which was excised with Mohs surgery. One year later, she developed primary mucinous carcinoma of the right upper eyelid, which was also treated Mohs surgery. Extensive workup was negative for evidence of an unknown primary carcinoma or metastasis. Primary mucinous carcinoma of the eyelids may occur as multifocal tumors, and bilateral disease is not necessarily indicative of metastatic disease.
Early and late surgical outcomes of ileal pouch-anal anastomosis within a defined population in Sweden
Authors: Dafnis George
Published: March 2016

Objective

Ileal pouch-anal anastomosis (IPAA), has become the procedure of choice in patients requiring reconstructive surgery for ulcerative colitis or familial adenomatous polyposis. The aim of this population-based study was to present data prospectively registered and retrospectively evaluated on the short-term and the long-term results of 124 consecutive IPAA performed chronologically by three surgeons in a single referral centre.

Materials and methods

All patients who underwent IPAA from 1993 to 2012 were included. Early and late morbidity and mortality were evaluated.

Results

Early complications were observed in 25 patients. There was one death from cardiac failure, high output stoma occurred in six patients and wound infection occurred in four patients. Complications were associated with higher BMI (P=0.032). Four patients had to be reoperated. Peroperative bleeding was reduced when using an ultrasonically activated scalpel for the perimuscular dissection (P<0.00001). Clavien–Dindo grade III–V affected five patients. Only one patient developed anastomotic leak and septic complications.

Late complications occurred in 61 patients. There was no procedure-related mortality. Pouchitis was the most common complication (n=37). Primary sclerosing cholangitis and age younger than 40 years were associated significantly with a three- and two-fold increased risk of pouchitis, respectively. Small bowel obstruction was the second most common complication (n=16), more common in women (P=0.031). The pouch failure rate was low: 2.4%. Clavien–Dindo grade III–V affected 13 patients.

Conclusion

In the hands of experienced high-volume surgeons, IPAA is a safe procedure associated with a relatively low early morbidity as well as an acceptable late morbidity.
Infrequent Immunohistochemical Expression of Napsin A in Endometrial Carcinomas
Authors: Al-Maghrabi Jaudah A. , Butt Nadeem S. , Anfinan Nisrin , Sait Khalid , Sait Hesham , Marzouki Anas , Khabaz Mohamad Nidal
Published: March 2016

Introduction:

Many studies described napsin A as a specific diagnostic marker that aids in differentiating lung adenocarcinomas from other respiratory tumors. This study describes the expression phenotype of napsin A in endometrial neoplasms, it investigates the relationship between this expression profile and the clinicopathologic parameters, and assess its utilization as an independent predictive marker.

Methods:

A total of 76 cases of previously diagnosed endometrial carcinoma (including 53 endometrioid adenocarcinomas, 6 endometrioid adenocarcinomas with squamous differentiation, 9 serous adenocarcinomas, 6 clear cell adenocarcinomas, and 2 malignant mixed mullerian tumors) and 30 tissue samples of noncancerous endometrium (including 16 proliferative endometriums, 10 secretory endometriums and 4 endometrial polyps) were retrieved from the archives of Pathology Department at King Abdulaziz University, Jeddah, Saudi Arabia. For napsin A detection, tissue microarrays and immunostaining were used.

Results:

A total number of 12 (15.78%) cases were positive for napsin A immunostaining. Brown granular cytoplasmic expression of napsin A was detected in 9.4% of endometrioid adenocarcinomas, 16.7% of endometrioid adenocarcinomas with squamous differentiation, 22.2% of papillary serous endometrial carcinomas, and 66.7% of clear cell carcinomas. Three (10%) control cases showed similar granular cytoplasmic expression. Positive napsin A immunostaining was more frequent in clear cell carcinoma, and there is a significant association between positive napsin A immunostaining and clear cell carcinoma (P-value=0.007). Significant associations have been found also between napsin A expression and older ages (above 60 y) and higher stage (IVB), the P-values of which were 0.035 and 0.043, respectively, but not with the tumor recurrence or survival rate.

Conclusions:

Although napsin A is infrequently expressed in endometrial carcinomas, positive results of napsin A immunostaining in endometrial neoplasms might support the diagnosis of clear cell carcinoma when the pathologic differential diagnosis includes other histologic subtypes.
False ALK Rearrangement Signals in Inflammatory Cells: A Pitfall in the Interpretation of ALK Fluorescence In Situ Hybridization in Non–Small Cell Lung Cancer
Authors: Uguen Arnaud , Talagas Matthieu , Andrieu-Key Sophie , Quintin-Roué Isabelle , Marcorelles Pascale , De Braekeleer Marc
Published: March 2016

Searching for ALK rearrangements has now become mandatory for the treatment of patients with advanced non–small cell lung cancer with anti-ALK-targeted therapy. The fluorescence in situ hybridization test is considered the “gold standard” to diagnose ALK-rearranged tumors. Nevertheless, some technical pitfalls may cause false-positive signals mimicking ALK rearrangements. In this technical article, we point out the importance of taking into account both histopathologic and ALK immunohistochemical features to interpret ALK fluorescence in situ hybridization analyses in inflammatory and necrotic tumors. This confrontation is crucial to avoid misdiagnosis and inappropriate therapeutic management.
Comparison of Clinicopathologic Parameters and Survivals Between Epstein-Barr Virus–positive and Her2-positive Gastric Cancers
Authors: Irkkan Cigdem , Balci Serdar , Güler Tezel Gaye , Akinci Bülent , Yalcin Bülent , Güler Gülnur
Published: March 2016

Gastric carcinomas are highly mortal neoplasms for which new therapeutic options are being searched. The molecular subtyping of gastric adenocarcinomas was proposed recently, and the relationship between etiopathogenetic types is still under investigation. Here we compared histopathologic, prognostic, and survival differences between Epstein-Barr virus (EBV)-positive and Her2-positive gastric adenocarcinomas. In a retrospective design, we searched the EBV status with Epstein Barr Virus encoded small RNA (EBER) in situ hybridization, and the Her2 status both by immunohistochemistry and by chromogenic in situ hybridization of 106 gastrectomized gastric carcinomas. Histologic and clinical prognostic parameters and survival information were determined, and retrieved from archival tissues and clinical notes. The Her2 positivity rate was 12.3% and the EBV positivity rate was 7.6%. Among EBER-positive cases, Her2 positivity was not detected. Her2 positivity was detected more in intestinal differentiated tumors, whereas EBER positivity was detected in undifferentiated tumors (P=0.003). There was no correlation of Her2 or EBER positivity with the tumor stage. Median survivals of EBER-positive, Her2-positive, and both negative cases were 11.5, 18, and 20.5 months, respectively. The tumor stage and distant metastasis were found to be significant for survival in the multivariate analysis. In our 106 gastrectomized gastric carcinoma cases, EBV-positive and Her2-positive groups were found to be unrelated as proposed in the upcoming classification of gastric carcinomas.
Anastomosing Hemangiomas Arising in Unusual Locations
Authors: John Ivy , Folpe Andrew L.
Published: March 2016

Anastomosing hemangioma, a recently recognized benign vascular neoplasm originally described in the kidney, may be confused with well-differentiated angiosarcoma. Rare cases of anastomosing hemangiomas have been described in the liver and in nonrenal genitourinary sites. We report a series of 17 anastomosing hemangiomas occurring in unusual locations, in particular in the paravertebral soft tissues. The 17 tumors occurred in 10 male and 6 female patients, ranging in age from 2 to 85 years. One patient had bilateral, synchronous tumors involving the right paracaval and left para-aortic soft tissues. Thirteen (76%) cases involved the soft tissues near the vertebral column, including the paravertebral region (n=4), the psoas muscle (n=2), the costovertebral angle (n=2), para-aortic soft tissue (n=2), and the paracaval, parasacral, and retroperitoneal soft tissues (n=1 each). Other locations included the anterior mediastinum, uterine cornu, infundibular pelvic ligament, and upper arm (n=1 each). Imaging studies, available in 13 cases, were not felt to be diagnostic of a hemangioma. The tumors ranged from 1.5 to 7.5 cm (median, 3.6 cm) in size and were grossly well demarcated. All cases showed typical morphologic features of anastomosing hemangiomas, including a nonlobular architecture, an anastomosing proliferation of capillary-sized vessels with mild endothelial cell nuclear variability, scattered hobnailed endothelial cells, and small fibrin thrombi. Mitotic activity was rare or absent. Adipocytic metaplasia and extramedullary hematopoiesis were present in subsets of cases. When performed, immunohistochemical studies showed expression of endothelial markers (eg, CD31, CD34). In only 1 case did the submitting pathologist favor a diagnosis of anastomosing hemangioma; 4 cases were submitted specifically to exclude a well-differentiated angiosarcoma. Clinical follow-up available in 13 cases has not revealed any local recurrences or metastases. This series, the first formal description of anastomosing hemangiomas involving soft tissue locations, shows these tumors to have a notable predilection for the paraspinal region. The diagnosis of soft tissue anastomosing hemangioma may be challenging, as imaging studies do not show classical features of hemangioma and as these tumors may be sampled with limited needle biopsies. Awareness of this entity, and appreciation that they may occur in nongenitourinary sites, should allow its confident distinction from potentially more aggressive lesions, in particular angiosarcoma.
Incidental and Isolated Follicular Lymphoma In Situ and Mantle Cell Lymphoma In Situ Lack Clinical Significance
Authors: Bermudez Glenda , González de Villambrosía Sonia , Martínez-López Azahara , Batlle Ana , Revert-Arce José B. , Cereceda Company Laura , Ortega Bezanilla César , Piris Miguel A. , Montes-Moreno Santiago
Published: March 2016

Follicular lymphoma in situ (FLIS) and mantle cell lymphoma in situ (MCLIS) are histopathologic findings of undetermined clinical significance. We studied a series of 341 consecutive lymph node resection specimens from patients diagnosed with colorectal (201 cases) and breast (140 cases) adenocarcinoma between 1998 and 2000. Incidental and isolated FLIS was identified in 11/341 patients (3.23%), whereas incidental and isolated MCLIS was found in 2/341 patients (0.59%). None of these cases developed overt lymphoma. A second series of 17 cases of FLIS (16 cases) and MCLIS (1 case) from consultation files was analyzed. Five cases with incidental and isolated FLIS were identified. None of these cases developed overt lymphoma. Overall, none of the 16 cases with incidental and isolated FLIS in both series developed overt FL after a median follow-up of 54 months (range, 7 to 187 mo). However, 12 of these cases with a clinical suspicion of lymphoproliferative disorder showed the association (in different lymph nodes) or combination (in the same sample) of FLIS or MCLIS with other lymphoid neoplasms (FL, splenic marginal zone lymphoma, nodal marginal zone lymphoma, Hodgkin lymphoma, diffuse large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, multiple myeloma). In conclusion, the clinical relevance of FLIS and MCLIS seems to strictly depend on the clinical context. Incidental FLIS or MCLIS seem to have a very low risk for transformation, which recommends careful clinical examination after histopathologic diagnosis and conservative management with follow-up for a limited period of time.
Recurrent BCOR Internal Tandem Duplication and YWHAE-NUTM2B Fusions in Soft Tissue Undifferentiated Round Cell Sarcoma of Infancy
Authors: Kao Yu-Chien , Sung Yun-Shao , Zhang Lei , Huang Shih-Chiang , Argani Pedram , Chung Catherine T. , Graf Nicole S. , Wright Dale C. , Kellie Stewart J. , Agaram Narasimhan P. , Ludwig Kathrin , Zin Angelica , Alaggio Rita , Antonescu Cristina R.
Published: March 2016

Soft tissue undifferentiated round cell sarcoma (URCS) occurring in infants is a heterogenous group of tumors, often lacking known genetic abnormalities. On the basis of a t(10;17;14) karyotype in a pelvic URCS of a 4-month-old boy showing similar breakpoints with clear cell sarcoma of kidney (CCSK), we have investigated the possibility of shared genetic abnormalities in CCSK and soft tissue URCS. Most CCSKs are characterized byBCORexon 16 internal tandem duplications (ITDs), whereas a smaller subset showsYWHAE-NUTM2B/Efusions. Because of overlapping clinicopathologic features, we have also investigated these genetic alterations in the so-called primitive myxoid mesenchymal tumor of infancy (PMMTI). Among the 22 infantile URCSs and 7 PMMTIs selected, RNA sequencing was performed in 5 and 2 cases, with frozen tissue, respectively. The remaining cases with archival material were tested forYWHAE-NUTM2B/Eby fluorescence in situ hybridization (FISH) or reverse transcription-polymerase chain reaction (RT-PCR), andBCORITD by PCR. A control group of 4 CCSKs and 14 URCSs in older children or adults without known gene fusion and 20 other sarcomas with similar histomorphology or age at presentation were also tested. AYWHAE-NUTM2Bfusion was confirmed in the index case by FISH and RT-PCR, whereasBCORITD was lacking. An identicalYWHAE-NUTM2Bfusion was found in another URCS case of a 5-month-old girl with a back lesion. The remaining cases and control group lackedYWHAEgene rearrangements; instead, consistentBCORITDs, similar to CCSK, were found in 15/29 (52%) infantile sarcoma cases (9/22 infantile URCS and 6/7 PMMTI). In the control cohort,BCORITD was found only in 3 CCSK cases but not in the other sarcomas. Histologically, URCS with both genotypes and PMMTI shared significant histologic overlap, with uniform small blue round cells with fine chromatin and indistinct nucleoli. A prominent capillary network similar to CCSK, rosette structures, and varying degree of myxoid change were occasionally seen.BCORITD–positive tumors occurred preferentially in the somatic soft tissue of the trunk, abdomen, and head and neck, sparing the extremities. RNAseq showed highBCORmRNA levels inBCORITD–positive cases, compared with other URCSs. In summary, we report recurrentBCORexon 16 ITD andYWHAE-NUTM2Bfusions in half of infantile soft tissue URCS and most PMMTI cases, but not in other pediatric sarcomas. These findings suggest a significant overlap between infantile URCS and CCSK, such as age at presentation, histologic features, and genetic signature, thus raising the possibility of a soft tissue counterpart to CCSK.
Lyme Myocarditis Presenting as Chest Pain in an Adolescent Girl
Authors: Fishe Jennifer N. , Marchese Ronald F. , Callahan James M.
Published: March 2016

A previously healthy adolescent girl presented to the emergency department with new onset chest and right upper quadrant abdominal pain. Laboratory studies and imaging were consistent with myocarditis. She developed heart block after admission and required stabilization in the cardiac intensive care unit. Lyme serology returned positive, and her condition was diagnosed as Lyme disease-associated myocarditis.
Size Matters
Authors: Ravichandran Yagnaram , Harrison Prince , Garrow Eugene , Chao Jennifer H.
Published: March 2016

Ultrasound is the initial diagnostic modality of choice for evaluation of pediatric appendicitis. We report a case that highlights the importance of pain control, distraction, focusing on the appearance of the appendix and the surrounding structures, the value of size cutoff points for appendicitis, and repeating ultrasound examinations to optimize yield.
Restrictive Diet Control as a Means of Child Abuse
Authors: Kudek Matthew R. , Luyet Francois , Herringa Ryan J. , Knox Barbara L.
Published: March 2016

We have recently encountered a series of cases where an obese caretaker is juxtaposed to a severely starved, malnourished dependent. The cases described all share a common characteristic: that the primary perpetrator was an obese caretaker who tried to exert absolute control over their victim's daily life in a way that included either a severe restriction or complete denial of food. Because the pathophysiology of both child abuse and obesity are incredibly complex and multifactorial, these cases are presented to encourage further discussion and more rigorous investigation into the validity of a hypothesis that has been derived from this set of cases: that the obesity of a child's caretaker may be an additional risk factor for child maltreatment by starvation.
High-Resolution Axonal Bundle (Fascicle) Assessment and Triple-Echo Steady-State T2 Mapping of the Median Nerve at 7 T
Authors: Riegler Georg , Drlicek Gregor , Kronnerwetter Claudia , Heule Rahel , Bieri Oliver , Bodner Gerd , Lieba-Samal Doris , Trattnig Siegfried
Published: March 2016

Objectives

The aims of this preliminary study were to determine the number of axonal bundles (fascicles) in the median nerve,1 using a high-resolution, proton density (PD)–turbo spin echo (TSE) fat suppression sequence, and to determine normative T2 values, measured by triple-echo steady state, of the median nerve in healthy volunteers and in patients with idiopathic carpal tunnel syndrome (CTS), at 7 T.2

Materials and Methods

This prospective study was approved by the local ethics committee and conducted between March 2014 and January 2015. All study participants gave written informed consent. Six healthy volunteers (30 ± 12 years) and 5 patients with CTS (44 ± 16 years) were included. Measurements were performed on both wrists in all volunteers and on the affected wrist in patients (3 right, 2 left). Based on 5-point scales, 2 readers assessed image quality (1, very poor; 5, very good) and the presence of artifacts that might have a possible influence on fascicle determination (1, severe artifacts; 5, no artifacts) and counted the number of fascicles independently on the PD-TSE sequences. Furthermore, T2 values by region of interest analysis were assessed. Student t tests, a hierarchic linear model, and intraclass correlation coefficients (ICCs) were used for statistical analysis.

Results

Proton density-TSE image quality and artifacts revealed a median of 5 in healthy volunteers and 4 in patients with CTS for both readers. Fascicle count of the median nerve ranged from 13 to 23 in all subjects, with an ICC of 0.87 (95% confidence interval [CI], 0.67–0.95). T2 values were significantly higher (P = 0.023) in patients (24.27 ± 0.97 milliseconds [95% CI, 22.19–26.38]) compared with healthy volunteers (21.01 ± 0.65 milliseconds [95% CI, 19.61–22.41]). The ICC for all T2 values was 0.97 (95% CI, 0.96–0.98).

Conclusions

This study shows the possibility of fascicle determination of the median nerve in healthy volunteers and patients with CTS (although probably less accurately) with high-resolution 7 T magnetic resonance imaging, as well as significantly higher T2 values in patients with CTS, which seems to be associated with pathophysiological nerve changes.
Limiting the Development of Anti-Cancer Drug Resistance in a Spatial Model of Micrometastases
Authors: Shah Ami B. , Rejniak Katarzyna A. , Gevertz Jana L.
Published: March 2016

While chemoresistance in primary tumors is well-studied, much less is known about the influence of systemic chemotherapy on the development of drug resistance at metastatic sites. In this work, we use a hybrid spatial model of tumor response to a DNA damaging drug to study how the development of chemoresistance in micrometastases depends on the drug dosing schedule. We separately consider cell populations that harbor pre-existing resistance to the drug, and those that acquire resistance during the course of treatment. For each of these independent scenarios, we consider one hypothetical cell line that is responsive to metronomic chemotherapy, and another that with high probability cannot be eradicated by a metronomic protocol. Motivated by experimental work on ovarian cancer xenografts, we consider all possible combinations of a one week treatment protocol, repeated for three weeks, and constrained by the total weekly drug dose. Simulations reveal a small number of fractionated-dose protocols that are at least as effective as metronomic therapy in eradicating micrometastases with acquired resistance (weak or strong), while also being at least as effective on those that harbor weakly pre-existing resistant cells. Given the responsiveness of very different theoretical cell lines to these few fractionated-dose protocols, these may represent more effective ways to schedule chemotherapy with the goal of limiting metastatic tumor progression.