bluuebunny/crossref_metadata_2025 huggingface dataset:
Localization of the Patency Capsule by Abdominal Tomosynthesis
Authors: Omori Teppei , Nakamura Shinichi , Shiratori Keiko
Published: June 2015

Background/Aims: A patency capsule (PC) is used to assess intestinal patency in patients with known or suspected stricture, but PC localization by plain abdominal X-ray (AXR) is difficult in those patients in whom the PC is not detected in the feces. Tomosynthesis is a promising, cost-effective, and low-radiation digital tomographic technique. This prospective study evaluated its use for PC localization in the intestinal tract. Methods: The study subjects were 49 patients in whom the PC was not detected in the feces and was identified intra-abdominally on AXR films. PC localization in the small or large intestines by AXR alone or by tomosynthesis with AXR was compared with abdominal computed tomography (CT), which is the gold standard. Results: The PC was judged in the large and small intestines in 22 and 27 patients by AXR alone versus 34 and 15 patients, respectively, by tomosynthesis combined with AXR. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for PC detection by AXR alone were 52.9, 53.3, 56.2, 50.0, and 53.1%, respectively. The same parameters were 100, 100, 100, 100, and 100%, respectively, for tomosynthesis with AXR, which were identical to those of CT. Conclusions: Tomosynthesis with AXR is superior to AXR alone, though similar to CT, with respect to localization of the PC.
A Generalized Sequential Bonferroni Procedure for GWAS in Admixed Populations Incorporating Admixture Mapping Information into Association Tests
Authors: Chen Wenan , Ren Chunfeng , Qin Huaizhen , Archer Kellie J. , Ouyang Weiwei , Liu Nianjun , Chen Xiangning , Luo Xingguang , Zhu Xiaofeng , Sun Shumei , Gao Guimin
Published: June 2015

Objective: To develop effective methods for GWAS in admixed populations such as African Americans. Methods: We show that, when testing the null hypothesis that the test SNP is not in background linkage disequilibrium with the causal variants, several existing methods cannot control well the family-wise error rate (FWER) in the strong sense in GWAS. These existing methods include association tests adjusting for global ancestry and joint association tests that combine statistics from admixture mapping tests and association tests that correct for local ancestry. Furthermore, we describe a generalized sequential Bonferroni (smooth-GSB) procedure for GWAS that incorporates smoothed weights calculated from admixture mapping tests into association tests that correct for local ancestry. We have applied the smooth-GSB procedure to analyses of GWAS data on American Africans from the Atherosclerosis Risk in Communities (ARIC) Study. Results: Our simulation studies indicate that the smooth-GSB procedure not only control the FWER, but also improves statistical power compared with association tests correcting for local ancestry. Conclusion: The smooth-GSB procedure can result in a better performance than several existing methods for GWAS in admixed populations.
Examining Determinants of Patient Outcome in a Low Clearance Clinic
Authors: Bhatia Raghav T. , Browne Oliver T. , Naudeer Sarah , Allgar Victoria , Bhandari Sunil
Published: June 2015

Background: With an aging population and limited resources, the incidence and prevalence of chronic kidney disease is increasing. We aimed at assessing the impact of the low clearance clinic (LCC) on not only the natural history of patients with deteriorating renal function but also the timing of renal replacement therapy (RRT) and mortality. Methods: A retrospective cohort study involving 271 patients who entered the LCC at Hull from July 2007 to December 2010 was conducted. Descriptive analysis based on baseline characteristics was performed and slope-estimated glomerular function rates (eGFR) before and after entry to the LCC were calculated. This aided survival analysis using quartiles and Kaplan-Meier. The change in slope eGFR was the study primary end point, but secondary end points, including mortality and time to RRT, were also measured. Results: The average length of time within the LCC was 14 months and of those receiving RRT, 61% received this intervention within one year compared with 38% after 1 year. The rapidly declining rate of eGFR prior to entry into the LCC was predictive of both those who would need haemodialysis sooner within a mean of 21 months and of mortality within an average of 26.3 months. Slope eGFRs before and after entry into the LCC showed that 63.3% of patients improved on entry into the LCC. Conclusions: The LCC impacts the rate of decline in eGFR. A rapidly declining eGFR prior to entering the LCC was predictive of RRT requirement. There was no significant impact on mortality.
The Positivity Effect on the Intensity of Experienced Emotion and Memory Performance in Mild Cognitive Impairment and Dementia
Authors: Gorenc-Mahmutaj Lina , Degen Christina , Wetzel Petra , Urbanowitsch Nadja , Funke Joachim , Schröder Johannes
Published: June 2015

Aims: We examined the ‘positivity effect' on memory performance in mild cognitive impairment (MCI) and dementia patients. Methods: In 109 subjects (28 controls, 32 with MCI, 27 with mild and 32 with moderate dementia), we investigated free recalls (immediate and delayed) and recognition of 12 pictures. Moreover, the emotional valence of the pictures perceived and the emotions evoked in the subjects were evaluated. Results: Patients with mild and moderate dementia recalled fewer pictures than those with MCI or the healthy controls. Across the groups, the positive pictures were better memorized and induced a higher arousal than the negative or neutral ones. Conclusions: Our findings indicate a positivity effect on memory performance and intensity of experience not only in healthy elderly patients but also in those with MCI or mild and moderate dementia. This effect does not refer to the compliance of the patients investigated since they perceived and experienced the pictures in the expected way.
Phantom Remodeling Effect of Dorsal Root Entry Zone Lesioning in Phantom Limb Pain Caused by Brachial Plexus Avulsion
Authors: Son Byung-chul , Ha Sang-woo
Published: June 2015

Background: Dorsal root entry zone (DREZ) lesioning has been reported to be effective for phantom limb pain caused by brachial plexus avulsion pain. Most reports on DREZ lesioning for brachial plexus avulsion pain have focused on the results of pain relief without a detailed description of phantom sensations following DREZ lesioning. Materials and Methods: Two patients (1 with amputation and the other nonamputated) with chronic intractable phantom limb pain caused by brachial plexus avulsion underwent DREZ lesioning on the avulsed segments of the cervical spinal cords. Changes of the phantom limb were observed. Results: Immediately following DREZ lesioning, the phantom limb pain disappeared in the amputee, the phantom arm was shortened and the phantom hand disappeared. The other patient with the nonamputated arm reported an immediate 50% reduction in the size of the phantom hand, and pain relief was up to 70% of the preoperative phantom limb pain. There was no further change in the phantom arm and hand during the follow-up of 1.5-2 years. Conclusions: The phantom arms and hands showed a prompt shortening and reduction in size, rather than a disappearance, following successful DREZ lesioning in patients with chronic phantom limb pain caused by brachial plexus avulsion.
The Influence of Bilateral Subthalamic Nucleus Deep Brain Stimulation on Impulsivity and Prepulse Inhibition in Parkinson's Disease Patients
Authors: Gee Lucy , Smith Heather , De La Cruz Priscilla , Campbell Joannalee , Fama Chris , Haller Jessica , Ramirez-Zamora Adolfo , Durphy Jennifer , Hanspal Era , Molho Eric , Barba Anne , Shin Damian , Pilitsis Julie G.
Published: June 2015

Background: At least 14% of Parkinson disease (PD) patients develop impulse control disorders (ICDs). The pathophysiology behind these behaviors and the impact of deep brain stimulation in a real-life setting remain unclear. Objectives: We prospectively examined the impact of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on ICDs in PD patients, as well as the relationship between impaired sensorimotor gaiting and impulsivity. Methods: Patients undergoing bilateral STN-DBS were assessed for ICDs preoperatively and 1-year postoperatively using a validated questionnaire (QUIP-RS). A subset of patients completed the Balloon Analogue Risk Task (BART) and auditory prepulse inhibition (PPI) testing. Results: Analysis revealed 12 patients had an improvement in score assessing ICDs (‘good responders'; p = 0.006) while 4 had a worse or stable score (‘poor responders'; p > 0.05). Good responders further exemplified a significant decrease in hypersexual behavior (p = 0.005) and binge eating (p = 0.01). Impaired PPI responses also significantly correlated with impulsivity in BART (r = -0.72, p = 0.044). Discussion: Following bilateral STN-DBS, 75% of our cohort had a reduction in ICDs, thus suggesting deep brain stimulation effectively manages ICDs in PD. The role of impaired PPI in predisposition to ICDs in PD warrants further investigation.
Evaluation of Micronuclei, Nuclear Anomalies and the Nuclear/Cytoplasmic Ratio of Exfoliated Cervical Epithelial Cells in Genital Candidiasis
Authors: Safi Oz Zehra , Dogan Gun Banu , Ozdamar Sukru Oguz
Published: June 2015

Objective:Candida is the most common cause of fungal infections. The aim of this study was to fill the gaps in the current knowledge on the frequencies of micronuclei and nuclear anomalies, and the nucleus/cytoplasmic ratio in genital candidiasis. Study Design: A total of 88 Papanicolaou- stained cervical smears, which comprised Candida spp. (n = 44) and control cases with no infectious agent (n = 44), were studied. In each smear, cells with micronuclei and nuclear anomalies were counted in 1,000 epithelial cells and also nuclear and cellular areas were evaluated using image analysis software at a magnification of ×400. Results: The frequencies of micronucleated and binucleated cells and cells with perinuclear halos, and the nucleus/cytoplasmic ratio of epithelial cells were higher in the Candida-infected group compared with the control group (p < 0.05). Conclusions: Genital candidiasis is able to induce changes in the size and shape of epithelial cells. The nuclear/cytoplasmic ratio and the frequency of micronuclei may reflect the DNA damage in the cervical epithelium. Micronucleus scoring could be used to screen the genomic damage profile of epithelial cells in candidiasis.
Factors Predicting Survival in ALS Patients - Data from a Population-Based Registry in Rhineland-Palatinate, Germany
Authors: Wolf Joachim , Safer Anton , Wöhrle Johannes C. , Palm Frederick , Nix Wilfred A. , Maschke Matthias , Grau Armin J.
Published: June 2015

Background: The possibility to survive with amyotrophic lateral sclerosis (ALS) varies considerably and survival extends from a few months to several years. A number of demographic and clinical factors predicting survival have been described; however, existing data are conflicting. We intended to predict patient survival in a population-based prospective cohort of ALS patients from variables known up to the time of diagnosis. Methods: Incident ALS patients diagnosed within three consecutive years were enrolled and regularly followed up. Candidate demographic and disease variables were analysed for survival probability using the Kaplan-Meier method. The Cox proportional hazard regression model was used to assess the influence of selected predictor variables on survival prognosis. Results: In the cohort of 193 patients (mean age 65.8, standard deviation 10.2 years), worse prognosis was independently predicted by older age, male gender, bulbar onset, probable or definite ALS according to El Escorial criteria, shorter interval between symptom onset and diagnosis, lower Functional Rating Scale, diagnosis of frontotemporal dementia, and living without a partner. Conclusions: Taking into account these predictor variables, an approximate survival prognosis of individual ALS patients at diagnosis seems feasible.
Canalicular Cyst
Authors: Jakobiec Frederick A. , Stagner Anna M. , Yoon Michael K.
Published: June 2015

Purpose: To report a new entity discovered in the lacrimal drainage system, a congenital canalicular cyst (as opposed to a diverticulum or canaliculops). Methods: Clinical, radiographic, histopathologic and immunohistochemical findings were reviewed. Results: A 49-year-old man developed a left upper eyelid cyst seen by CT scanning to be attached to a small boney spicule. No connection to the lacrimal sac or canaliculus was discovered during surgical excision. Histopathologically, the cyst was lined mostly by canalicular epithelium, expressing a cytokeratin profile similar to that of a normal canaliculus and canaliculops. Conclusion: This case increases ophthalmologists' appreciation of the range of conditions that can affect the lacrimal drainage and canalicular system. The treatment for a diverticulum is marsupialization, whereas that for a canalicular cyst is complete excision.
Determination of the Renal Threshold for Glucose Excretion in Familial Renal Glucosuria
Authors: Aires Inês , Fila Marc , Polidori David , Santos Ana Rita , Costa Ana Brito , Calado Joaquim
Published: June 2015

Background/Aims: Familial Renal Glucosuria (FRG) is characterized by the presence of persistent isolated glucosuria in the absence of hyperglycemia. Mutations in SLC5A2, the gene coding for the sodium-glucose co-transporter 2 (SGLT2), are responsible for FRG. Phenotype/genotype correlations in FRG have mostly relied on the quantification of Urinary Glucose Excretion (UGE), which is dependent on both the filtered glucose load and the renal glucose reabsorptive capacity. In the current work, the renal threshold for glucose excretion (RTG) was determined in an FRG cohort, with the purpose of characterizing the impact of SGLT2 mutations on renal glucose transport. Methods: From January to December of 2013, eight FRG individuals with identified SLC5A2 mutations were enrolled. Patients were given a Mixed-Meal Tolerance Test during which blood glucose and UGE were measured over a 4 h period and the data was used to calculate RTG, according to a recently validated protocol. Results: In patients with homozygous mutations, RTG values were very low, with a mean (SD) of 0.95 (1.17) mmol/l, compared to commonly reported values of approximately 10-11.1 mmol/l in healthy subjects. In subjects with heterozygous mutations, mean (SD) RTG values were 4.91 (1.23) mmol/l, which are approximately one-half of the values in subjects without mutations. Conclusions: In FRG, mutations in SLC5A2 lead to reductions in RTG and increases in UGE. Because determination of RTG is not influenced by the filtered glucose load, the calculated RTG values provide a more refined measure of the impact of mutations on renal glucose transport than can be obtained from UGE alone.
Aim for the Suprasternal Notch: Technical Note to Avoid Bowstringing after Deep Brain Stimulation
Authors: Akram Harith , Limousin Patricia , Hyam Jonathan , Hariz Marwan I. , Zrinzo Ludvic
Published: June 2015

Background: Bowstringing may occur when excessive fibrosis develops around extension cables in the neck after deep brain stimulation (DBS) surgery. Though the occurrence of this phenomenon is rare, we have noted that it tends to cause maximal discomfort when the cables cross superficially over the convexity of the clavicle. We hypothesise that bowstringing may be avoided by directing the extension cables towards the suprasternal notch. Methods: When connecting DBS leads to an infraclavicular pectoral implantable pulse generator (IPG), tunnelling is directed towards the suprasternal notch, before being directed laterally towards the IPG pocket. In previously operated patients with established fibrosis, the fibrous tunnel is opened and excised as far cranially as possible, allowing medial rerouting of cables. Using this approach, we reviewed our series of patients who underwent DBS surgery over 10 years. Results: In 429 patients, 7 patients (2%) with cables tunnelled over the convexity of the clavicle complaining of bowstringing underwent cable exploration and rerouting. This eliminated bowstringing and provided better cosmetic results. When the cable trajectory was initially directed towards the suprasternal notch, no bowstringing was observed. Conclusion: The tunnelling trajectory appears to influence postoperative incidence of fibrosis associated with DBS cables. Modifying the surgical technique may reduce the incidence of this troublesome adverse event.
Interleukin-6 CpG Methylation and Body Weight Correlate Differently in Type 2 Diabetes Patients Compared to Obese and Lean Controls
Authors: Aumueller Eva , Remely Marlene , Baeck Hanna , Hippe Berit , Brath Helmut , Haslberger Alexander G.
Published: June 2015

Background/Aims: Diabetes mellitus type 2 (DMT2) is accompanied by systemic low-grade inflammation with elevated levels of interleukin-6 (IL-6), which is encoded by a gene (IL-6) previously shown to be regulated by DNA methylation. We investigated seven CpG sites in IL-6 in individuals with DMT2, obese individuals and lean controls. Further, the DMT2 group received the glucagon-like peptide 1 agonist liraglutide. Methods: Blood samples were taken at the beginning of the study and after 4 months. The DNA methylation was assessed using pyrosequencing. Results: Methylation levels at the CpG sites -664, -628 and +13 at the first sampling time point (T1) and at -666 and -664 at the second sampling time point (T2) correlated negatively with initial body weight in the DMT2 group. We found positive correlations for the obese and the lean control group. In the obese group, CpG +27 methylation at T1 correlated with initial body weight (r = 0.685; p = 0.014). In the lean group, CpG -664 at T1 (r = 0.874; p = 0.005) and CpG -628 at T2 (r = 0.632; p = 0.050) correlated with initial body weight. Conclusion: These findings are an informative basis for further studies to elucidate epigenetic mechanisms underlying DMT2. Additionally, our results might provide starting points for the development of biomarkers for prevention and therapy strategies.
The Prognostic Value of the Primary Tumor's Nodal Status after Surgery for Colorectal Liver Metastases in the Era of Effective Systemic Therapy
Authors: van der Stok Eric P. , Grünhagen Dirk J. , Alberda Wijnand J. , Reitsma Maxime , Rothbarth Joost , Verhoef Cornelis
Published: June 2015

Background: The nodal status of primary colorectal cancer is of prognostic value for survival after the resection for colorectal liver metastases (CRLM). However, in the past decade, effective adjuvant chemotherapy for lymph node positive primary colon cancer was introduced. This study evaluated the prognostic value of primary lymph node status in patients with resectable metachronous CRLM in the era of effective systemic therapy. Methods: Between January 2000 and December 2011, all consecutive patients undergoing curative liver resection for CRLM were retrospectively analyzed. Overall survival (OS) was analyzed by the localization of the primary tumor (colon vs. rectum) and by lymph node status (positive vs. negative) of the primary tumor. Results: A total of 286 patients with metachronous CRLM's were selected. Five-year OS was similar for colon and rectal primaries (42 and 40%, p = 0.62). Lymph node positivity was only a prognostic factor in rectal primaries (N+ 32% vs. N0 49%, p = 0.04) and not in colon primaries (N+ 42% vs. N0 41%, p = 0.99). In multivariate analysis, these results were confirmed. Conclusion: The current study demonstrates that the nodal status of primary colon malignancies does not have prognostic value in patients undergoing resection for metachronous CRLM. A possible explanation might be the administration of effective adjuvant chemotherapy in node positive colon cancer.
Prognostic Significance of Regional Arterial Stiffness for Stroke in Hypertension
Authors: Kubozono Takuro , Ohishi Mitsuru
Published: June 2015

Background: Hypertension is strongly associated with cardiovascular disease. It has been reported that arterial stiffness is related to cardiovascular mortality and morbidity in hypertensive patients and that the physiological evaluation of arterial stiffness may assist clinicians in the early detection of atherosclerosis. Summary: It has been demonstrated that increased arterial stiffness is an independent predictor of cardiovascular disease, including stroke. Arterial stiffness is associated with structural changes in the brain. However, the stiffness responses of muscular arteries are different from those of elastic arteries, and so the impact of arterial stiffness and the conclusions to be drawn may be different depending on the region in which the measurement is taken. Key Messages: In this review, we summarize the current literature describing the association between arterial stiffness, including carotid-femoral and brachial-ankle pulse wave velocity and cardio-ankle vascular index, and cardiovascular disease, specifically stroke. We discuss the utility and prognostic significance of regional arterial stiffness measurements.
Assessing Hydration in Children: From Science to Practice
Authors: Guelinckx I. , Frémont-Marquis A.S. , Eon E. , Kavouras S.A. , Armstrong L.E.
Published: June 2015

Raising children's awareness about their hydration status could be done through a noninvasive biomarker. Urine color (UC) has been validated as a biomarker of hydration in adults and children aged 8-14 years. The aim of this survey was to design and to evaluate the level of understanding and attractiveness of a self-assessment, UC-based hydration tool for children aged 6-11 years. The first phase of the survey consisted of face-to-face interviews during which 84 children identified those graphical elements necessary to understand the hydration message from 6 illustration-based designs containing the UC chart. The graphic elements selected were the basis to create 3 new designs. During the 2nd phase, the level of understanding and attractiveness of these 3 new designs was then evaluated via an online questionnaire by a total of 1,231 children in 3 countries. The design with the highest level of understanding was totally or partially understood by 76% of the participants, independent of age and gender. The levels of understanding, however, differed in the countries. In Indonesia, the levels of understanding of the 3 designs were comparable; whereas in both France (74%) and Mexico (78%), significantly more participants totally and partially understood one of the 3 designs. The levels of attractiveness of the 3 designs were comparable, independent of country, age, and gender. On average, 80% of all participants liked the 3 designs a bit or a lot. Only 14% did not like the designs, and 5% of participants had no opinion regarding attractiveness. These results indicated that three out of four children like and understand the correct hydration message from a strictly illustration-based tool containing the eight-point UC scale.
Eczema in Early Childhood, Sociodemographic Factors and Lifestyle Habits Are Associated with Food Allergy: A Nested Case-Control Study
Authors: Ben-Shoshan Moshe , Soller Lianne , Harrington Daniel W. , Knoll Megan , La Vieille Sebastian , Fragapane Joseph , Joseph Lawrence , St. Pierre Yvan , Wilson Kathie , Elliott Susan J. , Clarke Ann E.
Published: June 2015

Background: Studies suggest an increase in food allergy prevalence over the last decade, but the contributing factors remain unknown. The aim of this study was to evaluate the association between the most common food allergies and atopic history, sociodemographic characteristics and lifestyle habits. Methods: We conducted a case-control study nested within the SPAACE study (Surveying Prevalence of Food Allergy in All Canadian Environments) - a cross-Canada, random telephone survey. Cases consisted of individuals with probable food allergy (self-report of convincing symptoms and/or physician diagnosis) to milk, egg, peanut, tree nut, shellfish, fish, wheat, soy, or sesame. Controls consisted of nonallergic individuals, matched for age. Cases and controls were queried on personal and family history of atopy, sociodemographic characteristics and lifestyle habits. Multivariate logistic regression was used to evaluate the association between atopy, sociodemographic characteristics and lifestyle habits with probable food allergy. Results: Between September 2010 and September 2011, 480 cases and 4,950 controls completed the questionnaire. For all 9 allergens, factors associated with a higher risk of probable allergy were as follows: (1) personal history of eczema (in the first 2 years of life), asthma or hay fever (odds ratio, OR 2.3, 95% CI 1.6-3.5; OR 2.8, 95% CI 2.2-3.6, and OR 2.3, 95% CI 1.8-3.0, respectively), (2) maternal, paternal or sibling's food allergy (OR 3.7, 95% CI 2.5-5.6; OR 3.0, 95% CI 1.8-5.1, and OR 3.1, 95% CI 2.2-4.2), (3) high household income (top 20%; OR 1.5, 95% CI 1.2-2.0). Males and older individuals were less likely to have food allergy (OR 0.7, 95% CI 0.6-0.9, and OR 0.99, 95% CI 0.99-1.00). Eczema in the first 2 years of life was the strongest risk factor for egg, peanut, tree nut and fish allergy. Conclusions: This is the largest population-based nested case-control study exploring factors associated with food allergies. Our results reveal that, in addition to previously reported factors, eczema in the first 2 years of life is consistently associated with food allergies.
Neuroimaging Findings in Cardiac Myxoma Patients: A Single-Center Case Series of 47 Patients
Authors: Brinjikji Waleed , Morris Jonathan M. , Brown Robert D. , Thielen Kent R. , Wald John T. , Giannini Caterina , Cloft Harry J. , Wood Christopher P.
Published: June 2015

Background and Purpose: Cardiac myxomas can present with a myriad of neurological complications including stroke, cerebral aneurysm formation and metastatic disease. Our study had two objectives: (1) to describe the neuroimaging findings of patients with cardiac myxomas and (2) to examine the relationship between a history of embolic complications secondary to myxoma and intracranial aneurysm formation, hemorrhage and metastatic disease. We hypothesized that patients who present with embolic complications related to myxoma would be more likely to have such complications. Materials and Methods: We searched our institutional database for all patients with pathologically proven cardiac myxomas from 1995 to 2014 who received neuroimaging. Neuroimaging findings were categorized as acute ischemic stroke, intracerebral hemorrhage, oncotic aneurysm, and cerebral metastasis. Cardiac myxoma patients were divided into those presenting with embolic complications (i.e. lower extremity emboli or cerebral emboli) and those presenting with non-embolic complications prior to surgical resection of the myxoma. The prevalence of intracranial hemorrhage, myxomatous aneurysm formation, and cerebral metastases was compared in myxoma patients presenting with and without embolic complications using a Chi-squared test. Results: Forty-seven consecutive patients were included in this study. Sixteen patients (34.0%) had imaging evidence of acute ischemic stroke. Of these, 13 had acute ischemic strokes directly attributed to the cardiac myxoma (27.7%) and 3 had acute ischemic strokes secondary to causes other than myxoma (6.4%). Seven patients (14.9%) had aneurysms. Two patients (4.3%) had parenchymal metastatic disease on long-term imaging. Fourteen patients (29.8%) presented with ischemic symptoms that were attributed to cardiac myxoma (1 with lower extremity ischemia, 1 with lower extremity ischemia and ischemic stroke, and 12 with ischemic stroke). Patients presenting with embolic complications related to the myxoma (ischemic stroke or lower extremity ischemia) were more likely to have imaging evidence of intracranial hemorrhage (21.4 vs. 3.0%, p = 0.09), oncotic aneurysm (35.7 vs. 6.1%, p = 0.03), and cerebral metastasis (14.3 vs. 0.0%, p = 0.07) on follow-up imaging. Conclusions: Ischemic stroke and intracranial oncotic aneurysm were found in a substantial proportion of cardiac myxoma patients undergoing neuroimaging. Patients presenting with embolic complications of cardiac myxoma are more likely to have intracranial hemorrhage, intracranial oncotic aneurysms, and cerebral metastatic disease.
Adult-Onset Acquired Partial Lipodystrophy Accompanied by Rheumatoid Arthritis
Authors: Muto Yusuke , Fujimura Taku , Kakizaki Aya , Tsuchiyama Kenichiro , Kusakari Yoshiyuki , Aiba Setsuya
Published: June 2015

Lipodystrophy is a group of metabolic disorders, possibly caused by autoimmune disease. In this report, we describe a case of adult-onset acquired partial lipodystrophy accompanied by rheumatoid arthritis without a family history. Interestingly, immunohistochemical staining revealed dense infiltration of IL-27-producing cells as well as MMP-7- and MMP-28-expressing cells, both of which have been reported to facilitate the development of autoimmune disease. Our present case might suggest possible mechanisms for acquired partial lipodystrophy.
Can Sputum Eosinophilia Be a Constant Feature in Severe Refractory Asthmatics? A 3-Year Longitudinal Study
Authors: Dente Federico L. , Latorre Manuela , Novelli Federica , Cianchetti Silvana , Bartoli Maria Laura , Bacci Elena , Di Franco Antonella , Vagaggini Barbara , Celi Alessandro , Paggiaro Pierluigi
Published: June 2015

In difficult-to-treat asthmatics, uncontrolled despite a high level of therapy and followed for 3 years with a mean number of sputum samples/patient = 10, sputum eosinophilia (≥3%) was observed in 87% of all sputum samples. Persistent sputum eosinophilia is a characteristic of severe uncontrolled asthma.
Thrombolysis for Acute Minor Stroke: Outcome and Barriers to Management
Authors: Laurencin Chloé , Philippeau Frédéric , Blanc-Lasserre Karine , Vallet Anne-Evelyne , Cakmak Serkan , Mechtouff Laura , Cho Tae-Hee , Ritzenthaler Thomas , Flocard Elodie , Bischoff Magali , El Khoury Carlos , Nighoghossian Norbert , Derex Laurent
Published: June 2015

Background: We evaluated the management, outcome and haemorrhagic risk in a cohort of ischaemic stroke patients with mild symptoms treated with intravenous tissue plasminogen activator (tPA) within the first 4.5 h. Methods: We analysed data from a prospective stroke thrombolysis registry. A total of 1,043 patients received tPA between 2010 and 2014 in the 5 stroke units of the RESUVAL stroke network (Rhône Valley, France). Among them, 170 patients had a National Institute of Health Stroke Scale (NIHSS) score ≤4 (minor group: MG) before tPA and 873 patients had a NIHSS score >4. Results: A high rate (77%) of excellent outcome (3-month-modified Rankin Scale score ≤1) was observed in the MG. No symptomatic intracerebral haemorrhage occurred and the rate of any haemorrhagic transformation was 5%. Fifty-four percent of the MG patients had visible arterial occlusion before tPA. Patients of the MG were less likely to be transported by Emergency Medical Services and to be directly admitted to the stroke unit or to imaging. Median delays from onset to admission, from admission to imaging and from onset to tPA were longer in the MG. Conclusion: Our data provided evidence of safety and suggested potential benefit of thrombolysis in patients with NIHSS score ≤4. A majority of these patients exhibited arterial occlusion before thrombolysis. Most often, patients with mild stroke are not given priority in terms of the mode of transport, direct admission to stroke unit and rapid imaging, resulting in an increased delay from onset to thrombolysis. Health system improvements are needed to provide all suspected stroke victims equal access to imaging and treatment on an emergency basis.
A Systematic Review and Analysis of Factors Associated with Methodological Quality in Laparoscopic Randomized Controlled Trials
Authors: Antoniou Stavros Athanasios , Andreou Alexandros , Antoniou George Athanasios , Bertsias Antonios , Köhler Gernot , Koch Oliver Owen , Pointner Rudolph , Granderath Frank-Alexander
Published: June 2015

Several methods for assessment of methodological quality in randomized controlled trials (RCTs) have been developed during the past few years. Factors associated with quality in laparoscopic surgery have not been defined till date. The aim of this study was to investigate the relationship between bibliometric and the methodological quality of laparoscopic RCTs. The PubMed search engine was queried to identify RCTs on minimally invasive surgery published in 2012 in the 10 highest impact factor surgery journals and the 5 highest impact factor laparoscopic journals. Eligible studies were blindly assessed by two independent investigators using the Scottish Intercollegiate Guidelines Network (SIGN) tool for RCTs. Univariate and multivariate analyses were performed to identify potential associations with methodological quality. A total of 114 relevant RCTs were identified. More than half of the trials were of high or acceptable quality. Half of the reports provided information on comparative demographic data and only 21% performed intention-to-treat analysis. RCTs with sample size of at least 60 patients presented higher methodological quality (p = 0.025). Upon multiple regression, reporting on preoperative care and the experience level of surgeons were independent factors of quality.
Phylogenetic Characterization of a Novel Insect-Specific Flavivirus Detected in a Culex Pool, Collected from Assam, India
Authors: Datta Sibnarayan , Gopalakrishnan Reji , Chatterjee Soumya , Veer Vijay
Published: June 2015

Objective: We report the phylogenetic characterization of a unique flavivirus sequence detected in a wild Culex tritaeniorhynchus mosquito pool, collected from the northeast Indian state of Assam. Methods: DNA and RNA were extracted from field-collected mosquito pools. Extracts were subjected to PCR and reverse transcriptase PCR amplification using universal and type-specific primers for direct detection of flavivirus-specific viral nucleic acids. An amplified flavivirus nonstructural protein 5 (NS5) genetic region was sequenced and BLAST searched, and phylogenetic analyses performed with reference sequences retrieved from GenBank. Results: Phylogenetic analyses revealed the sequence to be related to insect-specific flaviviruses (ISFs) of the genus Flavivirus, family Flaviviridae. Despite being related to the Palm Creek virus (PCV; an ISF very recently reported from Northern Australia), the present sequence (provisionally named Assam virus) was found to be highly divergent from PCV and other ISF sequences available in GenBank. The partial NS5 sequence analysis demonstrated low nucleotide sequence identity (66-77%) with known ISFs reported from other parts of the globe. Conclusion: Findings of this study suggest the presence of a candidate novel ISF - the first to be reported from India.
Arterial Stiffening and Clinical Outcomes in Dialysis Patients
Authors: Kato Akihiko
Published: June 2015

Cardiovascular disease (CVD) is an important cause of morbidity and mortality in dialysis patients. Brachial-ankle pulse wave velocity (baPWV) is more efficient to handily assess arteriosclerosis than aortic PWV. The cardio-ankle vascular index (CAVI) is also a novel blood pressure-independent arterial stiffness parameter. In dialysis patients, both baPWV and CAVI are increased compared to general subjects. Several studies have demonstrated that increased baPWV is associated with carotid atherosclerosis and diastolic left ventricular dysfunction in hemodialysis (HD) patients. In addition, higher baPWV is related to all-cause and cardiovascular (CV) mortality. CAVI is similarly associated with CVD. However, baPWV is superior to CAVI as a predictor of CV outcomes in HD patients. Besides these outcomes, a close relationship exists between sarcopenia, abdominal visceral obesity and arterial stiffening. Reduction of thigh muscle mass is inversely correlated with baPWV and CAVI in males. Abdominal fatness is also associated with increased arterial stiffness in females. These observations provide further evidence of higher risk of CV events in HD patients with sarcopenic obesity. In addition, arterial stiffness is associated with cerebral small vessel disease and decreased cognitive function in the elderly. However, it is unknown whether arterial stiffness may be useful as an early indicator of cognitive decline in dialysis patients. Because dialysis patients are at risk of developing dementia, more studies are needed to elucidate the causal link between arterial stiffness and cognitive impairment.
A Fulminant Case of Granulomatosis with Polyangiitis with Meningeal and Parenchymal Involvement
Authors: Yajima Ryuji , Toyoshima Yasuko , Wada Yoko , Takahashi Tetsuya , Arakawa Hiroyuki , Ito Gaku , Kobayashi Daisuke , Yamada Mitsunori , Kawachi Izumi , Narita Ichiei , Takahashi Hitoshi , Nishizawa Masatoyo
Published: June 2015

Central nervous system (CNS) involvement, such as pachymeningitis and/or cerebrovascular events, is rare in patients with granulomatosis with polyangiitis (GPA). Furthermore, the details of pathological examinations of cases have rarely been described. We describe a case of GPA that manifested as an isolated paranasal sinus disease that invaded the subarachnoid space and caused a hemorrhagic venous infarction. We also describe the pathological characteristics of the biopsied brain material from the successful decompressive craniectomy. In particular, granulomatous inflammation with geographic necrosis and multinucleated giant cells were observed in the perivascular area of the thickened dura mater and leptomeninges. Small vessels in the meninges were involved in the granulomatous lesions, and the lumens of the veins were often occluded. In the cerebral cortices and white matter in these areas, hemorrhagic infarction was widely observed. We suggest that our findings represent a novel mechanism of CNS involvement in GPA. Moreover, we believe that the emergency decompressive craniectomy and partial lobectomy for the cerebral infarction in this patient with GPA likely contributed to his survival.
Pilocytic Astrocytoma Presenting as an Orbital Encephalocele: A Case Report
Authors: Bruzek Amy , Shepherd Daniel , Van Gompel Jamie , Jentoft Mark
Published: June 2015

We describe the case of a 29-year-old male who presented with new-onset seizures. He was subsequently found to have an orbital encephalocele containing a focus of pilocytic astrocytoma. We believe that this is the first report of a pilocytic astrocytoma located within the orbit that did not originate from the optic pathway. It is also the first case of a pilocytic astrocytoma completely contained within an encephalocele. This case suggests a close pathological examination of encephaloceles for underlying diseases.
Association of Serum Lipids with Outcomes in Hispanic Hemodialysis Patients of the West versus East Coasts of the United States
Authors: Moradi Hamid , Abhari Pouya , Streja Elani , Kashyap Moti L. , Shah Gaurang , Gillen Daniel , Pahl Madeleine V. , Vaziri Nosratola D. , Kalantar-Zadeh Kamyar
Published: June 2015

Background: Paradoxical associations exist between serum lipid levels and mortality in patients on maintenance hemodialysis (MHD) including those of Hispanic origin. However, there are significant racial and ethnic variations in patients of ‘Hispanic' background. We hypothesized that clinically meaningful differences existed in the association between lipids and survival in Hispanic MHD patients on the West versus East Coast. Methods: We examined the survival impact of serum lipids in a 2-year cohort of 15,109 MHD patients of Hispanic origin being treated in California, Texas, representing the West versus New York, New Jersey and Florida representing the East Coast, using Cox models with various degrees of adjustments. Results: The association of serum total and HDL cholesterol with mortality follows a U-shaped pattern in Hispanic patients residing in the West. This is in contrast to Hispanic patients in the East Coast whose survival seems to improve with increasing total and HDL cholesterol levels. Elevated serum LDL levels in Hispanic patients on the West Coast are associated with a significant increase in mortality, while this association is not observed in patients residing on the East Coast. Conclusions: Substantial differences exist in the association of serum lipids with mortality in MHD patients of Hispanic background depending on whether they reside on the West or East Coast of the United States. These geographical variances most likely reflect ethnic, racial and genetic distinctions, which are usually ignored. Future studies should take into account these critical variations in a population of patients who make up a significant portion of our society.
The Relationship between Positive Peritoneal Cytology and the Prognosis of Patients with Uterine Cervical Cancer
Authors: Kurita Tomoko , Matsuura Yusuke , Koi Chiho , Kagami Seiji , Kawagoe Toshinori , Hachisuga Toru
Published: June 2015

Objective: We investigated the association of positive peritoneal cytology with prognosis in uterine cervical cancer. Study Design: We reviewed the medical records and cytologic materials of 225 Japanese patients with FIGO IB1-IVB uterine cervical cancer who had undergone surgery at our University Hospital between 1993 and 2012. Univariate and multivariate regression analyses were performed for statistical analysis. Results: Positive peritoneal cytology was noted in 6 of 225 patients (2.7%). Positive peritoneal cytology was found in 4 of 149 patients (2.6%) with squamous cell carcinoma (SCC) and in 2 of 70 patients (2.8%) with non-SCC (p = 0.9434). The 5-year survival rate of patients with positive peritoneal cytology was significantly lower than that of patients with negative cytology (50 vs. 84.6%, p = 0.001) in univariate survival analysis. However, peritoneal cytology no longer remained significant in multivariate analysis. Conclusion: Although we conclude that positive peritoneal cytology in uterine cervical cancer is a poor prognostic factor, further investigation and multi-institutional studies are necessary.
Early Squamous Cell Carcinoma of the Anal Canal Resected by Endoscopic Submucosal Dissection
Authors: Tamaru Yuzuru , Oka Shiro , Tanaka Shinji , Ninomiya Yuki , Asayama Naoki , Shigita Kenjiro , Nishiyama Soki , Hayashi Nana , Arihiro Koji , Chayama Kazuaki
Published: June 2015

The standard treatment approach for squamous cell carcinoma (SCC) of the anal canal includes abdominoperineal resection and chemoradiotherapy. However, there are currently very few reports of early SCC of the anal canal resected by endoscopic submucosal dissection (ESD). We report 2 rare cases of SCC of the anal canal resected by ESD. In case 1, a 66-year-old woman underwent a colonoscopy due to blood in her stool, and an elevated lesion, 15 mm in size, was identified from the rectum to the dentate line of the anal canal on internal hemorrhoids. The lesion was diagnosed as an early SCC of the anal canal, and ESD was successfully performed. The histopathological diagnosis was SCC in situ. In case 2, a 71-year-old woman underwent a colonoscopy due to constipation, and an elevated lesion, 25 mm in size, was identified from the dentate line to the anal canal. The lesion was diagnosed as early-stage SCC of the anal canal, and ESD was successfully performed. The histopathological diagnosis was SCC in situ. No complications or recurrence after ESD occurred in either case.
A Case of Renal Primitive Neuroectodermal Tumor Confirmed by Fluorescence in situ Hybridization
Authors: Etani Toshiki , Naiki Taku , Ando Ryosuke , Iida Keitaro , Naiki-Ito Aya , Takahashi Satoru , Kobayashi Daichi , Kawai Noriyasu , Tozawa Keiichi , Yasui Takahiro , Kohri Kenjiro
Published: June 2015

Primitive neuroectodermal tumor (PNET) is a member of the Ewing's sarcoma family of tumors (ESFT). We report a case of PNET in a 66-year-old male who presented with a large solid tumor within the parenchyma of the middle pole of the left kidney with metastases to the left adrenal gland and right ischium. A fine-needle biopsy was performed and showed a small round cell tumor. Results of immunohistochemical staining suggested this tumor belonged to ESFT. Preoperative VDC-IE (combined vincristine, doxorubicin and cyclophosphamide followed by another combination of ifosfamide and etoposide) chemotherapy and left radical nephrectomy and adrenalectomy were performed. The histopathological findings of the resected tumor were similar to those in the biopsy specimen, but the results of AE1/AE3 were different. For the diagnosis, fluorescence in situ hybridization was performed. Split signals of the EWSR1 gene were detected, and transmission electron microscopy showed neuroendocrine granules and microtubules. The final diagnosis of this tumor was PNET of the kidney.
Successful Treatment with S-1 and Oxaliplatin Combination Therapy in an Elderly Patient with Metastatic Colorectal Cancer Initially Presenting with Membranous Nephropathy
Authors: Matsunaga Mototsugu , Miwa Keisuke , Oka Yosuke , Ushijima Tomoyuki , Yuge Kotaro , Fukahori Masaru , Katagiri Mitsuhiro , Akagi Yoshito
Published: June 2015

The incidence, morbidity, and mortality of colorectal cancer are increasing, largely owing to an increasingly aging population. Additionally, along with the increasing age of cancer patients, the number of patients with various comorbidities such as membranous nephropathy is also rising, and problems associated with the administration of chemotherapy to elderly patients with these conditions are becoming more common. Herein, we describe a case involving an 80-year-old woman who presented with general malaise, edematous limbs, and pleural effusion. An abdominal CT revealed multiple, relatively large, metastatic lesions in a wide area of the liver and left pleural effusion, and she was accordingly diagnosed with membranous nephropathy secondary to ascending colon cancer and multiple liver metastases. Despite her advanced age and the presence of membranous nephropathy, her general condition was favorable and chemotherapy was hence administered. Taking the toxicity profiles and the patient's preference into consideration, S-1 and oxaliplatin (SOX) therapy was selected, which showed a good tolerability. An abdominal CT after 8 cycles of SOX therapy revealed a marked reduction in the metastatic lesions in the liver and a decrease in the left pleural effusion, and the levels of tumor markers also decreased (partial response). At the latest follow-up, after the completion of 16 cycles, the condition of the patient remained stable, without any apparent signs of progressive disease. Based on this case, we conclude that, even for elderly patients with systemic complications or comorbid diseases, standard treatments should be considered after their general conditions, and therapeutic regimens have been sufficiently examined.
Evaluation of Angiogenesis in Early Mycosis Fungoides Patients: Dermoscopic and Immunohistochemical Study
Authors: Bosseila Manal , Sayed Sayed Khadiga , El-Din Sayed Safinaz Salah , Abd El Monaem Noha Ali
Published: June 2015

Background: Angiogenesis is the production of new blood vessels from an existing vascular network; it plays a critical role in solid tumor development and metastasis. Objectives: To assess angiogenesis in early cases of mycosis fungoides (MF) and to determine vascular patterns in MF dermoscopically. Methods: 25 patients with MF and 20 healthy controls were included. The MF lesions were assessed dermoscopically. CD34 immunohistochemistry was performed to count dermal microvessel density (MVD). Results: The total dermal MVD was significantly higher in MF patients (19.77 ± 5.81) than in controls (4.44 ± 3.16; p = 0.013). Among them, there were 10.8 ± 4.1 sprouts of endothelial buds (clusters of cells per field) in patients and 2.4 ± 2 in controls (p = 0.000). The dotted pattern of blood vessels was the most frequently encountered pattern in the MF lesions by dermoscopy. Conclusions: Our findings support that neoangiogenesis is significantly increased in early MF lesions and that the main dermoscopic feature of MF is dotted blood vessels.