bluuebunny/crossref_metadata_2025 huggingface dataset:
Brazilian Amazon Traditional Medicine and the Treatment of Difficult to Heal Leishmaniasis Wounds with Copaifera
Authors: Albuquerque Kelly Cristina Oliveira de , Veiga Andreza do Socorro Silva da , Silva João Victor da Silva e , Brigido Heliton Patrick Cordovil , Ferreira Erica Patrícia dos Reis , Costa Erica Vanessa Souza , Marinho Andrey Moacir do Rosário , Percário Sandro , Dolabela Maria Fâni
Published: January 2017

The present study describes the use of the traditional species Copaifera for treating wounds, such as ulcers scarring and antileishmanial wounds. It also relates phytochemical studies, evaluation of the leishmanicidal activity, and toxicity. The species of Copaifera with a higher incidence in the Amazon region are Copaifera officinalis, Copaifera reticulata, Copaifera multijuga Hayne. The copaiba oil is used in the Amazon’s traditional medicine, especially as anti‐inflammatory ingredient, in ulcers healing, and in scarring and for leishmaniasis. Chemical studies have shown that these oils contain diterpenes and sesquiterpenes. The copaiba oil and terpenes isolated have antiparasitic activity, more promising in the amastigote form of L. amazonensis. This activity is probably related to changes in the cell membrane and mitochondria. The oil showed low cytotoxicity and genotoxicity. Furthermore, it may interfere with immune response to infection and also has a healing effect. In summary, the copaiba oil is promising as leishmanicidal agent.
Texture Analysis of Abnormal Cell Images for Predicting the Continuum of Colorectal Cancer
Authors: Chaddad Ahmad , Tanougast Camel
Published: January 2017

Abnormal cell (ABC) is a markedly heterogeneous tissue area and can be categorized into three main types: benign hyperplasia (BH), carcinoma (Ca), and intraepithelial neoplasia (IN) or precursor cancerous lesion. In this study, the goal is to determine and characterize the continuum of colorectal cancer by using a 3D-texture approach. ABC was segmented in preprocessing step using an active contour segmentation technique. Cell types were analyzed based on textural features extracted from the gray level cooccurrence matrices (GLCMs). Significant texture features were selected using an analysis of variance (ANOVA) of ABC with a p value cutoff of p<0.01. Features selected were reduced with a principal component analysis (PCA), which accounted for 97% of the cumulative variance from significant features. The simulation results identified 158 significant features based on ANOVA from a total of 624 texture features extracted from GLCMs. Performance metrics of ABC discrimination based on significant texture features showed 92.59% classification accuracy, 100% sensitivity, and 94.44% specificity. These findings suggest that texture features extracted from GLCMs are sensitive enough to discriminate between the ABC types and offer the opportunity to predict cell characteristics of colorectal cancer.
ROS‐Dependent Activation of Autophagy through the PI3K/Akt/mTOR Pathway Is Induced by Hydroxysafflor Yellow A‐Sonodynamic Therapy in THP‐1 Macrophages
Authors: Jiang Yueqing , Kou Jiayuan , Han Xiaobo , Li Xuesong , Zhong Zhaoyu , Liu Zhongni , Zheng Yinghong , Tian Ye , Yang Liming
Published: January 2017

Monocyte‐derived macrophages participate in infaust inflammatory responses by secreting various types of proinflammatory factors, resulting in further inflammatory reactions in atherosclerotic plaques. Autophagy plays an important role in inhibiting inflammation; thus, increasing autophagy may be a therapeutic strategy for atherosclerosis. In the present study, hydroxysafflor yellow A‐mediated sonodynamic therapy was used to induce autophagy and inhibit inflammation in THP‐1 macrophages. Following hydroxysafflor yellow A‐mediated sonodynamic therapy, autophagy was induced as shown by the conversion of LC3‐II/LC3‐I, increased expression of beclin 1, degradation of p62, and the formation of autophagic vacuoles. In addition, inflammatory factors were inhibited. These effects were blocked by Atg5 siRNA, the autophagy inhibitor 3‐methyladenine, and the reactive oxygen species scavenger N‐acetyl cysteine. Moreover, AKT phosphorylation at Ser473 and mTOR phosphorylation at Ser2448 decreased significantly after HSYA‐SDT. These effects were inhibited by the PI3K inhibitor LY294002, the AKT inhibitor triciribine, the mTOR inhibitor rapamycin, mTOR siRNA, and N‐acetyl cysteine. Our results demonstrate that HSYA‐SDT induces an autophagic response via the PI3K/Akt/mTOR signaling pathway and inhibits inflammation by reactive oxygen species in THP‐1 macrophages.
Macrophage Migration Inhibitory Factor as an Emerging Drug Target to Regulate Antioxidant Response Element System
Authors: Yukitake Hiroshi , Takizawa Masayuki , Kimura Haruhide
Published: January 2017

Oxidative stress is involved in pathophysiology and pathological conditions of numerous human diseases. Thus, understanding the mechanisms underlying the redox homeostasis in cells and organs is valuable for discovery of therapeutic drugs for oxidative stress‐related diseases. Recently, by applying chemical biology approach with an ARE activator, BTZO‐1, we found macrophage migration inhibitory factor (MIF) as a new regulator of antioxidant response element‐ (ARE‐) mediated gene transcription. BTZO‐1 and its active derivatives bound to MIF and protected cells and organs from oxidative insults via ARE activation in animal models with oxidative stress such as ischemia/reperfusion injury, inflammatory bowel diseases, and septic shock. In this review, we briefly highlight key findings in understanding the MIF‐ARE system.
Effects of Father-Neonate Skin-to-Skin Contact on Attachment: A Randomized Controlled Trial
Authors: Chen Er-Mei , Gau Meei-Ling , Liu Chieh-Yu , Lee Tzu-Ying
Published: January 2017

This study examines how skin-to-skin contact between father and newborn affects the attachment relationship. A randomized controlled trial was conducted at a regional teaching hospital and a maternity clinic in northern Taiwan. The study recruited 83 first-time fathers aged 20 years or older. By block randomization, participants were allocated to an experimental (n=41) or a control (n=42) group. With the exception of skin-to-skin contact (SSC), participants from each group received the same standard care. Both groups also received anEarly Childcare for Fathersnursing pamphlet. During the first three days postpartum, the intervention group members were provided a daily SSC intervention with their respective infants. Each intervention session lasted at least 15 minutes in length. The outcome measure was the Father-Child Attachment Scale (FCAS). After adjusting for demographic data, the changes to the mean FCAS were found to be significantly higher in the intervention group than in the control group. We recommend that nurses and midwives use instructional leaflets and demonstrations during postpartum hospitalization, encouraging new fathers to take an active role in caring for their newborn in order to enhance father-neonate interactions and establish parental confidence. This trial is registered with clinical trial registration numberNCT02886767.
Cystic Echinococcosis: A Case of Extrahepatic Intra-Abdominal Involvement
Authors: Leitão Patrícia , Carvalho André , Fernandes Teresa , Gonçalves José
Published: January 2017

Hydatid disease, or echinococcal disease, is a parasitic infestation caused by the larval stage of the Echinococcus tapeworm and it primarily affects the liver and lung but involvement of other organs is also possible secondary to peritoneal seeding or hematogeneous dissemination. We describe a rare case of extensive abdominal disease, with lesions affecting the liver, peritoneum, and lesser omentum, requiring aggressive surgical intervention. Complementary diagnostic exams were crucial to reach the diagnosis and evaluate the extension of the disease.
Evolution of Cooperation through Power Law Distributed Conflicts
Authors: Kim Pilwon
Published: January 2017

At an individual level, cooperation can be seen as a behaviour that uses personal resource to support others or the groups which one belongs to. In a conflict between two individuals, a selfish person gains an advantage over a cooperative opponent, while in a group-group conflict the group with more cooperators wins. In this work, we develop a population model with continual conflicts at various scales and show cooperation can be sustained even when interpersonal conflicts dominate, as long as the conflict size follows a power law. The power law assumption has been met in several observations from real-world conflicts. Specifically if the population is structured on a scale-free network, both the power law distribution of conflicts and the survival of cooperation can be naturally induced without assuming a homogeneous population or frequent relocation of members. On the scale-free network, even when most people become selfish from continual person-person conflicts, people on the hubs tend to remain unselfish and play a role as “repositories” of cooperation.
Comparative RNA-Sequence Transcriptome Analysis of Phenolic Acid Metabolism in Salvia miltiorrhiza, a Traditional Chinese Medicine Model Plant
Authors: Song Zhenqiao , Guo Linlin , Liu Tian , Lin Caicai , Wang Jianhua , Li Xingfeng
Published: January 2017

Salvia miltiorrhiza Bunge is an important traditional Chinese medicine (TCM). In this study, two S. miltiorrhiza genotypes (BH18 and ZH23) with different phenolic acid concentrations were used for de novo RNA sequencing (RNA-seq). A total of 170,787 transcripts and 56,216 unigenes were obtained. There were 670 differentially expressed genes (DEGs) identified between BH18 and ZH23, 250 of which were upregulated in ZH23, with genes involved in the phenylpropanoid biosynthesis pathway being the most upregulated genes. Nine genes involved in the lignin biosynthesis pathway were upregulated in BH18 and thus result in higher lignin content in BH18. However, expression profiles of most genes involved in the core common upstream phenylpropanoid biosynthesis pathway were higher in ZH23 than that in BH18. These results indicated that genes involved in the core common upstream phenylpropanoid biosynthesis pathway might play an important role in downstream secondary metabolism and demonstrated that lignin biosynthesis was a putative partially competing pathway with phenolic acid biosynthesis. The results of this study expanded our understanding of the regulation of phenolic acid biosynthesis in S. miltiorrhiza.
Bovine Serum Albumin-Glutaraldehyde Sealed Fish-Mouth Closure of the Pancreatic Remnant during Distal Pancreatectomy
Authors: Klein Fritz , Sauer Igor Maximilian , Pratschke Johann , Bahra Marcus
Published: January 2017

Introduction. Postoperative pancreatic fistula formation remains the major complication after distal pancreatectomy. At our institution, we have recently developed a novel bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure technique of the pancreatic remnant during distal pancreatectomy. The aim of this study was to analyze the impact of this approach with regard to technical feasibility and overall postoperative outcome. Patients and Methods. 32 patients who underwent a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant during distal pancreatectomy between 2012 and 2014 at our institution were analyzed for clinically relevant postoperative pancreatic fistula formation (Grades B and C according to ISGPF definition) and overall postoperative morbidity. Results. Three out of 32 patients (9.4%) developed Grade B pancreatic fistula, which could be treated conservatively. No Grade C pancreatic fistulas were observed. Postpancreatectomy hemorrhage occurred in 1 patient (3.1%). Overall postoperative complications > Clavien II were observed in 5 patients (15.6%). There was no postoperative mortality. Conclusion. The performance of a bovine serum albumin-glutaraldehyde sealed hand sutured fish-mouth closure of the pancreatic remnant was shown to be technically feasible and may lead to a significant decrease of postoperative pancreatic fistula formation after distal pancreatectomy.
Evaluation of Plasmatic Kisspetin-10 as a Biomarker for Malignancy and Subtype Differentiation in Small Renal Tumours
Authors: Horstmann Marcus , Krause Felix , Steinbach Daniel , Twelker Lars , Grimm Marc-Oliver
Published: January 2017

Objective: To evaluate Kisspeptin-10 (Kiss-10) in patients with small renal tumours (SRTs) and controls. Material and Methods: Kiss-10 was measured in preoperative plasma samples in a cohort of 143 patients with unilateral renal tumours smaller than or equal to 4 cm and 40 age-matched controls by a competitive ELISA test kit. The cohort of patients included 56 patients with clear cell renal cell carcinoma (ccRCC), 43 with papillary RCC (pRCC), 12 with chromophobe RCC (chRCC) and 32 with oncocytomas. Results: Kiss-10 was detected in all patients and controls. SRT patients revealed significantly higher Kiss-10 levels than controls (mean value 10.04 vs. 6.37 pmol/l, p < 0.001). In SRT patients, Kiss-10 was detected at significantly different concentrations between the subgroups (p = 0.021). The highest concentration was observed in those with oncocytomas (11.50 pmol/) followed by chRCC, pRCC and ccRCC patients (9.89, 10.01 and 9.25 pmol/l, respectively). Receiver operating characteristic curve analyses revealed an area under the curve (AUC) of 0.82 for the comparison of all tumours vs. controls (p < 0.001) and an AUC of 0.671 for all malignant tumours vs. oncoytomas (p = 0.003). Conclusion: This study shows that Kiss-10 levels are significantly altered by malignancy and tumour subtypes even in patients with SRTs. Kiss-10 therefore deserves further attention as a plasmatic biomarker for renal tumours.
A Single Oral Dose of Geranylgeranylacetone Upregulates Vascular Endothelial Growth Factor and Protects against Kainic Acid-Induced Neuronal Cell Death: Involvement of the Phosphatidylinositol-3 Kinase/Akt Pathway
Authors: Kawasaki Yukari , Fujiki Minoru , Uchida Susumu , Morishige Masaki , Momii Yasutomo , Ishii Keisuke
Published: January 2017

Background: Previous studies demonstrated the cytoprotective effect of geranylgeranylacetone (GGA), a heat shock protein inducer, against ischemic insult or kainic acid (KA)-induced neuronal cell death. Phosphatidylinositol-3 kinase (PI3K)/Akt is thought to be an important factor that mediates neuroprotection. However, the signaling pathways in the brain in vivo after oral GGA administration remain unclear. Methods: We measured and compared hippocampal neuron density to investigate the effect of GGA on KA-induced cell death in rats. We evaluated the effects of pretreatment with wortmannin (Wort), a specific PI3K inhibitor, on GGA-induced neuroprotection against KA-induced cell death. To clarify the relationship between PI3K/Akt activation and neuroprotection, we used immunoblot analysis to determine the amounts of p-Akt and vascular endothelial growth factor (VEGF) proteins present after GGA administration with or without Wort treatment. Results: Neuroprotective effects of GGA (pretreatment with a single oral dose of GGA, 800 mg/kg, 48 h before KA injection) were prevented by Wort pretreatment, which indicates that the selective PI3K/Akt pathway may mediate the GGA-dependent protection. Oral GGA-induced p-Akt and VEGF, and GGA pretreatment enhanced KA-induced VEGF, both of which were prevented by Wort pretreatment. Conclusion: These results suggest that a single oral dose of GGA induces p-Akt and that GGA plays an important role in neuroprotection against KA-induced neuronal cell death through VEGF induction.
Binding versus Conventional Pancreaticojejunostomy in Preventing Postoperative Pancreatic Fistula: A Systematic Review and Meta-Analysis
Authors: Zhang Xianbin , Dong Xin , Liu Peng , Yan Yumei , Wei Yushan , Zechner Dietmar , Gong Peng , Vollmar Brigitte
Published: January 2017

Background: The aim of this study was to compare the safety and efficacy of a new technology, binding pancreaticojejunostomy (BPJ), with conventional pancreaticojejunostomy (CPJ) after pancreaticoduodenectomy in preventing postoperative pancreatic fistula (POPF). Methods: Randomized controlled trials and observational studies were retrieved from literature searches. Pooled OR with 95% CI for dichotomous variables and weighted mean difference with 95% CI for continuous variables were calculated. Fixed-effect and random-effect models as well as subgroup analysis were used for sensitivity analysis. Results: No statistically significant differences were found in the incidence of POPF, delayed gastric emptying, postpancreatectomy hemorrhage, reoperation, morbidity, mortality, operation time, intraoperative blood loss, blood transfusion, and hospital stay between 2 groups. However, the total costs of hospitalization and ordinary stay were higher in BPJ group (€10,513 ± €6,536 vs. €8,238 ± €4,687, p = 0.002; €7,946 ± €5,023 vs. €5,700 ± €2,902, p = 0.015, respectively). Conclusions: Our study showed BPJ was as safe as CPJ. However, no significant superiority was found in BPJ group regarding the incidence of POPF. The total costs of hospital stay were higher for patients undergoing BPJ. Surgeons can prefer to perform the digestive tract reconstruction of their choice.
Advanced Neuroimaging Techniques in Pediatric Hydrocephalus
Authors: Patel Smruti K. , Yuan Weihong , Mangano Francesco T.
Published: January 2017

From the early days of pneumoencephalography and ventriculography to the emerging technology of magnetic resonance diffusion tensor imaging (DTI) of the present day, neuroimaging has always been a critical tool in the diagnosis and treatment of pediatric hydrocephalus. There is accumulating evidence from both human and animal research suggesting that one of the major pathophysiological mechanisms underlying poor outcomes in these children is damage to vulnerable white matter (WM) structures in the brain as a result of ventricular enlargement and increased intracranial pressure. However, a clear understanding of these WM abnormalities and their implications on neurobehavioral outcomes in these patients is not well understood. To this end, DTI has recently been studied to allow noninvasive quantification of these abnormalities. Our review discusses the evolution of neuroimaging in pediatric hydrocephalus and focuses on the use of advanced imaging techniques, such as DTI, which is supported by a growing body of literature as a promising noninvasive imaging tool in the diagnosis and long-term management of this patient population. We conclude with a brief discussion on emerging techniques and experimental imaging.
In vitro Evaluation of the Cleansing Effect of a Monofilament Fiber Debridement Pad Compared to Gauze Swabs
Authors: Wiegand Cornelia , Reddersen Kirsten , Hipler Uta-Christina , Abel Martin , Ruth Peter , Andriessen Anneke
Published: January 2017

Background: Removal of nonvital tissue is an accepted method to eradicate biofilms and to stimulate wound healing. Debridement using a monofilament polyester fiber pad has clinically been shown to be effective as well as pain and trauma free. Methods: For in vitro determination of the cleansing capacity of this product compared to gauze swabs, a wound debridement model was used with glass plates coated with a bovine serum albumin solution, stained with hematoxylin. Both products were moistened and fixed to a weight connected to a regulated motor and were then pulled over the holding device with the coated glass plate under standardized conditions (power = 0.067 N/cm2, velocity = 1.6 cm/s). Results: At a low coating concentration (0.5%) both products were equally effective, but at a high concentration (1.5%) cleansing did not occur after 5 wipes. When wiping the plates 15 times, the debridement pad cleansed significantly (p < 0.001) better than gauze. When consecutively wiping 4 coated plates with a single debridement pad or swab, the pad exhibited and maintained a significantly higher cleansing capacity while gauze quickly lost its effect. Conclusion: Our in vitro test results indicated a higher cleansing capacity of the debridement pad compared to gauze swabs.
Baseline and On-Treatment Markers Determining Prognosis of First-Line Chemotherapy in Combination with Bevacizumab in Patients with Metastatic Colorectal Cancer
Authors: Quidde Julia , Denne Laura , Kutscheidt Andreas , Kindler Manfred , Kirsch Andreas , Kripp Melanie , Petersen Volker , Schulze Matthias , Seraphin Jörg , Tummes Dirk , Arnold Dirk , Stein Alexander
Published: January 2017

Background: In metastatic colorectal cancer, no upfront or on-treatment markers are available to determine the prognosis or efficacy for chemotherapy in combination with bevacizumab. Patients and Methods: The current analysis was performed to evaluate the prognostic value of disease and patient characteristics (age, number of metastatic sites, stage of primary tumor, performance status, carcinoembryonic antigen (CEA)) and on-treatment changes of CEA (response after 8-12 weeks of treatment and specific patterns of CEA kinetics) in patients from an observational cohort study of chemotherapy with bevacizumab. Results: Baseline factors were available from 1,438 patients. Patients with baseline CEA levels > 20 ng/ml, more than 1 metastatic site, and age > 75 years showed significantly lower progression-free (PFS) and overall survival in multivariate analysis. A CEA response of > 30% during treatment was associated with increased PFS. In addition, the pattern of CEA kinetics predicts survival and response to treatment. Conclusion: In summary, baseline CEA, number of metastatic sites, and age are strong independent prognostic factors for survival. By monitoring CEA, clear patterns with distinct prognostic value can be determined. CEA kinetics and/or response after 8-12 weeks might be a useful and simple tool to stratify the post-induction treatment approach based on individual prognosis in the future.
The Use of MitraClip for Symptomatic Patients with Hypertrophic Obstructive Cardiomyopathy
Authors: Thomas Felix , Rader Florian , Siegel Robert J.
Published: January 2017

Objectives: Current nonpharmacological therapies for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM), including septal myectomy and alcohol septal ablation (ASA), carry significant risks for serious cardiac conduction abnormalities. We present a review of the currently available published data regarding the novel use of the relatively low-risk MitraClip® system in the treatment of symptomatic patients. Methods: Data were collected from 4 separate studies on the use of the MitraClip on 15 symptomatic HOCM patients with systolic anterior motion (SAM) of the mitral valve apparatus. Information regarding the degree of mitral regurgitation (MR), left-ventricular outflow tract (LVOT) gradient, and NYHA class was consolidated. Results: After MitraClip treatment, all patients had a resolution of SAM, a reduction in MR, and a reduction in the LVOT gradient from a mean of 75.8 ± 39.7 to 11.0 ± 5.6 mm Hg. Nearly all patients demonstrated improvements in symptoms by either new NYHA class designations or improved exercise tolerance. The procedure was not associated with conduction abnormalities or arrhythmias. Conclusion: MitraClip therapy may be a safe and effective treatment for symptomatic HOCM patients; it can help to avoid the potential risks associated with alternative therapies in high-risk surgical patients.
Diffusion Tensor Imaging Detects Occult Cerebellar Injury in Severe Neonatal Hypoxic-Ischemic Encephalopathy
Authors: Lemmon Monica E. , Wagner Matthias W. , Bosemani Thangamadhan , Carson Kathryn A. , Northington Frances J. , Huisman Thierry A.G.M. , Poretti Andrea
Published: January 2017

Background: Despite the benefits of whole-body hypothermia therapy, many infants with hypoxic-ischemic encephalopathy (HIE) die or have significant long-term neurodevelopmental impairment. Prospectively identifying neonates at risk of poor outcome is essential but not straightforward. The cerebellum is not classically considered to be a brain region vulnerable to hypoxic-ischemic insults; recent literature suggests, however, that the cerebellum may be involved in neonatal HIE. In this study, we aimed to assess the microstructural integrity of cerebellar and linked supratentorial structures in neonates with HIE compared to neurologically healthy neonatal controls. Methods: In this prospective cohort study, we performed a quantitative diffusion tensor imaging (DTI) analysis of the structural pathways of connectivity, which may be affected in neonatal cerebellar injury by measuring fractional anisotropy (FA) and mean diffusivity (MD) within the superior, middle, and inferior cerebellar peduncles, dentate nuclei, and thalami. All magnetic resonance imaging (MRI) studies were grouped into 4 categories of severity based on a qualitative evaluation of conventional and advanced MRI sequences. Multivariable linear regression analysis of cerebellar scalars of patients and controls was performed, controlling for gestational age, age at the time of MRI, and HIE severity. Spearman rank correlation was performed to correlate DTI scalars of the cerebellum and thalami. Results: Fifty-seven (23 females, 40%) neonates with HIE and 12 (6 females, 50%) neonatal controls were included. There were 8 patients (14%) in HIE severity groups 3 and 4 (injury of the basal ganglia/thalamus and/or cortex). Based on a qualitative analysis of conventional and DTI images, no patients had evidence of cerebellar injury. No significant differences between patients and controls were found in the FA and MD scalars. However, FA values of the middle cerebellar peduncles (0.294 vs. 0.380, p < 0.001) and MD values of the superior cerebellar peduncles (0.920 vs. 1.007 × 10-3 mm/s2, p = 0.001) were significantly lower in patients with evidence of moderate or severe injury on MRI (categories 3 and 4) than in controls. In patients, cerebellar DTI scalars correlated positively with DTI scalars within the thalami. Conclusion: Our results suggest that infants with moderate-to-severe HIE may have occult injury of cerebellar white-matter tracts, which is not detectable by the qualitative analysis of neuroimaging data alone. Cerebellar DTI scalars correlate with thalamic measures, highlighting that cerebellar injury is unlikely to occur in isolation and may reflect the severity of HIE. The impact of concomitant cerebellar injury in HIE on long-term neurodevelopmental outcome warrants further study.
Polycythemia Vera Management and Challenges in the Community Health Setting
Authors: Gerds Aaron T. , Dao Kim-Hien
Published: January 2017

Patients with polycythemia vera (PV) experience shortened survival, increased risk of thromboembolic and hemorrhagic events, and burdensome symptoms. For all patients with PV, treatment with aspirin and hematocrit control with phlebotomy are recommended. In addition, patients with high-risk status or poor hematocrit control benefit from cytoreductive therapy with hydroxyurea, although approximately 1 in 4 patients develops resistance or intolerance. For patients who are resistant to or intolerant of hydroxyurea, studies have shown that ruxolitinib, a Janus kinase 1/2 inhibitor, provides hematocrit control, reduces spleen size, normalizes blood counts, and improves PV-related symptoms. For many patients, PV is managed in a community health setting, and it is important that community hematologists, oncologists, and internists are familiar with the contemporary management of PV to improve patient outcomes, including management for patients who present with unique health-care needs. This review provides an overview of current treatment options for patients with PV and discusses challenging circumstances encountered by community providers in the management of PV, including symptom assessment, identification of hydroxyurea resistance/intolerance, pregnancy, elective surgeries, concomitant immunosuppressants, and managing patients in areas with limited access to specialized hematologic care.
Evaluation of QTc Interval Prolongation in Breast Cancer Patients after Treatment with Epirubicin, Cyclophosphamide, and Docetaxel and the Influence of Interobserver Variation
Authors: Puppe Julian , van Ooyen Deborah , Neise Jeanne , Thangarajah Fabinshy , Eichler Christian , Krämer Stefan , Pfister Roman , Mallmann Peter , Wirtz Marina , Michels Guido
Published: January 2017

Background: Chemotherapy with anthracyclines is associated with life-threatening electrocardiographic alterations including corrected QT (QTc) interval prolongation. Patients and Methods: In this study we assessed the effect of epirubicin, cyclophosphamide, and docetaxel (EC-Doc) on the QTc interval in 10 patients with early breast cancer. Cardiac toxicity was assessed with symptoms, transthoracic echocardiography, electrocardiography (ECG), and serum cardiac markers at baseline and after 4 cycles of EC and 4 cycles of docetaxel. To evaluate the influence of interobserver variation, the QTc interval was analyzed by a cardiologist, a gynecologist, and with automated ECG interpretation software. Results: There was a significant QTc prolongation after EC treatment independent of the investigator. In addition, a significant increase in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels was noted after EC treatment. QTc prolongation and NT-proBNP levels normalized after docetaxel treatment. Other biochemical markers were within normal ranges. No clinically relevant effect on left ventricular ejection fraction was observed. Conclusion: This prospective study demonstrated that EC treatment increases the QTc interval and NT-proBNP levels in women with early breast cancer. This effect was reversible and independent of docetaxel administration. Moreover, the treating physician can safely perform QTc interval evaluation as part of clinical routine independent of his/her specialty. Due to the small number of patients, further conclusions are limited at this point.
A Case of Plasmablastic Lymphoma Achieving Complete Response and Durable Remission after Lenalidomide-Based Therapy
Authors: Schmit Jessica M. , DeLaune Jess , Norkin Maxim , Grosbach Alan
Published: January 2017

Background: Plasmablastic lymphoma (PBL) is an uncommon variant of diffuse large B-cell lymphoma that is characterized by its plasmacytoid features, aggressive tendencies, and frequent association with human immunodeficiency virus (HIV) infection or other immunocompromised states. Multi-agent, intensive chemotherapy regimens are recommended as first-line treatment by the National Comprehensive Cancer Network. However, the toxicity of these regimens is high and prognosis remains poor. Case Report: We report a patient with HIV-negative PBL who achieved complete response and durable remission using a lenalidomide-based chemotherapy regimen as first-line therapy. Conclusion: Cyclophosphamide, lenalidomide, dexamethasone (CRD) may provide an alternative initial therapeutic option for patients with PBL who cannot tolerate the intensive chemotherapy regimens currently recommended.
Gastrointestinal Stromal Tumour with Synchronous Bone Metastases: A Case Report and Literature Review
Authors: Rochigneux Philippe , Mescam-Mancini Lénaig , Perrot Delphine , Bories Erwan , Moureau-Zabotto Laurence , Sarran Anthony , Guiramand Jérôme , Bertucci François
Published: January 2017

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours of the digestive tract, derived from Cajal interstitial cells. Bone metastases are very rare, and there is no consensus regarding their treatment. Here, we present the unusual case of a 66-year-old man with a gastric GIST with synchronous bone and liver metastases, fully documented at the pathological and molecular levels with a KIT exon 11 mutation. After 9 months of imatinib, the scanner showed a 33% partial response of target lesions. We also review the literature and describe the characteristics, treatment, and outcome of all cases previously reported.
Metastasis of Colon Cancer to the Breast
Authors: Tsung Swei H.
Published: January 2017

Breast metastases from extramammary neoplasms are extremely rare, and even more so is metastasis of colon cancer to the breast. Despite its rarity, metastatic disease to the breast is an important diagnostic issue because its treatment differs greatly from that of primary cancer. Proper diagnosis of this rare event requires an accurate clinical history, proper immunohistochemical workup, and a high level of suspicion.
MRI of Cerebellar Infarction
Authors: De Cocker Laurens J.L. , Lövblad Karl-Olof , Hendrikse Jeroen
Published: January 2017

Background: MRI is the imaging modality of choice for diagnosing brain infarction. Because of few or atypical clinical symptoms and a relatively low sensitivity of CT scans, many cerebellar infarctions may be detected only with MRI. With adequate recognition of cerebellar infarction on MRI and prompt initiation or optimisation of preventive therapeutic measures, more dramatic strokes may be avoided in selected cases. Summary: We first briefly review the clinical presentation of cerebellar infarctions, followed by a short refresher on cerebellar anatomy and pathophysiological mechanisms of cerebellar infarcts. Then, we review the arterial cerebellar perfusion territories recently made visible with territorial arterial spin labeling (ASL), followed by a discussion and illustration of the MRI appearance of cerebellar infarcts in different stages. Similar to large cerebellar infarcts, recent studies investigating volumetric MRI datasets have now shown that small cerebellar infarcts occur in typical spatial patterns, knowledge of which may help in the diagnosis of even the smallest of cerebellar infarcts on MRI. Key Messages: MRI is the modality of choice for diagnosing cerebellar infarction. The posterior inferior cerebellar artery (PICA)-territories can be visualised with super-selective territorial ASL MRI. The PICA supplies at least the medial part of the posterior cerebellar surface. Anterior inferior cerebellar artery-infarcts can be mistaken for lateral PICA-infarcts. Small infarcts typically affect the cortex and often present as incidental cavities. Subacute cerebellar infarcts may be missed on imaging due to a phenomenon called “fogging.”
Adesão à higiene de mãos entre profissionais de um serviço de pronto atendimento
Authors: Oliveira Adriana Cristina de , De Paula Adriana Oliveira , Souza Mariana Almeida de , Silva Alanna Gomes
Published: January 2017

Objetivo: avaliar a taxa de adesão à higiene de mãos de uma equipe multiprofissional. Materiais e métodos: estudo transversal, realizado em uma unidade de pronto atendimento de um hospital universitário de Belo Horizonte-MG, entre maio e agosto de 2013, por meio de observação direta das equipes médicas e de enfermagem. As observações se basearam nos cinco momentos para higienização das mãos da Organização Mundial de Saúde, utilizando-se um instrumento estruturado. Os dados foram analisados no SPSS, realizando-se análise descritiva e univariada. Resultados: registraram-se 931 oportunidades de higienização das mãos, 88,9% entre os técnicos de enfermagem, 6,9% médicos, 3,7% enfermeiros e 0,5% para auxiliares de enfermagem, obtendo-se uma taxa de adesão global de 19,4%. A higienização simples com água e sabão foi mais utilizada pelos profissionais (47%). Conclusão: a taxa de adesão à higienização das mãos foi considerada baixa, observando-se a necessidade e treinamentos para melhoria da mesma.
Uma orquestra de viola caipira como instrumento de potencialização do processo ensino-aprendizagem
Authors: Sales Max
Published: January 2017

Esta comunicação é resultado de uma pesquisa realizada sobre a Orquestra Pingo D´Água, um grupo formado por alunos do curso de viola caipira de uma escola particular de música em São João Del-Rei (MG), que se dedica à prática da música caipira e ao estudo da viola. A orquestra funciona como uma atividade complementar às aulas do curso e foi criada com o intuito de construir um ambiente criativo e de intenso aprendizado que é alimentado continuamente pela convivência entre seus integrantes. O objetivo deste trabalho é refletir sobre as experiências proporcionadas pelo envolvimento dos músicos com as atividades da orquestra e sua relação com o processo de ensino-aprendizagem sob o ponto de vista dos próprios integrantes. Para tanto, o trabalho foi estruturado em três partes: 1) Um estudo bibliográfico sobre como os conhecimentos relacionados à viola caipira tem sido transmitidos ao longo do tempo e como esse processo determinou a forma como o instrumento é utilizado atualmente. 2) Uma descrição de aspectos presentes nas atividades da orquestra comuns a outras manifestações musicais populares de tradição oral. 3) São apresentadas informações obtidas por meio de entrevistas realizadas com os integrantes da orquestra, contextualizadas em quatro categorias:  Motivação, situações aleatórias de aprendizado,  identidade e  potencialização do aprendizado.
A viola caipira na Festa de Santo Reis em uma cidade do sul de Minas Gerais
Authors: Garcia Rafael Marin da Silva
Published: January 2017

A presente comunicação apresenta um breve panorama da utilização da viola caipira na Festa de Santo Reis realizada na cidade de Alfenas, sul de Minas Gerais. A presença da viola caipira na instrumentação das Companhias de Reis reflete a forte ligação que os foliões destes grupos tradicionais possuem com a chamada música caipira tradicional de raiz e sertaneja, da qual resulta uma interessante sobreposição de estilos e práticas musicais mesmo quando a viola caipira está sendo utilizada exclusivamente para atender propósitos sagrados e mágico-religiosos da festividade. Assim, a Festa de Santo Reis na cidade estudada possui como uma de suas características um constante diálogo entre o regionalismo da dimensão profana, representado pela música caipira e sertaneja, e o universalismo da dimensão sagrada e mágico-religiosa do catolicismo rústico, representado pelos hinos de adoração a Santo Reis. Embora este diálogo entre práticas musicais diferentes seja conduzido por um conjunto de instrumentos, a viola caipira se apresenta como o instrumento que dinamiza tanto os discursos que representam a dimensão regional e profana, ligada à música caipira, quanto os discursos que representam o universalismo sagrado da Festa de Santo Reis, possuindo então um importante papel catalizador e aglutinador destas diferentes práticas musicais.
Age- and Sex-Related Influences on Left Ventricular Mechanics in Elderly Individuals Free of Prevalent Heart Failure
Authors: Hung Chung-Lieh , Gonçalves Alexandra , Shah Amil M. , Cheng Susan , Kitzman Dalane , Solomon Scott D.
Published: January 2017

Background—

Advanced age is related to left ventricular (LV) remodeling. We sought to investigate the relationships between aging, elevated hemodynamic load, cardiac mechanics, and LV remodeling in an elderly community-based population.

Methods and Results—

We studied 1105 subjects (76±5 years, 61% women) without prevalent heart failure, who attended the visit 5 of the ARIC study (Atherosclerosis Risk in Communities). LV global longitudinal strain, global circumferential strain, and torsion indices were analyzed using 3-dimensional echocardiography. Advanced age was associated with greater LV concentricity, lower myocardial diastolic relaxation, reduced global longitudinal strain (adjusted estimate, 0.39±0.19% (SE)/decade;
P
=0.038), borderline greater global circumferential strain (adjusted estimate, −0.59±0.36% (SE)/decade;
P
=0.08), and higher torsion indices (adjusted estimate for torsion, 0.33±0.04° (SE)/decade;
P
<0.001). In addition, greater concentricity was associated with decreased global longitudinal strain and greater torsion in multivariable models (all
P
<0.001). Women showed smaller LV cavity size, greater concentricity, lower myocardial relaxation velocity E′, though demonstrated greater global longitudinal strain, global circumferential strain, and torsion than men (all
P
<0.05). Overall, subjects with hypertension and increasing age were more likely to have higher torsion, though the association between advanced age and greater torsion was more pronounced in women than in men (both interaction
P
<0.05).

Conclusions—

In an asymptomatic, senescent community–dwelling population, we observed a distinct, sex-specific pattern of cardiac remodeling. Although we observed worse diastolic and longitudinal function with advanced age or elevated load in both sexes, a significant increase of torsion was more pronounced in women.
Blood Pressure Trajectories From Childhood to Young Adulthood Associated With Cardiovascular Risk
Authors: Hao Guang , Wang Xiaoling , Treiber Frank A. , Harshfield Gregory , Kapuku Gaston , Su Shaoyong
Published: January 2017

The purpose of this study is to identify subgroups of individuals with similar trajectories in blood pressure (BP) from childhood to young adulthood and to determine the relationship of BP trajectories with carotid intima–media thickness (IMT) and left ventricular mass index (LVMI). BP was measured ≤16 times during a 23-year period in 683 participants from childhood to young adulthood. IMT and LVMI were measured in 551 participants and 546 participants, respectively. Using latent class models, 3 trajectory groups in BP from childhood to young adulthood were identified, including high-increasing, moderate-increasing, and low-increasing groups. We found that trajectory of systolic BP was a significant predictor of both IMT and LVMI with increased rate of growth in systolic BP associated with higher levels of IMT and LVMI (
P
for trend
<0.001). Similar to the BP trajectory groups from childhood to young adulthood, 3 trajectory groups in BP during childhood (≤18 years) were identified, and participants in the high-increasing group had thicker IMT (
P
<0.001) and increased LVMI (
P
=0.043) in comparison with those in the low-increasing group. Results were similar for mid-BP trajectories but not for diastolic BP trajectories. Our results suggested that different BP trajectories exist from childhood to young adulthood, and the trajectories were independently associated with IMT and LVMI. We, for the first time, reported the association between systolic BP trajectories derived from childhood with subclinical cardiovascular risk in young adulthood, indicating that monitoring trajectories of BP from childhood may help identify a high cardiovascular risk population in early life.
Effects of Sacubitril/Valsartan Versus Olmesartan on Central Hemodynamics in the Elderly With Systolic Hypertension
Authors: Williams Bryan , Cockcroft John R. , Kario Kazuomi , Zappe Dion H. , Brunel Patrick C. , Wang Qian , Guo Weinong
Published: January 2017

Effective treatment of systolic hypertension in elderly patients remains a major therapeutic challenge. A multicenter, double-blind, randomized controlled trial with sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, was conducted to determine its effects versus olmesartan (angiotensin receptor blocker) on central aortic pressures, in elderly patients (aged ≥60 years) with systolic hypertension and pulse pressure >60 mm Hg, indicative of arterial stiffness. Patients (n=454; mean age, 67.7 years; mean seated systolic blood pressure, 158.6 mm Hg; mean seated pulse pressure, 69.7 mm Hg) were randomized to receive once-daily sacubitril/valsartan 200 mg or olmesartan 20 mg, force titrated to double the initial doses after 4 weeks, before primary assessment at 12 weeks. The study extended double-blind treatment for 12 to 52 weeks, during which amlodipine (2.5–5 mg) and subsequently hydrochlorothiazide (6.25–25 mg) were added-on for patients not achieving blood pressure target (<140/90). At week 12, sacubitril/valsartan reduced central aortic systolic pressure (primary assessment) greater than olmesartan by −3.7 mm Hg (
P
=0.010), further corroborated by secondary assessments at week 12 (central aortic pulse pressure, −2.4 mm Hg,
P
<0.012; mean 24-hour ambulatory brachial systolic blood pressure and central aortic systolic pressure, −4.1 mm Hg and −3.6 mm Hg, respectively, both
P
<0.001). Differences in 24-hour ambulatory pressures were pronounced during sleep. After 52 weeks, blood pressure parameters were similar between treatments (
P
<0.002); however, more patients required add-on antihypertensive therapy with olmesartan (47%) versus sacubitril/valsartan (32%;
P
<0.002). Both treatments were equally well tolerated. The PARAMETER study (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Measuring Arterial Stiffness in the Elderly), for the first time, demonstrated superiority of sacubitril/valsartan versus olmesartan in reducing clinic and ambulatory central aortic and brachial pressures in elderly patients with systolic hypertension and stiff arteries.
Time partitioning in mesocarnivore communities from different habitats of NW Italy: insights into martens’ competitive abilities
Authors: Torretta E. , Mosini A. , Piana M. , Tirozzi P. , Serafini M. , Puopolo F. , Saino N. , Balestrieri A.
Published: January 2017

Most studies focused on species coexistence have been directed at the differential use of habitat and food resources; nonetheless, the differential use of the diel cycle may enhance the coexistence of same-sized species. We investigated the activity patterns of mesocarnivores (red fox (Vulpes vulpes), European badger (Meles meles), pine marten (Martes martes), stone marten (M. foina)) in NW Italy via camera-trapping. We hypothesized that the smallest species would tend to avoid competition by selecting time periods when larger species were less active. Foxes, badgers, and stone martens were mainly nocturnal. In lowland areas overlap between coexisting species was generally low, while in Mediterranean habitats all activity patterns tended to be unimodal and overlap was generally high. The pine marten showed a cathemeral pattern. We suggest that the lower ability of the stone marten to avoid interference competition at community-level may play a major role in determining its widespread exclusion from forested areas by the pine marten.
A survey of East Palaearctic Lycosidae (Araneae). 12. Two new Mongolicosa species from Mongolia
Authors: FOMICHEV ALEXANDER A. , MARUSIK YURI M.
Published: January 2017

Two new species of Mongolicosa Marusik, Azarkina et Koponen, 2004 are described from Mongolia: M. przhewalskii sp. n. (♀♂) and M. uncia sp. n. (♀♂). A map with distribution records of all known Mongolicosa species and descriptions of new species are provided.
The Irrelevance of Infant Observations for Psychoanalysis
Authors: Wolff Peter H.
Published: January 2017

The current consensus among psychoanalysts holds that direct infant observations are one means for testing the developmental propositions of psychoanalytic theory; that the observations have already falsified some of the theory's basic propositions; and that they hold the key to a qualitatively different developmental theory of psychoanalysis. The consensus, although not universal, has motivated a wide range of research programs on early infancy, whose findings are commonly interpreted as disclosing psychoanalytic metapsychology and clinical theory in an entirely new light. This essay examines some of the assumptions that have motivated such investigations, as well as the research strategies by which the new versions of theory are promulgated. On the basis of these explorations it is concluded that psychoanalytically informed infant observations may be the source for new theories of social-emotional development, but that they are essentially irrelevant for psychoanalysis as a psychology of meanings, unconscious ideas, and hidden motives.
The Interpretation of Daydreams, I
Authors: Raphling David
Published: January 2017

There is a notable lack of interest in the daydream, whether in clinical work, in the literature, or in psychoanalytic teaching, compared with the attention received by nocturnal dreams, fantasy activity, and other psychoanalytic material. This neglect of daydreams may be related to the apparent infrequency with which patients report them in analytic treatment Possible explanations for the unavailability of daydreams as analytic material are examined. The paper offers detailed clinical material that will provide some of the necessary analytic data with which to begin an exploration of the nature of daydreams and their role in the analytic process.