bluuebunny/crossref_metadata_2025 huggingface dataset:
Effector-Mediated Eradication of Precursor B Acute Lymphoblastic Leukemia with a Novel Fc-Engineered Monoclonal Antibody Targeting the BAFF-R
Authors: Parameswaran Reshmi , Lim Min , Fei Fei , Abdel-Azim Hisham , Arutyunyan Anna , Schiffer Isabelle , McLaughlin Margaret E. , Gram Hermann , Huet Heather , Groffen John , Heisterkamp Nora
Published: May 2014

B-cell activating factor receptor (BAFF-R) is expressed on precursor B acute lymphoblastic leukemia (pre-B ALL) cells, but not on their pre-B normal counterparts. Thus, selective killing of ALL cells is possible by targeting this receptor. Here, we have further examined therapeutic targeting of pre-B ALL based on the presence of the BAFF-R. Mouse pre-B ALL cells lacking BAFF-R function had comparable viability and proliferation to wild-type cells, but were more sensitive to drug treatment in vitro. Viability of human pre-B ALL cells was further reduced when antibodies to the BAFF-R were combined with other drugs, even in the presence of stromal protection. This indicates that inhibition of BAFF-R function reduces fitness of stressed pre-B ALL cells. We tested a novel humanized anti–BAFF-R monoclonal antibody optimalized for FcRγIII-mediated, antibody-dependent cell killing by effector cells. Antibody binding to human ALL cells was inhibitable, in a dose-dependent manner, by recombinant human BAFF. There was no evidence for internalization of the antibodies. The antibodies significantly stimulated natural killer cell–mediated killing of different human patient-derived ALL cells. Moreover, incubation of such ALL cells with these antibodies stimulated phagocytosis by macrophages. When this was tested in an immunodeficient transplant model, mice that were treated with the antibody had a significantly decreased leukemia burden in bone marrow and spleen. In view of the restricted expression of the BAFF-R on normal cells and the multiple anti–pre-B ALL activities stimulated by this antibody, a further examination of its use for treatment of pre-B ALL is warranted. Mol Cancer Ther; 13(6); 1567–77. ©2014 AACR.
Mammary Cancer Chemoprevention by Withaferin A Is Accompanied byIn VivoSuppression of Self-Renewal of Cancer Stem Cells
Authors: Kim Su-Hyeong , Singh Shivendra V.
Published: May 2014

Current dogma favors elimination of therapy-resistant cancer stem cells for chemoprevention of breast cancer. We showed recently that mammary cancer development in a transgenic mouse model (mouse mammary tumor virus-neu; MMTV-neu) was inhibited significantly upon treatment with withaferin A (WA), a steroidal lactone derived from a medicinal plant. Herein, we demonstrate that the mammary cancer prevention by WA is accompanied by in vivo suppression of breast cancer stem cells (bCSC). In vitro mammosphere formation was dose-dependently inhibited by WA treatment in MCF-7 and SUM159 human breast cancer cells. Other markers of bCSC, including aldehyde dehydrogenase 1 (ALDH1) activity and CD44high/CD24low/epithelial-specific antigen-positive (ESA+) fraction, were also decreased significantly in the presence of plasma achievable doses of WA. However, WA exposure resulted in cell line–specific changes in Oct4, SOX-2, and Nanog mRNA expression. WA administration to MMTV-neu mice (0.1 mg/mouse, 3 times/week for 28 weeks) resulted in inhibition of mammosphere number and ALDH1 activity in vivo. Mechanistic studies revealed that although urokinase-type plasminogen activator receptor overexpression conferred partial protection against bCSC inhibition by WA, Notch4 was largely dispensable for this response. WA treatment also resulted in sustained (MCF-7) or transient (SUM159) downregulation of Bmi-1 (B-cell–specific Moloney murine leukemia virus insertion region-1) protein. Ectopic expression of Bmi-1 conferred partial but significant protection against ALDH1 activity inhibition by WA. Interestingly, WA treatment caused induction of Kruppel-like factor 4 (KLF4) and its knockdown augmented bCSC inhibition by WA. In conclusion, this study shows in vivo effectiveness of WA against bCSC. Cancer Prev Res; 7(7); 738–47. ©2014 AACR.
Autophagy Inhibition Improves Chemosensitivity in BRAFV600E Brain Tumors
Authors: Levy Jean M. Mulcahy , Thompson Joshua C. , Griesinger Andrea M. , Amani Vladimir , Donson Andrew M. , Birks Diane K. , Morgan Michael J. , Mirsky David M. , Handler Michael H. , Foreman Nicholas K. , Thorburn Andrew
Published: May 2014

Autophagy inhibition is a potential therapeutic strategy in cancer, but it is unknown which tumors will benefit. The BRAFV600E mutation has been identified as important in pediatric central nervous system (CNS) tumors and is known to affect autophagy in other tumor types. We evaluated CNS tumor cells with BRAFV600E and found that mutant (but not wild-type) cells display high rates of induced autophagy, are sensitive to pharmacologic and genetic autophagy inhibition, and display synergy when the clinically used autophagy inhibitor chloroquine was combined with the RAF inhibitor vemurafenib or standard chemotherapeutics. Importantly, we also demonstrate that chloroquine can improve vemurafenib sensitivity in a resistant ex vivo primary culture and provide the first demonstration in a patient harboring the V600E mutation treated with vemurafenib that the addition of chloroquine can improve clinical outcomes. These findings suggest that CNS tumors with BRAFV600E are autophagy-dependent and should be targeted with autophagy inhibition in combination with other therapeutic strategies.

Significance: Autophagy inhibition may improve cancer therapy, but it is unclear which tumors will benefit. We found that BRAF mutations cause brain tumor cells to depend on autophagy and display selective chemosensitization with autophagy inhibition. We present a pediatric case in which deliberate autophagy inhibition halted tumor growth and overcame acquired BRAF-inhibition resistance. Cancer Discov; 4(7); 773–80. ©2014 AACR.

This article is highlighted in the In This Issue feature, p. 745
Discordant Genotype-Phenotype Correlation in Familial Hyperaldosteronism Type III with KCNJ5 Gene Mutation: A Patient Report and Review of the Literature
Authors: Adachi Masanori , Muroya Koji , Asakura Yumi , Sugiyama Kenji , Homma Keiko , Hasegawa Tomonobu
Published: May 2014

Background: Familial hyperaldosteronism type III (FH-III) is a rare autosomal dominant disease for which five missense mutations in KCNJ5 have been identified. FH-III has a wide phenotypic variability from spironolactone-responsive hyperaldosteronism to massive adrenal hypertrophy with drug-resistant hypertension. This variation has mainly been attributed to genotype, because, in contrast to other genotypes (G151R, T158A, I157S, and Y152C), (1) FH-III patients with G151E have shown milder phenotype, and (2) G151E-harboring cells were found to have rapid lethality due to much larger sodium conductance of the encoded channel (Kir3.4), which prevents adrenal hypertrophy. Methods: Here we describe the clinical course of a sporadic case of FH-III, with de novo G151R mutation. Results: The patient developed polyuria at around 1.5 years of age and developed hypertension and hypokalemia by 4 years of age. Thereafter, spironolactone treatment successfully ameliorated hyperaldosteronism for 7 years with no discernible adrenal enlargement. Conclusion: Diverse clinical severity in FH-III cannot be defined solely by KCNJ5 genotype.
Decreases in Energy and Increases in Phase Locking of Event-Related Oscillations to Auditory Stimuli Occur during Adolescence in Human and Rodent Brain
Authors: Ehlers Cindy L. , Wills Derek N. , Desikan Anita , Phillips Evelyn , Havstad James
Published: May 2014

Synchrony of phase (phase locking) of event-related oscillations (EROs) within and between different brain areas has been suggested to reflect communication exchange between neural networks and as such may be a sensitive and translational measure of changes in brain remodeling that occur during adolescence. This study sought to investigate developmental changes in EROs using a similar auditory event-related potential (ERP) paradigm in both rats and humans. Energy and phase variability of EROs collected from 38 young adult men (aged 18-25 years), 33 periadolescent boys (aged 10-14 years), 15 male periadolescent rats [at postnatal day (PD) 36] and 19 male adult rats (at PD103) were investigated. Three channels of ERP data (frontal cortex, central cortex and parietal cortex) were collected from the humans using an ‘oddball plus noise' paradigm that was presented under passive (no behavioral response required) conditions in the periadolescents and under active conditions (where each subject was instructed to depress a counter each time he detected an infrequent target tone) in adults and adolescents. ERPs were recorded in rats using only the passive paradigm. In order to compare the tasks used in rats to those used in humans, we first studied whether three ERO measures [energy, phase locking index (PLI) within an electrode site and phase difference locking index (PDLI) between different electrode sites] differentiated the ‘active' from ‘passive' ERP tasks. Secondly, we explored our main question of whether the three ERO measures differentiated adults from periadolescents in a similar manner in both humans and rats. No significant changes were found in measures of ERO energy between the active and passive tasks in the periadolescent human participants. There was a smaller but significant increase in PLI but not PDLI as a function of active task requirements. Developmental differences were found in energy, PLI and PDLI values between the periadolescents and adults in both the rats and the human participants. Neuronal synchrony as indexed by PLI and PDLI was significantly higher to the infrequent (target) tone compared to the frequent (nontarget) tone in all brain sites in all of the regions of interest time-frequency intervals. Significantly higher ERO energy and significantly lower synchrony was seen in the periadolescent humans and rats compared to their adult counterparts. Taken together these findings are consistent with the hypothesis that adolescent remodeling of the brain includes decreases in energy and increases in synchrony over a wide frequency range both within and between neuronal networks and that these effects are conserved over evolution.
Photodynamic Therapy: Current Status and Future Directions
Authors: Benov Ludmil
Published: May 2014

Photodynamic therapy (PDT) is a minimally invasive therapeutic modality used for the management of a variety of cancers and benign diseases. The destruction of unwanted cells and tissues in PDT is achieved by the use of visible or near-infrared radiation to activate a light-absorbing compound (a photosensitizer, PS), which, in the presence of molecular oxygen, leads to the production of singlet oxygen and other reactive oxygen species. These cytotoxic species damage and kill target cells. The development of new PSs with properties optimized for PDT applications is crucial for the improvement of the therapeutic outcome. This review outlines the principles of PDT and discusses the relationship between the structure and physicochemical properties of a PS, its cellular uptake and subcellular localization, and its effect on PDT outcome and efficacy.
Comparison of Biolimus A9–Eluting (Nobori) and Everolimus-Eluting (Promus Element) Stents in Patients With De Novo Native Long Coronary Artery Lesions
Authors: Lee Jong-Young , Park Duk-Woo , Kim Young-Hak , Ahn Jung-Min , Kim Won-Jang , Kang Soo-Jin , Lee Seung-Whan , Lee Cheol Whan , Park Seong-Wook , Yun Sung-Cheol , Yang Tae-Hyun , Lee Bong-Ki , Lee Nae-Hee , Yang Joo-Young , Shin Won-Yong , Park Hun Sik , Kim Kee-Sik , Hur Seung Ho , Lee Sung Yun , Park Jong-Seon , Choi Yun Seok , Lee Seung Uk , Her Sung-Ho , Park Seung-Jung
Published: May 2014

Background—

Procedural and clinical outcomes still remain unfavorable for patients with long coronary lesions who undergo percutaneous coronary intervention. The current study, therefore, evaluated 2 innovative drug-eluting stents for the management of long-lesion coronary artery disease.

Methods and Results—

This randomized, multicenter, prospective trial, called the Long Drug-Eluting Stent (LONG-DES) V trial, compared the biodegradable polymer–based biolimus A9–eluting stent (BES) and the durable polymer–based platinum chromium everolimus-eluting stent (PtCr-EES) in 500 patients with long (≥25 mm) coronary lesions. The primary end point of the trial was in-segment late luminal loss at the 9-month angiographic follow-up. The BES and PtCr-EES groups had similar baseline characteristics, with a slightly shorter lesion length in the BES group versus the PtCr-EES group (29.24±12.17 versus 32.27±13.84 mm;
P
=0.016). In-segment late luminal loss was comparable between the 2 groups at the 9-month angiographic follow-up (BES, 0.14±0.38 versus PtCr-EES, 0.11±0.37 mm; difference, 0.031; 95% confidence interval, −0.053 to 0.091;
P
=0.03 for a noninferiority margin of 0.11,
P
=0.45 for superiority), as was in-stent late luminal loss (0.20±0.41 versus 0.24±0.38 mm;
P
=0.29). The incidence of in-segment (6.1% versus 4.9%;
P
=0.63) and in-stent (3.7% versus 4.9%;
P
=0.59) binary restenosis was also similar between the groups. There was no significant between-group difference in the rate of composite outcome of death, myocardial infarction, and target vessel revascularization (41, 16.7% in BES versus 42, 16.5% in PtCr-EES;
P
=0.94).

Conclusions—

BES and PtCr-EES implantation showed analogous angiographic and clinical outcomes for patients with de novo long coronary lesions.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01186120.
Left Ventricular Reverse Remodeling, Device-Related Adverse Events, and Long-Term Outcome After Cardiac Resynchronization Therapy in the Elderly
Authors: Höke Ulas , Putter Hein , Van Der Velde Enno T. , Schalij Martin J. , Delgado Victoria , Bax Jeroen J. , Marsan Nina Ajmone
Published: May 2014

Background—

Limited data are available on efficacy, safety, and long-term prognosis after cardiac resynchronization therapy (CRT) in elderly patients. We aimed at evaluating the effect of CRT, device-related adverse events, and long-term outcome after CRT among elderly patients.

Methods and Results—

A total of 798 CRT recipients (208 elderly: age, ≥75 years; 590 nonelderly: age, <75 years) underwent clinical and echocardiographic evaluation at baseline and 6-month follow-up. Elderly patients had similar improvements in clinical symptoms, left ventricular function, and left ventricular reverse remodeling as their counterparts. Similar rates of device-related in-hospital (within 24 hours;
P
=0.552), early (within 30 days;
P
=0.984), and long-term adverse events (entire follow-up; hazard ratio, 0.90;
P
=0.620) were observed between groups. During long-term follow-up (median, 38.6 months; interquartile range, 22.5–61.8 months), all-cause mortality rate was significantly higher among the elderly patients. However, the differences in cumulative event rates started after 4 years of follow-up (
P
=0.013), and the cause of death was mainly noncardiac (29% in the elderly versus 19% in nonelderly;
P
<0.001). Diabetes mellitus (hazard ratio, 2.322;
P
=0.019), impaired renal function (hazard ratio, 0.975;
P
=0.006), and reduced 6-minute walk distance (hazard ratio, 0.996;
P
<0.019) were independently associated with all-cause mortality in elderly patients.

Conclusions—

CRT efficacy and device-related adverse events in elderly patients were comparable with that of nonelderly patients. However, after 4 years of follow-up, elderly patients showed worse survival and the cause of death was mainly noncardiac. Diabetes mellitus, impaired renal function, and reduced 6-minute walk distance were independently associated with all-cause mortality of elderly patients.
Risk Factors for Computed Tomography Angiography Spot Sign in Deep and Lobar Intracerebral Hemorrhage Are Shared
Authors: Radmanesh Farid , Falcone Guido J. , Anderson Christopher D. , Battey Thomas W.K. , Ayres Alison M. , Vashkevich Anastasia , McNamara Kristen A. , Schwab Kristin , Romero Javier M. , Viswanathan Anand , Greenberg Steven M. , Goldstein Joshua N. , Rosand Jonathan , Brouwers H. Bart
Published: May 2014

Background and Purpose—

Patients with intracerebral hemorrhage (ICH) who present with a spot sign on computed tomography angiography are at increased risk of hematoma expansion and poor outcome. Because primary ICH is the acute manifestation of chronic cerebral small vessel disease, we investigated whether different clinical or imaging characteristics predict spot sign presence, using ICH location as a surrogate for arteriolosclerosis- and cerebral amyloid angiopathy–related ICH.

Methods—

Patients with primary ICH and available computed tomography angiography at presentation were included. Predictors of spot sign were assessed using uni- and multivariable regression, stratified by ICH location.

Results—

Seven hundred forty-one patients were eligible, 335 (45%) deep and 406 (55%) lobar ICH. At least one spot sign was present in 76 (23%) deep and 102 (25%) lobar ICH patients. In multivariable regression, warfarin (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.01–5.71;
P
=0.04), baseline ICH volume (OR, 1.20; 95% CI, 1.09–1.33, per 10 mL increase;
P
<0.001), and time from symptom onset to computed tomography angiography (OR, 0.89; 95% CI, 0.80–0.96, per hour;
P
=0.009) were associated with the spot sign in deep ICH. Predictors of spot sign in lobar ICH were warfarin (OR, 3.95; 95% CI, 1.87–8.51;
P
<0.001) and baseline ICH volume (OR, 1.20; 95% CI, 1.10–1.31, per 10 mL increase;
P
<0.001).

Conclusions—

The most potent associations with spot sign are shared between deep and lobar ICH, suggesting that the acute bleeding process that arises in the setting of different chronic small vessel diseases shares commonalities.
Comparison of Computed Tomographic and Magnetic Resonance Perfusion Measurements in Acute Ischemic Stroke
Authors: Lin Longting , Bivard Andrew , Levi Christopher R. , Parsons Mark W.
Published: May 2014

Background and Purpose—

Magnetic resonance perfusion (MRP) and computed tomographic perfusion (CTP) are being increasingly applied in acute stroke trials and clinical practice, yet the comparability of their perfusion values is not well validated. The aim of this study was to validate the comparability of CTP and MRP measures.

Methods—

A 3-step approach was used. Step 1 was a derivation step, where we analyzed 45 patients with acute ischemic stroke who had both CTP and MRP performed within 2 hours of each other and within 9 hours of stroke onset. In this step, we derived the optimal perfusion map with the least difference between MRP and CTP. In step 2, the optimal map was validated on whole-brain perfusion data of 15 patients. Step 3 was to apply the optimal perfusion map to define cross-modality reperfusion from acute CTP to 24-hour MRP in 45 patients and, in turn, to assess how accurately this predicted 3-month clinical outcome.

Results—

Among 8 different perfusion maps included in this study, time to peak of the residual function (
T
max
) was the only one with a nonsignificant difference between CTP and MRP in delineating perfusion defects. This was validated on whole-brain perfusion data, showing high concordance of
T
max
between the 2 modalities (concordance correlation coefficient of Lin, >0.91); the best concordance was at 6 s. At
T
max
>6 s threshold, MRP and CTP reached substantial agreement in mismatch classification (κ >0.61). Cross-modality reperfusion calculated by
T
max
>6 s strongly predicted good functional outcome at 3 months (area under the curve, 0.979;
P
<0.05).

Conclusions—

MRP and CTP can be used interchangeably if one uses
T
max
measurement.
Fluids in Motion: Inspiration and Realization for Artists and STEMists
Authors: Zabusky Norman J.
Published: May 2014

The author examines contemporary work in fluids in motion and demonstrates strong connections between visual art and science resulting from innovative technology. In one burgeoning domain—falling liquid drops impacting solid surfaces and liquid pools—it is valuable to compare how artists and scientists describe their goals and their use of high-speed photography to capture and measure events. The author also examines the use of devices to create still images, animations and objects: computers/software for simulation, visualization and 3D printing; installations at focal locations. Finally, he examines the utilization of digital technology by artists, educators, museums and galleries for innovative and interactive displays.
Three new araphid diatoms (Bacillariophyta) from the Maritime Antarctic Region
Authors: VAN DE VIJVER BART , MORALES EDUARDO A. , KOPALOVÁ KATEŘINA
Published: May 2014

A revision of taxa from the genus Staurosira and Staurosirella from the Maritime Antarctic Region, formerly identified as Staurosirella (Fragilaria) pinnata and Fragilaria alpestris, resulted in the description of three new taxa: Staurosira pottiezii Van de Vijver sp. nov., Staurosirella antarctica Van de Vijver & E.Morales sp. nov. and S. frigida Van de Vijver & E.Morales sp. nov. Detailed light (LM) and scanning electron microscope (SEM) observations are used to better characterize the morphology and ultrastructure of these three new taxa. Comparisons with similar taxa and the ecological preferences of each species are added. The revision of these species confirmed the endemic nature of the Antarctic diatom flora.
Additional notes on Oreocharis yunnanensis, a species of Gesneriaceae from southern Yunnan, China, including morphological and molecular data
Authors: TAN YUN-HONG , LI JIAN-WU , CHEN WEN-HONG , WEN BIN , MÖLLER MICHAEL
Published: May 2014

Oreocharis yunnanensis, a recently described species from southern Yunnan, China, is here compared using morphological and molecular evidence, with its closest congener O. aurea and O. hirsuta, but can be easily distinguished from the latter two by its cordate leaves, 3–4 branched cymes with 4–16(–20) flowers, corolla larger, corolla tube constricted or slightly constricted above the base and then moderately enlarged without constriction at the throat, longer relative to the corolla lip, the upper corolla lip much smaller than the lower lip, lobes entire or calyx margins 2–3 denticulate, disc entire or subentire, and stigma capitate.
A new species of Salix (Salicaceae) from Tibet (Xizang), China
Authors: HE LI , LIAO SHUAI , ZHANG ZHIXIANG
Published: May 2014

We describe and illustrate Salix elongata, a new species of Salix endemic to southeastern Tibet (Xizang). The new species is similar to S. opsimantha in having terminal catkins, oblong bracts, and glabrous ovaries, but differs from the latter as follows: stems decumbent and rooting, petioles long, ovary stipes equal to or longer than the adaxial nectary, styles distinct for half their lengths, stigmas small.
Confirmation of Valeriana nivalis (Valerianaceae) to the Argentinian flora
Authors: ZANOTTI CHRISTIAN A. , SUESCÚN MABEL A. , ACOSTA JUAN M.
Published: May 2014

We confirm the occurrence of Valeriana nivalis to the Argentinean flora, based on results of both morphological and molecular phylogenetic studies. We also include a taxonomic description, distribution, and additional information to discern V. nivalis from V. pycnantha.
A new species of Miroculis Edmunds, 1963 (Ephemeroptera: Leptophlebiidae) from Northeastern Brazil
Authors: LIMA LUCAS R. C. , RAIMUNDI ERIKCSEN A. , PINHEIRO ULISSES , SALLES FREDERICO F.
Published: May 2014

Miroculis stenopterus, sp. nov., is described based on material from State of Pernambuco, Northeastern Brazil. The imago of the new species can be distinguished, among other characteristics, by an uncommon forewing shape, long and narrow, similar to species of genus Microphlebia. The tentatively associated nymph can be distinguished from other species of the genus mainly by the abdominal color pattern and the ratio of labial palp segment 2 to segment 1 (1.01–1.04 x).
Aeshna shennong sp. nov., a new species from Hubei Province, China (Odonata: Anisoptera: Aeshnidae)
Authors: ZHANG HAO-MIAO , CAI QING-HUA
Published: May 2014

Aeshna shennnong sp. nov. (holotype male: Dajiuhu national wetland park in Shennongjia National Nature Reserve, Shennongjia City, Hubei Province, China, 28. VIII. 2013) is described, illustrated and compared with its most similar congener, A. petalura Martin, 1908. The holotype will be deposited in the Collection of Aquatic Animals, Institute of Hydrobiology, Chinese Academy of Sciences, Wuhan City, Hubei Province, China. New distribution records of A. petalura from mainland China are also provided.
Parametric Estimation of the Stochastic Dynamics of Sea Surface Winds
Authors: Thompson William F. , Monahan Adam H. , Crommelin Daan
Published: May 2014

In this study, the parameters of a stochastic–dynamical model of sea surface winds are estimated from long time series of sea surface wind observational data. The model was introduced by A. H. Monahan, who developed an idealized model from a highly simplified representation of the momentum budget of a surface atmospheric layer of fixed depth. Such estimation of model parameters is challenging, in particular for a multivariate model with nonlinear terms as is considered here. The authors use a method developed recently by Crommelin and Vanden-Eijnden, which approaches the estimation problem variationally, finding the spectrally “best fit” stochastic differential equation to a time series of observations.

While the estimation procedure assumes forcing that is white in time, observed time series are generally better approximated as forced by red noise. Using a red-noise-forced linear system, the authors first show that the estimation procedure can still be used to estimate model parameters. Because the assumption of white noise is violated, these estimates lead to model autocorrelation functions that differ from the observed time series. Application of the estimation procedure to the wind data is further complicated by the fact that the boundary layer model is inconsistent with certain observed features of the wind. When these mismatches between the model and observations are accounted for, the estimation procedure generally results in parameter estimates consistent with the climatological features of the associated meteorological fields. Important exceptions to this result are the layer thickness and layer-top eddy diffusivity, which are poorly estimated where the vector winds are close to Gaussian.
Peak Nasal Inspiratory Flowmetry for Selection of Patients for Radiofrequency Ablation of Turbinates
Authors: Koleli Hakan , Paltura Ceki , Sahin-Yilmaz Aslı , Topak Murat , Develioglu Omer Necati , Kulekçi Mehmet
Published: May 2014

Objectives:

Our goals were to investigate (1) the effectiveness of the topical vasoconstrictor test (TVT) and peak nasal inspiratory flow (PNIF) measurement for the selection of patients with inferior turbinate hypertrophy (ITH) who will benefit from radiofrequency ablation (RFA) of the turbinates and (2) the efficacy of the TVT and PNIF in follow-up of treatment outcomes.

Methods:

Patients with bilateral chronic nasal obstruction due to ITH underwent assessment with a visual analog scale (VAS) and PNIF before and after the TVT. Twenty patients with symptom improvement according to VAS and PNIF results were enrolled in the study. These patients underwent RFA, and PNIF and VAS scores were determined before and 1 and 6 months after the TVT. These results were compared to evaluate the preoperative prediction of RFA treatment success.

Results:

Radiofrequency ablation of the turbinates resulted in significant changes in objective and subjective scores. Preoperative (baseline) subjective and objective responses to decongestant were positively correlated ( P = .024 and P < .05, respectively). Preoperative (baseline) objective responses to decongestant were significantly correlated with the objective outcomes of surgery ( P = .006 and P < .05, respectively).

Conclusion:

The combined use of PNIF and the TVT allows for the preoperative prediction of the success of RFA and the selection of patients who will benefit most from RFA.
Scandals, Media and Good Governance in China and Kenya
Authors: Hassid Jonathan , Brass Jennifer N
Published: May 2014

Conventional wisdom holds that democratic governments listen to their populations, while authoritarian governments do not. This paper questions the extent to which this dynamic applies in cases of government scandals, using the illustrative cases of China and Kenya. We expect democratic countries with free media to be responsive and authoritarian states to ignore public pressure. Counter to this expectation, however, authoritarian China is more responsive to public pressure to clean up scandals than democratic Kenya. Using case studies and quantitative analysis, we argue that while democracy and free media are important for government responsiveness to scandal, they are neither necessary nor sufficient conditions. We assert that political will, state capacity to respond and high public expectations for state action are also necessary.
Breaking Through the Glass Ceiling: Strategies to Enhance the Advancement of Women in Ghana’s Public Service
Authors: Kwaku Ohemeng Frank L , Adusah-Karikari Augustina
Published: May 2014

Ghanaian women have made, and continue to make, considerable progress on their journey to the upper echelons of the decision-making institutions of the country. However, the overall number of women in decision-making positions, especially in the civil service, is distressingly small. At the end of 2011, for example, of 36 positions available only six were filled by women, as chief directors of a ministry. What is being witnessed in the civil service, then, is what has been described in the academic literature and popular press as the glass ceiling. This paper examines what has been and is being done by government, and what sort of strategies will be necessary to deal with the problem. The questions addressed are what are the strategies; and how effective are they in breaking down the glass ceiling that appears to exist in the civil service and which prevents women from progressing into senior management. What is the way forward – or up – in breaking through the glass ceiling?
Effects of acrylamide on mechanical and tribological properties of carbon fiber-reinforced epoxy composites
Authors: Chong Chuanguang , Shang Wulin , Che Yuanyuan , Huang Jin , Zhou Shaofeng , Zhang Qiaoxin
Published: May 2014

The aim of this study was to clarify the effects of acrylamide on mechanical and tribological properties of short carbon fiber–reinforced bisphenol-A-type epoxy composites. The short carbon fiber/epoxy-based composites with or without acrylamide were prepared by solution blending and moderate temperature-curing techniques. Obviously, the short carbon fiber resulted in the enhancement of flexural strength and modulus of the short carbon fiber/epoxy-based composites in contrast to the epoxy-based composites. When the loading-level of short carbon fiber was 8 parts (corresponding to 100 parts of the epoxy matrix), the short carbon fiber 8/epoxy composites containing the same loading-level of acrylamide showed the highest flexural strength and modulus. At the same time, it was found that the addition of acrylamide further improved strength, modulus of the short carbon fiber/epoxy-based composites. Furthermore, the friction coefficient values of the acrylamide-modified short carbon fiber 8/epoxy composites were lower than that without the addition of acrylamide. The worn morphologies observed by scanning electron microscope revealed that the wear mechanism of the acrylamide-modified short carbon fiber 8/epoxy composites was fatigue wear.
Evidence-based psychotherapies I: qualifiers and limitations in what we know
Authors: Kazdin Alan E
Published: May 2014

Psychosocial interventions have advanced remarkably for the treatment of a broad range of psychiatric disorders and related sources of impairment among children, adolescents, and adults. By one count, over 320 interventions have been identified as evidence-based in light of rigorously controlled studies and replication of treatment effects. Yet, how evidence-based psychotherapies have been evaluated and reported raises questions about their impact. This article evaluates both methodological and substantive issues that limit what can be stated about evidence-based psychotherapies and their effects. Among the methodological topics are the control conditions to which evidence-based psychotherapies are compared, selective reporting of measures, and the limited evidence that evidence-based psychotherapies have clinically significant impact. Among the substantive issues are the paucity of research on moderators that would help us better direct patients to treatments from which they are likely to profit and our limited understanding of the mechanisms responsible for therapeutic change. The issues discussed are fundamental to what can be stated about the impact of evidence-based psychotherapies and impact and the bases for their effects. It is not clear at present whether concerted efforts are in place to alter research in ways that would redress the issues. There are, however, novel new directions for research that build on the evidence-based psychotherapies, and these are addressed in a companion article.
Parameter estimation of piecewise Hammerstein systems
Authors: Wang Feng , Xing Keyi , Xu Xiaoping
Published: May 2014

The system is often described as a series of blocks linked together in non-linear system identification. Such block-oriented models are built with static non-linear subsystems and linear dynamic systems. This paper deals with the parameter estimation of Hammerstein systems with piecewise non-linearities, which is a blocked-oriented model where a static non-linear blocking is followed by a linear dynamic system. The basic idea is as follows. The key term separation technique is applied initially, and then a corresponding auxiliary model is constructed. Hence, the identification problem of the system is converted to a non-linear function optimization problem over parameter space. Once again, the estimates of all the parameters are obtained by a proposed particle swarm optimization algorithm. Finally, compared with the existing methods, the simulation results confirm that the presented method is valid. Moreover, the presented method is further extended to estimate Hammerstein systems with discontinuity non-linearities.
Burnout: Recognize and Reverse
Authors: Anne Samantha
Published: May 2014

Physician burnout may be underrecognized and can cause significant detrimental effects on personal health and job satisfaction. Burnout has been associated with medical errors, alcohol and drug abuse, and neglect and abandonment of career goals. With self‐awareness, development of coping mechanisms, and the adoption of a strong social and professional support network, burnout can be combated. This article focuses on recognizing characteristics of burnout and providing strategies to cope to avoid reaching a high degree of burnout.
Hemodynamic performance of Trifecta: Single-center experience of 400 patients
Authors: Modi Amit , Budra Mindaugas , Miskolczi Szabolcs , Velissaris Theodore , Kaarne Markku , Barlow Clifford W , Livesey Steven A , Ohri Sunil K , Tsang Geoffrey M
Published: May 2014

Objective

To evaluate postoperative hemodynamic gradients and early outcomes of aortic valve replacement with the Trifecta bioprosthesis.

Methods

Between 2011 and 2013, 400 patients underwent aortic valve replacement with a Trifecta bioprosthesis. Gradients were calculated by transthoracic echocardiography before discharge. Data were collected retrospectively; patients with postoperative severe left ventricular dysfunction or > mild mitral regurgitation were excluded.

Results

The mean age was 75.9 ± 8.5 years, 197 (49.25%) patients were male, and 140 (35%) were >80-years old. Concomitant procedures were performed in 207 (51.75%) patients, and 30 (7.5%) had redo procedures. Supraannular aortoplasty with bovine pericardium was necessary in 25 (6.25%) cases. Hospital mortality was 2.75% (11 patients). Postoperative peak and mean gradients were 21.7 ± 9.3 and 11.1 ± 4.3 mm Hg for 19-mm valves ( n = 29); 19.5 ± 7 and 9.7 ± 3.6 mm Hg for 21-mm valves ( n = 158); 17.3 ± 6.6 and 8.7 ± 3.2 mm Hg for 23-mm valves ( n = 134); 15.1 ± 6.1 and 7.8 ± 3.3 mm Hg for 25-mm valves ( n = 56); 13.2 ± 3.7 and 6.9 ± 2.6 mm Hg for 27-mm valves ( n = 11). Nine patients had trivial and one had mild transvalvular regurgitation. Mean follow-up was 1 ± 0.62 years; no patient required reoperation. Kaplan-Meier survival at 1 and 2 years was 94.3% ± 1.3% and 93.7% ± 1.4%.

Conclusion

Early postoperative gradients are low after Trifecta implantation. Significant transvalvular regurgitation was not observed, but the incidence of supraannular aortoplasty may be increased.
B-type natriuretic peptide as prognostic marker in tetralogy of Fallot surgery
Authors: Kapoor Poonam Malhotra , Subramanian Arun , Malik Vishwas , Kiran Usha , Velayoudham Devagourou
Published: May 2014

Background

B-type natriuretic peptide has been extensively studied in patients with cardiovascular disease, but its impact on the perioperative outcome of patients with cyanotic congenital heart defects is still unclear. We assessed the perioperative changes in B-type natriuretic peptide levels and their correlation with preoperative factors and clinical outcomes in a large homogenous group of patients with tetralogy of Fallot undergoing definitive repair at a tertiary care center.

Methods

A prospective study was undertaken in the cardiac operating room and intensive care unit at a single institution; 250 patients with tetralogy of Fallot undergoing intracardiac repair under cardiopulmonary bypass were studied. B-type natriuretic peptide levels were taken at 3 time points and correlated with clinical variables.

Results

Baseline B-type natriuretic peptide levels correlated with the degree of cyanosis in all 4 groups. B-type natriuretic peptide levels at 24 h after admission to the intensive care unit correlated with mortality in the adult subset of patients. B-type natriuretic peptide levels > 290 pg mL−1 in the intensive care unit predicted an increased probability of adverse clinical outcomes.

Conclusions

We demonstrated a rise in serum B-type natriuretic peptide levels in patients with tetralogy of Fallot undergoing definitive repair on cardiopulmonary bypass. B-type natriuretic peptide levels may be monitored to identify patients with cyanosis at increased risk of an augmented inflammatory response to cardiopulmonary bypass.
A cost-reducing extracorporeal membrane oxygenation (ECMO) program model: a single institution experience
Authors: Cavarocchi NC , Wallace S , Hong EY , Tropea A , Byrne J , Pitcher HT , Hirose H
Published: May 2014

Background:

The worldwide demand for ECMO support has grown. Its provision remains limited due to several factors (high cost, complicated technology, lack of expertise) that increase healthcare cost. Our goal was to assess if an intensive care unit (ICU)-run ECMO model without continuous bedside perfusionists would decrease costs while maintaining patient safety and outcomes.

Method:

A new ECMO program was implemented in 2010, consisting of dedicated ICU multidisciplinary providers (ICU-registered nurses, mid-level providers and intensivists). In year one, we introduced an education platform, new technology and dedicated space. In year two, continuous bedside monitoring by perfusionists was removed and new management algorithms designating multidisciplinary providers as first responders were established. The patient safety and cost benefit from the removal of the continuous bedside monitoring of the perfusionists of this new ECMO program was retrospectively reviewed and compared.

Results:

During the study period, 74 patients (28 patients in year 1 and 46 patients in year 2) were placed on ECMO (mean days: 8 ± 5.7). The total annual hospital expenditure for the ECMO program was significantly reduced in the new model ($234,000 in year 2 vs. $600,264 in year 1), showing a 61% decrease in cost. This cost decrease was attributed to a decreased utilization of perfusion services and the introduction of longer lasting and more efficient ECMO technology. We did not find any significant changes in registered nurse ratios or any differences in outcomes related to ICU safety events.

Conclusion:

We demonstrated that the ICU-run ECMO model managed to lower hospital cost by reducing the cost of continuous bedside perfusion support without a change in outcomes.
Prognostic significance of red cell distribution width in acute mesenteric ischemia
Authors: Bilgiç İ , Dolu F , Şenol K , Tez M
Published: May 2014

Objective:

Acute mesenteric ischemia (AMI) is an infrequent, but complicated, life-threatening condition. Given this poor outcome, an estimation of mortality would aid in decision making for physicians, patients and their families. Red cell distribution width (RDW) is reflective of systemic inflammation. RDW is a remarkable prognostic marker for determining the risk of mortality in a wide range of clinical manifestations. The objective of this study was to investigate the association between RDW and mortality in patients with AMI.

Methods:

The medical records of patients who underwent laparotomy with a preoperative diagnosis of AMI were reviewed retrospectively. Primary outcome variable was the hospital mortality rate.

Results:

Estimating the receiver operating characteristic area under the curve showed that RDW has good discriminative power for mortality (area under the curve = 0.713; 95% confidence interval, 0.584–0.841). With a cut-off value of 14.85 for RDW, mortality could be correctly predicted in approximately 70% of cases.

Conclusions:

Increased RDW at admission was a predictor of the extent of necrosis and mortality in AMI patients. Further prospective studies are necessary to more accurately assess the importance of RDW in these patients.
Calcium Oxalate Nephrolithiasis and Tubular Necrosis in Recent Metamorphs of Rana sylvatica (Lithobates sylvaticus) Fed Spinach During the Premetamorphic (Tadpole) Stage
Authors: Forzán M. J. , Ferguson L. V. , Smith T. G.
Published: May 2014

Amphibians in the family Ranidae (true frogs) seem highly susceptible to oxalosis, particularly when fed a diet high in oxalic acid during the premetamorphic (tadpole) stage. The authors describe the mortality of 150 captive-raised wood frogs ( Rana sylvatica or Lithobates sylvaticus) from oxalate nephrolithiasis and renal tubular necrosis caused by consumption of boiled spinach during tadpole development. Renal lesions were due to intraluminal transparent crystals which were birefringent under polarized light and were identified morphologically and histochemically as composed of calcium oxalate. Evidence of early fibrosis or squamous metaplasia, and a presentation at least 2 weeks after spinach consumption had ended, suggested a subacute course. Tadpole-feeding protocols should avoid plants with high oxalate content (eg, spinach and rhubarb leaves), and any episode of high mortality in captive amphibians along with nephrolithiasis should prompt an evaluation of the feed sources for material with high oxalate content.
Development of sustainable waste management toward zero landfill waste for the petrochemical industry in Thailand using a comprehensive 3R methodology: A case study
Authors: Usapein Parnuwat , Chavalparit Orathai
Published: May 2014

Sustainable waste management was introduced more than ten years ago, but it has not yet been applied to the Thai petrochemical industry. Therefore, under the philosophy of sustainable waste management, this research aims to apply the reduce, reuse, and recycle (3R) concept at the petrochemical factory level to achieve a more sustainable industrial solid waste management system. Three olefin plants in Thailand were surveyed for the case study. The sources and types of waste and existing waste management options were identified. The results indicate that there are four sources of waste generation: (1) production, (2) maintenance, (3) waste treatment, and (4) waste packaging, which correspond to 45.18%, 36.71%, 9.73%, and 8.37% of the waste generated, respectively. From the survey, 59 different types of industrial wastes were generated from the different factory activities. The proposed 3R options could reduce the amount of landfill waste to 79.01% of the amount produced during the survey period; this reduction would occur over a period of 2 years and would result in reduced disposal costs and reduced consumption of natural resources. This study could be used as an example of an improved waste management system in the petrochemical industry.
Effect of Compliance With a Nurse-Led Intensive Care Unit Checklist on Clinical Outcomes in Mechanically and Nonmechanically Ventilated Patients
Authors: Al Ashry Haitham S. , Abuzaid Ahmed S. , Walters Ryan W. , Modrykamien Ariel M.
Published: May 2014

Background:

Use of checklists brings about improvements in a variety of patient outcomes. Nevertheless, whether compliance with a nurse-led intensive care unit (ICU) checklist produces the same effect is currently unknown.

Methods:

This is a retrospective analysis of data obtained during the implementation of a quality improvement project consisting of the utilization of a nurse-led ICU checklist. A consecutive series of checklists obtained from patients admitted in our ICU during 7 consecutive months were included. The ICU stay, hospital stay, and ventilator stay were compared between patients whose practitioners completed or did not complete the checklist. Variables were analyzed using Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. A 2-tailed P < .05 was considered statistically significant.

Results:

One thousand checklists, corresponding to 346 eligible patients, were collected over 7 months. Mechanical ventilation was used in 203 (59%) patients. Completed checklists were observed for 37.6% (n = 130) of all patients and 38.9% ( n = 79) of mechanically ventilated patients. After adjusting for age, Acute Physiology and Chronic Health Evaluation II (APACHE II), body mass index, reason for admission, and type of ICU, completion of the checklist was associated with a 20% increase in the number of days in the ICU compared with the group with incomplete lists. In mechanically ventilated patients, completion of the checklist was associated with a 31% increase in hospital length of stay, a 34% increase in the number of ICU days, and a 32% increase in mechanical ventilation days.

Conclusion:

Compliance with completion of a nurse-led ICU checklist was associated with prolonged ICU stay, hospital stay, and ventilator stay.
The Rechabites Revisited: The History of the Rechabites Twenty-Five Years On
Authors: Knights Chris H.
Published: May 2014

In this article the author revisits the ‘History of the Rechabites’, chs. 8–10 of the Story of Zosimus, a text he first studied in the 1980s, in the light of the work done on the text more recently by Nikolsky and Davila. He looks more closely at the reasons why the text may or may not be Jewish and concludes that, despite his earlier published views, it is more likely to be a Christian composition than a Jewish one.