bluuebunny/crossref_metadata_2025 huggingface dataset:
Rituximab in Adult Minimal Change Disease and Focal Segmental Glomerulosclerosis
Authors: Kronbichler Andreas , Bruchfeld Annette
Published: January 2015

Treatment of nephrotic syndrome due to minimal change disease and focal segmental glomerulosclerosis remains a challenge since steroid dependence, steroid resistance and a relapsing disease course exhibits a high cumulative steroid dosage. The necessity of using alternative steroid-sparing immunosuppressive agents with potential toxic side effects also restricts their long-term use. Rituximab, a monoclonal antibody targeting CD20, has been increasingly used in the therapy of difficult-to-treat nephrotic syndrome. A clinical response has been shown for patients with steroid-dependent or frequently relapsing nephrotic syndrome, whereas the benefit seems to be limited in steroid-resistant patients, especially those with underlying focal segmental glomerulosclerosis. No potentially life-threatening adverse events have been observed in the treatment of adult minimal change disease and focal segmental glomerulosclerosis following rituximab administration. Since most reports are retrospective and evidence of efficacy is derived from small case series, more prospective trials in a controlled, randomized manner are highly desirable to delineate the use of rituximab or other B cell-depleting agents in steroid-dependent, frequently relapsing or steroid-resistant patients.
New Biologics for Glomerular Disease on the Horizon
Authors: Karras Alexandre , Jayne David
Published: January 2015

The major advances achieved in immunology and cellular biology have led to the development of biotherapies that specifically target different mediators and pathways involved in the physiopathology of renal diseases. After the major breakthroughs obtained with B-cell depletion in autoantibody-mediated glomerulopathies, several other immunomodulation strategies are being tested in autoimmune glomerulonephritides, such as blockade of B-cell costimulation and activation, inhibition of complement pathways or modification of the T-B-lymphocyte crosstalk. Other drugs, inhibiting proinflammatory cytokines, are being developed in order to control the inflammatory response initiating and amplifying the kidney tissue injury observed in different systemic diseases. Finally, several promising therapeutic agents target specific renal cells such as podocytes or fibroblasts, blocking the common final steps of the deleterious pathological process underlying various types of nephropathy. Although several of these drugs are still under evaluation in phase 2/3 clinical trials, biotherapies have undoubtedly opened a new era in the treatment of glomerular disease.
The 99mTc-DTPA Urinary Clearance Method May Be Preferable to the Plasma Disappearance Method for Assessing Glomerular Filtration Rate in Diabetic Nephropathy
Authors: Huang Shih-Han S. , Eliasziw Misha , Spence J. David , Filler Guido , Vezina William C. , Churchill David N. , Cattran Daniel C. , Richardson Bonnie , House Andrew A.
Published: January 2015

Background: Isotopic glomerular filtration rate (iGFR) measurement is comparable to the inulin method. In this study, we compared urinary and plasma iGFR methodologies in patients with diabetic nephropathy. Methods: A total of 147 patients from 3 sites in the Diabetic Intervention with Vitamins to Improve Nephropathy (DIVINe) trial provided 213 sets of urine and blood collections, at baseline, 18 and 36 months. Results: The mean (with standard deviation) plasma iGFR of 60.7 (24.9) ml/min/1.73 m2 compared to urinary iGFR of 52.0 (28.0) ml/min/1.73 m2 was statistically significant (p value <0.001). Although plasma and urinary iGFRs were highly related (R2 = 0.86), plasma iGFR increasingly overestimated urinary iGFRs at lower GFRs. In contrast to the cross-sectional analyses, the two measures of iGFR were weakly related (R2 = 0.32) in regard to patients' change over 18 months of follow-up. Conclusion: Plasma iGFR may not be a suitable method for accurately measuring GFR in patients with advancing degrees of chronic kidney disease from diabetic nephropathy.
Polyuria in Hantavirus Infection Reflects Disease Severity and Is Associated with Prolonged Hospital Stay: A Systematic Analysis of 335 Patients from Southern Germany
Authors: Latus Joerg , Kitterer Daniel , Dippon Juergen , Müller Simon , Artunc Ferruh , Segerer Stephan , Alscher M. Dominik , Braun Niko
Published: January 2015

Background/Aims: Puumala virus (PUUV) infection leads to nephropathia epidemica (NE), especially in endemic areas in Central Europe. The clinical course of NE is characterized by acute kidney injury (AKI) with thrombocytopenia followed by polyuria to a different degree. The prevalence of polyuria and its associated risk factors have not been reported in a large cohort of NE patients. Methods: Clinical and laboratory data during the acute phase of the disease were obtained from the medical reports and files of 335 patients who received in-hospital treatment during acute hantavirus infection. Comprehensive statistical models were developed to estimate the probability of polyuria. Results: The median age at diagnosis was 47 years (interquartile range, IQR 40-59) and 48% of the patients developed polyuria with a urinary output of 5,100 ml/day (IQR 4,200-7,300). The hospital stay was significantly longer in the polyuric group compared to the nonpolyuric group [8 days (IQR 6-10) vs. 6 days (IQR 5-8); p = 0.04]. Using logistic regression analysis, male gender (odds ratio, OR = 1.6; 95% confidence interval, CI 1.05-2.58; p = 0.03), oliguria/anuria during NE (OR = 2.56; 95% CI 1.65-4.01; p < 0.001), severe AKI (OR = 1.87; 95% CI 1.22-2.9; p < 0.001), and hematuria (OR = 1.78; 95% CI 1.02-3.15; p = 0.04) were significantly associated with the development of polyuria. In a multivariate model, the probability of polyuria was 0.19 (SEM ± 0.05) in female patients presenting with mild/moderate AKI without anuria/oliguria. Conclusions: Almost 50% of hospitalized NE patients developed polyuria, which was associated with a prolonged hospital stay. The probability of the development of polyuria was lowest in female patients with mild/moderate, non-oliguric/anuric AKI.
Inhalation of Hydrogen Gas Is Beneficial for Preventing Contrast-Induced Acute Kidney Injury in Rats
Authors: Homma Koichiro , Yoshida Tadashi , Yamashita Maho , Hayashida Kei , Hayashi Matsuhiko , Hori Shingo
Published: January 2015

Background: The present study aimed at investigating the effect of a novel antioxidant, hydrogen (H2) gas, on the severity of contrast-induced acute kidney injury (CIAKI) in a rat model. Methods: CIAKI was induced in rats by intravenous injection of a contrast medium, Ioversol, in addition to reagents inhibiting prostaglandin and nitric oxide synthesis. During the injection of these reagents, the rats inhaled H2 gas or control gas. Results: One day after the injection, serum levels of urea nitrogen were significantly lower in H2 gas-inhaling CIAKI rats (17.6 ± 2.3 mg/dl) than those in control gas-treated CIAKI rats (36.0 ± 7.3 mg/dl), although they both were elevated as compared to untreated rats (14.9 ± 0.9 mg/dl). Consistently, creatinine clearance in H2 gas-treated CIAKI rats was higher than that in control gas-treated counterparts. Renal histological analysis revealed that the formation of proteinaceous casts and tubular necrosis was improved by H2 gas inhalation. Mechanistic analyses showed that inhalation of H2 gas significantly reduced renal cell apoptosis, expression of cleaved caspase 3, and expression of an oxidative stress marker, 8-hydroxydeoxyguanosine, in injured kidneys. Conclusion: Results suggest that H2 gas inhalation is effective in ameliorating the severity of CIAKI in rats by reducing renal cell apoptosis and oxidative stress.
Impact of Baseline Health-Related Quality of Life Scores on Survival of Incident Patients on Peritoneal Dialysis: A Cohort Study
Authors: Grincenkov Fabiane Rossi dos Santos , Fernandes Natália , Pereira Beatriz dos Santos , Bastos Kleyton , Lopes Antônio Alberto , Finkelstein Fredric O. , Pecoits-Filho Roberto , Qureshi Abdul Rashid , Divino-Filho José Carolino , Bastos Marcus Gomes
Published: January 2015

Introduction: In an attempt to decrease mortality in patients with end-stage renal disease, an increase in the lifetime of these patients without much focus on health-related quality of life (HRQOL) was pursued for a long period of time. However, lately, an improvement in the quality of this extended lifetime has focused on both the physical as well as the social and emotional aspects, as these parameters may be associated with clinical outcomes in end-stage renal disease patients. Aim: To evaluate the impact of self-determined HRQOL at admission on survival of incident peritoneal dialysis (PD) patients. Patients and Methods: A total of 1,624 incident Brazilian PD patients participating in a multicenter prospective cohort study (BRAZPD) were evaluated. HRQOL was assessed using the SF-36, divided into mental and physical components. Cox proportional regression analysis was used to determine the influence of HRQOL (mental and physical components) on mortality. Multivariate Cox proportional hazards analyses were used to adjust gradually for more potential explanatory variables: first for demographic variables, followed by additional adjustment for socioeconomic, clinical and laboratory variables. The significance level in all analyses was set at p < 0.05. All analyses were carried out with SPSS 17.0. Results: Incident PD patients presented with low HRQOL scores on admission to therapy. Even after correction for sociodemographic variables, comorbidities, PD modality and laboratory parameters, HRQOL (both the mental and the physical components) remained a predictor [HR: 0.97 (CI: 0.95-0.98); HR: 0.97 (CI: 0.96-0.99), respectively] of survival. Conclusion: On admission to therapy, patients presenting with low HRQOL scores for both the mental and the physical components were associated with a higher mortality. These results suggest that early and timely intervention measures to improve the QOL of these patients are important.
Differential Membrane Expression of Toll-Like Receptors and Intracellular Cytokine Induction in Peripheral Blood Monocytes of Patients with Chronic Kidney Disease and Diabetic Nephropathy
Authors: Zikou Xanthi , Tellis Constantinos C. , Rousouli Kleopatra , Dounousi Evangelia , Siamopoulos Kostas C. , Tselepis Alexandros D.
Published: January 2015

Background: Toll-like receptors (TLRs) are key players in the innate immune system whose activation leads to an inflammatory response. Inflammation plays an important role in the pathogenesis of chronic kidney disease (CKD) and diabetes mellitus. The aim of our study was to assess the proinflammatory state of nondialysis CKD patients by evaluating the membrane expression of TLR2 and TLR4 and the intracellular IL-1β and IL-6 production in response to the ligand Pam3Cys-Ser-(Lys)4 (Pam3CSK4). Methods: 85 nondialysis CKD patients [mean estimated glomerular filtration rate: 34 (17-90) ml/min/1.73 m2] were divided in 2 groups: 55 nondiabetic CKD patients (CKD group) and 30 patients with diabetic nephropathy (DN group). The two groups were compared with 36 healthy subjects (control group). TLR2 and TLR4 membrane expression in monocytes and Pam3CSK4-induced intracellular production of IL-1β and IL-6 were assessed by flow cytometry. Results: Both patient groups showed increased TLR2 membrane expression compared with the control group, both at baseline (p < 0.05 for both) and after Pam3CSK4 stimulation (p < 0.05 for both). The DN group exhibited significantly higher TLR4 expression at baseline compared to the CKD and control groups (p < 0.04 and p < 0.02, respectively). Intracellular IL-1β and IL-6 levels at baseline were significantly lower in CKD patients compared to the DN and control groups. After Pam3CSK4 stimulation, intracellular IL-1β and IL-6 increased in all groups, but were lower in the CKD group versus the control group or DN group, which exhibited higher levels than the controls. Conclusions: Nondialysis CKD patients showed significant alterations in TLR2 and TLR4 membrane expression, and impaired Pam3CSK4-induced cytokine production in monocytes, a phenomenon that is markedly influenced by the presence of diabetes.
Activation of Type I and Type III Interferons in Chronic Hepatitis C
Authors: Mihm Sabine
Published: January 2015

Infection with hepatitis C virus (HCV) results in chronic and progressive liver disease. Persistency rates add up to 85%. Despite recognition of the virus by the human host in peripheral blood and in the liver, immune response appears to be ineffective in clearing infection. The ability to spontaneously eradicate the virus as well as the outcome of infection upon therapy with human recombinant interferon-α (IFN-α) was found to correlate most closely with genetic variations within the region encoding the IFN-λ genes, as revealed by genome-wide association studies on main ethnic populations in 2009. This review summarizes the induction of type I and type III IFN genes and their effectors, the IFN-stimulated genes. It focusses on the in vivo situation in chronic HCV infection in man both in the peripheral blood compartment and in the liver. It also addresses the impact of genetic polymorphisms in the region of type III IFN genes on their activation. Finally, it discusses how antiviral drugs (i.e. IFN-α, ribavirin and the direct-acting antivirals) may complementarily control the activation of endogenous IFNs and succeed in combatting infections.
A Novel Mutation in the Endothelin B Receptor Gene in a Moroccan Family with Shah-Waardenburg Syndrome
Authors: Doubaj Yassamine , Pingault Véronique , Elalaoui Siham C. , Ratbi Ilham , Azouz Mohamed , Zerhouni Hicham , Ettayebi Fouad , Sefiani Abdelaziz
Published: January 2015

Waardenburg syndrome (WS) is a neurocristopathy disorder combining sensorineural deafness and pigmentary abnormalities. The presence of additional signs defines the 4 subtypes. WS type IV, also called Shah-Waardenburg syndrome (SWS), is characterized by the association with congenital aganglionic megacolon (Hirschsprung disease). To date, 3 causative genes have been related to this congenital disorder. Mutations in the EDNRB and EDN3 genes are responsible for the autosomal recessive form of SWS, whereas SOX10 mutations are inherited in an autosomal dominant manner. We report here the case of a 3-month-old Morrocan girl with WS type IV, born to consanguineous parents. The patient had 3 cousins who died in infancy with the same symptoms. Molecular analysis by Sanger sequencing revealed the presence of a novel homozygous missense mutation c.1133A>G (p.Asn378Ser) in the EDNRB gene. The proband's parents as well as the parents of the deceased cousins are heterozygous carriers of this likely pathogenic mutation. This molecular diagnosis allows us to provide genetic counseling to the family and eventually propose prenatal diagnosis to prevent recurrence of the disease in subsequent pregnancies.
Adherence to a Mediterranean Diet and Prediction of Incident Stroke
Authors: Tsivgoulis Georgios , Psaltopoulou Theodora , Wadley Virginia G. , Alexandrov Andrei V. , Howard George , Unverzagt Frederick W. , Moy Claudia , Howard Virginia J. , Kissela Brett , Judd Suzanne E.
Published: January 2015

Background and Purpose—

There are limited data on the potential association of adherence to Mediterranean diet (MeD) with incident stroke. We sought to assess the longitudinal association between greater adherence to MeD and risk of incident stroke.

Methods—

We prospectively evaluated a population-based cohort of 30 239 individuals enrolled in REasons for Geographic and Racial Differences in Stroke (REGARDS) study, after excluding participants with stroke history, missing demographic data or food frequency questionnaires, and unavailable follow-up information. Adherence to MeD was categorized using MeD score. Incident stroke was adjudicated by expert panel review of medical records during a mean follow-up period of 6.5 years.

Results—

Incident stroke was identified in 565 participants (2.8%; 497 and 68 cases of ischemic stroke [IS] and hemorrhagic stroke, respectively) of 20 197 individuals fulfilling the inclusion criteria. High adherence to MeD (MeD score, 5–9) was associated with lower risk of incident IS in unadjusted analyses (hazard ratio, 0.83; 95% confidence interval, 0.70–1.00;
P
=0.046). The former association retained its significance (hazard ratio, 0.79; 95% confidence interval, 0.65–0.96;
P
=0.016) after adjustment for demographics, vascular risk factors, blood pressure levels, and antihypertensive medications. When MeD was evaluated as a continuous variable, a 1-point increase in MeD score was independently associated with a 5% reduction in the risk of incident IS (95% confidence interval, 0–11%). We documented no association of adherence to MeD with incident hemorrhagic stroke. There was no interaction of race (
P
=0.37) on the association of adherence to MeD with incident IS.

Conclusions—

High adherence to MeD seems to be associated with a lower risk of incident IS independent of potential confounders. Adherence to MeD is not related to the risk of incident hemorrhagic stroke.
Figures of Iurodstvo in Tarkovsky’s The Passion According to Andrei
Authors: Efird Robert
Published: January 2015

Variations on the holy fool recur throughout the films of Andrei Tarkovsky but the figure of the iurodivyi is perhaps never more pervasive or critical to the task at hand than in his second feature-length film, The Passion According to Andrei. This article examines holy foolishness as an essential aspect of the artistic personality in Tarkovsky’s depiction of Andrei Rublev, Boriska, and Theophanes the Greek. In addition, Tarkovsky’s idiosyncratic narrative style, with its close similarities to Deleuze’s description of the time-image, exhibits similarly oppositional and provocative patterns. As this examination finds, the holy fool may also function as a figure for the overarching narrative as it strives, through various means, to push the viewer from complacent modes of thought and stimulate a more direct, less spatialized perception of time or duration.
Kenosis, Race and the Sacredly Mobile Adolescent: A Revised Christology for Racial Reconciliation
Authors: Keuss Jeff
Published: January 2015

This paper argues for a reappropriation of kenosis as a vital aspect of Christology that is particularly important in the understanding of what I have termed “sacredly mobile adolescents”— teens who inhabit a core identity value as fluidity of personhood rather than fixity. The concept of kenosis is explored through a combination of theological and biblical lenses. This understanding is then correlated against the experiences of ‘Third Culture Kids’ (young adults who have spent significant time in childhood in other cultural settings) to establish a model of youth ministry that approaches a kenotic form of identity construction through its life and practices.
Youth and Creation: A Biblical Theology of Growth & Development
Authors: Noval Christian
Published: January 2015

The main purpose for Theology of Youth is to present a theological understanding of youth. Theological Anthropology is helpful with this task, but classical Theological Anthropology based on the creation account in Genesis creates particular challenges for understanding youth. Wisdom literature and in particular Job’s narrative of his creation in Job 10 proves more useful since it can explain growth and development as a part each human being’s creation.
Koinonia: A Roman Catholic Perspective on a Theological Pattern for Youth Ministry in Church as a Community
Authors: Höring Patrik C
Published: January 2015

The current situation in church and modern society makes it necessary to leave comprehensive theories of pastoral care. Facing a youth that can only be described as an aggregate, and regarding a pluralization of practice, methods and approaches, a contemporary theory of youth ministry will not be a complete design but rather a flexible theory, which is open for different situations and diverse ways of action. This article outlines a theological concept of youth work corresponding to the self-conception of the church by revealing its characteristic trait as a koinonia (community, communion and relationship) as a suitable pattern for such a flexible theory of youth ministry needed today.
Description of the immature stages of Platycrepidius dewynteri Chassain (Coleoptera, Elateridae, Agrypninae, Platycrepidiini) from Brazil with a synopsis of the larval characters of Agrypninae tribes
Authors: ROSA SIMONE POLICENA , ALBERTONI FABIANO F. , BENÁ DANIELA DE CASSIA
Published: January 2015

Mature larva and pupa of Platycrepidius dewynteri Chassain are described, from Pará state, Brazil. Biological notes under laboratory conditions and comparison with P. bicinctus Candèze are also included. Additionally, we present a synopsis and a morphological comparative study based mainly on literature of the known mature larvae of the Agrypninae genera.
On the Local Available Energetics in a Moist Compressible Atmosphere
Authors: Peng Jun , Zhang Lifeng , Zhang Yun
Published: January 2015

A new derivation of local available energetics for a fully compressible, nonhydrostatic, moist atmosphere is presented. The available energetics is defined relative to an arbitrary dry reference state in hydrostatic balance with stable stratification. By introducing the modified potential temperature, a positive-definite expression of the moist available potential energy (APE) is derived. The change of the moist APE must include the role of convection to function both as a source of latent heat and as an atmosphere dehumidifier. The sum of this moist APE and the available elastic energy (AEE) is the moist available energy. In the local energy cycle, the moist available energy is partly used to generate kinetic energy (KE) and partly used to lift the water vapor to the higher level where it precipitates, resulting in the increase of gravitational energy of moist species. The moist APE is converted into vertical KE through the buoyancy term; the vertical KE is converted into the AEE through the vertical perturbation pressure gradient term; and the AEE is converted into horizontal KE through the horizontal divergence/convergence term. In addition, there exist two adiabatic nonconservative processes, which act on the AEE and APE, respectively. A suitable choice of the reference state should make these two processes much less significant than the conversions between the available energy and KE. An alternative method is presented to construct such a reference state. Application to the idealized baroclinic atmosphere shows that this reference state is much more relevant to the local available energy analysis than the isothermal one.
Annular Mode Variability of the Atmospheric Meridional Energy Transport and Circulation
Authors: Yamada Ray , Pauluis Olivier
Published: January 2015

Month-to-month variability in the meridional atmospheric energy transport is analyzed in the Modern-Era Retrospective Analysis for Research and Applications (MERRA) reanalysis for 1979–2012. The meridional transport of moist static energy (MSE) is composited onto the high and low phases of the northern and southern annular modes (NAM and SAM). While the high phase of the NAM and SAM is known to involve a poleward shift in the midlatitude storm track and jet, it is shown here that the distribution of poleward MSE transport shifts equatorward. This change is explained by examining the variability of the underlying meridional circulation. In particular, changes in the mass transport averaged on dry and moist static energy levels are considered. These circulations have an advantage over the conventional Eulerian circulation for explaining the total energy transport. They are computed using the statistical transformed Eulerian-mean (STEM) formulation, which provides a decomposition of the circulation into Eulerian-mean and eddy-driven components. The equatorward shift in the MSE transport is largely explained by a poleward shift of the Ferrel cell, while changes in the eddy-driven circulation have a comparatively small effect on the energy transport. The changes in the residual circulation and jet are shown to be consistent through momentum balance arguments. Mean-eddy feedback mechanisms that drive and sustain the annular modes are discussed at the end as a possible explanation for why the changes in the eddy-driven circulation are weak compared to the changes in the Eulerian circulation.
Institutional Resilience in Extreme Operating Environments
Authors: Barin Cruz Luciano , Aguilar Delgado Natalia , Leca Bernard , Gond Jean-Pascal
Published: January 2015

This study shows how institutional work contributes to institutional resilience in extreme operating environments (EOEs). The authors draw from a longitudinal analysis of the operations of Desjardins International Development (DID), a French Canadian nongovernmental organization (NGO) that, both before and after the major earthquake of 2010, supported the implementation of cooperative banking in Haiti. Building on a unique access to DID’s internal documents as well as on 49 interviews with DID employees, the authors highlight the ways in which political, technical, and cultural forms of institutional work triggered the emergence of social capital, which in turn supported the rise of new forms of institutional work that enabled institutional resilience. The results show how organizational activities focused on shaping institutions may have unintended effects that enable institutional resilience in EOEs, and demonstrate how the accumulation of institutional work by an organization contributes to the enhancement of its social capital.
The Nation in Antiquity
Authors: King Lamont DeHaven
Published: January 2015

This article supports the tendency among Egyptologists to classify ancient Kemet as a nation. In so doing, it challenges the modernist and postmodernist assertion that the nation first emerged in the West during the 18th and 19th centuries. It conceptualizes the nation in two ways: as the coincidence of common ethnicity and clearly defined territory—the nation-state; and more simply, as an entity that claims the right to control a state. Kemet’s war of national liberation—the expulsion of the Hyksos during the Second Intermediate Period—illustrates the former conceptualization of the nation. However, the common ethnic identity that had been nurtured since unification was not a major factor in the civil war during the First Intermediate Period. Consequently, this quest for reunification is an example of the nation as a political movement.
Multiscale Analyses of the Bone-implant Interface
Authors: Cha J.Y. , Pereira M.D. , Smith A.A. , Houschyar K.S. , Yin X. , Mouraret S. , Brunski J.B. , Helms J.A.
Published: January 2015

Implants placed with high insertion torque (IT) typically exhibit primary stability, which enables early loading. Whether high IT has a negative impact on peri-implant bone health, however, remains to be determined. The purpose of this study was to ascertain how peri-implant bone responds to strains and stresses created when implants are placed with low and high IT. Titanium micro-implants were inserted into murine femurs with low and high IT using torque values that were scaled to approximate those used to place clinically sized implants. Torque created in peri-implant tissues a distribution and magnitude of strains, which were calculated through finite element modeling. Stiffness tests quantified primary and secondary implant stability. At multiple time points, molecular, cellular, and histomorphometric analyses were performed to quantitatively determine the effect of high and low strains on apoptosis, mineralization, resorption, and collagen matrix deposition in peri-implant bone. Preparation of an osteotomy results in a narrow zone of dead and dying osteocytes in peri-implant bone that is not significantly enlarged in response to implants placed with low IT. Placing implants with high IT more than doubles this zone of dead and dying osteocytes. As a result, peri-implant bone develops micro-fractures, bone resorption is increased, and bone formation is decreased. Using high IT to place an implant creates high interfacial stress and strain that are associated with damage to peri-implant bone and therefore should be avoided to best preserve the viability of this tissue.
Assisted dying – should the UK change its stance?
Authors: Gordon Daniel , Raphael Claire E , Vassiliou Vassilios
Published: January 2015

Along with an increasing interest in assisted dying by many European and North American countries, some of which have already modified their existing laws to accommodate this, the interest in assisted dying in the UK has increased once again following Lord Falconer’s Assisted Dying for the Terminally Ill Bill. Drawing on examples from countries where similar assisted dying laws are already in place, this article analyses and contextualises the proposed bill and discusses its potential pitfalls and benefits for the UK.
Freshwater drowning in a child: A case study demonstrating the role of post-mortem computed tomography
Authors: Filograna Laura , Tartaglione Tommaso , Vetrugno Giuseppe , Guerra Claudio , Fileni Adriano , Bonomo Lorenzo
Published: January 2015

In recent years, modern imaging techniques have gained ground in forensics. A crucial question is whether virtual autopsy is capable of replacing traditional autopsy.

Forensic diagnosis of freshwater drowning (FWD) is based on the evidence of findings from external inspection (e.g. frothy fluid exuding from the mouth and nostrils), internal examination (e.g. pulmonary congestion, enlargement of heart chambers) and biochemical analysis (haemodilution), findings which are non-specific. The detection of diatoms in organs of the systemic circulation may be of some assistance, but this analysis is rarely performed and is of debatable validity.

An 18-month-old child was found dead at home in a swimming pool. Considering the family's wishes to avoid autopsy, the district attorney authorised a whole-body post-mortem computed tomography scan (PMCT). The main imaging findings were frothy fluid in the upper airways, fluid in the trachea and main bronchi, many pulmonary nodular ground glass opacities (GGO) in non-dependent regions and haemodilution. CT imaging did not show any other forensically relevant abnormality.

A high concordance was found between the CT findings reported in the literature in cases of FWD and the imaging results. Thus, after the exclusion of other causes of death, advised by the forensic pathologist, the district attorney closed the case and the death was attributed to FWD.

This case report demonstrates that PMCT imaging in cases of suspected FWD can provide some important findings for the diagnosis of FWD as the cause of death.
Transfusion in Head and Neck Free Flap Patients
Authors: Puram Sidharth V. , Yarlagadda Bharat B. , Sethi Rosh , Muralidhar Vinayak , Chambers Kyle J. , Emerick Kevin S. , Rocco James W. , Lin Derrick T. , Deschler Daniel G.
Published: January 2015

Objective

To characterize patterns of utilization and outcomes following transfusion in head and neck patients undergoing free flap reconstruction.

Study Design

Case series with chart review.

Setting

Tertiary academic medical center.

Subjects and Methods

Two hundred eighty‐two head and neck patients undergoing free flap reconstruction from 2011 to 2013. Outcome parameters included post‐transfusion hematocrit increase, length of stay (LOS), flap survival, and perioperative complications.

Results

Of all head and neck free flap patients, 48.9% received blood transfusions. Average pretransfusion hametocrit (Hct) was 24.7% ± 0.2% with 2.5 ± 0.1 units of blood transfused. Transfused patients were more likely to have been taken back to the operating room. Rates of transfusion were similar between flap types, although anterolateral thigh (ALT) and fibular free flap (FFF) patients had higher transfusion requirements compared to radial forearm free flap (RFFF) patients. Further, FFF patients trended toward receiving transfusions earlier. Transfusion did not influence flap survival but was associated with wound dehiscence, myocardial infarction, congestive heart failure, respiratory distress, and pneumonia. Subset analyses by flap type revealed that differences were significant among the RFFF and FFF cohorts but not ALT patients. When comparing patients who were transfused for Hct <21 to those transfused for Hct <27, there were no differences in LOS, flap survival, or postsurgical complications.

Conclusions

Among the different types of flaps, FFF and ALT are associated with higher transfusion requirements. Transfusion in patients undergoing free flap reconstruction does not significantly affect flap survival but was associated with perioperative complications. Our data support consideration of a restrictive transfusion policy in free flap patients.
Hearing Preservation after Middle Fossa Vestibular Schwannoma Removal
Authors: Quist Tyler S. , Givens Daniel J. , Gurgel Richard K. , Chamoun Roukoz , Shelton Clough
Published: January 2015

Objective

To describe 5‐year hearing preservation rates following microsurgical excision of vestibular schwannoma (VS) via the middle cranial fossa (MCF) approach.

Study Design

Case series with chart review.

Setting

This study was performed at a tertiary care academic medical center.

Subjects and Methods

Fifty‐seven subjects with VS underwent resection via an MCF approach between February 1998 and January 2009. Pure‐tone average (PTA) and word recognition score (WRS) were obtained preoperatively, immediately postoperatively, and at 5‐year follow‐up.

Results

Preoperative serviceable hearing (American Academy of Otolaryngology—Head and Neck Surgery class A/B) was present in 49 (86%) of the 57 patients, with an average PTA of 23 dB (range, 1‐50 dB) and an average WRS of 97% (range, 76%‐100%). Immediate postoperative serviceable hearing was maintained in 27 (55%) patients, with an average PTA and WRS of 31 dB (5‐50 dB) and 96% (70%‐100%), respectively. Five‐year follow‐up was available for 16 of the 27 patients. Twelve (75%) of the 16 patients maintained serviceable hearing with an average PTA and WRS of 35 dB (4‐49 dB) and 95% (84%‐100%), respectively. Of the 16 subjects who did maintain class A or B hearing, the mean change in PTA and WRS was 5 dB and 0.4%, respectively. Of the 4 patients who did not maintain class A/B hearing, average change in PTA and WRS was 16 dB (4.5‐23 dB) and 16% (0%‐40%), respectively.

Conclusions

For patients with VS in whom serviceable hearing is preserved following the MCF approach, the long‐term hearing outcome remains durable in most patients.
Facial Nerve Monitoring during Parotidectomy
Authors: Sood Amit J. , Houlton Jeffrey J. , Nguyen Shaun A. , Gillespie M. Boyd
Published: January 2015

Objectives

To determine the effectiveness of intraoperative facial nerve monitoring (FNM) in preventing immediate and permanent postoperative facial nerve weakness in patients undergoing primary parotidectomy.

Data Sources

PubMed‐NCBI database from 1970 to 2014.

Review Methods

A systematic review and meta‐analysis of the literature was conducted. Acceptable studies included controlled series that evaluated facial nerve function following primary parotidectomy with or without FNM (intraoperative nerve monitor vs control). Primary and secondary end points were defined as immediate postoperative and permanent facial nerve weakness (House‐Brackmann score, ≥2), respectively.

Results

After a review of 1414 potential publications, 7 articles met inclusion criteria, with a total of 546 patients included in the final meta‐analysis. The incidence of immediate postoperative weakness following parotidectomy was significantly lower in the FNM group compared to the unmonitored group (22.5% vs 34.9%; P =. 001). The incidence of permanent weakness was not statistically different in the long term (3.9% vs 7.1%; P =. 18). The number of monitored cases needed to prevent 1 incidence of immediate postoperative facial nerve weakness was 9, given an absolute risk reduction of 11.7% This corresponded to a 47% decrease in the incidence of immediate facial nerve dysfunction (odds ratio, 0.53; 95% CI, 0.35 to 0.79; P =. 002).

Conclusion

In primary cases of parotidectomy, intraoperative FNM decreases the risk of immediate postoperative facial nerve weakness but does not appear to influence the final outcome of permanent facial nerve weakness.
Mobile Applications in Otolaryngology–Head and Neck Surgery
Authors: Wong Matthew C. , Fung Kevin
Published: January 2015

Objectives

To study the current selection of mobile applications (apps) relating to otolaryngology–head and neck surgery (OtoHNS). To conduct a review of the apps available in OtoHNS.

Data Sources

App Store, Google Play, BlackBerry World, Windows Store.

Methods

The Apple, Google, Windows, and Blackberry mobile app stores were searched for apps relating to OtoHNS. App information was analyzed based on in‐store descriptions, and apps were downloaded and reviewed.

Conclusions and Implications for Practice

There is a rapidly expanding collection of apps with a wide variety of functions available in OtoHNS. There are several high‐quality apps for education and clinical use, which have been highlighted in our review. Mobile apps have the potential to become widely incorporated into OtoHNS, although there is a need for appropriate guidance from the specialty to ensure app quality and accuracy of content.
Tone of Writing on Fashion Retail Websites, Social Support, e-Shopping Satisfaction, and Category Knowledge
Authors: Lee Eun-Jung , Hahn Kim
Published: January 2015

Quality customer-company dynamics contributes to a satisfactory in-store shopping experience, and lacking this social element in virtual retail contexts can be a critical negativity. In attempting to address the social role of the text-based content in fashion e-tail contexts, this study tested the effect of tone of writing of web content on website socialness and e-shopping satisfaction, the intervening mechanism of social support, and the moderating effect of customers' category knowledge. A fictitious e-tail site selling women's fashion accessories was developed as the stimuli for the main study to reflect two different tone of writing conditions (conversational versus formal). The results indicated the positive, significant effect of conversational tone of the text-based content on website socialness, which subsequently increased e-shopping satisfaction through the social support benefits. The positive effects of emotional and informational supports on e-shopping satisfaction were stronger with the participants of low category knowledge than high category knowledge. Implications and ideas for future research are discussed.
A rapid infusion pump driven by micro electromagnetic linear actuation for pre-hospital intravenous fluid administration
Authors: Zhao Peng , Chong Yinbao , Zhao An , Lang Lang , Wang Qing , Liu Jiuling
Published: January 2015

A rapid infusion pump with a maximum flow rate of 6 L/h was designed experimentally using a micro electromagnetic linear actuator, and its effectiveness was evaluated by comparing with that of a commercial Power Infuser under preset flow rates of 0.2, 2, and 6 L/h. The flow rate, air detection sensitivity, occlusion response time, quantitative determination of hemolysis, and power consumption of the infusion devices were extensively investigated using statistical analysis methods ( p < 0.05). The experimental results revealed that the flow rate of the designed infusion pump was more stable and accurate, and the hemolysis was significantly less than that of the Power Infuser. The air detection sensitivity and the power consumption could be comparable to that of the Power Infuser except the occlusion response time. The favorable performance made the designed infusion pump a potential candidate for applications in pre-hospital fluid administration.
Evaluation of Procedure-Related Bleeding Risk in Patients Receiving Bivalirudin During Percutaneous Coronary Intervention
Authors: Baek Vivian S. , Hurren Jeff , Edwin Stephanie B.
Published: January 2015

Background:Bivalirudin has historically been considered an attractive anticoagulant during percutaneous coronary intervention (PCI) because of reduced bleeding complications reported by early trials. Bivalirudin use during PCIs has been a subject of controversy because of conflicting data and recent findings. Objective: To evaluate the clinical characteristics of patients receiving bivalirudin to determine if an opportunity to improve use exists based on risk of procedure-related bleeding. Methods: This was a single-center, retrospective, observational study (n = 100) of all adult patients who received bivalirudin during cardiac catheterization at St John Hospital and Medical Center from June to August 2013. The risk of bleeding complications associated with PCI was estimated using a clinical risk algorithm developed from the National Cardiovascular Data Registry (NCDR). Results: Treatment with bivalirudin was safe and effective. Of the 100 patients who received bivalirudin, only 34% were identified as having a high risk of procedure-related bleeding according to the NCDR clinical risk algorithm. There was no incidence of stent thrombosis noted and only 1 case of provisional glycoprotein IIb/IIIa inhibitor use. No episodes of Thrombolysis in Myocardial Infarction (TIMI) major bleeding were noted in the study population; however, 1 patient met TIMI minor bleeding criteria. Limitations of this study include small sample size and retrospective nature of the study. Conclusion: Opportunities to establish a more cost-effective use of bivalirudin may exist through implementation of protocols incorporating the NCDR risk assessment model.
Novel Technique of Sampling the Urinary Bladder for Urothelial Carcinoma Specimens
Authors: Mai Kien T. , Ball Christopher G. , Swift Joanne , A. Flood Trevor , Belanger Eric C.
Published: January 2015

Sampling of the urinary bladder (UB) in radical cystectomy specimens is usually performed by obtaining sections through the lesions taken in rather random planes. The technique is hindered by the difficulty in identifying the anatomical relationship of the tumor with the remaining urinary bladder. Fifty radical cystectomy specimens were bisected in the horizontal plane at the middle portion of the UB then fixed without tissue stretching in 10% buffered formalin for at least 24 hours. The UBs were serially sectioned in parallel horizontal planes from the UB neck to the dome into rings of 3 to 10 mm thickness. The sections were orderly arranged and photographed. At least one ring of tissue was entirely submitted along with areas of interest or representative areas. Our proposed technique of transverse sections results in a mild increase in the number of sections submitted for microscopic examination. The advantages of our methods are ( a) consistency and ease of sampling that help the microscopic-macroscopic correlation, ( b) suitability for gross examination and for determining depth of invasion and largest tumor diameter, ( c) improved identification of satellite lesions, and ( d) suitability for neoplastic mapping and suitability for reexamination. The technique was validated by comparing with results of current technique.
Intra-Alveolar Intestinal Epithelium
Authors: Jessurun Jose
Published: January 2015

Primary pulmonary mucin-rich lesions with abundant goblet cells growing within alveolar spaces are either classified as mucinous adenocarcinoma (previously called mucinous bronchioloalveolar carcinoma) or colloid carcinoma. Some of these lesions display a morphologic pattern characterized by paucicellular discontinuous patches of nonatypical colonic type epithelium attached to alveolar walls without evidence of invasion. Immunohistochemically, these epithelial patches express an intestinal immunophenotype (CD20+, CDX-2+, CK7−, TTF-1−). None of the lesions so far reported with these histological and immunohistochemical characteristics have recurred or metastasized. Herein we describe 2 patients with this type of intra-alveolar mucinous lesions who have been meticulously followed-up for 9 and 14 years, respectively, without evidence of disease progression. Based on their histologic appearance, immunoreactivity, and on the presence of occasional CDX-2 expressing cells in terminal airways adjacent to the lesions, we propose alternative interpretations of the mucin-producing epithelium. More important, a separate provisional category for these lesions is suggested that eliminates their force inclusion as adenocarcinomas.
What is Wrong With Cardiac Conditioning? We May be Shooting at Moving Targets
Authors: Iliodromitis Efstathios K. , Cohen Michael V. , Dagres Nikolaos , Andreadou Ioanna , Kremastinos Dimitrios Th. , Downey James M.
Published: January 2015

Early recanalization of the occluded culprit coronary artery clearly reduces infarct size in both animal models and patients and improves clinical outcomes. Unfortunately, reperfusion can seldom be accomplished before some myocardium infarcts. As a result there has been an intensive search for interventions that will make the heart resistant to infarction so that reperfusion could salvage more myocardium. A number of interventions have been identified in animal models, foremost being ischemic preconditioning. It protects by activating signaling pathways that prevent lethal permeability transition pores from forming in the heart’s mitochondria at reperfusion. Such conditioning can be accomplished in a clinically relevant manner either by staccato reperfusion (ischemic postconditioning) or by pharmacological activation of the conditioning signaling pathways prior to reperfusion. Unfortunately, clinical trials of ischemic postconditioning and pharmacologic conditioning have been largely disappointing. We suggest that this may be caused by inappropriate use as models intended to mimic the clinical scenario of young healthy animals that receive none of the many drugs currently given to our patients. Patients may be resistant to some forms of conditioning because of comorbidities, for example, diabetes, or they may already be conditioned by adjunct medications, for example, P2Y12 inhibitors or opioids. Incremental technological improvements in patient care may render some approaches to cardioprotection redundant, and thus the clinical target may be continually changing, while our animal models have not kept pace. In remote conditioning, a limb is subjected to ischemia/reperfusion prior to or during coronary reperfusion. Its mechanism is not as well understood as that of ischemic preconditioning, but the results have been very encouraging. In the present article, we will review ischemic, remote, and pharmacologic conditioning and possible confounders that could interfere with their efficacy in clinical trials in 2 settings of myocardial ischemia: (1) primary angioplasty in acute myocardial infarction and (2) elective angioplasty.
Time–intensity profile of pitanga nectar (Eugenia uniflora L.) with different sweeteners: Sweetness and bitterness
Authors: Freitas Mírian Luisa Faria , de Lima Dutra Mariana Borges , Bolini Helena Maria André
Published: January 2015

Pitanga has been used by the Brazilian food industry mainly for juice production. This fruit shows good economic potential due to its high concentration of vitamins and minerals. The aim of the present work was to characterize the time–intensity profile of pitanga nectar sweetened with different sweeteners to verify differences on the perception of sweet and bitter tastes. The sweeteners used to replace sucrose were sucralose, aspartame, stevia 40% rebaudioside A, stevia 95% rebaudioside A, neotame, and 2:1 cyclamate/saccharin blend. Fifteen assessors were selected according to their discriminating capability and trained to participate in the time–intensity analysis for sweetness and bitterness. The samples prepared with sucralose and 2:1 cyclamate/saccharin blend presented a similar sweetness profile to the sample prepared with sucrose, and the samples prepared with sucralose and aspartame presented a similar bitterness profile to the sample prepared with sucrose. Thus, sucralose would be the most suitable sweetener to replace sucrose in pitanga nectar.