bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of clinical leadership in teams’ course on quality, efficiency, responsiveness and trust in the emergency department: study protocol of a trailing research study
Authors: Husebø Sissel Eikeland , Olsen Øystein Evjen
Published: August 2016

Introduction

Clinical leadership has long been recognised as critical for optimising patient safety, quality of care and interprofessional teamwork in busy and stressful healthcare settings. There is a need to compensate for the absence of the conventional mentor-to-apprentice transfer of clinical leadership knowledge and skills. While young doctors and nurses are increasingly proficient in medical, surgical and technical skills, their training in, and knowledge of clinical leadership skills, is not adequate to meet the demands for these non-technical skills in the emergency department. Thus, the purpose of the paper is to present and discuss the study protocol of clinical leadership in a course for teams that aims to improve quality, efficiency, responsiveness of healthcare services and collegial trust in the emergency department.

Methods and analysis

The study employs a trailing research design using multiple quantitative and qualitative methods in the summative (pretest and post-test) and formative evaluation. Quantitative data have been collected from a patient questionnaire, the emergency departments’ database and by the observation of team performance. Qualitative data have been collected by shadowing healthcare professionals and through focus group interviews. To ensure trustworthiness in the data analysis, we will apply member checks and analyst triangulation, in addition to providing contextual and sample description to allow for evaluation of transferability of our results to other contexts and groups.

Ethics and dissemination

The study is approved by the ethics committee of the western part of Norway and the hospital. The study is based on voluntary participation and informed written consent. Informants can withdraw at any point in time. The results will be disseminated at research conferences, peer review journals and through public presentations to people outside the scientific community.
Integrating palliative care into the community: the role of hospices and schools
Authors: Paul Sally , Cree Viviene E , Murray Scott A
Published: August 2016

Objectives

Palliative care services have, up to now, paid insufficient attention to social aspects of dying and bereavement and this has affected how patients and their families experience end of life and bereavement within their communities. New public health approaches to palliative care offer a different way forward by seeking to develop communities that support death and bereavement. Such approaches are now a priority for the majority of hospices in the UK and work with schools has been identified as a key area of work. Practice that engages schools and children on issues concerning end-of-life care is, however, underdeveloped and underdocumented. This research explored the role of hospices in working with schools to promote education and support around end-of-life and bereavement experiences.

Methods

Action research was used to explore the potential for hospices to work with schools and engage participants in change processes. The research was conducted in 1 hospice and 2 primary schools in Scotland. Participants included children, parents and school and hospice staff.

Results

Seven innovations were identified that were found to be useful for the school curriculum and the relationship between hospices, school communities and wider society. A model for integrated practice between hospices and schools is suggested.

Conclusions

This research adds to knowledge about how hospices might engage in community engagement activities that encourage school staff to develop greater openness and support around end-of-life and bereavement care for their children. This will require a rethinking of normal hospice services to also participate in community capacity building.
Accuracy of classification of invasive lobular carcinoma on needle core biopsy of the breast
Authors: Naidoo Kalnisha , Beardsley Brooke , Carder Pauline J , Deb Rahul , Fish David , Girling Anne , Hales Sally , Howe Miles , Wastall Laura M , Lane Sally , Lee Andrew H S , Philippidou Marianna , Quinn Cecily , Stephenson Tim , Pinder Sarah E
Published: August 2016

Although the UK National Institute for Health and Care Excellence guidelines recommend that in patients with biopsy-proven invasive lobular carcinoma (ILC), preoperative MRI scan is considered, the accuracy of diagnosis of ILC in core biopsy of the breast has not been previously investigated. Eleven pathology laboratories from the UK and Ireland submitted data on 1112 cases interpreted as showing features of ILC, or mixed ILC and IDC/no special type (NST)/other tumour type, on needle core biopsy through retrieval of histology reports. Of the total 1112 cases, 844 were shown to be pure ILC on surgical excision, 154 were mixed ILC plus another type (invariably ductal/NST) and 113 were shown to be ductal/NST. Of those lesions categorised aspureILC on core, 93% had an element of ILC correctly identified in the core biopsy sample and could be considered concordant. Of cores diagnosed as mixed ILC plus another type on core, complete agreement between core and excision was 46%, with 27% cases of pure ILC, whilst 26% non-concordant. These data indicate that there is not a large excess of expensive MRIs being performed as a result of miscategorisation histologically.
Intraprocedural abciximab bolus versus pretreatment oral dual antiplatelet medication for endovascular stenting of unruptured intracranial aneurysms
Authors: Levitt Michael R , Moon Karam , Albuquerque Felipe C , Mulholland Celene B , Kalani M Yashar S , McDougall Cameron G
Published: August 2016

Background

Standard pretreatment with dual antiplatelet medication (DAPM) was compared with a standalone intraprocedural abciximab bolus for the prevention of thromboembolic and hemorrhagic events during endovascular stenting of unruptured intracranial aneurysms.

Materials and methods

We treated 94 patients with 99 aneurysms with intracranial stenting (with or without coiling). Patients were either pretreated with DAPM daily for ≥3 days before stenting (pretreatment group) or received an abciximab bolus during or immediately after stent placement followed by postoperative DAPM (abciximab group), at the treating physician's discretion. Twenty patients underwent immediate postoperative MRI. Demographic, clinical, and radiological information and periprocedural complications were recorded.

Results

There were 52 procedures in the pretreatment group and 47 in the abciximab group. More flow-diverting stents were placed in the pretreatment group than in the abciximab group (45 vs 23, p<0.001), and the aneurysm diameter was larger (11.2±6.7 vs 8.3±4.7 mm, p=0.01). There were 11 thrombotic and 7 access site complications, with no significant difference between the groups (p>0.99 and p=0.12, respectively). There were no intracranial hemorrhages. In patients with postoperative MRI, there was no difference in the presence of diffusion-restricted lesions between groups (p=0.20). Multivariate analysis of a composite of any complication did not show significant associations with aneurysm or patient variables in either group.

Conclusions

Standalone intraprocedural abciximab bolus was not associated with an increased rate of complications compared with pretreatment with DAPM for unruptured intracranial aneurysm stenting.
Cognitive impairment among patients with multiple sclerosis: associations with employment and quality of life
Authors: Campbell J , Rashid W , Cercignani M , Langdon D
Published: August 2016

Objectives

To explore the relationship between cognitive impairment and conventional measures of disability in multiple sclerosis (MS), quality of life (QOL) and employment status using the brief international cognitive assessment for multiple sclerosis (BICAMS) in the routine outpatient clinic.

Methods

62 patients with MS were assessed on the BICAMS test battery for cognitive impairment. Data were obtained on employment status and a number of questionnaires completed including fatigue severity score, multiple sclerosis neuropsychological questionnaire, hospital anxiety and depression scale, the functional assessment of multiple sclerosis (FAMS) as well as on the EuroQOL five dimension questionnaire (EQ-5D). Other assessments include the patient activation measure and unidimensional self-efficacy scale for multiple sclerosis.

Results

Cognitive assessment revealed 44 subjects (65%) had evidence of cognitive impairment on formal testing. In comparison with patients without evidence of cognitive impairment, cognitively impaired patients exhibited significantly higher rates of unemployment (p=0.009). The symbol digits modalities test was the most significant predictor of unemployment. Cognitive impairment was associated with lower QOL scores on the FAMS (p=0.001) and EQ-5D (p<0.001).

Conclusions

BICAMS provides a sensitive and easy to administer screening test for cognitive impairment within the outpatient setting. Cognitive impairment is common in our cohort of patients with MS attending outpatients and appears to be associated with increased rates of unemployment and lower measures of QOL.
Career aspiration in UK veterinary students: the influences of gender, self‐esteem and year of study
Authors: Castro S. M. , Armitage‐Chan E.
Published: August 2016

It is widely reported that the veterinary profession is becoming increasingly female‐dominated, but there are concerns that this is not represented in positions of leadership. Although there are well‐documented data describing the under‐representation of women in various senior veterinary positions (academic deans, practice owners, positions on professional councils and corporate boards), it is less clear why this occurs. Although likely multifactorial, the relative contributions from a gender divide in intent to pursue leadership positions, women being dissuaded from considering senior roles, or differences in success rate (e.g. in leadership appointments), are unknown. This study was performed to investigate whether there is a gender divide among veterinary students in intent to pursue a leadership role and also to explore other influencing factors in career aspiration in veterinary students. Students from five UK veterinary schools were surveyed using an electronically distributed questionnaire. Career aspiration and leadership ambition were identified as being influenced by gender, with a greater proportion of male students (83 per cent) than female students (73 per cent) indicating they aspired to owning a practice. Career aspiration was also positively influenced by self‐esteem, confidence and previously holding a position in the students’ union or other club or society; however, all of these were also more apparent in male students than female students. Career aspiration also appeared to be influenced by year of study, with a decline seen at each increasing student year group, and this was unrelated to gender or self‐esteem.
Effects of fisetin on hyperhomocysteinemia-induced experimental endothelial dysfunction and vascular dementia
Authors: Hemanth Kumar Boyina , Arun Reddy Ravula , Mahesh Kumar Jerald , Dinesh Kumar B. , Diwan Prakash V.
Published: August 2016

This study was designed to investigate the effects of fisetin (FST) on hyperhomocysteinemia (HHcy)-induced experimental endothelial dysfunction (ED) and vascular dementia (VaD) in rats. Wistar rats were randomly divided into 8 groups: control, vehicle control, l-methionine, FST (5, 10, and 25 mg/kg, p.o.), FST-per se (25 mg/kg, p.o.), and donepezil (0.1 mg/kg, p.o.). l-Methionine administration (1.7 g/kg, p.o.) for 32 days induced HHcy. ED and VaD induced by HHcy were determined by vascular reactivity measurements, behavioral analysis using Morris water maze and Y-maze, along with a biochemical and histological evaluation of thoracic aorta and brain tissues. Administration of l-methionine developed behavioral deficits; triggered brain lipid peroxidation (LPO); compromised brain acetylcholinesterase activity (AChE); and reduced the levels of brain superoxide dismutase (SOD), brain catalase (CAT), brain reduced glutathione (GSH), and serum nitrite; and increased serum homocysteine and cholesterol levels. These effects were accompanied by decreased vascular NO bioavailability, marked intimal thickening of the aorta, and multiple necrotic foci in brain cortex. HHcy-induced alterations in the activities of SOD, CAT, GSH, AChE, LPO, behavioral deficits, ED, and histological aberrations were significantly attenuated by treatment with fisetin in a dose-dependent manner. Collectively, our results indicate that fisetin exerts endothelial and neuroprotective effects against HHcy-induced ED and VaD.
Linking time budgets to habitat quality suggests that beavers (Castor canadensis) are energy maximizers
Authors: Gallant Daniel , Léger Lisa , Tremblay Éric , Berteaux Dominique , Lecomte Nicolas , Vasseur Liette
Published: August 2016

According to optimal foraging theory, consumers make choices that maximize their net energy intake per unit of time. We used foraging theory as a framework to understand the foraging behaviour of North American beavers (Castor canadensis Kuhl, 1820), an important herbivore that engineers new habitats. We tested the hypothesis that beavers are energy maximizers by verifying the prediction that they allocate time to foraging activities independently of habitat quality in Kouchibouguac National Park of Canada in New Brunswick, where nearly five decades of unabated colonization by beavers led to family units established in habitats of varying quality. We observed the behaviour of 27 beavers at seven ponds from May to August 2001, at dusk and dawn. Habitat quality did not influence time that beavers allocated to foraging. This finding supported our hypothesis. The only factor in the best model explaining time spent foraging was the progression of spring and summer seasons (weekly periods). Limiting factors such as infrastructure maintenance and intermittent reactions to danger remain poorly understood for this important herbivore. Future research should focus on establishing the importance that habitat quality (food availability) and environmental stress (weather, predators) have on shaping its time budget and, consequently, its survival and reproductive success.
A Retargetable Compilation Framework for Heterogeneous Reconfigurable Computing
Authors: Ul-Abdin Zain , Svensson Bertil
Published: August 2016

The future trend in microprocessors for the more advanced embedded systems is focusing on massively parallel reconfigurable architectures, consisting of heterogeneous ensembles of hundreds of processing elements communicating over a reconfigurable interconnection network. However, the mastering of low-level microarchitectural details involved in the programming of such massively parallel platforms becomes too cumbersome, which limits their adoption in many applications. Thus, there is a dire need for an approach to produce high-performance scalable implementations that harness the computational resources of the emerging reconfigurable platforms.

This article addresses the grand challenge of accessibility of these diverse reconfigurable platforms by suggesting the use of a high-level language, occam-pi, and developing a complete design flow for building, compiling, and generating machine code for heterogeneous coarse-grained hardware. We have evaluated the approach by implementing complex industrial case studies and three common signal processing algorithms. The results of the implemented case studies suggest that the occam-pi language-based approach, because of its well-defined semantics for expressing concurrency and reconfigurability, simplifies the development of applications employing runtime reconfigurable devices. The associated compiler framework ensures portability as well as the performance benefits across heterogeneous platforms.
Fine-Grained Interconnect Synthesis
Authors: Rodionov Alex , Biancolin David , Rose Jonathan
Published: August 2016

One of the key challenges for the FPGA industry going forward is to make the task of designing hardware easier. A significant portion of that design task is the creation of the interconnect pathways between functional structures. We present a synthesis tool that automates this process and focuses on the interconnect needs in the fine-grained (sub-IP-block) design space. Here there are several issues that prior research and tools do not address well: the need to have fixed, deterministic latency between communicating units (to enable high-performance local communication without the area overheads of latency insensitivity), and the ability to avoid generating unnecessary arbitration hardware when the application design can avoid it. Using a design example, our tool generates interconnect that requires 69% fewer lines of specification code than a handwritten Verilog implementation, which is a 32% overall reduction for the entire application. The resulting system, while requiring 6% more total functional and interconnect area, achieves the same performance. We also show a quantitative and qualitative advantages against an existing commercial interconnect synthesis tool, over which we achieve a 25% performance advantage and 15%/57% logic/memory area savings.
The kielin/chordin-like protein KCP attenuates nonalcoholic fatty liver disease in mice
Authors: Soofi Abdul , Wolf Katherine I. , Ranghini Egon J. , Amin Mohammad A. , Dressler Gregory R.
Published: August 2016

Nonalcoholic fatty liver disease (NAFLD) is a common cause of chronic liver disease and is increasing with the rising rate of obesity in the developed world. Signaling pathways known to influence the rate of lipid deposition in liver, known as hepatic steatosis, include the transforming growth factor (TGF) superfamily, which function through the SMAD second messengers. The kielin/chordin-like protein (KCP) is a large secreted protein that can enhance bone morphogenetic protein signaling while suppressing TGF-β signaling in cells and in genetically modified mice. In this report, we show that aging KCP mutant ( Kcp−/−) mice are increasingly susceptible to developing hepatic steatosis and liver fibrosis. When young mice are put on a high-fat diet, Kcp−/−mice are also more susceptible to developing liver pathology, compared with their wild-type littermates. Furthermore, mice that express a Pepck-KCP transgene ( KcpTg) in the liver are resistant to developing liver pathology even when fed a high-fat diet. Analyses of liver tissues reveal a significant reduction of P-Smad3, consistent with a role for KCP in suppressing TGF-β signaling. Transcriptome analyses show that livers from Kcp−/−mice fed a normal diet are more like wild-type livers from mice fed a high-fat diet. However, the KCP transgene can suppress many of the changes in liver gene expression that are due to a high-fat diet. These data demonstrate that shifting the TGF-β signaling paradigm with the secreted regulatory protein KCP can significantly alter the liver pathology in aging mice and in diet-induced NAFLD.
Diastolic dysfunction in prediabetic male rats: Role of mitochondrial oxidative stress
Authors: Koncsos Gábor , Varga Zoltán V. , Baranyai Tamás , Boengler Kerstin , Rohrbach Susanne , Li Ling , Schlüter Klaus-Dieter , Schreckenberg Rolf , Radovits Tamás , Oláh Attila , Mátyás Csaba , Lux Árpád , Al-Khrasani Mahmoud , Komlódi Tímea , Bukosza Nóra , Máthé Domokos , Deres László , Barteková Monika , Rajtík Tomáš , Adameová Adriana , Szigeti Krisztián , Hamar Péter , Helyes Zsuzsanna , Tretter László , Pacher Pál , Merkely Béla , Giricz Zoltán , Schulz Rainer , Ferdinandy Péter
Published: August 2016

Although incidence and prevalence of prediabetes are increasing, little is known about its cardiac effects. Therefore, our aim was to investigate the effect of prediabetes on cardiac function and to characterize parameters and pathways associated with deteriorated cardiac performance. Long-Evans rats were fed with either control or high-fat chow for 21 wk and treated with a single low dose (20 mg/kg) of streptozotocin at week 4. High-fat and streptozotocin treatment induced prediabetes as characterized by slightly elevated fasting blood glucose, impaired glucose and insulin tolerance, increased visceral adipose tissue and plasma leptin levels, as well as sensory neuropathy. In prediabetic animals, a mild diastolic dysfunction was observed, the number of myocardial lipid droplets increased, and left ventricular mass and wall thickness were elevated; however, no molecular sign of fibrosis or cardiac hypertrophy was shown. In prediabetes, production of reactive oxygen species was elevated in subsarcolemmal mitochondria. Expression of mitofusin-2 was increased, while the phosphorylation of phospholamban and expression of Bcl-2/adenovirus E1B 19-kDa protein-interacting protein 3 (BNIP3, a marker of mitophagy) decreased. However, expression of other markers of cardiac auto- and mitophagy, mitochondrial dynamics, inflammation, heat shock proteins, Ca2+/calmodulin-dependent protein kinase II, mammalian target of rapamycin, or apoptotic pathways were unchanged in prediabetes. This is the first comprehensive analysis of cardiac effects of prediabetes indicating that mild diastolic dysfunction and cardiac hypertrophy are multifactorial phenomena that are associated with early changes in mitophagy, cardiac lipid accumulation, and elevated oxidative stress and that prediabetes-induced oxidative stress originates from the subsarcolemmal mitochondria.

Listen to this article's corresponding podcast http://ajpheart.podbean.com/e/myocardial-dysfunction-in-prediabetes/ .
Left ventricular pressure-volume measurements and myocardial gene expression profile in type 2 diabetic Goto-Kakizaki rats
Authors: Korkmaz-Icöz Sevil , Lehner Alice , Li Shiliang , Vater Adrian , Radovits Tamás , Brune Maik , Ruppert Mihály , Sun Xiaoxin , Brlecic Paige , Zorn Markus , Karck Matthias , Szabó Gábor
Published: August 2016

The Goto-Kakizaki (GK) rat, a non-obese model of type 2 diabetes mellitus (T2DM), was generated by the selective inbreeding of glucose-intolerant Wistar rats. This is a convenient model for studying diabetes-induced cardiomyopathy independently from the effects of the metabolic syndrome. We investigated the myocardial functional and structural changes and underlying molecular pathomechanisms of short-term and mild T2DM. The presence of DM was confirmed by an impaired oral glucose tolerance in the GK rats compared with the age-matched nondiabetic Wistar rats. Data from cardiac catheterization showed that in GK rats, although the systolic indexes were not altered, the diastolic stiffness was increased compared with nondiabetics (end-diastolic-pressure-volume-relationship: 0.12 ± 0.04 vs. 0.05 ± 0.01 mmHg/μl, P < 0.05). Additionally, DM was associated with left-ventricular hypertrophy and histological evidence of increased myocardial fibrosis. The plasma pro-B-type natriuretic peptide, the cardiac troponin-T, glucose, and the urinary glucose concentrations were significantly higher in GK rats. Among the 125 genes surveyed using PCR arrays, DM significantly altered the expression of five genes [upregulation of natriuretic peptide precursor-A and connective tissue growth factor, downregulation of c-reactive protein, interleukin-1β, and tumor necrosis factor (TNF)-α mRNA-level]. Of the altered genes, which were evaluated by Western blot, only TNF-α protein expression was significantly decreased. The ECG recordings revealed no significant differences. In conclusion, while systolic dysfunction, myocardial inflammation, and abnormal electrical conduction remain absent, short-term and mild T2DM induce the alteration of cardiac TNF-α at both the mRNA and protein levels. Further assessments are required to reveal if TNF-α plays a role in the early stage of diabetic cardiomyopathy development.
Quantification of intact plasma AGT consisting of oxidized and reduced conformations using a modified ELISA
Authors: Satou Ryousuke , Kobori Hiroyuki , Katsurada Akemi , Miyata Kayoko , Navar L. Gabriel
Published: August 2016

The pleiotropic actions of the renin-angiotensin system (RAS) depend on the availability of angiotensinogen (AGT) which generates angiotensin I (ANG I) when cleaved by renin. Thus, quantification of the intact AGT (iAGT) concentrations is important to evaluate the actual renin substrate available. The iAGT conformation exists as oxidized AGT (oxi-AGT) and reduced AGT (red-AGT) in a disulfide bond, and oxi-AGT has a higher affinity for renin, which may exacerbate RAS-associated diseases. Accordingly, we determined iAGT, oxi-AGT, and red-AGT levels in plasma from rats and mice. Blood samples were obtained by cardiac puncture and then immediately mixed with an inhibitor solution containing a renin inhibitor. Total AGT (tAGT) levels were measured by tAGT ELISA which detects both cleaved and iAGT. iAGT levels were determined by iAGT ELISA which was found to only detect red-AGT. Thus, it was necessary to treat samples with dithiothreitol, a reducing agent, to quantify total iAGT concentration. tAGT levels in rat and mouse plasma were 1,839 ± 139 and 1,082 ± 77 ng/ml, respectively. iAGT levels were 53% of tAGT in rat plasma but only 22% in mouse plasma, probably reflecting the greater plasma renin activity in mice. The ratios of oxi-AGT and red-AGT were ∼4:1 (rat) and 16:1 (mouse). Plasma iAGT consists of oxi-AGT and red-AGT, suggesting that oxidative stress can influence ANG I generation by the AGT conformation switch. Furthermore, the lower availability of plasma iAGT in mice suggests that it may serve as a limiting factor in ANG I formation in this species.
Human motor control of landing from a drop in simulated microgravity
Authors: Gambelli C. N. , Theisen D. , Willems P. A. , Schepens B.
Published: August 2016

Landing on the ground on one's feet implies that the energy gained during the fall be dissipated. The aim of this study is to assess human motor control of landing in different conditions of fall initiation, simulated gravity, and sensory neural input. Six participants performed drop landings using a trapdoor system and landings from self-initiated counter-movement jumps in microgravity conditions simulated in a weightlessness environment by different pull-down forces of 1-, 0.6-, 0.4-, and 0.2 g. External forces applied to the body, orientation of the lower limb segments, and muscular activity of 6 lower limb muscles were recorded synchronously. Our results show that 1) subjects are able to land and stabilize in all experimental conditions; 2) prelanding muscular activity is always present, emphasizing the capacity of the central nervous system to approximate the instant of touchdown; 3) the kinetics and muscular activity are adjusted to the amount of energy gained during the fall; 4) the control of landing seems less finely controlled in drop landings as suggested by higher impact forces and loading rates, plus lower mechanical work done during landing for a given amount of energy to be dissipated. In conclusion, humans seem able to adapt the control of landing according to the amount of energy to be dissipated in an environment where sensory information is altered, even under conditions of non-self-initiated falls.
Whey protein with potassium bicarbonate supplement attenuates the reduction in muscle oxidative capacity during 19 days of bed rest
Authors: Bosutti Alessandra , Salanova Michele , Blottner Dieter , Buehlmeier Judith , Mulder Edwin , Rittweger Jörn , Yap Moi Hoon , Ganse Bergita , Degens Hans
Published: August 2016

The effectiveness of whey protein plus potassium bicarbonate-enriched diet (WP+KHCO3) in mitigating disuse-induced changes in muscle fiber oxidative capacity and capillarization was investigated in a 21-day crossover design bed rest study. Ten healthy men (31 ± 6 yr) once received WP+KHCO3 and once received a standardized isocaloric diet. Muscle biopsies were taken 2 days before and during the 19th day of bed rest (BR) from the soleus (SOL) and vastus lateralis (VL) muscle. Whole-body aerobic power (V̇o2 max), muscle fatigue, and isometric strength of knee extensor and plantar flexor muscles were monitored. Muscle fiber types and capillaries were identified by immunohistochemistry. Fiber oxidative capacity was determined as the optical density (OD) at 660 nm of succinate dehydrogenase (SDH)-stained sections. The product of fiber cross-sectional area and SDH-OD (integrated SDH) indicated the maximal oxygen consumption of that fiber. The maximal oxygen consumption supported by a capillary was calculated as the integrated SDH in its supply area. BR reduced isometric strength of knee extensor muscles ( P < 0.05), and the fiber oxidative capacity ( P < 0.001) and V̇o2 max ( P = 0.042), but had no significant impact on muscle capillarization or fatigue resistance of thigh muscles. The maximal oxygen consumption supported by a capillary was reduced by 24% in SOL and 16% in VL ( P < 0.001). WP+KHCO3 attenuated the disuse-induced reduction in fiber oxidative capacity in both muscles ( P < 0.01). In conclusion, following 19 days of bed rest, the decrement in fiber oxidative capacity is proportionally larger than the loss of capillaries. WP+KHCO3 appears to attenuate disuse-induced reductions in fiber oxidative capacity.
Endothelial Transcytosis of Insulin: Does It Contribute to Insulin Resistance?
Authors: Lee Warren L. , Klip Amira
Published: August 2016

Most research on insulin resistance has focused on impaired signaling at the level of target tissues like skeletal muscle. Insulin delivery is also important and includes recruitment and perfusion of capillaries bearing insulin, but also the transit of insulin across the capillary endothelium. The mechanisms of this second stage (insulin transcytosis) and whether it contributes to insulin resistance remain uncertain.
Guide Wire Induced Cardiac Tamponade: The Soft J Tip Is Not So Benign
Authors: Dwivedi Sankalp , Siddiqui Fayez , Patel Milan , Cardozo Shaun
Published: August 2016

Central venous catheter (CVC) insertion rarely causes cardiac tamponade due to perforation. Although it is a rare complication, it can be lethal if not identified early. We report a case of cardiac tamponade caused by internal jugular (IJ) central venous catheter (CVC) insertion using a soft J-tipped guide wire which is considered safe and rarely implicated with cardiac tamponade. A bedside transthoracic echocardiogram (TTE) revealed a pericardial effusion with tamponade. An emergent bedside pericardiocentesis was done revealing bloody fluid and resulted in clinical stabilization.
Effect of Top-Region Area of Flat-Top Pyramid Patterned Sapphire Substrate on the Optoelectronic Performance of GaN-Based Light-Emitting Diodes
Authors: Hsueh Hsu-Hung , Ou Sin-Liang , Peng Yu-Che , Cheng Chiao-Yang , Wuu Dong-Sing , Horng Ray-Hua
Published: August 2016

The flat-top pyramid patterned sapphire substrates (FTP-PSSs) have been prepared for the growth of GaN epilayers and the fabrication of lateral-type light-emitting diodes (LEDs) with an emission wavelength of approximately 470 nm. Three kinds of FTP-PSSs, which were denoted as FTP-PSS-A, FTP-PSS-B, and FTP-PSS-C, respectively, were formed through the sequential wet etching processes. The diameters of circle areas on the top regions of these three FTP-PSSs were 1, 2, and 3 μm, respectively. Based on the X-ray diffraction results, the full-width at half-maximum values of rocking curves at (002) plane for the GaN epilayers grown on conventional sapphire substrate (CSS), FTP-PSS-A, FTP-PSS-B, and FTP-PSS-C were 412, 238, 346, and 357 arcsec, while these values at (102) plane were 593, 327, 352, and 372 arcsec, respectively. The SpeCLED-Ratro simulation results reveal that the LED prepared on FTP-PSS-A has the highest light extraction efficiency than that of the other devices. At an injection current of 350 mA, the output powers of LEDs fabricated on CSS, FTP-PSS-A, FTP-PSS-B, and FTP-PSS-C were 157, 254, 241, and 233 mW, respectively. The results indicate that both the crystal quality of GaN epilayer and the light extraction of LED can be improved via the use of FTP-PSS, especially for the FTP-PSS-A.
Effects of a Nonthermal Atmospheric Pressure Plasma Jet on Human Gingival Fibroblasts for Biomedical Application
Authors: Lee Jung-Hwan , Kim Kyoung-Nam
Published: August 2016

Nonthermal atmospheric pressure plasma jets (APPJ) have been developed and applied in biomedical research as a cancer treatment or bacterial sterilization. However, the drawback of APPJ on normal oral cells during plasma treatment and underlying cell death mechanisms have not been studied and clearly explained, although there is known to be an influence from reactive oxygen species (ROS). Hence, this study investigates whether and how a nonthermal atmospheric pressure air plasma jet kills human normal gingival cells using immortalized human gingival fibroblasts (hTERT-hNOF cells). In this study, a set of physicochemical or biological methods were used to illuminate the killing mechanisms. It was found that ROS were induced intracellularly without a breakdown of the cell wall and apoptosis was involved in cell death when an air APPJ treatment was performed on the cells directly without media; the air treatment only supported a detachment of the cells without increase of ROS. It was also revealed that a correlation between intracellular ROS concentration and cells viability existed. These results indicated that the direct air APPJ treatment possibly raises safety issue to normal tissue and thereby APPJ application in biomedical field needs morein vitroandin vivostudy to optimize it.
Docosahexaenoic Acid Rescues Synaptogenesis Impairment and Long-Term Memory Deficits Caused by Postnatal Multiple Sevoflurane Exposures
Authors: Tao Guorong , Luo Yan , Xue Qingsheng , Li Guohui , Tan Yongchang , Xiao Jinglei , Yu Buwei
Published: August 2016

Sevoflurane exposures were demonstrated to induce neurotoxicity in the developing brain in both human and animal studies. However, there is no effective approach to reverse it. The present study aimed to evaluate the feasibility of utilizing docosahexaenoic acid (DHA) to prevent sevoflurane-induced neurotoxicity. P6 (postnatal 6 days) mice were administrated DHA after exposure to 3% sevoflurane for two hours daily in three consecutive days. Molecular expressions of synaptic makers (PSD95, synaptophysin) and synaptic morphological changes were investigated by Western blot analysis and transmission electron microscopy, respectively. Meanwhile, Morris water maze test was used to assess spatial memory of mice at P31 (postnatal 31 days). DHA restored sevoflurane-induced decreased level of PSD95 and synaptophysin expressions and increased PSD areas and also improved long-term spatial memory. These results suggest that DHA could rescue synaptogenesis impairment and long-term memory deficits in postnatal caused by multiple sevoflurane exposures.
Outbreaks of Virulent Infectious Bursal Disease in Flocks of Battery Cage Brooding System of Commercial Chickens
Authors: Aliyu H. B. , Sa’idu L. , Jamilu A. , Andamin A. D. , Akpavie S. O.
Published: August 2016

Clinical and pathological investigations were conducted on outbreaks of infectious bursal disease (IBD) in pullets under brooding using the battery cage system in a commercial poultry farm in Kaduna, Nigeria. Two consecutive outbreaks of IBD on the same farm were studied. The onset of the disease and morbidity and mortality rates were recorded. Postmortem examinations were conducted and gross lesions recorded. Tissues were collected and fixed in 10% buffered formalin and processed for histopathological examinations. In the first outbreak, 80 to 100% of the chicks were affected at the age of 4 to 5 weeks and mortality rate was 95.8% and lasted for 9 days. In the second outbreak, the mortality rate was 43.3% and it also lasted for 9 days. At the onset of the disease, the birds were also 4-week-old like in case 1. The disease was diagnosed based on clinical signs, pathology, and agar gel immunodiffusion test (AGID). Clinical signs, gross lesions, and histopathological findings were characteristic of virulent infectious bursal disease. After the first outbreak (case 1) the house was disinfected using polidine® (iodophor compound), V-ox® (inorganic peroxygen compounds), CID20® (quaternary ammonium chloride, aldehydes, and alcohol), terminator III® (phenols), and glutasan® (aldehyde and quaternary ammonium chloride). But they failed to eliminate the IBD virus from the poultry pen.
Evaluation and Correction of Quantitative Precipitation Forecast by Storm-Scale NWP Model in Jiangsu, China
Authors: Wang Gaili , Wang Dan , Yang Ji , Liu Liping
Published: August 2016

With the development of high-performance computer systems and data assimilation techniques, storm-scale numerical weather prediction (NWP) models are gradually used for short-term deterministic forecasts. The primary objective of this study is to evaluate and correct precipitation forecasts of a storm-scale NWP model called the advanced regional prediction system (ARPS). The evaluation and correction consider five heavy precipitation events that occurred in the summer of 2015 in Jiangsu, China. The performances of the original and corrected ARPS precipitation forecasts are evaluated as a function of lead time using standard measurements and a spatial verification method called Structure-Amplitude-Location (SAL). In general, the ARPS could not produce optimal forecasts for very short lead times, and the forecast accuracy improves with increasing lead time. The ARPS overestimates precipitation for all lead times, which is confirmed by large bias in many forecasts in the first and second quadrant of the diagram of SAL, especially at the 1 h lead time. The amplitude correction is performed by matching percentile values of the ARPS precipitation forecasts and observations for each lead time. Amplitude correction significantly improved the ARPS precipitation forecasts in terms of the considered performance indices of standard measures and A-component and S-component of SAL.
A Case of Skull Base Osteomyelitis with Multiple Cerebral Infarction
Authors: Miyabe Haruka , Uno Atsuhiko , Nakajima Takahiro , Morizane Natsue , Enomoto Keisuke , Hirose Masayuki , Hazama Toshinori , Takenaka Yukinori
Published: August 2016

Skull base osteomyelitis is classically documented as an extension of malignant otitis externa. Initial presentation commonly includes aural symptoms and cranial nerve dysfunctions. Here we present a case that emerged with multiple infarctions in the right cerebrum. A male in his 70s with diabetes mellitus and chronic renal failure presented with left hemiparesis. Imaging studies showed that blood flow in the carotid artery remained at the day of onset but was totally occluded 7 days later. However, collateral blood supply prevented severe infarction. These findings suggest that artery-to-artery embolization from the petrous and/or cavernous portion of the carotid artery caused the multiple infarctions observed on initial presentation. Osteomyelitis of the central skull base was diagnosed on the basis of the following findings taken together: laboratory results showing high levels of inflammation, presence ofPseudomonas aeruginosain the otorrhea and blood culture, multiple cranial nerve palsies that appeared later, the bony erosion observed on CT, and the mass lesion on MRI. Osteomyelitis was treated successfully by long-term antibiotic therapy; however, the patient experienced cefepime-induced neurotoxicity during therapy. The potential involvement of the internal carotid artery in this rare and life-threatening disease is of particular interest in this case.
Metatarsal Shaft Fracture with Associated Metatarsophalangeal Joint Dislocation
Authors: Tung Taranjit Singh
Published: August 2016

Metatarsophalangeal joint dislocations of lesser toes are often seen in the setting of severe claw toes. Traumatic irreducible dislocations have been reported in rare cases following both low-energy and high-energy injuries to the forefoot. In this case report, I present a previously unreported association of a metatarsal shaft fracture with metatarsophalangeal joint dislocation of a lesser toe.
Synthesis, Characterization, Anticancer, and Antioxidant Studies of Ru(III) Complexes of Monobasic Tridentate Schiff Bases
Authors: Ejidike Ikechukwu P. , Ajibade Peter A.
Published: August 2016

Mononuclear Ru(III) complexes of the type [Ru(LL)Cl2(H2O)] (LL = monobasic tridentate Schiff base anion: (1Z)-N′-(2-{(E)-[1-(2,4-dihydroxyphenyl)ethylidene]amino}ethyl)-N-phenylethanimidamide [DAE], 4-[(1E)-N-{2-[(Z)-(4-hydroxy-3-methoxybenzylidene)amino]ethyl}ethanimidoyl]benzene-1,3-diol [HME], 4-[(1E)-N-{2-[(Z)-(3,4-dimethoxybenzylidene)amino]ethyl}ethanimidoyl]benzene-1,3-diol [MBE], andN-(2-{(E)-[1-(2,4-dihydroxyphenyl)ethylidene]amino}ethyl)benzenecarboximidoyl chloride [DEE]) were synthesized and characterized using the microanalytical, conductivity measurements, electronic spectra, and FTIR spectroscopy. IR spectral studies confirmed that the ligands act as tridentate chelate coordinating the metal ion through the azomethine nitrogen and phenolic oxygen atom. An octahedral geometry has been proposed for all Ru(III)-Schiff base complexes.In vitroanticancer studies of the synthesized complexes against renal cancer cells (TK-10), melanoma cancer cells (UACC-62), and breast cancer cells (MCF-7) was investigated using the Sulforhodamine B assay. [Ru(DAE)Cl2(H2O)] showed the highest activity with IC50valves of3.57±1.09,6.44±0.38, and9.06±1.18 μM against MCF-7, UACC-62, and TK-10, respectively, order of activity being TK-10 < UACC-62 < MCF-7. The antioxidant activity by DPPH and ABTS inhibition assay was also examined. Scavenging ability of the complexes on DPPH radical can be ranked in the following order: [Ru(DEE)Cl2(H2O)] > [Ru(HME)Cl2(H2O)] > [Ru(DAE)Cl2(H2O)] > [Ru(MBE)Cl2(H2O)].
Heart Failure Complicated by Alveolar Hemorrhage due to Vascular Collapse and Amyloid Deposits in Wild-Type Transthyretin Amyloidosis
Authors: Kido Yasutoshi , Takahashi Masao , Fukuma Nobuaki , Kawata Takayuki , Tanaka Atsushi , Hayashi Akimasa , Shibahara Junji , Daimon Masao , Morita Hiroyuki , Akazawa Hiroshi , Komuro Issei
Published: August 2016

The main clinical manifestations of wild-type transthyretin (TTR)-related amyloidosis are progressive heart failure and neuropathy. There have been some reports on cerebral hemorrhage due to cerebral amyloid angiopathy in patients with TTR-related amyloidosis, but little is known about the vascular involvement in other organs. A 77-year-old woman experienced heart failure and was admitted for deteriorating heart failure status. Echocardiography showed diffuse hypokinesis of the left ventricle with biventricular wall thickness. On the 12th hospital day, the blood oxygen saturation level suddenly dropped and, despite oxygen supplementation and intensive care, the patient died. An autopsy revealed systemic deposition of amyloids which were immunolabeled by an anti-TTR antibody. Furthermore, gene-sequencing analysis showed no evidence of TTR gene mutations. The patient was diagnosed postmortem with wild-type TTR-related amyloidosis. Pathological findings revealed alveolar hemorrhage of the lung. Massive amyloid deposits were present in the vessels, and collapsed internal elastic laminae with lymphocyte infiltration were observed at the site of amyloid deposits in the bronchial artery, suggesting that deposits with inflammation might cause the collapse of the bronchial artery and lead to hemorrhage. In amyloidosis patients who suffer heart failure, there is the potential for vascular collapse caused by the accumulation of amyloid deposits with inflammation.
Auswirkungen von obstruktiver Schlafapnoe und Tabakkonsum auf die endotheliale Funktion
Authors: Herkenrath Simon-Dominik
Published: August 2016

Hintergrund: Es ist bekannt, dass endotheliale Dysfunktion im Kontext von obstruktiver Schlafapnoe (OSA) oder Tabakkonsum auftreten kann. Die schädlichen Auswirkungen auf die vaskuläre Funktion bei gleichzeitigem Vorliegen beider Bedingungen sind hingegen weitgehend unbekannt. Ziel: Untersuchung der Frage, ob die Gleichzeitigkeit von OSA und Rauchen eine additive Schädigung im Hinblick auf endotheliale Dysfunktion bewirkt. Methoden: Eine männliche Population aus China ohne chronische innere Erkrankungen in der Vorgeschichte wurde gebeten, einen Fragebogen unter anderem zur Rauchexposition in Packungsjahren zu beantworten und sich einer Polysomnographie und einer peripheren arteriellen Tonometrie (PAT) zur Beurteilung der endothelialen Funktion zu unterziehen. Gemessen wurden die Serumwerte von 8-Isoprostan, AOPP (advanced oxidation protein products) und MCP-1 (monocyte chemo-attractant protein-1). Ergebnisse: 114 Männer wurden in die Studie eingeschlossen. Die PAT-Ratio, korrigiert für Alter und Body-Mass-Index, korrelierte invers mit dem Gesamt-Schweregrad der OSA: Apnoe-Hypopnoe-Index (AHI), r = -0,160 (p = 0,092); Sauerstoff-Entsättigungsindex, r = -0,214 (p = 0,024); Dauer der Sauerstoffsättigung <90%, r = -0,219 (p = 0,020) und Mindest-Sauerstoffsättigung, r = 0,250 (p = 0,008). Die PAT-Ratio sank mit steigender Zahl der Packungsjahre (p = 0,018). Sie war niedriger, wenn Raucheranamnese und mittelschwere bis schwere OSA (AHI ≥15/h) gleichzeitig vorlagen, als wenn nur einer oder keiner der Faktoren gegeben war (p = 0,011). Die Serumwerte von 8-Isoprostan und AOPP hingen positiv mit der Schwere der OSA zusammen, während MCP-1 mit der Quantität der Rauchexposition korrelierte. Multiple lineare Regressionsanalysen ergaben, dass die Schwere der intermittierenden Hypoxie, der MCP-1-Wert und die Zahl der Packungsjahre unabhängig Prognosefaktoren für die PAT-Ratio waren. Schlussfolgerung: Während OSA - insbesondere intermittierende Hypoxämie - und Rauchen für sich genommen schon unabhängige Risikofaktoren darstellten, war das gleichzeitige Vorliegen von mittelschwerer bis schwerer OSA und Tabakkonsum mit den schwersten Beeinträchtigungen der endothelialen Funktion assoziiert. Übersetzung aus Respiration 2016;91:124-131 (DOI:10.1159/000443527)
Successful Treatment of Relapsing Bowen's Disease with Ingenol Mebutate: The Use of Dermoscopy to Monitor the Therapeutic Response
Authors: Mainetti Carlo , Guillod Caroline , Leoni-Parvex Sandra
Published: August 2016

Ingenol mebutate (IM) has recently been approved for the topical treatment of actinic keratoses. It appears to have a dual mechanism of action: rapid necrosis after gel application and a subsequent immune-mediated response, which targets any residual dysplastic epidermal cells. We report the successful treatment of a woman, who had been relapsing into Bowen's disease (BD) on her right forefinger for 8 years. During her clinical history, she had received an allogeneic, HLA-identical stem cell transplant for myeloproliferative syndrome with a JAK2V617F mutation and lobectomy of the pulmonary right lower lobe for adenocarcinoma. We used dermoscopy to monitor the therapeutic response of BD. We discuss IM gel as a possible therapeutic option for BD.
Ingenol Mebutate 150 mg as Physician-Directed Treatment of Bowen's Disease Under Occlusion
Authors: Alkhalaf Ahmed , Hofbauer Günther F.L.
Published: August 2016

Ingenol mebutate (IM) is a topical pharmacotherapy approved in Switzerland since 2012 for treating non-hypertrophic, non-hyperkeratotic actinic keratosis. We report a case with off-label use of IM where Bowen's disease has been successfully treated with physician-directed IM 0.015% gel under occlusion over the chest area.