bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of the Alere i Strep A Test and the BD Veritor System in the Detection of Group A Streptococcus and the Hypothetical Impact of Results on Antibiotic Utilization
Authors: Berry Gregory J. , Miller Catherine R. , Prats Mariana Moreno , Marquez Christopher , Oladipo Olajumoke O. , Loeffelholz Michael J. , Petersen John R.
Published: January 2018

Rapid detection of group A
Streptococcus
(GAS) is an integral component of treatment decisions in the clinic, especially in the pediatric population. We prospectively collected 216 specimens from symptomatic, predominantly pediatric patients and evaluated the performance of the Alere i Strep A test (Alere i; Alere Inc., Scarborough, ME) and the BD Veritor system (BD Veritor; Becton, Dickinson and Company, Sparks, MD), with culture results being used as a comparator. Real-time PCR (RT-PCR) was performed as an arbiter in discordant cases. Comprehensive chart review was also done to determine the hypothetical impact of the results on antibiotic use. Alere i had a sensitivity and a specificity of 100% and 91.3%, respectively, and BD Veritor had a sensitivity and a specificity of 76.2% and 93.6%, respectively, when the results were compared to those of GAS culture. Further analysis of discordant results using RT-PCR revealed that while BD Veritor missed 13 confirmed positive cases, Alere i detected 100% (
n
= 13) of the same cases. Analysis of assay agreement showed that Alere i and BD Veritor had only moderate agreement (agreement = 0.888 [95% confidence interval {CI}, 0.838 to 0.927]; kappa index = 0.689 [95% CI, 0.91 to 0.974]). We also found both the underutilization and the overutilization of antibiotics based on the results of molecular testing. Overall, Alere i showed superior performance over BD Veritor in the detection of GAS pharyngitis and could potentially assist in better antibiotic utilization.
Graduate Biomedical Science Education Needs a New Philosophy
Authors: Bosch Gundula , Casadevall Arturo
Published: January 2018

There is a growing realization that graduate education in the biomedical sciences is successful at teaching students how to conduct research but falls short in preparing them for a diverse job market, communicating with the public, and remaining versatile scientists throughout their careers. Major problems with graduate level education today include overspecialization in a narrow area of science without a proper grounding in essential critical thinking skills. Shortcomings in education may also contribute to some of the problems of the biomedical sciences, such as poor reproducibility, shoddy literature, and the rise in retracted publications. The challenge is to modify graduate programs such that they continue to generate individuals capable of conducting deep research while at the same time producing more broadly trained scientists without lengthening the time to a degree. Here we describe our first experiences at Johns Hopkins and propose a manifesto for reforming graduate science education.
Integrating prevention and health promotion in a London prison
Authors: Finnie Adam John
Published: January 2018

Many people enter prison with poor health from a background of deprivation and with unhealthy lifestyle habits, yet spending time in prisons is often actively detrimental to health. There is therefore a clear value in providing high-quality health promotion services in prisons that are effective at reaching those who need support to improve their lifestyle. The health promotion service at HMP Brixton provides a health trainers clinic to address lifestyle issues but found that it was sometimes challenging to identify appropriate patients and that the service was inefficient as a result. Analysis of our referral sources suggested that taking steps to increase the proportion of referrals made during screening and other clinics might lead to more appropriate and engaged patients. In this study, we set out to use quality improvement methods to increase referral from these sources. This involved improvements to the processes involved in delivering National Health Service Health Checks that were the primary source of referrals for health trainers and by improving links between the health trainer team and other clinicians. The changes were successful in increasing referrals from these sources. This work was completed during a period of exceptional disruption in the prison service and is relevant to secure healthcare sites that aim to ensure prevention activities are efficient and targeted.
Thirty-day hospital readmissions among mechanically ventilated emergency department patients
Authors: Page David B , Drewry Anne M , Ablordeppey Enyo , Mohr Nicholas M , Kollef Marin H , Fuller Brian M
Published: January 2018

Background

Unplanned 30-day readmissions have a negative impact on patients and healthcare systems. Mechanically ventilated ED patients are at high risk for complications, but factors associated with readmission are unknown.

Objective

(1) Determine the rate of 30-day hospital readmission for ED patients receiving mechanical ventilation. (2) Identify associations between ED-based risk factors and readmission.

Design

Retrospective cohort study.

Setting

Tertiary-care, academic medical centre.

Patients

Adult ED patients receiving mechanical ventilation.

Measurements

Baseline demographics, comorbid conditions, illness severity and treatment variables were collected, as were clinical outcomes occurring during the index hospitalisation. The primary outcome was 30-day hospital readmission rate. Multivariable logistic regression was used to evaluate factors associated with the primary outcome.

Results

A total of 1262 patients were studied. The primary outcome occurred in 287 (22.7%) patients. There was no association between care in the ED and readmission. During the index hospitalisation, readmitted patients had shorter ventilator, hospital and intensive care unit duration (P<0.05 for all). The primary outcome was associated with African-American race (adjusted OR 1.34 (95% CI 1.02 to 1.78)), chronic obstructive pulmonary disease (adjusted OR 1.52 (95% CI 1.12 to 2.06)), diabetes mellitus (adjusted OR 1.34 (95% CI 1.02 to 1.78)) and higher illness severity (adjusted OR 1.03 (95% CI 1.01 to 1.05)).

Conclusions

Almost one in four mechanically ventilated ED patients are readmitted within 30 days, and readmission is associated with patient-level and institutional-level factors. Strategies must be developed to identify, treat and coordinate care for the most at-risk patients.
HER2 is frequently overexpressed in hepatoid adenocarcinoma and gastric carcinoma with enteroblastic differentiation: a comparison of 35 cases to 334 gastric carcinomas of other histological types
Authors: Fujimoto Masakazu , Matsuzaki Ibu , Nishino Masaru , Iwahashi Yoshifumi , Warigaya Kenji , Kojima Fumiyoshi , Ono Kazuo , Murata Shin-Ichi
Published: January 2018

Aims

α-Fetoprotein (AFP)-producing gastric carcinoma (AFPGC) is one of the most aggressive GC subtypes. Frequent expression of human epidermal growth factor receptor 2 (HER2) has previously been reported in hepatoid adenocarcinoma (HAC), a major histological subtype of AFPGC originating from common-type GC (CGC). However, HER2 expression levels in other AFPGC histological subtypes are unknown. In this study, we analysed HER2 expression in GCs with primitive phenotypes in addition to HAC.

Methods

HER2 expression was evaluated in representative complete sections from 16 HACs, 19 GCs with enteroblastic differentiation (GCEDs) and 334 GCs of other histological types as controls. The Ruschoff/Hofmann method was used to score HER2 immunohistochemistry. Samples with a HER2 score of 2+ were further assessed using fluorescence in situ hybridisation. Oncofetal protein (OFP) expression in HAC and GCED was tested via immunohistochemical staining for AFP, glypican 3 and Sal-like protein 4.

Results

Thirty of 35 HAC/GCED cases comprised more than two histological patterns. The HER2 positivity rates of each histological component in the HACs/GCEDs were 25.0% for HAC (n=16), 34.6% for GCED (n=26) and 48.1% for CGC (n=27), which were higher than those of the control group (13.8%). Additionally, the majority of CGC components in HACs/GCEDs were positive for OFP (88.9%).

Conclusions

HER2 is frequently overexpressed not only in HAC but also in GCED and CGC components of HACs/GCEDs, which suggests an association between HER2 and OFP expression. Moreover, our findings suggest that HER2-positive CGC has a higher risk of progression to HAC/GCED than HER2-negative GC.
Elevated serum levels of cardiovascular biomarkers are associated with progression of renal cancer
Authors: Kamai Takao , Tokura Yuumi , Uematsu Toshitaka , Sakamoto Kazumasa , Suzuki Issei , Takei Kohei , Narimatsu Takahiro , Kambara Tsunehito , Yuki Hideo , Betsunoh Hironori , Abe Hideyuki , Fukabori Yoshitatsu , Yashi Masahiro , Yoshida Ken-Ichiro
Published: January 2018

Objective

Renal cell carcinoma (RCC) is a hypervascular tumour due to high constitutive production of vascular endothelial growth factor (VEGF), which is activated by hypoxia-inducible factor (HIF). Elevated levels of cardiovascular peptides, including brain natriuretic peptide (BNP), have been reported in patients with cancer, regardless of whether they have overt cardiovascular disease. Furthermore, it has been demonstrated that hypoxia stimulates BNP production by an HIF-dependent manner. However, the clinical implications of such cardiovascular peptides in patients with RCC have not been assessed.

Methods

In patients with clear cell RCC who underwent nephrectomy, we investigated the relationship between the serum level of BNP or N-terminal pro-BNP (NT-proBNP) and various clinicopathological characteristics, including serum VEGF and expression of BNP and HIF-2 alpha in the primary tumour.

Results

Elevated preoperative serum levels of BNP, NT-proBNP and VEGF, as well as increased tumour expression of HIF-2 alpha, were associated with a worse performance status, local invasion, distant metastasis and shorter overall survival. HIF-2 alpha expression showed a positive correlation with the preoperative serum VEGF level, while there was no relation between the serum levels of BNP/NT-proBNP and VEGF or tumour expression of HIF-2 alpha. BNP expression was very low in both tumour tissues and normal kidney tissues. Serum levels of BNP, NT-proBNP and VEGF all decreased significantly after nephrectomy.

Conclusions

Our findings suggested that the preoperative serum levels of BNP and NT-proBNP are markers of tumour progression, as well as indicators of subclinical functional and structural myocardial damage in patients with advanced RCC.
Blood pressure target achievement and antihypertensive medication use in women and men after first-ever myocardial infarction: the Tromsø Study 1994–2016
Authors: Hopstock Laila A , Eggen Anne Elise , Løchen Maja-Lisa , Mathiesen Ellisiv B , Nilsen Amalie , Njølstad Inger , Wilsgaard Tom
Published: January 2018

Background

Recurrent cardiovascular events after myocardial infarction (MI) are frequent, and gender differences in blood pressure treatment have been reported. Despite increased focus on secondary prevention, recent reports indicate that treatment targets are not achieved. There is a need for gender-specific analyses of post-MI blood pressure treatment target achievement and antihypertensive medication adherence.

Design

We investigated the change in systolic and diastolic blood pressure and antihypertensive drug use after first-ever MI over two time periods in a Norwegian population-based study.

Methods

We followed 10 089 participants (55% women) attending the Tromsø Study in 1994–1995 (MI-cohort I) and 8412 participants (55% women) attending the Tromsø Study 2007–2008 (MI-cohort II) for first-ever MI up to their participation in 2007–2008 and 2015–2016, respectively. We used linear regression models to investigate sex and age differences in change in blood pressure.

Results

A total of 396 participants in MI-cohort I and 131 participants in MI-cohort II had a first-ever MI in the observation periods. In MI-cohort I, 35% of the women and 52% of the men achieved the treatment targets of blood pressure <140/90 mm Hg (130/80 mm Hg if diabetic), while the proportions for MI-cohort II were 50% and 54% for women and men, respectively. Antihypertensive use was reported in 88% of women and 87% of men in MI-cohort I, and 76% of women and 81% of men in MI-cohort II.

Conclusions

We found an overall low achievement of the treatment target. The findings call for better strategies for secondary prevention for both women and men.
Upper bounds for geodesic periods over hyperbolic manifolds
Authors: Su Feng
Published: January 2018

We prove an upper bound for geodesic periods of Maass forms over hyperbolic manifolds. By definition, such periods are integrals of Maass forms restricted to a special geodesic cycle of the ambient manifold, against a Maass form on the cycle. Under certain restrictions, the bound will be uniform.
Nonperturbative vacuum polarization effects in two-dimensional supercritical Dirac–Coulomb system I. Vacuum charge density
Authors: Davydov A. , Sveshnikov K. , Voronina Yu.
Published: January 2018

Based on the original combination of analytical methods, computer algebra tools and numerical calculations, proposed recently in Refs. 1–3, the nonperturbative vacuum polarization effects in the 2+1[Formula: see text]D supercritical Dirac–Coulomb system with [Formula: see text] are explored. Both the vacuum charge density [Formula: see text] and vacuum energy [Formula: see text] are considered. The main result of the work is that in the overcritical region [Formula: see text] turns out to be a rapidly decreasing function [Formula: see text] with [Formula: see text] and [Formula: see text] being the size of the external Coulomb source. Due to a lot of details of calculation the whole work is divided into two parts I and II. In the present part I, we consider the evaluation and behavior of the vacuum density [Formula: see text], which further is used in part II for evaluation of the vacuum energy, with emphasis on the renormalization, convergence of the partial expansion for [Formula: see text] and behavior of the integral induced charge [Formula: see text] in the overcritical region.
Counterexamples to the quadrisecant approximation conjecture
Authors: Bai Sheng , Wang Chao , Wang Jiajun
Published: January 2018

A quadrisecant line of a knot [Formula: see text] is a straight line which intersects [Formula: see text] in four points, and a quadrisecant is a 4-tuple of points of [Formula: see text] which lie in order along the quadrisecant line. If [Formula: see text] has a finite number of quadrisecants, take [Formula: see text] to be the set of points of [Formula: see text] which are in a quadrisecant. Replace each subarc of [Formula: see text] between two adjacent points of [Formula: see text] along [Formula: see text] with the straight line segment between them. This gives the quadrisecant approximation of [Formula: see text]. It was conjectured that the quadrisecant approximation is always a knot with the same knot type as the original knot. We show that every knot type contains two knots, the quadrisecant approximation of one knot has self-intersections while the quadrisecant approximation of the other knot is a knot with a different knot type.
A novel of PEG-conjugated phthalocyanine and evaluation of its photocytotoxicity and antibacterial properties for photodynamic therapy
Authors: Uslan Canan , İşleyen Naciye Durmuş , Öztürk Yetkin , Yıldız Burcu Turanlı , Çakar Z. Petek , Göksel Meltem , Durmuş Mahmut , Gürsel Yeşim Hepuzer , Sesalan B. Şebnem
Published: January 2018

A poly(ethylene glycol) (PEG)-conjugated silicon(IV) phthalocyanine axially substituted with (PEG1000) chains (SiPc-PEG) was synthesized, and this novel phthalocyanine was characterized by [Formula: see text]H-NMR, FT-IR and UV-Vis spectrophotometric methods. Elemental analysis data were beneficial for the evaluation of the chemical structure of the new compound. The total number of (O–CH[Formula: see text]–CH[Formula: see text] units was calculated as 44 and the structure of the new PEG-conjugated silicon phthalocyanine was determined by the use of integral areas in [Formula: see text]H-NMR spectrum and the ratio of SiPc:PEG1000 was found as 1:2. The photophysical and photochemical properties were determined in both DMSO and aqueous solutions. In addition, the photocytotoxicity of the novel PEG-conjugated silicon(IV) phthalocyanine was also examined by testing against human cervical-carcinoma (HeLa) and hepato-carcinoma cells (HuH-7). The IC[Formula: see text] value for the SiPc-PEG compound was determined as 0.28 [Formula: see text]M for HeLa cells and 0.4 [Formula: see text]M for HuH-7 cells. These results imply that HeLa cells are apparently more responsive to photodynamic therapy (PDT) treatment by SiPc-PEG than HuH-7 cells at low concentrations (up to 0.5 [Formula: see text]M) of the studied photosensitizer. Additionally, SiPc-PEG showed antibacterial activity against Escherichia coli at 48 h of incubation, the viabilities of E.coli cultures exposed to 1000 [Formula: see text]g/mL and 2500 [Formula: see text]g/mL SiPc-PEG concentration were reduced by about 90%, and the additional growth inhibitory effect of photoactivation was also observed clearly at these efficient concentrations. To conclude, the novel compound may have a high potential for photodynamic therapy.
Dynamics of gene regulatory networks with stochastic propensities
Authors: Akman O. , Comar T. , Harris A. L. , Hrozencik D. , Li Y.
Published: January 2018

Gene regulatory networks (GRNs) control the production of proteins in cells. It is well-known that this process is not deterministic. Numerous studies employed a non-deterministic transition structure to model these networks. However, it is not realistic to expect state-to-state transition probabilities to remain constant throughout an organism’s lifetime. In this work, we focus on modeling GRN state transition (edge) variability using an ever-changing set of propensities. We suspect that the source of this variation is due to internal noise at the molecular level and can be modeled by introducing additional stochasticity into GRN models. We employ a beta distribution, whose parameters are estimated to capture the pattern inherent in edge behavior with minimum error. Additionally, we develop a method for obtaining propensities from a pre-determined network.
Global distribution and use of water from karst aquifers
Authors: Stevanović Zoran
Published: January 2018

Karst aquifers are some of the most important and well-used sources of water worldwide. The tapping of karst waters for use as drinking water has been important in the historical and economic development of many karst regions. Recent studies have found that karstified rocks and aquifer systems cover
c.
15% of the Earth's ice-free land. The greatest area of karst outcrops (>1 × 10
6
km
2
) is in Russia, the USA, China and Canada. In the Mediterranean basin, groundwater is generally more abundant in karst than in other aquifers and has been extensively exploited. Karst groundwater is also widely used in the Middle East, China, North America, and northern and eastern Africa and is of crucial importance for the sustainable development of tourism and the economy. Karst aquifers currently supply
c.
10% of the global population with drinking water and, in some zones, they are the only water resource available. However, the share of karst aquifers in the global supply of water will decrease with the predicted increase in population, concentrated in urban areas, and improvements in treatment technologies for water from other sources.
Palaeogeographical evolution of the Lower Jurassic: high-resolution biostratigraphy and sequence stratigraphy in the Central European Basin
Authors: Barth Gregor , Pieńkowski Grzegorz , Zimmermann Jens , Franz Matthias , Kuhlmann Gesa
Published: January 2018

Basin-scale stratigraphic correlation is the fundamental base for successful reservoir exploration, and especially when dealing with cross-border areas. Differences in lithostratigraphic and chronostratigraphic nomenclature between sub-basins and countries often result in problematic estimations of reservoir geometries and potential. This study combines available biostratigraphic, biofaunal and lithofacies data, together with sequence-stratigraphical correlations of the Lower Jurassic from the Central European Basin (CEB), to propose a genetic-based framework of transgressive and regressive depositional units. The determination of four major biofacies environments, composed of (I) polyhaline open-marine/offshore environments, (II) upper mesohaline marine–brackish environments, (III) lower mesohaline brackish environments and (IV) low oligohaline to freshwater continental environments comprising very rare marine phytoplankton and terrestrial spores and pollens, were translated into 12 biofacies reconstructions of ammonite (sub-) chronozone levels. Variations of biofacies reconstructions in time and space were supplemented by biostratigraphically constrained large-scale progradational and retrogradational sedimentary architecture. Retrogradation is accompanied by increasing polyhaline environments and pinpoint basinwide third-order flooding events, whereas progradation is accompanied by decreasing polyhaline environments pointing to third-order regressions. The outcomes of this study support exploration of Lower Jurassic deep geothermal reservoirs or CO
2
storage sites in the eastern CEB (especially Germany and Poland).
Supersonic Combustion in Air-Breathing Propulsion Systems for Hypersonic Flight
Authors: Urzay Javier
Published: January 2018

Great efforts have been dedicated during the last decades to the research and development of hypersonic aircrafts that can fly at several times the speed of sound. These aerospace vehicles have revolutionary applications in national security as advanced hypersonic weapons, in space exploration as reusable stages for access to low Earth orbit, and in commercial aviation as fast long-range methods for air transportation of passengers around the globe. This review addresses the topic of supersonic combustion, which represents the central physical process that enables scramjet hypersonic propulsion systems to accelerate aircrafts to ultra-high speeds. The description focuses on recent experimental flights and ground-based research programs and highlights associated fundamental flow physics, subgrid-scale model development, and full-system numerical simulations.
Exosomes Associated with Human Ovarian Tumors Harbor a Reversible Checkpoint of T-cell Responses
Authors: Shenoy Gautam N. , Loyall Jenni , Maguire Orla , Iyer Vandana , Kelleher Raymond J. , Minderman Hans , Wallace Paul K. , Odunsi Kunle , Balu-Iyer Sathy V. , Bankert Richard B.
Published: January 2018

Nano-sized membrane-encapsulated extracellular vesicles isolated from the ascites fluids of ovarian cancer patients are identified as exosomes based on their biophysical and compositional characteristics. We report here that T cells pulsed with these tumor-associated exosomes during TCR-dependent activation inhibit various activation endpoints including translocation of NFκB and NFAT into the nucleus, upregulation of CD69 and CD107a, production of cytokines, and cell proliferation. In addition, the activation of virus-specific CD8+ T cells that are stimulated with the cognate viral peptides presented in the context of class I MHC is also suppressed by the exosomes. The inhibition occurs without loss of cell viability and coincidentally with the binding and internalization of these exosomes. This exosome-mediated inhibition of T cells was transient and reversible: T cells exposed to exosomes can be reactivated once exosomes are removed. We conclude that tumor-associated exosomes are immunosuppressive and represent a therapeutic target, blockade of which would enhance the antitumor response of quiescent tumor-associated T cells and prevent the functional arrest of adoptively transferred tumor-specific T cells or chimeric antigen receptor T cells. Cancer Immunol Res; 6(2); 236–47. ©2018 AACR.
Benefits of Individualized Feedback in Internet-Based Interventions for Depression: A Randomized Controlled Trial
Authors: Zagorscak Pavle , Heinrich Manuel , Sommer Daniel , Wagner Birgit , Knaevelsrud Christine
Published: January 2018

Background: Even though there is an increasing number of studies on the efficacy of Internet-based interventions (IBI) for depression, experimental trials on the benefits of added guidance by clinicians are scarce and inconsistent. This study compared the efficacy of semistandardized feedback provided by psychologists with fully standardized feedback in IBI. Methods: Participants with mild-to-moderate depression (n = 1,089, 66% female) from the client pool of a health insurance company participated in a cognitive-behavioral IBI targeting depression over 6 weeks. Individuals were randomized to weekly semistandardized e-mail feedback from psychologists (individual counseling; IC) or to automated, standardized feedback where a psychologist could be contacted on demand (CoD). The contents and tasks were identical across conditions. The primary outcome was depression; secondary outcomes included anxiety, rumination, and well-being. Outcomes were assessed before and after the intervention and 3, 6, and 12 months later. Changes in outcomes were evaluated using latent change score modeling. Results: Both interventions yielded large pre-post effects on depression (Beck Depression Inventory-II: dIC = 1.53, dCoD = 1.37; Patient Health Questionnaire-9: dIC = 1.20, dCoD = 1.04), as well as significant improvements of all other outcome measures. The effects remained significant after 3, 6, and 12 months. The groups differed with regard to attrition (IC: 17.3%, CoD: 25.8%, p = 0.001). Between-group effects were statistically nonsignificant across outcomes and measurement occasions. Conclusion: Adding semistandardized guidance in IBI for depression did not prove to be more effective than fully standardized feedback on primary and secondary outcomes, but it had positive effects on attrition.
Vitamin D and the Pathophysiology of Inflammatory Skin Diseases
Authors: Umar Meenakshi , Sastry Konduru S. , Al Ali Fatima , Al-Khulaifi Moza , Wang Ena , Chouchane Aouatef I.
Published: January 2018

Background: Vitamin D is a secosteroid, which was initially known for its skeletal role; however, in recent years, its functions in different organs have been increasingly recognized. In this review, we will provide an overview of vitamin D functions in the skin physiology with specific focus on its role in certain inflammatory skin conditions such as psoriasis and atopic dermatitis. Methods: A comprehensive literature search was carried out in PubMed and Google Scholar databases using keywords like “vitamin D,” “skin,” “atopic dermatitis,” and “psoriasis.” Only articles published in English and related to the study topic were included in this review. Results: Vitamin D is integrally connected to the skin for its synthesis, metabolism, and activity. It regulates many physiological processes in the skin ranging from cellular proliferation, differentiation, and apoptosis to barrier maintenance and immune functions. Vitamin D deficiency is associated with the risk of psoriasis and atopic dermatitis, and several clinical/observational studies have suggested the beneficial effect of vitamin D in the therapy of these 2 inflammatory skin disorders. Conclusions: Vitamin D exerts a pleiotropic effect in the skin and could be an important therapeutic option for psoriasis and atopic dermatitis.
A Case of Retinal Detachment with Unique Optical Coherence Tomography Findings after Gamma Knife® Radiosurgery Treatment for Choroidal Melanoma
Authors: Kimura Daisaku , Kida Teruyo , Sato Takaki , Fukumoto Masanori , Kohmoto Ryohsuke , Kojima Shota , Mizuno Hiroshi , Sakaguchi Hitoshi , Sugasawa Jun , Ikeda Tsunehiko
Published: January 2018

Purpose: To report a case of retinal detachment with unique optical coherence tomography (OCT) findings after Gamma Knife® (GK; Elekta Instrument AB, Stockholm, Sweden) treatment for choroidal melanoma (CM). Case Report: A 48-year-old woman underwent GK therapy for CM in her right eye from the macula to the temporal side. While the tumor subsequently shrank, the patient developed radiation retinopathy, which was treated with laser photocoagulation. The tumor lesions later subsided; however, her visual acuity (VA) decreased 8 years after the initial treatment. Although the tumor lesions in the right eye had become scarred, a bullous retinal detachment with fixed folds occurred in the superior-nasal quadrants. OCT examination revealed a preretinal membrane, vitreoretinal traction, and an inner retinal break; however, no outer retinal break was clearly detectable. MRI scans showed no increase in tumorous lesions, and 123I-IMP SPECT imaging showed no photon accumulation. Thus, it was determined that there was no tumor activity. The corrected VA in her right eye was light perception, and it was determined that there was no indication for vitreous surgery. Conclusion: In this case, an inner retinal break was formed by the vitreoretinal traction around the scarred tumor and radiation retinopathy, thus suggesting the possibility of the development of a rhegmatogenous retinal detachment presumably complicated with an outer retinal break.
Patch Grafting Using an Ologen Collagen Matrix to Manage Tubal Exposure in Glaucoma Tube Shunt Surgery
Authors: Tanito Masaki , Sano Ichiya , Ikeda Yoshifumi , Fujihara Etsuko
Published: January 2018

Purpose: To report the results using an ologen Collagen Matrix as a patch graft in eyes with tubal exposure after tube shunt surgery. Case Reports: Case 1 was an 82-year-old man with tubal exposure in his right eye 26 months after receiving a Baerveldt glaucoma implant. The tube was covered by surrounding conjunctival tissue combined with subconjunctival placement of an ologen Collagen Matrix as a patch graft. Two years after implantation, the tube was not exposed. Anterior-segment optical coherence tomography (AS-OCT) showed dense conjunctival tissue over the tube. Case 2 was an 82-year-old man with peripheral keratitis, anterior scleritis, and secondary glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve and cataract surgery. Intraoperatively, scleritis-related scleral thinning prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Seventeen months after implantation, the tube was not exposed. Case 3 was a 52-year-old man with diabetic maculopathy and steroid-induced glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve. Intraoperatively, a flap defect prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Three weeks postoperatively, AS-OCT showed thick subconjunctival tissue over the tube. Three months after implantation, the tube was not exposed. Conclusions: The ologen Collagen Matrix can be used successfully as a patch graft to prevent and treat tubal exposure after tube shunt surgery.
Thromboelastometry and Platelet Function during Acclimatization to High Altitude
Authors: Rocke Alistair , Paterson Gordon , Barber Matthew , Jackson Alexander , Main Shona , Stannett Calum , Schnopp Martin , Baillie J. , Horne Elizabeth , Moores Carl , Harrison Paul , Nimmo Alastair , Thompson A.
Published: January 2018

Interaction between hypoxia and coagulation is important given the increased risk of thrombotic diseases in chronically hypoxic patients who reside at sea level and in residents at high altitude. Hypoxia alters the proteome of platelets favouring a prothrombotic phenotype, but studies of activation and consumption of specific coagulation factors in hypoxic humans have yielded conflicting results. We tested blood from 63 healthy lowland volunteers acclimatizing to high altitude (5,200 m) using thromboelastometry and assays of platelet function to examine the effects of hypoxia on haemostasis. Using data from two separate cohorts of patients following identical ascent profiles, we detected a significant delay in clot formation, but increased clot strength by day 7 at 5,200 m. The latter finding may be accounted for by the significant rise in platelet count and fibrinogen concentration that occurred during acclimatization. Platelet function assays revealed evidence of platelet hyper-reactivity, with shortened PFA-100 closure times and increased platelet aggregation in response to adenosine diphosphate. Post-expedition results were consistent with the normalization of coagulation following descent to sea level. These robust findings indicate that hypoxia increases platelet reactivity and, with the exception of the paradoxical delay in thromboelastometry clotting time, suggest a prothrombotic phenotype at altitude. Further work to elucidate the mechanism of platelet activation in hypoxia will be important and could impact upon the management of patients with acute or chronic hypoxic respiratory diseases who are at risk of thrombotic events.
Platelet Function in ITP, Independent of Platelet Count, Is Consistent Over Time and Is Associated with Both Current and Subsequent Bleeding Severity
Authors: Frelinger A. , Grace R. , Gerrits A. , Carmichael S. , Forde E. , Michelson A.
Published: January 2018

Background Treatment decisions for patients with immune thrombocytopenia (ITP) are difficult because patients with similarly low platelet counts differ in their bleeding tendency. We recently reported that platelet function tests, independent of platelet count, are associated with concurrent bleeding severity, suggesting that these tests may be useful indicators of future bleeding in ITP.

Objectives To test this hypothesis, we evaluated the consistency of these platelet function tests over time and their association with subsequent bleeding severity.

Methods Bleeding score and platelet biomarkers were evaluated in a cross-sectional study of children with ITP at two visits separated by a median of 10 months.

Results and Conclusions Correlations between Visit 1 and Visit 2 results for immature platelet fraction, circulating and agonist-stimulated platelet surface P-selectin, and activated GPIIb–IIIa and GPIbα indicated consistency of the platelet phenotype over time. Consistent with our previous findings, platelet biomarkers at each visit were significantly associated with the concurrent bleeding score. Furthermore, increased P-selectin on circulating platelets and reduced agonist-stimulated P-selectin and activated GPIIb–IIIa-positive platelets at Visit 1 were significantly associated with bleeding scores at Visit 2 and remained significantly associated with bleeding severity after adjustment for platelet count. These results suggest a mechanistic link between desensitization of agonist receptors and increased bleeding severity. In summary, platelet function in ITP, independent of platelet count, is consistent over time and is associated with both concurrent and subsequent bleeding severity. These findings support further evaluation of platelet function testing to help guide patient management in ITP.
Trends in Diagnosis‐Specific Work Disability Before and After Stroke: A Longitudinal Population‐Based Study in Sweden
Authors: Lallukka Tea , Ervasti Jenni , Lundström Erik , Mittendorfer‐Rutz Ellenor , Friberg Emilie , Virtanen Marianna , Alexanderson Kristina
Published: January 2018

Background

Although a stroke event often leads to work disability, diagnoses behind work disability before and after stroke are largely unknown. We examined the pre‐event and postevent trends in diagnosis‐specific work disability among patients of working age.

Methods and Results

We included all new nonfatal stroke events in 2006–2008 from population‐based hospital registers in Sweden among women and men aged 25 to 60 years (n=12 972). Annual days of diagnosis‐specific work disability were followed for 4 years before and after stroke. Repeated measures negative binomial regression models using the generalized estimating equations method were fitted to examine trends in diagnosis‐specific work disability before and after the event. Already during the 4 pre‐event years, work disability attributed to circulatory diseases increased among women (rate ratio, 1.99; 95% confidence interval, 1.68–2.36) and men (rate ratio, 2.20; 95% confidence interval, 1.88–2.57). Increasing trends before stroke were also found for work disability attributed to mental disorders, musculoskeletal diseases, neoplasms, diseases of the nervous, respiratory, and digestive systems, injuries, and diabetes mellitus. As expected, a sharp increase in work disability days attributed to circulatory diseases was found during the first year after the event among both sexes. Overall, during 4 years after the stroke, there was a decreasing trend for circulatory diseases and injuries, whereas the trend was increasing for nervous diseases and diabetes mellitus.

Conclusions

Work disability attributed to several mental and somatic diagnoses is higher already before a stroke event.
Culprit and Nonculprit Recurrent Ischemic Events in Patients With Myocardial Infarction: Data From SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies)
Authors: Varenhorst Christoph , Hasvold Pål , Johansson Saga , Janzon Magnus , Albertsson Per , Leosdottir Margret , Hambraeus Kristina , James Stefan , Jernberg Tomas , Svennblad Bodil , Lagerqvist Bo
Published: January 2018

Background

Long‐term disease progression after myocardial infarction (
MI
) is inadequately understood. We evaluated the pattern and angiographic properties (culprit lesion [
CL
]/non‐CL [
NCL
]) of recurrent
MI
(re‐
MI
) in a large real‐world patient population.

Methods and Results

Our observational study used prospectively collected data in 108 615 patients with first‐occurrence
MI
enrolled in the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) between July 1, 2006 and November 29, 2014. During follow‐up (median, 3.2 years), recurrent hospitalization for
MI
occurred in 11 117 patients (10.2%). Of the patients who underwent coronary angiography for the index
MI
, a
CL
was identified in 44 332 patients. Of those patients, 3464 experienced an re‐
MI
; the infarct originated from the
NCL
in 1243 patients and from the
CL
in 655 patients. In total, 1566 re‐
MI
s were indeterminate events and could not be classified as
NCL
or
CL
re‐MIs. The risk of re‐
MI
within 8 years related to the
NCL
was 0.06 (95% confidence interval [CI], 0.05–0.06), compared with 0.03 (95%
CI
, 0.02–0.03) for the
CL
. There were no large differences in baseline characteristics of patients with subsequent
NCL
versus
CL
re‐
MI
s. Independent predictors of
NCL
versus
CL
re‐
MI
were multivessel disease (odds ratio, 2.29; 95%
CI
, 1.87–2.82), male sex (odds ratio, 1.36; 95% CI, 1.09–1.71), and a prolonged time between the index and re‐MI (odds ratio, 1.16; 95%
CI
, 1.10–1.22).

Conclusions

In a large cohort of patients with first‐occurrence
MI
undergoing percutaneous coronary intervention, the risk of re‐MI originating from a previously untreated lesion was twice higher than the risk of lesions originating from a previously stented lesion.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov
. Unique identifier:
NCT
03099395.
Outcomes of Patients With Atrial Fibrillation Newly Recommended for Oral Anticoagulation Under the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline
Authors: Gray Matthew P. , Saba Samir , Zhang Yuting , Hernandez Inmaculada
Published: January 2018

Background

In March 2014, the American Heart Association updated their guidelines for the management of oral anticoagulation (
OAC
) in atrial fibrillation, recommending
OAC
for all patients with
CHA
2
DS
2
‐
VAS
c ≥2. Previously, only patients with
CHADS
2
≥2 were recommended for anticoagulation. This study compared effectiveness and safety outcomes of
OAC
among patients who would receive
OAC
using the 2014 guidelines but not the 2011 guidelines.

Methods and Results

Using claims data from a 5% sample of 2013–2014 Medicare beneficiaries, we identified patients with initially diagnosed atrial fibrillation between 2013 and 2014 and selected those who would receive
OAC
under the 2014 guidelines but not the 2011 guidelines (those with
CHA
2
DS
2
‐
VAS
c score ≥2 or
CHADS
2
score <2). Patients were categorized according to their use of
OAC
after first atrial fibrillation diagnosis (2937 users and 2914 nonusers). Primary outcomes included the composite of ischemic stroke, systemic embolism and death, and any bleeding event. Cox proportional hazard models were constructed to compare the risk of primary outcomes between the 2 groups, while controlling for patient demographic and clinical characteristics. There was no difference in the combined risk of stroke, systemic embolism, and death between the treatment groups (hazard ratio, 1.00; 95% confidence interval, 0.84–1.20). The risk of bleeding was higher for patients receiving
OAC
than for patients not receiving
OAC
(hazard ratio, 1.70, 95% confidence interval, 1.46–1.97).

Conclusions

The benefit of
OAC
is not well defined in this patient population, and new studies that minimize residual confounding are needed to fully understand the risk/benefit of
OAC
in patients with atrial fibrillation and low to moderate stroke risk.
Disorders of Consciousness: Is a Dichotomous Legal Approach Justified?
Authors: Law Richard W.M. , Choong Kartina A.
Published: January 2018

Advances made in medical care mean that many critically ill patients with an acquired brain injury may survive with a disorder of consciousness. This may be in the form of a vegetative state (VS) or a minimally conscious state (MCS). Medically, there is a growing tendency to view these conditions as occupying the same clinical spectrum rather than be considered as discrete entities. In other words, their difference is now understood as one of degree rather than kind. However, is English law keeping pace with this development in medical knowledge? This article seeks to highlight the duality that exists in the legal decision-making process in England and Wales, and question the justifiability and sustainability of this dichotomous approach in the light of medicine’s current understanding on disorders of consciousness.
Introduction to the Special Issue on Multisensory Research Forum (IMRF 2016, Suzhou)
Authors: Chen Lihan , Feng Wenfeng , Yue Zhenzhu
Published: January 2018

This editorial introduction briefly summarized the general information and keynote topics of 17th International Multisensory Research Forum (IMRF 2016), which was held in Suzhou, China on June 15–18, 2016. In this IMRF2016 Multisensory Research special issue, seven papers have been collected. Some topics represent mainstream, traditional studies, while others show a range of multidisciplinary approaches. We categorized the main topics in this issue to four aspects: expertise in multisensory timing, neuronal signatures underlying cross-modal correspondence, coupling between perception and action, and lastly, a revisit of the principles for multisensory segregation and integration.
Observations on Malenchus geraerti n. sp. (Rhabditida: Tylenchidae), a morphological and molecular phylogenetic study
Authors: PEDRAM MAJID , SOLEYMANZADEH MAHYA , POURJAM EBRAHIM , MOBASSERI MAHYAR
Published: January 2018

Malenchus geraerti n. sp., recovered from natural regions of northern Iran, is described and illustrated based on morphological, morphometric and molecular data. The new species is characterized by having females with a short body, an anteriorly wide S-shaped amphidial opening narrowing posteriorly, cuticle with prominent annuli, lateral field a plain band with smooth margins, muscular metacorpus with well-developed valve and corresponding plates, spermatheca filled with small spheroid sperm cells, vulva sunken in body with large epiptygma and no flap, and conical tail tapering gradually to a more or less pointed tip. Males of the new species are characterized by having a short body, tylenchoid spicules, adcloacal bursa with smooth margin and tail similar to that of the female. Morphologically, the new species is similar to five known species of the genus: M. fusiformis, M. machadoi, M. pachycephalus, M. solovjovae and M. undulatus. It most closely resembles M. pachycephalus, but as a cryptic species it can be differentiated using morphological and molecular characteristics. Comparisons with the four other aforementioned species are also discussed. Molecular phylogenetic studies using partial sequences of small and large subunit ribosomal DNA fragments reveal that the new species forms a clade with the species M. neosulcus in the small subunit (SSU) rDNA, and two species of Lelenchus in the large subunit (LSU) rDNA tree.
Multimodel Future Projections of Wintertime North Atlantic and North Pacific Tropospheric Jets: A Bayesian Analysis
Authors: Whittleston D. , McColl K. A. , Entekhabi D.
Published: January 2018

The impact of future greenhouse gas forcing on the North Atlantic and North Pacific tropospheric jets remains uncertain. Opposing changes in the latitudinal temperature gradient—forced by amplified lower-atmospheric Arctic warming versus upper-atmospheric tropical warming—make robust predictions a challenge. Despite some models simulating more realistic jets than others, it remains the prevailing approach to treat each model as equally probable (i.e., democratic weighting). This study compares democratically weighted projections to an alternative Bayesian-weighting method based on the ability of models to simulate historical wintertime jet climatology. The novel Bayesian technique is developed to be broadly applicable to high-dimensional fields. Results show the Bayesian weighting can reduce systematic bias and suggest the wintertime jet response to greenhouse gas forcing is largely independent of this historical bias (i.e., not state dependent). A future strengthening and narrowing is seen in both winter jets, particularly at the upper levels. The widely reported poleward shift at the level of the eddy-driven jet does not appear statistically robust, particularly over the North Atlantic, indicating sensitivity to current model deficiencies.
Influence of the micro-structure on saturated transverse flow in fibre arrays
Authors: Gommer Frank , Endruweit Andreas , Long Andrew C
Published: January 2018

This study analyses the influence of the random filament arrangement in fibre bundles on the resin flow behaviour. Transverse steady-state resin flow that occurs behind a liquid resin flow front was simulated numerically through statistically equivalent micro-structures at high-fibre volume fractions, Vf > 0.6, as observed in fibre bundles. The need of applying a minimum gap distance between neighbouring filaments was overcome by automated local mesh refinement. The derived permeability values showed significant scatter. Convergence of these values was determined at a ratio of flow length to filament radius greater than 20 for all three analysed fibre volume fractions. Mean permeabilities were between 6 and 10 times lower than those predicted for a hexagonal fibre array. A statistical model is proposed, which is able to predict the scatter of observed permeabilities based on simple micro-structural descriptors.