bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcranial doppler ultrasonography in children with sickle cell anemia: Clinical and laboratory correlates for elevated blood flow velocities
Authors: Lagunju IkeOluwa , Sodeinde Olugbemiro , Brown Biobele , Akinbami Felix , Adedokun Babatunde
Published: October 2013

Background

Transcranial Doppler (TCD) sonography of major cerebral arteries is now recommended for routine screening for stroke risk in children with sickle cell disease (SCD).

Methods

We performed TCD studies on children with sickle cell anemia (SCA) seen at the pediatric hematology clinic over a period of 2 years. TCD scans were repeated yearly in children with normal flow velocities and every 3 months in children with elevated velocities. Findings were correlated with clinical variables, hematologic indices, and arterial oxygen saturation. Predictors of elevated velocities were identified by multiple linear regressions.

Results

We enrolled 237 children and performed a total of 526 TCD examinations. Highest time‐averaged maximum flow velocities were ≥170 cm/s in 72 (30.3%) cases and ≥200 cm/s in 20 (8.4%). Young age, low hematocrit, low hemoglobin, and arterial oxygen desaturation <95% showed significant correlations with presence of increased cerebral flow velocities.

Conclusions

Low hematocrit, low hemoglobin concentration, young age, and low arterial oxygen desaturation predicted elevated cerebral blood flow velocities and, invariably, increased stroke risk, in children with SCA. Children who exhibit these features should be given high priority for TCD examination in the setting of limited resources. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:89–95, 2014
Sonographic classification of draining pathways of obstructed hepatic veins in Budd‐Chiari syndrome
Authors: Gai Yong‐Hao , Cai Shi‐Feng , Guo Wen‐Bin , Zhang Chun‐Qing , Liang Bo , Jia Tao , Zhang Guo‐Quan
Published: October 2013

Purpose

To describe and propose a sonographic classification of the blood‐draining pathways of obstructed hepatic veins in Budd‐Chiari syndrome.

Methods

This retrospective study included 206 patients with hepatic vein obstructions who underwent sonographic examination. We evaluated the afflicted hepatic veins, as well as the course, orifice, blood flow direction of draining veins, and communicating branches. Results were classified and compared with digital subtraction angiography and computed tomography angiography.

Results

Of 618 hepatic veins in 206 patients, 542 were obstructed. The blood‐draining pathways were classified as hepatic vein‐accessory hepatic vein (131/206), hepatic vein‐hepatic vein/accessory hepatic+hepatic vein (49/206), and, less frequently, collateral pathways (26/206). Blood was drained from obstructed hepatic veins to the inferior vena cava, right atrium, para‐umbilical veins, or hepatic subcapsular veins through communicating branches of various number and diameters. Doppler signals were obtained from the draining veins.

Conclusions

Sonography provides accurate information regarding the blood‐draining pathways of obstructed hepatic veins in Budd‐Chiari syndrome, which may be helpful for treatment and follow‐up. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:134–142, 2014
Screening and risk factors for anal cancer precursors in men infected with HIV in Taiwan
Authors: Cheng Shu‐Hsing , Chu Fang‐Yeh , Wang Chi‐Chao , Hsueh Yu‐Mei
Published: October 2013

Homosexual men infected with human immunodeficiency virus (HIV) are at a greater risk of developing anal cancer. Men who are infected with HIV and visited the outpatient clinics in Taoyuan General Hospital were enrolled to this study. During March to December 2011, thin preparation anal Pap smear and human papillomavirus (HPV) genotyping were performed in 230 subjects, of which 69 subjects underwent anoscopic biopsy. Their mean age was 32.9 ± 8.1 years, and 181 (78.6%) men were homosexual. The proportion and 95% confidence interval (CI) of subjects with anal dysplasia in cytology was 23.0% (17.56–28.44), including 13.4% (9.26–18.14) with atypical squamous cells of undetermined significance, 7.0% (3.70–10.30) with low‐grade squamous intraepithelial lesions, and 2.6% (0.54–4.66) with high‐grade squamous intraepithelial lesions. For participants having atypical squamous cells of undetermined significance or higher grades, multivariate logistic regression models yielded adjusted odds ratios (95% CI) of 12.61 (1.63–97.56) for homosexuality, 1.62 (1.31–2.00) for number of oncogenic HPV types, and 1.01 (1.00–1.02) for number of lifetime sexual partners. For detection of histological grade II or III anal intraepithelial neoplasm in anoscopic biopsies, the sensitivity of sequential tests for oncogenic HPV and cytology with atypical squamous cells of undetermined significance or higher grades was 100%. The positive likelihood ratio was 3.09 (P = 0.05). It is important to consider anal cancer precursors among homosexual men who are infected with HIV. Anal cytology and oncogenic HPV genotyping testing are effective screening methods. J. Med. Virol. 86:193–201, 2014. © 2013 Wiley Periodicals, Inc.
De novo combination therapy adefovir plus lamivudine as a treatment for women of child‐bearing age with HBeAg‐positive chronic hepatitis B Before Pregnancy
Authors: Li‐Na Ma , Xiang‐Chun Ding , Xiao‐Yan Liu , Chun‐Qiong Xu , Liu Shuai‐Wei , Yan Xie
Published: October 2013

Substantial progress has been achieved in antiviral therapy for chronic hepatitis B; however, options for women of child‐bearing age with HBeAg‐positive chronic hepatitis B remain a challenge. In this study, we sought to determine whether de novo combination therapy of Adefovir plus Lamivudine was a super treatment for women of child‐bearing age with HBeAg‐positive chronic hepatitis B prior to conception. A total of 122 women patients of child‐bearing age with HBeAg‐positive chronic hepatitis B were randomly assigned to receive (i) 10 mg Adefovir plus 100 mg Lamivudine (64 patients) or (ii) 10 mg Adefovir monotherapy (58 patients), administrated orally once daily for 96 weeks. The therapeutic efficacy within each group was compared at weeks 48 and 96. The results showed that de novo combination therapy of Adefovir plus Lamivudine significantly reduced HBV‐DNA detectability, and enhanced ALT normalization and HBeAg seroconversion in women of child‐bearing age with HBeAg‐positive chronic hepatitis B. No virological breakthrough and genotypic resistance were observed in the combination therapy group. Additionally, the combination therapy with Adefovir plus Lamivudine was well tolerated. This study suggests that de novo combination therapy of Adefovir plus Lamivudine offers a therapeutic advantage for women of child‐bearing age with HBeAg‐positive chronic hepatitis B when taken before conception. J. Med. Virol. 86:433–436, 2014. © 2013 Wiley Periodicals, Inc.
Effect of lipoic acid and α‐glyceryl‐phosphoryl‐choline on astroglial cell proliferation and differentiation in primary culture
Authors: Grasso S. , Bramanti V. , Tomassoni D. , Bronzi D. , Malfa G. , Traini E. , Napoli M. , Renis M. , Amenta F. , Avola R.
Published: October 2013

Lipoic acid plays a crucial role as antioxidant and metabolic component of enzymes involved in glucose metabolism of different cell types. Choline alphoscerate (α‐glyceryl‐phosphoryl‐choline [αGPC]) is a semisynthetic derivative of phosphatidylcholines representing, among acetilcholine precursors, a cholinergic drug. In the present study, we evaluated the expression of some proliferation and differentiation markers in 15 or 21 DIV astrocyte cultures treated with 50 μM (+)lipoic acid or (+/−)lipoic acid and/or 10 mM αGPC for 24 hr. In addition, we evaluated the possible genoprotective effect by analysis of DNA status detected by alkaline comet assay. The addition of single drugs [(+)lipoic acid, (+/−)lipoic acid, or αGPC] induced an “upward modulation” of the expression of biomarkers used in our study. On the contrary, the cotreatment with either (+)lipoic acid + αGPC or (+/−)lipoic + αGPC surprisingly showed no significant modification or even a downregulation of the above‐mentioned biomarkers. This latter finding demonstrated no additional effect after the cotreatment with both drugs with respect to the single treatments alone. Further studies are necessary to clarify the specific mechanism evoked by the processing of these neuroprotective agents in our in vitro models. Finally, these preliminary findings may represent a good tool with which to clarify the antioxidant and metabolic roles played by lipoic acid in proliferating and differentiating astroglial cell cultures, during an interactive cross‐talk between glial and neuronal cells, after brain lesions or damage correlated with oxidative stress that may occur in some degenerative diseases. © 2013 Wiley Periodicals, Inc.
Ciliary neurotrophic factor and fibroblast growth factor increase the speed and number of regenerating axons after optic nerve injury in adult Rana pipiens
Authors: Vega‐Meléndez Giam S. , Blagburn Jonathan M. , Blanco Rosa E.
Published: October 2013

Neurotrophins such as ciliary neurotrophic factor (CNTF) and brain‐derived neurotrophic factor (BDNF) and growth factors such as fibroblast growth factor (FGF‐2) play important roles in neuronal survival and in axonal outgrowth during development. However, whether they can modulate regeneration after optic nerve injury in the adult animal is less clear. The present study investigates the effects of application of these neurotrophic factors on the speed, number, and distribution of regenerating axons in the frog Rana pipiens after optic nerve crush. Optic nerves were crushed and the factors, or phosphate‐buffered saline, were applied to the stump or intraocularly. The nerves were examined at different times after axotomy, using anterograde labeling with biotin dextran amine and antibody against growth‐associated protein 43. We measured the length, number, and distribution of axons projecting beyond the lesion site. Untreated regenerating axons show an increase in elongation rate over 3 weeks. CNTF more than doubles this rate, FGF‐2 increases it, and BDNF has little effect. In contrast, the numbers of regenerating axons that have reached 200 μm at 2 weeks were more than doubled by FGF‐2, increased by CNTF, and barely affected by BDNF. The regenerating axons were preferentially distributed in the periphery of the nerve; although the numbers of axons were increased by neurotrophic factor application, this overall distribution was substantially unaffected. © 2013 Wiley Periodicals, Inc.
Joint instability and cartilage compression in a mouse model of posttraumatic osteoarthritis
Authors: Onur Tarik S. , Wu Ruobin , Chu Stacey , Chang Wenhan , Kim Hubert T. , Dang Alexis B.C.
Published: October 2013

Joint instability and cartilage trauma have been previously studied and identified as key mediators in the development of posttraumatic osteoarthritis (PTOA). The purpose of this study was to use an in vivo model to compare the effect of joint instability, caused by the rupture of the anterior cruciate ligament (ACL), versus cartilage compression. In this study, mice were subjected to cyclical axial loads of twelve Newtons (N) for 240 cycles or until the ACL ruptured. One and eight weeks after this procedure, knees were sectioned coronally and evaluated for osteoarthritis by histology. Using a scoring scale established by [Pritzker K, Gay S, Jimenez S, et al. (2006): Osteoarthritis Cartilage 14:13–29], the articular cartilage across each surface was scored and combined to produce a total degeneration score. The ACL‐ruptured group had a significantly greater total degeneration score than either control or compression treated joints at 1 and 8 weeks. Additionally, only sections from ACL‐ruptured knees consistently showed synovitis after 1 week and osteophyte formation after 8 weeks. Thus, it appears using that ACL rupture consistently creates a severe osteoarthritis phenotype, while axial cartilage compression alone does not appear to be an appropriate method of inducing PTOA in vivo. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:318–323, 2014.
Sex‐related differences in neuromuscular control: Implications for injury mechanisms or healthy stabilisation strategies?
Authors: Flaxman Teresa E. , Smith Andrew J. J. , Benoit Daniel L.
Published: October 2013

Sex‐related differences in neuromuscular activation have been previously identified and are thought to be an underlying contributor to the ACL injury mechanism. During dynamic tasks evaluating the role of muscle action as it relates to joint stability is difficult since individual muscle contributions to force generation are confounded by biomechanical factors of movement. The purpose of this study was to examine sex‐related differences in knee muscle action during a weight‐bearing isometric exercise and identify the stabilising role of these muscles. Healthy young adults stood with their dominant leg in a boot fixed to a force platform. A force matching protocol required participants to modulate normalised ground reaction forces in various combinations of anterior‐posterior, medial‐lateral loads while maintaining a constant joint position. Normalised electromyographic data of eight muscles crossing the knee joint were displayed in polar plots. Patterns were quantified with an orientation analysis and mean activation magnitudes were computed. Females demonstrated symmetrical activation patterns with significantly greater activation in the rectus femoris (p = 0.037), lateral gastrocnemius (p = 0.012), and tensor fascia lata (p = 0.005) compared to males. High between‐subject reliability (ICC = 0.772–0.977) was observed across groups suggesting we have identified fundamental sex‐related differences in knee joint stabilisation strategies. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:310–317, 2014.
Infrared stabilization of rice bran and its effects on γ‐oryzanol content, tocopherols and fatty acid composition
Authors: Yılmaz Neşe , Tuncel Necati Barış , Kocabıyık Habib
Published: October 2013

BACKGROUND

Rice bran is a nutritionally valuable by‐product of paddy milling. In this study an experimental infrared (IR) stabilization system was developed to prevent rice bran rancidity. The free fatty acid content of raw and IR‐stabilized rice bran samples was monitored every 15 days during 6 months of storage. In addition, energy consumption was determined.

RESULTS

The free fatty acid content of rice bran stabilized at 600 W IR power for 5 min remained below 5% for 165 days. No significant change in γ‐oryzanol content or fatty acid composition but a significant decrease in tocopherol content was observed in stabilized rice bran compared with raw bran. IR stabilization was found to be comparable to extrusion with regard to energy consumption.

CONCLUSION

IR stabilization was effective in preventing hydrolytic rancidity of rice bran. By optimizing the operational parameters of IR stabilization, this by‐product has the potential for use in the food industry in various ways as a value‐added commodity. © 2013 Society of Chemical Industry
Mycotoxigenic moulds and mycotoxins in flours consumed in Turkey
Authors: Demirel Rasime , Sariozlu Nalan Yilmaz
Published: October 2013

BACKGROUND

Aflatoxins (AFs) and ochratoxin A (OTA) are metabolites produced by several fungi of the genera Aspergillus and Penicillium and have been found to contaminate human foods and animal feeds. The aim of this study was to investigate the abundance and diversity of total microfungi and mycotoxigenic fungi in 25 samples of different grain‐based flours from four regions of Turkey (Thrace and Central, Northwest and West Anatolia) and to evaluate the level of AF and OTA contamination. Microscopic and polymerase chain reaction analyses were used to identify fungi, while high‐performance liquid chromatography was used for the detection of AFs and OTA.

RESULTS

A total of 551 fungal strains were obtained from the samples and identified morphologically and by multi‐locus gene sequencing. All samples were contaminated with fungi ((2–4.8) × 104 colony‐forming units g−1) and three of them exceeded the European Commission (EC) limits. The data also revealed that 70.5 and 14.7% of the fungal isolates were positive for AF and OTA production respectively. In addition, 21 samples were contaminated by AFs (14.98 and 22.4 µg kg−1 for AFB1) and OTA (3.02 and 4.76 µg kg−1) and three of them exceeded the EC limits.

CONCLUSION

This study is the first report on problems with the occurrence of microfungi, mycotoxin contamination, AFs and OTA in different grain‐based flour samples from Turkey and highlights developable points of current limits for food and public health safety. © 2013 Society of Chemical Industry
Isolated hepatic perfusion for metastatic melanoma
Authors: Yamamoto Maki , Zager Jonathan S.
Published: October 2013

Unresectable hepatic metastases from melanoma present a challenge to the physician. Although there have been advances in systemic therapies for patients with metastatic cutaneous melanoma to the liver, the overall prognosis is poor and is worse in patients with metastatic ocular melanoma. Isolated hepatic perfusion, open or percutaneous, allows high doses of cytotoxic chemotherapy to be delivered directly to the liver while minimizing systemic exposure, and has emerged as a viable treatment options for these complex patients. J. Surg. Oncol. 2014 109:383–388. © 2013 Wiley Periodicals, Inc.
Expression of microRNA‐218 in human pancreatic ductal adenocarcinoma and its correlation with tumor progression and patient survival
Authors: Zhu Ziman , Xu Yuefang , Du Jundong , Tan Jingwang , Jiao Huabao
Published: October 2013

Background

Our aim was to analyze clinicopathologic and prognostic values of microRNA (miR)‐218 in pancreatic ductal adenocarcinima (PDAC).

Methods

TaqMan quantitative RT‐PCR was used to determine the expression of miR‐218 in human PDAC cells and tissue samples. The association of miR‐218 expression with clinicopathologic variables was analyzed. Kaplan–Meier survival analysis was performed to analyze the association of miR‐218 expression with recurrence‐free survival or overall survival of patients. Univariate and multivariate Cox regression analyses were performed.

Results

The relative level of miR‐218 in PDAC cells was significantly lower than that in normal human pancreatic duct epithelial cell line. Also, the mean level of miR‐218 in PDAC tissues was significantly lower than that in normal pancreatic tissues. Statistical analyses indicated that low miR‐218 expression was closely associated with poor tumor differentiation, advanced tumor stage, higher incidence of lymph node metastasis, and tumor recurrence. Kaplan–Meier survival analyses showed that patients with low miR‐218 expression had lower recurrence‐free and overall survival than those with high miR‐218 expression. Univariate and multivariate Cox regression analyses showed that miR‐218 might be an independent prognostic factor.

Conclusion

Reduced miR‐218 in PDAC tissues was correlated with tumor progression, and might be an independent poor prognostic factor for patients. J. Surg. Oncol. 2014 109:89–94. © 2013 Wiley Periodicals, Inc.
Ability of FDG‐PET/CT in the detection of gallbladder cancer
Authors: Ramos‐Font Carlos , Gómez‐Rio Manuel , Rodríguez‐Fernández Antonio , Jiménez‐Heffernan Amelia , Sánchez Rocío Sánchez , Llamas‐Elvira Jose Manuel
Published: October 2013

Purpose

To assess the value of FDG‐PET/CT in the evaluation of gallbladder carcinomas (GBC).

Methods

A prospective cohort of patients with suspicion of or confirmed GBC was studied with FDG‐PET/CT. Diagnostic accuracy parameters were calculated in comparison with pathology and/or the clinical course of patients. Clinical impact of PET/CT imaging was estimated.

Results

Forty‐nine patients were enrolled (34 malignant tumors, 15 benign lesions; 37 staging, 12 restaging). Overall diagnostic accuracy was 95.9% for the diagnosis of the primary lesion, 85.7% for lymph node involvement and 95.9% for metastatic disease. Mean SUVmax in malignant gallbladder lesions was 7.92 ± 6.25 Analysis of ROC curves showed a SUVmax cut‐off value of 3.62 for malignancy (S: 78.1%; Sp: 88.2%). Diagnostic accuracy in the restaging group reached 100%. FDG‐PET/CT changed the management of 22.4% of the population.

Comments

Diagnosis of malignancy or benignity of suspicious gallbladder lesions is accurately made with FDG PET/CT, allowing a precise staging of GBC due to its ability to identify unsuspected metastatic disease. SUVmax has a complementary role in addition to visual analysis. J. Surg. Oncol. 2014 109:218–224. © 2013 Wiley Periodicals, Inc.
Long‐term results of endoscopic resection for type I gastric neuroendocrine tumors
Authors: Uygun Ahmet , Kadayifci Abdurrahman , Polat Zulfikar , Yilmaz Kemalettin , Gunal Armagan , Demir Hakan , Bagci Sait
Published: October 2013

Background

A number of different therapies, including endoscopic resection, have been suggested for the treatment of Type 1 gastric neuroendocrine tumors (NETs). The current study aimed to determine the long‐term efficacy of endoscopic resection for Type 1 gastric NETs.

Methods

Twenty‐two patients (from 1999 to 2012) with Type 1 gastric NETs were included in the study. All patients were treated with endoscopic resection and received regular followed‐up appointments at a tertiary referral center.

Results

All patients were initially diagnosed with hypergastrinemia, atrophic gastritis and intestinal metaplasia. Polyps' diameters were >1 cm in 4 patients, and between 0.5 and 1 cm in 18 patients. All detectable lesions were successfully resected. One patient required surgery due to gastric perforation during endoscopic mucosal resection. Recurrence was detected in four patients (18%) and endoscopic resection was performed again. Local or distant metastasis was not observed in any patient during follow‐up. Median follow‐up time was 7 years, with a maximum of 14 years. Seventeen patients (78%) completed a 5‐year follow‐up period, and overall disease‐free survival rate was 100%.

Conclusions

Long‐term follow‐ups with 22 patients suggest that endoscopic resection of Type 1 gastric NETs is a safe and effective treatment option with a relatively low recurrence rate. J. Surg. Oncol. 2014 109:71–74. © 2013 Wiley Periodicals, Inc.
Lateral pelvic lymph node dissection can be omitted in lower rectal cancer in which the longest lateral pelvic and perirectal lymph node is less than 5 mm on MRI
Authors: Ogawa Shimpei , Itabashi Michio , Hirosawa Tomoichiro , Hashimoto Takuzo , Bamba Yoshiko , Kameoka Shingo
Published: October 2013

Background and Objectives

The goal of the study was to examine the use of magnetic resonance imaging (MRI) for identification of patients with lower rectal cancer who may benefit from lateral pelvic lymph node dissection (LPLD).

Methods

Diagnoses and oncological outcomes were examined in 160 cases. Patients in whom the long‐axis diameter of the longest detected lymph node was <5 mm or ≥5 mm were classified as LPLN(−) (n = 102) and LPLN(+) (n = 58), respectively.

Results

Diagnostic results gave a 21.6% positive predictive value (PPV) and a 95.0% negative predictive value (NPV) for the LPLN. These values were 59.6% and 91.5%, respectively, for the perirectal lymph node (PRLN). Multivariate analysis showed that a pathologic PRLN (pPRLN)(+) status was an independent prognostic factor for relapse‐free survival (RFS) (P = 0.0424) in the LPLN(−) group. The 5‐year RFS did not differ significantly between cases that did not and did undergo LPLD (90.0% vs. 83.8%) in the LPLN(−) and pPRLN(−) groups.

Conclusions

The low PPV and high NPV indicate that it is difficult to identify patients who may benefit from LPLD. However, the results show that LPLD has no benefit in LPLN(−) and PRLN(−) cases and that these cases can be identified based on MRI findings. J. Surg. Oncol. 2014 109:227–233. © 2013 Wiley Periodicals, Inc.
Palliative surgery in patients with unresectable colorectal liver metastases: a propensity score matching analysis
Authors: Yoon Yong Sik , Kim Chan Wook , Lim Seok‐Byung , Yu Chang Sik , Kim So Yeon , Kim Tae Won , Kim Min‐Ju , Kim Jin Cheon
Published: October 2013

Background and Objectives

The current study was primarily intended to determine the best surgical treatment for patients with unresectable liver metastatic colorectal cancer (CRC). In addition, we assessed whether the improvement in survival resulting from palliative resection (PR) of the primary tumor was a function of the extent of liver metastasis.

Methods

The demographics, tumor characteristics, and survival outcomes of 261 patients who underwent palliative surgery for unresectable liver metastatic CRC were analyzed. A propensity‐score model was used to compare the group of patients receiving PR and non‐resection (NR).

Results

There were 195 PR patients and 66 NR. The median survival of PR and NR patients was 21 months and 10 months, respectively (P < 0.001). In a Cox multivariate analysis of 51 propensity‐score matched pairs, PR resulted in longer survival than NR (Hazard Ratio for NR 1.481; 95% confidence interval: 1.003–2.185; P = 0.048). The extent of liver metastasis only led to better survival of PR than NR patients among patients with limited liver metastasis not among those with extensive liver metastasis (P = 0.001).

Conclusions

PR appears to result in better survival than NR when the patient's overall condition permits an aggressive approach, especially in patients with limited liver metastases. J. Surg. Oncol. 2014 109:239–244. © 2013 Wiley Periodicals, Inc.
Is cartilage conduction classified into air or bone conduction?
Authors: Nishimura Tadashi , Hosoi Hiroshi , Saito Osamu , Miyamae Ryosuke , Shimokura Ryota , Matsui Toshie , Yamanaka Toshiaki , Levitt Harry
Published: October 2013

Objectives/Hypothesis

The aim of this study was to establish the sound transmission characteristics of cartilage conduction proposed by Hosoi (2004), which is available by a vibration signal delivered to the aural cartilage from a transducer.

Study Design

Experimental study.

Method

Eight volunteers with normal hearing participated. Thresholds at frequencies of 0.5, 1, 2, and 4 kHz for air conduction, bone, and cartilage conductions were measured with and without an earplug. The sound pressure levels on the eardrum at the threshold estimated with a Head and Torso Simulator were compared between air and cartilage conductions. The force levels calibrated with an artificial mastoid at the threshold were compared between bone and cartilage conductions.

Results

The difference in the estimated sound pressure levels on the eardrum at the thresholds between air and cartilage conductions were within 10 dB. In contrast, the force levels at the thresholds for cartilage conduction were remarkably lower than those for bone conduction. These findings suggested that sounds were probably transmitted via the eardrum for cartilage conduction. The threshold shifts by an earplug showed no significant difference between bone and cartilage conductions at 0.5 kHz. At 1 and 2 kHz, the threshold‐shifts increased significantly in the order of bone, cartilage, and air conductions. These results suggested that airborne sound induced by the vibration of the cartilaginous portion of the ear canal played a significant role in sound transmission for cartilage conduction.

Conclusions

Cartilage conduction has different characteristics from conventional air and bone conductions.

Level of Evidence

N/A. Laryngoscope, 124:1214–1219, 2014
Paradoxical vocal fold motion disorder in the elite athlete: Experience at a large division I university
Authors: Marcinow Anna M. , Thompson Jennifer , Chiang Tendy , Forrest L. Arick , deSilva Brad W.
Published: October 2013

Objectives/Hypothesis

To review our experience at a large division I university with the diagnosis and management of paradoxical vocal fold motion disorder (PVFMD) in elite athletes.

Study Design

A single institution retrospective review and cohort analysis.

Methods

All elite athletes (division I collegiate athletes, triathletes, and marathon runners) with a diagnosis of PVFMD were identified. All patients underwent flexible fiberoptic laryngoscopy (FFL) to confirm the diagnosis of PVFMD. The type of PVFMD therapy was identified and efficacy of treatment was graded based on symptom resolution.

Results

Forty‐six consecutive athletes with PVFMD were identified. A total of 30/46 (65%) were division 1 collegiate athletes and 16/46 (35%) were triathletes or marathon runners. In comparison to a nonathlete PVFMD cohort, athletes were less likely to present with a history of reflux (P < 0.01), psychiatric diagnosis (P < 0.01), dysphonia (P < 0.01), cough (P = 0.02), or dysphagia (P < 0.01). The use of postexertion FFL provided additional diagnostic information in 11 (24%) patients. Laryngeal control therapy (LCT) was recommended for 45/46. A total of 36/45 attended at least one LCT session and 25 (69%) reported improvement of symptoms. Additionally, biofeedback, practice‐observed therapy, and thyroarytenoid muscle botulinum toxin injection were required in three, two, and two patients, respectively.

Conclusion

The addition of postexertion FFL improves the sensitivity to detect PVFMD in athletes. PVFMD in athletes responds well to LCT. However, biofeedback, practice‐observed therapy, and botulinum toxin injection may be required for those patients with an inadequate response to therapy.

Level of Evidence

4. Laryngoscope, 124:1425–1430, 2014
Ethical Considerations Surrounding Survival Benefit–Based Liver Allocation
Authors: Keller Eric J. , Kwo Paul Y. , Helft Paul R.
Published: October 2013

The disparity between the demand for and supply of donor livers has continued to grow over the last 2 decades, and this has placed greater weight on the need for efficient and effective liver allocation. Although the use of extended criteria donors has shown great potential, it remains unregulated. A survival benefit–based model was recently proposed to answer calls to increase efficiency and reduce futile transplants. However, it was previously determined that the current allocation system was not in need of modification and that instead geographic disparities should be addressed. In contrast, we believe that there is a significant need to replace the current allocation system and complement efforts to improve donor liver distribution. We illustrate this need first by identifying major ethical concerns shaping liver allocation and then by using these concerns to identify strengths and shortcomings of the Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease system and a survival benefit–based model. The latter model is a promising means of improving liver allocation: it incorporates a greater number of ethical principles, uses a sophisticated statistical model to increase efficiency and reduce waste, minimizes bias, and parallels developments in the allocation of other organs. However, it remains limited in its posttransplant predictive accuracy and may raise potential issues regarding informed consent. In addition, the proposed model fails to include quality-of-life concerns and prioritize younger patients. We feel that it is time to take the next steps toward better liver allocation not only through reductions in geographic disparities but also through the adoption of a model better equipped to balance the many ethical concerns shaping organ allocation. Thus, we support the development of a similar model with suggested amendments. Liver Transpl 20:140-146, 2014. © 2013 AASLD.
Can Liver Transplantation Provide the Statistical Cure?
Authors: Cucchetti Alessandro , Vitale Alessandro , Cescon Matteo , Gambato Martina , Maroni Lorenzo , Ravaioli Matteo , Ercolani Giorgio , Burra Patrizia , Cillo Umberto , Pinna Antonio D.
Published: October 2013

Liver transplantation (LT) represents the only chance of long-term survival for patients with end-stage liver disease. When the mortality rate for transplant patients returns to the same level as that for the general population, they can be considered statistically cured. However, cure models in the setting of LT have never been applied. Data from 1371 adult patients undergoing LT for the first time between January 1999 and December 2012 at 2 Italian centers were reviewed in order to establish probabilities of being cured by LT. A parametric Weibull model was applied to compare the mortality rate after LT to the rate expected for the general population (matched by sex and age). The observed 3-, 5-, and 10-year overall survival rates after LT were 77.8%, 73.3%, and 65.6%, respectively, and they did not differ between the 2 centers (P = 0.37). The cure fraction for the entire study population was 63.4% (95% confidence interval = 52.6%-72.0%), and the time to cure was 10 years with a 90% confidence level. The best cure fraction was observed for younger recipients without hepatitis C virus (HCV) who had favorable donor-recipient matches, that is, low Donor Model for End-Stage Liver Disease (D-MELD) scores (90.1%); conversely, the lowest probability was observed for elderly HCV recipients with high D-MELD scores (34.6%). The time to cure was 6.22 years for non-HCV patients and 14.78 years for HCV patients. The median survival time for uncured patients was 2.29 years. Among uncured recipients, the longest survival time was observed for younger patients (7.31 years). In conclusion, we provide here a new clinical measure for LT suggesting that survival after transplantation can approximate that of the general population and provide a statistical cure. Liver Transpl 20:210-217, 2014. © 2013 AASLD.
Effects of calcium and vitamin D3 on transforming growth factors in rectal mucosa of sporadic colorectal adenoma patients: A randomized controlled trial
Authors: Tu Huakang , Flanders W. Dana , Ahearn Thomas U. , Daniel Carrie R. , Gonzalez‐Feliciano Amparo G. , Long Qi , Rutherford Robin E. , Bostick Roberd M.
Published: October 2013

Transforming growth factor alpha (TGFα) and TGFβ1 are growth‐promoting and ‐inhibiting autocrine/paracrine growth factors, respectively, that may (1) affect risk for colorectal cancer and (2) be modifiable by anti‐proliferative exposures. The effects of supplemental calcium and vitamin D3 on these two markers in the normal‐appearing colorectal mucosa in humans are unknown. We conducted a pilot, randomized, double‐blind, placebo‐controlled, 2 × 2 factorial clinical trial (n = 92; 23/treatment group) of calcium 2 g and/or vitamin D3 800 IU/d versus placebo over 6 mo. TGFα and TGFβ1 expression was measured in biopsies of normal‐appearing rectal mucosa using automated immunohistochemistry and quantitative image analysis at baseline and 6‐mo follow‐up. In the calcium, vitamin D3, and calcium plus vitamin D3 groups relative to the placebo group (1) the mean overall expression of TGFβ1 increased by 14% (P = 0.25), 19% (P = 0.17), and 22% (P = 0.09); (2) the ratio of TGFα expression in the upper 40% (differentiation zone) to that in the lower 60% (proliferation zone) of the crypts decreased by 34% (P = 0.11), 31% (P = 0.22), and 26% (P = 0.33); and (3) the TGFα/TGFβ1 ratio in the upper 40% of the crypts decreased by 28% (P = 0.09), 14% (P = 0.41), and 22% (P = 0.24), respectively. These preliminary results, although not statistically significant, suggest that supplemental calcium and vitamin D3 may increase TGFβ1 expression and shift TGFα expression downward from the differentiation to the proliferation zone in the crypts in the normal‐appearing colorectal mucosa of sporadic colorectal adenoma patients, and support further investigation in a larger clinical trial. © 2013 Wiley Periodicals, Inc.
The optimal duration of frequency‐volume charts related to compliance and reliability
Authors: van Haarst Ernst P. , Bosch J. L. H. Ruud
Published: October 2013

Aims

To assess Frequency–volume charts (FVCs) for the yield of additional recorded days and the ideal duration of recording related to compliance and reliability.

Methods

Of 500 consecutive urologic outpatients willing to complete a 7‐day FVC, 378 FVCs were evaluable. During seven consecutive days every voiding time and volume were recorded. Missed entries were indicated with a coded letter, thereby assessing the true frequency and compliance. Reliability is the agreement of the day‐to‐day FVC parameters with the 7‐day FVC pattern. Single‐day reliability was assessed and used in the Spearman–Brown formula.

Results

FVCs of 228 male and 150 females were evaluated. Mean age was 55.2 years (standard deviation [SD]: 16.2 years), and mean 24‐hr urine production was 1,856 ml (SD: 828 ml). The percentage of patients with complete FVCs decreased from 78% on day 2 to 58% on day 7, and dropped below 70% after 4 days. Single‐day reliability was r = 0.63 for nocturnal urine production, r = 0.72 for 24‐hr urine production, and r = 0.80 for mean voided volume. At 5 days, reliability of 90% was achieved for all parameters.

Conclusions

With each additional day, FVCs showed a decrease in compliance and an increase in reliability. At day 3, reliability of 80% was achieved for all FVC parameters, but compliance dropped to 73%. Beyond 5 days, the yield of additional recorded days was limited. We advocate an FVC duration of 3 days, but the duration may be shortened or extended depending on the goal of the FVC. Neurourol. Urodynam. 33:296–301, 2014. © 2013 Wiley Periodicals, Inc.
Initial testing (stage 1) of the topoisomerase II inhibitor pixantrone, by the pediatric preclinical testing program
Authors: Kurmasheva Raushan T. , Reynolds C. Patrick , Kang Min H. , Allievi Cecilia , Houghton Peter J. , Smith Malcolm A.
Published: October 2013

Pixantrone, a novel aza‐anthracenedione with cytotoxic activity, was tested against the PPTP in vitro panel (3.0 nM to 30.0 μM) and against a limited panel of PPTP Wilms tumors and sarcomas (7.5 mg/kg) administered intravenously using an every 4 day × 3 schedule. In vitro pixantrone showed a median relative IC50 value of 54 nM (range <3 nM to 1.03 μM). In vivo pixantrone induced significant differences in EFS distribution compared to controls in two of eight solid tumor xenografts at dose levels relevant to human drug exposure. A complete response was observed for one Wilms tumor xenograft. Pediatr Blood Cancer 2014;61:922–924. © 2013 Wiley Periodicals, Inc.
Timing of adjuvant radiotherapy and treatment outcome in childhood ependymoma
Authors: Liu Anthony Pak‐Yin , Shing Matthew Ming‐Kong , Yuen Hui‐Leung , Li Chak‐Ho , Ling Siu‐Cheung , Luk Chung‐Wing , Ha Shau‐Yin , Li Chi‐Kong , Kwong Dora Lai‐Wan , Chan Godfrey Chi‐Fung
Published: October 2013

Background

Several trials incorporating adjuvant focal RT for treatment of young children with ependymoma have demonstrated improved survival with acceptable adverse effects. The optimal timing of RT administration is, however, unknown.

Procedure

A retrospective review of territory‐wide database was performed to identify pediatric patients with ependymoma diagnosed between 1995 and 2011. OS and EFS were compared between patients receiving upfront RT (<150 days of diagnosis), delayed RT (≥150 days of diagnosis), or no RT.

Results

Thirty‐one patients with intracranial ependymoma were identified. Median age was 3.5 years and 14 (45%) were male. Primary tumor was supratentorial in 10 (32%) and infratentorial in 21 (68%). All patients underwent initial surgery, with gross‐total resection (GTR) in 27 (87%). Twelve (39%) received upfront RT, 10 (32%) had delayed RT and 9 (29%) had no RT. During the study period, there were 11 relapses (35%) and 10 deaths (32%). Five‐year OS was 69.9% and 5yr‐EFS was 49.3%. In univariate analysis, GTR led to improved OS (P < 0.001) and EFS (P = 0.004); superior OS and EFS was observed in patients who received RT when compared with those without (P = 0.018 and 0.011, respectively). Upfront RT also resulted in better OS and EFS than delayed RT (P = 0.049 and 0.014, respectively). No significant effect on survival was observed with age, sex, tumor location, RT dosage, and protocol used. In multivariate analysis, GTR significantly improved OS (P = 0.002) and EFS (P = 0.004).

Conclusions

Our results support the early initiation of adjuvant RT in the multi‐modal management of pediatric ependymomas. Pediatr Blood Cancer 2014;61:606–611. © 2013 Wiley Periodicals, Inc.
A randomized, double‐blind, placebo‐controlled clinical trial of megestrol acetate as an appetite stimulant in children with weight loss due to cancer and/or cancer therapy
Authors: Cuvelier Geoff D.E. , Baker Tina J. , Peddie Elaine F. , Casey Linda M. , Lambert Pascal J. , Distefano Dianne S. , Wardle Marlene G. , Mychajlunow Beth A. , Romanick Marcel A. , Dix David B. , Wilson Beverly A.
Published: October 2013

Background

Megestrol acetate (MA) is an appetite stimulant with efficacy in promoting weight gain in adults with cancer‐associated anorexia–cachexia. Studies documenting MA efficacy in children, however, are limited. We present the first randomized, double‐blind, placebo‐controlled clinical trial of MA versus placebo in children with cancer and weight loss.

Methods

Subjects <18 years of age with weight loss (minimum 5% from highest previous weight; or %ideal body weight <90%) due to cancer and/or cancer therapy were randomized to either MA (7.5 mg/kg/day) or placebo for a planned study duration of 90 days. Primary outcome was the difference between groups in mean percent weight change from beginning to end of the study period. Secondary outcomes included effects on anthropometrics, body composition, need for tube feeding or parenteral nutrition, and toxicities.

Results

Twenty‐six patients were randomly assigned (13 MA, 13 placebo). The MA group experienced a mean weight gain of +19.7% compared to a mean weight loss of −1.2% in the placebo group, for a difference of +20.9% (95%CI: +11.3% to +30.5%, P = 0.003) in favor of MA over placebo. MA subjects experienced significant increases in weight for age z‐scores, body mass index z‐scores, and mid upper arm circumference compared to placebo. DXA scanning suggested disproportionate increases in fat accrual. Adrenal suppression was the main toxicity of MA.

Conclusion

In children with high‐risk malignancies, MA resulted in significant increases in mean percent weight change compared to placebo. Further studies of MA should be pursued to better delineate the effect on nutritional status. Pediatr Blood Cancer 2014;61:672–679. © 2013 Wiley Periodicals, Inc.
Study nonlinear vibration of cross‐ply laminated plates using scale models
Authors: Yazdi Ali A.
Published: October 2013

This article describes the establishment of necessary similarity conditions for geometrically nonlinear vibrations of thin cross‐ply laminated plates. The Von‐karman's strain‐displacement relations have been employed to model structural nonlinearity of the system. The Galerkin procedure is used to reduce the nonlinear partial differential equations to a nonlinearly second‐order ordinary differential equation. An analytical investigation based on the direct use of the governing equations of the systems is undertaken to derive the necessary scaling laws and similarity conditions. In this study, a set of scaling laws are introduced that can predict the nonlinear free vibration frequency of the prototypes by projecting the frequency of the model, accurately. The effects of distorted models with relaxations in the number of plies, stacking sequence, and different vibration amplitudes are studied. The results presented herein indicate that models with different relaxations can predict the nonlinear vibration frequency of prototypes with good accuracy. POLYM. COMPOS., 35:752–758, 2014. © 2013 Society of Plastics Engineers
Polymer/carbon nanotube composite film formation: A fluorescence study
Authors: Yargı Önder , Uğur Şaziye , Pekcan Önder
Published: October 2013

In this study, the effect of multi‐walled Carbon nanotube (MWNT) on film formation behavior of Polystrene (PS) latex film was investigated by using steady state fluorescence technique. Films were prepared by mixing of pyrene (P)‐labeled PS latex with different amounts of MWNTs varying in the range between 0 and 20 wt%. After drying, MWNT containing films were separately annealed above glass transition temperature (Tg) of PS ranging from 100 to 270°C for 10 min. In order to monitor film formation behavior of PS/MWNT composites, Scattered light (Is) and fluorescence intensities (IP) from P were measured after each annealing step to monitor the stages of film formation. At 0–20 wt% range of MWNT content films, minimum film formation (To), void closure (Tv), and healing, (Th) temperatures were determined. Void closure and interdiffusion stages were modeled and related activation energies were determined. It was observed that while void closure activation energies increased, backbone activation energies decreased as the percent of MWNT is increased in the composite films. POLYM. COMPOS., 35:817–826, 2014. © 2013 Society of Plastics Engineers
Unsaturated polyester–poly(ε‐caprolactone) hybrid nanocomposites: Thermal–mechanical properties
Authors: Salom Catalina , Calvo del Valle Silvia , Prolongo Margarita G. , María Masegosa Rosa
Published: October 2013

This paper reports on the thermal behavior and mechanical properties of nanocomposites based on unsaturated polyester resin (UP) modified with poly(ɛ‐caprolactone) (PCL) and reinforced with an organically modified clay (cloisite 30B). To optimize the dispersion of 30B and the mixing of PCL in the UP resin, two different methods were employed to prepare crosslinked UP–PCL‐30B hybrid nanocomposites. Besides, two samples of poly(ɛ‐caprolactone) of different molecular weight (PCL2: Mn = 2.103g.mol−1 and PCL50: Mn = 5.104g.mol−1) were used at several concentrations (4, 6, 10 wt%). The 30B concentration was 4 wt% in all the nanocomposites. The morphology of the samples was studied by scanning electron microscopy (SEM). The analysis of X‐ray patterns reveals that intercalated structures have been found for all ternary nanocomposites, independently of the molecular weight, PCL concentration and the preparation method selected. A slight rise of the glass transition temperature, Tg, is observed in UP/PCL/4%30B ternary nanocomposites regarding to neat UP. The analysis of the tensile properties of the ternary (hybrid) systems indicates that UP/4%PCL2/4%30B nanocomposite improves the tensile strength and elongation at break respect to the neat UP while the Young modulus remains constant. POLYM. COMPOS., 35:827–838, 2014. © 2013 Society of Plastics Engineers
Toughening of PA6 nanocomposites by reactive acrylonitrile–butadiene–styrene core–shell rubber particles
Authors: Zhou Liwei , Wan Yang , Chen Xiumei , Sun Shulin , Zhou Chao
Published: October 2013

The effect of addition of organoclay and the reactive ABS‐g‐MA core‐shell particles on the mechanical properties and morphology of blends of polyamide (PA6) were reported. The reactive rubber particles with core‐shell structure were selected as modifier instead of conventional reactive bulk rubber. The microstructure of the ternary nanocomposites was characterized by X‐ray diffraction (XRD), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). Impact strength and stress–strain behavior of blends were measured as a function of organoclay content and core/shell ratio of ABS‐g‐MA. The organoclay plates affected the interfacial adhesion between polyamide and the core‐shell particles because of a shielding effect of organclay on the interacting of amine end groups of PA6 with the MA groups of ABS‐g‐MA. The poor dispersion behavior of ternary nanocomposites was observed when the core/shell ratio is 80/20, and with an increase of organoclay content, the core/shell dispersed phase size increased. Blends based on the maleated elastomer with the core/shell ratio 60/40 gave a more beneficial balance of toughness versus stiffness. POLYM. COMPOS., 35:864–871, 2014. © 2013 Society of Plastics Engineers