bluuebunny/crossref_metadata_2025 huggingface dataset:
The exercise intensity at maximal oxygen uptake (i⩒O2max): Methodological issues and repeatability
Authors: Merry Kevin L. , Glaister Mark , Howatson Glyn , Van Someren Ken
Published: June 2016

The minimum exercise intensity that elicits ⩒O2max (i⩒O2max) is an important variable associated with endurance exercise performance. i⩒O2max is usually determined during a maximal incremental exercise test; however, the magnitude and duration of the increments used influence the i⩒O2max value produced by a given test. The aims of this study were twofold. The first was to investigate whether the i⩒O2max value produced by a single cycle ergometer test (i⩒O2max(S)) was repeatable. The second was to determine if i⩒O2max(S) represents the minimum intensity at which ⩒O2max is elicited when compared to a refined i⩒O2max value (i⩒O2max(R)) derived from repeated tests. Seventeen male cyclists (age 33.9 ± 7.7 years, body mass 80.9 ± 10.2 kg, height 1.82 ± 0.05 m; VO2max 4.27 ± 0.62 L min−1) performed four maximal incremental tests for the determination of i⩒O2max(S) and i⩒O2max(R) (3 min stages; 20 W increments). Trials 1 and 2 were identical and used for assessing the repeatability of i⩒O2max(S), trials 3 and 4 began at different intensities and were used to determine i⩒O2max(R). i⩒O2max(S) showed good test–retest repeatability for i⩒O2max (CV = 4.1%; ICC = 0.93), VO2max (CV = 6.3%; ICC = 0.88) and test duration (CV = 6.7%; ICC = 0.89). There was no significant difference between i⩒O2max(S) and i⩒O2max(R) (303 ± 40 W vs. 301 ± 42 W) (P < .05). The present results suggest that i⩒O2max determined directly during a maximal incremental test is repeatable and provides a very good estimate of the minimum exercise intensity that elicits ⩒O2max.
Titian’sChrist with the Coin: Recovering the Spiritual Currency of Numismatics in Renaissance Ferrara
Authors: Nygren Christopher J.
Published: June 2016

Titian paintedChrist with the Coinfor Alfonso d’Este around 1516. The painting served as the cover piece for a collection of ancient coins and has been read as a commentary on politics and taxation. Instead, this article reveals how the painting reconfigured Alfonso’s interaction with ancient coins, transforming the everyday activity of the collector into an occasion of spiritual reformation. Reading numismatic antiquarianism against the exegetical tradition that accrued around the Gospel pericope (Matthew 22:21) reveals the painting as the nexus of two regimes of virtue — one Christian, one classical — both of which turn upon coins as manifold objects.
Clinical Classification in Pediatric Pulmonary Arterial Hypertension Associated with Congenital Heart Disease
Authors: Zijlstra Willemijn M. H. , Douwes Johannes M. , Ploegstra Mark‐Jan , Krishnan Usha , Roofthooft Marcus T. R. , Hillege Hans L. , Ivy D. Dunbar , Rosenzweig Erika B. , Berger Rolf M. F.
Published: June 2016

Congenital heart disease (CHD) is a frequent cause of pediatric pulmonary arterial hypertension (PAH), with diverse etiology and outcome. We aimed to describe phenotypic heterogeneity in pediatric PAH associated with CHD (PAH‐CHD), assess the applicability of the Nice CHD classification, and explore whether this classification accurately reflects patient/disease characteristics and survival. All children with CHD from a contemporary cohort of consecutive pediatric PAH patients followed in three major referral centers (Denver, New York, the Netherlands) were characterized and classified on the basis of the latest proposed clinical classification for PAH‐CHD (World Symposium on Pulmonary Hypertension, Nice, 2013). According to this classification, 24% of 134 children were classified into group 1, 14% into group 2, 19% into group 3, and 30% into group 4; 11% could not be classified. Types of CHD and hemodynamic profile differed between groups, with the highest right atrial pressure in group 4 (P < 0.040). Group 3 children had Down syndrome less frequently (P = 0.011) but other (un)defined syndromes most frequently (P = 0.063) and received most intense PAH‐targeted therapy (P = 0.003). With 15 deaths and one lung transplant (12%; median follow‐up: 4.3 years), survival differences could not be demonstrated between the groups in the Nice CHD classification. Pediatric PAH‐CHD is a heterogeneous condition frequently associated with extracardiac, developmental factors that are believed to affect disease development. The Nice CHD classification identifies groups with specific patient/disease characteristics. However, a substantial proportion of children could not be classified. Group 3 forms a distinct disease entity. Its prognostic value could not be determined because of the low number of events. The Nice CHD classification supports clinical characterization of PAH‐CHD; however, further refinement is needed to classify all children with PAH‐CHD.
The role of the dynein light intermediate chain in retrograde IFT and flagellar function inChlamydomonas
Authors: Reck Jaimee , Schauer Alexandria M. , VanderWaal Mills Kristyn , Bower Raqual , Tritschler Douglas , Perrone Catherine A. , Porter Mary E.
Published: June 2016

The assembly of cilia and flagella depends on the activity of two microtubule motor complexes, kinesin-2 and dynein-2/1b, but the specific functions of the different subunits are poorly defined. Here we analyze Chlamydomonas strains expressing different amounts of the dynein 1b light intermediate chain (D1bLIC). Disruption of D1bLIC alters the stability of the dynein 1b complex and reduces both the frequency and velocity of retrograde intraflagellar transport (IFT), but it does not eliminate retrograde IFT. Flagellar assembly, motility, gliding, and mating are altered in a dose-dependent manner. iTRAQ-based proteomics identifies a small subset of proteins that are significantly reduced or elevated in d1blic flagella. Transformation with D1bLIC-GFP rescues the mutant phenotypes, and D1bLIC-GFP assembles into the dynein 1b complex at wild-type levels. D1bLIC-GFP is transported with anterograde IFT particles to the flagellar tip, dissociates into smaller particles, and begins processive retrograde IFT in <2 s. These studies demonstrate the role of D1bLIC in facilitating the recycling of IFT subunits and other proteins, identify new components potentially involved in the regulation of IFT, flagellar assembly, and flagellar signaling, and provide insight into the role of D1bLIC and retrograde IFT in other organisms.
Hard-tail emission in the soft state of low-mass X-ray binaries and their relation to the neutron star magnetic field
Authors: Asai Kazumi , Mihara Tatehiro , Mastuoka Masaru , Sugizaki Mutsumi
Published: June 2016

Average hard-tail X-ray emission in the soft state of nine bright Atoll low-mass X-ray binaries containing a neutron star (NS-LMXBs) are investigated by using the light curves of MAXI/GSC (Gas Slit Camera) and Swift/BAT (Burst Alert Telescope). Two sources (4U 1820−30 and 4U 1735−44) exhibit a large hardness ratio (15–50 keV/2–10 keV: HR >0.1), while the other sources distribute at HR ≲ 0.1. In either case, HR does not depend on the 2–10 keV luminosity. Therefore the difference of HR is due to the 15–50 keV luminosity, which is Comptonized emission. The Compton cloud is assumed to be around the neutron star. The size of the Compton cloud would affect the value of HR. Although the magnetic field of an NS-LMXB is weak, we could expect a larger Alfvén radius than the innermost stable circular orbit or the neutron star radius in some sources. In such cases, the accretion inflow is stopped at the Alfvén radius and would create a relatively large Compton cloud. This would result in the observed larger Comptonized emission. By attributing the difference of the size of Compton cloud to the Alfvén radius, we can estimate the magnetic fields of neutron stars. The obtained lower/upper limits are consistent with the previous results.
High-frequency excess in the radio continuum spectrum of the type-1 Seyfert galaxy NGC 985
Authors: Doi Akihiro , Inoue Yoshiyuki
Published: June 2016

The Seyfert galaxy NGC 985 is known to show a high-frequency excess in its radio continuum spectrum at a milli-Jansky level on the basis of previous observations at 1.4–15 GHz; a steep spectrum at low frequencies (a spectral index, α = −1.10 ± 0.03) changes at ∼10 GHz into an inverted spectrum at higher frequencies (α = +0.86 ± 0.09). We conduct new observations at 15–43 GHz using the Very Large Array and at 100 GHz using the Nobeyama Millimeter Array. As a result, the high-frequency excess has been confirmed as continuing at even higher radio frequencies, up to 43 GHz. The non-detection at 100 GHz was not so strong a constraint, and therefore the spectral behavior above 43 GHz remains unclear. The astrometric position of the high-frequency excess component coincides with the optical position of the Seyfert nucleus and the low-frequency radio position to an accuracy of 0${^{\prime\prime}_{.}}$1, corresponding to ∼80 pc; the radio source size is constrained to be <0${^{\prime\prime}_{.}}$02, corresponding to <16 pc. We discuss the physical origin of the observed high-frequency excess component. Dust emission at the Rayleigh–Jeans regime, free–free emission from X-ray radiating high-temperature plasma, free–free emission from the ensemble of broad-line region clouds, or thermal synchrotron from hot accretion flow cannot be responsible for the observed radio flux. Compact jets under synchrotron self-absorption may be unlikely in terms of observed time scales. Alternatively, we cannot rule out the hypotheses of synchrotron jets free–free absorbed by a circumnuclear photo-ionized region, and self-absorbed nonthermal synchrotron from disk corona, as the origin of the high-frequency excess component.
Management of rhinosinusitis: an evidence based approach
Authors: Para Andrew J. , Clayton Elisabeth , Peters Anju T.
Published: June 2016

Purpose of review

The most recent recommendations for the management of both acute (ARS) and chronic rhinosinusitis (CRS) based on the strongest data available for each treatment modality are summarized in this review. The clinical relationships between CRS and its comorbidities are also discussed.

Recent findings

The most promising advances in rhinosinusitis management involve the use of mAbs (anti-IgE, anti-IL-5, anti-IL-4Rα) in trials of CRS with nasal polyposis. Otherwise, the mainstays of treatment for both ARS and CRS have largely remained the same over the past several years.

The treatment of ARS primarily involves symptomatic control with intranasal corticosteroids and nasal saline irrigation; antibiotics should be reserved for the patients who are believed to have bacterial rhinosinusitis. Treating CRS effectively involves using intranasal corticosteroids and irrigation, systemic corticosteroids, and potentially systemic antibiotics. Biologics (mAbs) have shown benefit in clinical studies. Providers should also be aware of concomitant disease processes that may afflict patients with CRS.
Emerging evidence of the role of gut microbiota in the development of allergic diseases
Authors: Simonyte Sjödin Kotryna , Vidman Linda , Rydén Patrik , West Christina E.
Published: June 2016

Purpose of review

The purpose is to review recent studies examining the role of gut microbiota in allergic diseases and asthma.

Recent findings

Work in experimental models gives further evidence that a disturbed gut microbiota influences the propensity to develop allergic manifestations, and that changing the gut microbiota by dietary means (high fiber/acetate or prebiotics) in pregnancy may reduce the risk of allergic airways disease and food allergy in the offspring, respectively. The gut microbiome in established allergic disease and prior to disease onset has also been assessed in clinical trials. One study demonstrated a strong association between high abundance of Faecalibacterium prausnitzii and decreased levels of butyrate and propionate, and established eczema. Lower relative abundance of Ruminococcaceae appears to be implicated in food sensitization and to precede the development of atopic eczema. Decreased relative abundance of Lachnospira, Veillonella, Faecalibacterium, and Rothia in early infancy was reported to be associated with increased asthma risk. Inoculation of germ-free mice with these genera decreased airway inflammation in their offspring thereby proposing a causal role of bacteria in preventing allergic airways disease.

Gut microbiome research is an actively developing field. Although candidate bacterial taxa have been reported it still remains unclear which bacteria (or other microbes), in which numbers and combinations, and when during the gut colonization process may prevent allergic diseases and asthma. There is still a call for standardized approaches that will enable direct comparison of different studies.
The difficult management of anaphylaxis in the elderly
Authors: González-de-Olano David , Lombardo Carla , González-Mancebo Eloína
Published: June 2016

Purpose of review

In this article, an overview of the main characteristics of the anaphylaxis in the elderly, a subset of the population with particular clinical and physiological features that might influence the presentation and management of this entity, is performed.

Recent findings

Life expectancy of the population is increasing and so is the prevalence of allergic diseases in the elderly, including anaphylaxis. Older people present higher risk of fatalities after anaphylaxis, and some comorbidities and pharmacological treatments they may use might also increase that risk.

Recognition of the main triggers, the risk factors, and the wide variety of presenting symptoms of anaphylaxis is therefore helpful in its management, as well as a prompt initiation of the treatment and a complete follow-up.
Development of nanostructures in the diagnosis of drug hypersensitivity reactions
Authors: Mayorga Cristobalina , Perez-Inestrosa Ezequiel , Molina Noemi , Montañez Maria I.
Published: June 2016

Purpose of review

This article provides an overview of novel nanoscale structures potentially applicable to the field of allergy, and to discuss the required properties, advantages, and disadvantages of those nanostructures for clinical application focusing on diagnosis of drug hypersensitivity reactions.

Recent findings

Advances in the development of different nanostructures are favoring their biomedical applications. One area of interest is the interaction between nanostructures and the immune system, including their ability to emulate carrier molecules and their potential use for the diagnosis of allergic reactions.

Immunoassays are the most widely used in-vitro test for evaluating immunoglobulin E (IgE)-mediated drug hypersensitivity reactions. However, they have important technical limitations affecting their sensitivity. A wide variety of nanostructures have been designed to quantify specific IgE, with the aim of diagnosing different kinds of allergies. Nanoparticles-based colloidal immunoassay employed in microdevices and/or miniaturized systems are improving IgE detection sensitivity. Dendrimers have shown immense potential for the design and development of sensor platforms for evaluating IgE-mediated drug hypersensitivity reactions, due to the increase in hapten density and IgE accessibility. In this sense, a variety of dendritic structures as well as their hybridization to different solid supports have been shown to be successful when applied in the diagnosis of drug allergy. Moreover, the knowledge of the complete antigenic determinants would allow their inclusion and therefore further improvement of the sensitivity.
Scylla and Charybdis: The MCAT, USMLE, and Degrees of Freedom in Undergraduate Medical Education
Authors: Gliatto Peter , Leitman I. Michael , Muller David
Published: June 2016

In recent years, medical educators have been making meaningful attempts to rethink how premedical students are prepared for medical school, and how medical students are prepared for residency. Among the many challenges to redesigning premedical and medical school curricula, one that stands out is the constraint imposed by our current methods of assessing aptitude, particularly our use of the Medical College Admissions Test (MCAT) and the United States Medical Licensing Examination (USMLE). For much of the past century, medical school and residency admissions committees have relied heavily on MCAT and USMLE scores to evaluate and rank candidates to their programs. These high-stakes exams determine to a large extent what is taught, and what is stressed, in preparation for and during medical school—despite the fact that scores have limited ability to predict future success in clinical medicine or biomedical research. Additionally, evidence indicates that students from disadvantaged and minority backgrounds do not fare as well on these exams and, as a result, may be disproportionately excluded from the medical profession. While medical school admissions committees have made limited incremental gains in holistic review, residency programs appear to be increasingly focused on USMLE Step scores and veering away from the spirit of holistic review. The authors propose that substantive change will remain slow in coming unless members of the medical education community radically rethink how we report scores from these exams, and how we use them in our selection of future medical students and residents.
Priority Areas and Potential Solutions for Successful Integration and Sustainment of Health Systems Science in Undergraduate Medical Education
Authors: Gonzalo Jed D. , Baxley Elizabeth , Borkan Jeffrey , Dekhtyar Michael , Hawkins Richard , Lawson Luan , Starr Stephanie R. , Skochelak Susan
Published: June 2016

Educators, policy makers, and health systems leaders are calling for significant reform of undergraduate medical education (UME) and graduate medical education (GME) programs to meet the evolving needs of the health care system. Nationally, several schools have initiated innovative curricula in both classroom and workplace learning experiences to promote education in health systems science (HSS), which includes topics such as value-based care, health system improvement, and population and public health. However, the successful implementation of HSS curricula across schools is challenged by issues of curriculum design, assessment, culture, and accreditation, among others. In this report of a working conference using thematic analysis of workshop recommendations and experiences from 11 U.S. medical schools, the authors describe seven priority areas for the successful integration and sustainment of HSS in educational programs, and associated challenges and potential solutions. In 2015, following regular HSS workgroup phone calls and an Accelerating Change in Medical Education consortium-wide meeting, the authors identified the priority areas: partner with licensing, certifying, and accrediting bodies; develop comprehensive, standardized, and integrated curricula; develop, standardize, and align assessments; improve the UME to GME transition; enhance teachers’ knowledge and skills, and incentives for teachers; demonstrate value added to the health system; and address the hidden curriculum. These priority areas and their potential solutions can be used by individual schools and HSS education collaboratives to further outline and delineate the steps needed to create, deliver, study, and sustain effective HSS curricula with an eye toward integration with the basic and clinical sciences curricula.
Pain Experiences of Children and Adolescents With Osteogenesis Imperfecta
Authors: Nghiem Tracy , Louli Julie , Treherne Stephanie C. , Anderson Charlotte E. , Tsimicalis Argerie , Lalloo Chitra , Stinson Jennifer N. , Thorstad Kelly
Published: June 2016

Objective:

Pain is a commonly experienced symptom for children and adolescents diagnosed with osteogenesis imperfecta (OI). The purpose of this integrative review was to describe the pain experience of children and adolescents with OI as well as critically appraise the content and methods of studies assessing OI pain.

Methods:

Five electronic bibliographic databases were searched. Published quantitative, qualitative, and/or mixed-method studies assessing pain in children and adolescents with OI were included and appraised. Constant comparison of the extracted data was used to synthesize themes.

Results:

A total of 783 titles were identified, and 19 studies that met the inclusion criteria were included in this review. Study appraisal scores ranged from 25.0% to 83.3% using the Quality Assessment Tool. The majority of studies included assessed pain as a secondary outcome (63%) and less than half used moderately established or well-established tools (42%). Two themes were uncovered: “Pain is Present and Problematic” and “Issues with Pain Assessment.” Key findings under each theme include: (1) the negative impacts of pain and the substandard use of pain management strategies; and (2) the lack of multidimensional and consistent pain assessments, as well as difficulties in assessing pain in younger children.

Discussion:

Research on OI has focused very little on pain experience in children and adolescents, and there is no standard method of assessing pain. To better describe the pain experience of these patients, future research should focus on better characterizing OI pain with the use of age-appropriate valid, reliable, and multidimensional pain assessment tools.
Prevalence of Chronic Neck Pain, Low Back Pain, and Knee Pain and Their Related Factors in Community-Dwelling Adults in Iran
Authors: Noormohammadpour Pardis , Mansournia Mohammad Ali , Koohpayehzadeh Jalil , Asgari Fereshteh , Rostami Mohsen , Rafei Ali , Kordi Ramin
Published: June 2016

Background:

Chronic musculoskeletal pain (CMP) is increasing in prevalence rapidly. Over the past 2 decades low back pain has been ranked globally as the primary cause of years lived with disability. The primary objective of this study was to investigate the prevalence of chronic neck pain (CNP), chronic low back pain (CLBP), and chronic knee pain (CKP) and their related risk factors in the national Iranian population.

Methods:

We analyzed data obtained through a cross-sectional, population-based survey of 7889 Iranians who were aged between 30 and 70 years.

Results:

The prevalence of CNP, CLBP, and CKP was 15.34%, 27.18%, and 29.97%, respectively. Female sex, aging, body mass index≥25, Lur or Arab ethnicity, illiteracy, passive smoking, positive osteoporosis history, and low or high physical activity levels were risk factors for CLBP, CNP, and CKP after adjustment for potential confounders. For example, in participants with a body mass index≥30, odds ratios for CNP, CLBP, and CKP adjusted for age, sex, ethnicity, living area, education, employment status, smoking, and physical activity levels were 1.26 (95% confidence interval [CI], 1.04-1.52), 1.37 (95% CI, 1.17-1.59), and 1.64 (95% CI, 1.41-1.91), respectively.

Conclusions:

This is the first study investigating the prevalence of CNP, CLBP, and CKP in the national population of Iran. It shows some modifiable risk factors for CMP, and suggests that affordable planning for these risk factors can be valuable in preventing CMP globally. However, this is a cross-sectional study and future longitudinal studies in this field are necessary.
Descriptive Analysis of Spinal Neuroaxial Injections, Surgical Interventions, and Physical Therapy Utilization for Degenerative Lumbar Spondylolisthesis Within Medicare Beneficiaries from 2000 to 2011
Authors: Sclafani Joseph A. , Constantin Alexandra , Ho Pei-Shu , Akuthota Venu , Chan Leighton
Published: June 2016

Study Design.

A retrospective, observational study.

Objective.

The aim of this study was to determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries.

Summary of Background Data.

Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of treatment algorithms including physical therapy and interventional techniques can be used to manage clinically significant degenerative spondylolisthesis.

Methods.

This study utilized the 5% national sample of Medicare carrier claims from 2000 through 2011. A cohort of beneficiaries with a new International Classification of Diseases 9th edition (ICD-9) diagnosis code for degenerative lumbar spondylolisthesis was identified. Current procedural terminology codes were used to identify the number of procedures performed each year by specialty on this cohort.

Results.

A total of 95,647 individuals were included in the analysis. Average age at the time of initial diagnosis was 72.8 ± 9.8 years. Within this study cohort, spondylolisthesis was more prevalent in females (69%) than males and in Caucasians (88%) than other racial demographics. Over 50% of beneficiaries underwent at least one injection, approximately one-third (37%) participated in physical therapy, one in five (21%) underwent spinal surgery, and one-third (36%) did not utilize any of these interventions. Greater than half of all procedures (124,280/216,088) occurred within 2 years of diagnosis. The ratio of focal interventions (transforaminal and facet interventions) to less selective (interlaminar) procedures was greater for the specialty of Physical Medicine and Rehabilitation than for the specialties of Anesthesiology, Interventional Radiology, Neurosurgery, and Orthopedic Surgery. The majority of physical therapy was dedicated to passive treatment modalities and range of motion exercises rather than active strengthening modalities within this cohort.

Conclusion.

Interventional techniques and physical therapy are frequently used treatment modalities for symptomatic degenerative spondylolisthesis. Understanding utilization of these techniques is important to determine relative clinical efficacies and to optimize future health care expenditures.

Level of Evidence: N/A
CRRT Regional Anticoagulation Using Citrate in the Liver Failure and Liver Transplant Population
Authors: Wonnacott Rob , Josephs Brandi , Jamieson Jill
Published: June 2016

Regional citrate for continuous renal replacement therapy (CRRT) use in patients with liver failure or post–liver transplant has been considered a contraindication because of the risk of citrate toxicity development. Regional citrate has the benefit of decreased bleeding risks over systemic anticoagulation; therefore, it is of great benefit to the coagulopathic and surgical populations. This article analyzes current empiric data and compares with a case study specifically related to liver failure, liver transplant, and CRRT use. We found that the use of a total serum to ionized calcium ratio was much more reliable in measuring liver function than liver enzyme figures. This when paired with a citrate-reduction guideline based on serum to ionized calcium ratios provided effective, early management of citrate toxicity. Using new measurements to calculate liver metabolism of citrate and using a new citrate-reducing guideline allow the bedside practitioner to use regional citrate anticoagulation in patients with liver failure and liver transplant who require CRRT.
Pharmacologic Strategies to Prevent Blood Loss and Transfusion in Orthotopic Liver Transplantation
Authors: Tischer Sarah , Miller James T.
Published: June 2016

Patients undergoing orthotopic liver transplantation are at risk of both life-threatening blood loss and thrombosis due to preexisting liver dysfunction and major intra- and postoperative coagulopathy. Traditional laboratory markers of hemostasis and coagulopathy are often inadequate to describe the alterations. Whole blood global viscoelastic tests, thromboelastography, and thromboelastometry may provide more complete pictures of the hematologic derangements and allow for more targeted therapy to prevent blood loss and massive transfusion. Antifibrinolytic medications such as aprotinin, tranexamic acid, and ɛ-aminocaproic acid have been used successfully to reduce blood loss and the need for transfusion, although most published data are from small prospective trials or larger retrospective cohorts. Recombinant factor VIIa has not been shown to improve outcomes. Although transfusion needs have been associated with adverse outcomes, no studied medications for prevention of blood loss and transfusion have been associated with improved mortality or graft survival post-liver transplant.
What Is Being Done to Increase Organ Donation?
Authors: Scheuher Cynthia
Published: June 2016

The need for organs greatly outnumbers the amount of organs donated for transplantation. This is true for all countries around the world. Many organizations globally have been created to solve this problem. Spain has been very successful with its drive to increase organ donation. Educational campaigns are a great tool being utilized by all countries and the medical communities to promote a positive perception of organ donation. These campaigns include using the television industry, raising money for travel expenses, and education seminars. This article looks at the different groups and programs aimed at increasing organ donation.
EN FACE IMAGING OF RETINAL ARTERY MACROANEURYSMS USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY
Authors: Hanhart Joel , Strassman Israel , Rozenman Yaakov
Published: June 2016

Purpose:

To describe the advantages of en face view with swept-source optical coherence tomography in assessing the morphologic features of retinal arterial macroaneurysms, their consequences on adjacent retina, planning laser treatment, and evaluating its effects.

Methods:

Three eyes were treated for retinal arterial macroaneurysms and followed by swept-source optical coherence tomography in 2014-2015. En face images of the retina and choroid were obtained by EnView, a swept-source optical coherence tomography program.

Results:

Retinal arterial macroaneurysms have a typical optical coherence tomography appearance. En face view allows delineation of the macroaneurysm wall, thrombotic components within the dilation, and lumen measurement. Hemorrhage, lipids, and fluids can be precisely described in terms of amount and extent over the macula and depth. This technique is also practical for planning focal laser treatment and determining its effects.

Conclusion:

En face swept-source optical coherence tomography is a rapid, noninvasive, high-resolution, promising technology, which allows excellent visualization of retinal arterial macroaneurysms and their consequences on surrounding tissues. It could make angiography with intravenous injection redundant in planning and assessing therapy.
TATTOO-ASSOCIATED UVEITIS WITH CHOROIDAL GRANULOMA: A RARE PRESENTATION OF SYSTEMIC SARCOIDOSIS
Authors: Pandya Vivek B. , Hooper Claire Y. , Merani Rohan , McCluskey Peter
Published: June 2016

Purpose:

The authors report a rare case of systemic sarcoidosis manifesting as bilateral granulomatous panuveitis and multiple tattoo granulomas.

Methods:

Case report.

Results:

A 30-year-old man presented with headaches, ocular pain, photophobia, and blurred vision. He was found to have significant skin inflammation, predominantly involving areas of tattoos. Fundoscopic examination revealed bilateral granulomatous panuveitis with small focal choroidal lesions. Skin biopsy demonstrated granulomatous inflammation of the dermis with tattoo pigment evident in numerous histiocytes. He was diagnosed with systemic sarcoidosis.

Conclusion:

The authors report another rare case of tattoo-associated uveitis, in which inflammation is limited to tattooed skin and the uvea. This uncommon presentation may prove informative in elucidating the pathogenesis of systemic sarcoidosis.
Spontaneous Resolution of Presumed Idiopathic Elevated Episcleral Venous Pressure
Authors: Breazzano Mark P. , Mawn Louise A. , Kuchtey Rachel W.
Published: June 2016

Purpose:

To report a case of presumed idiopathic elevated episcleral venous pressure (EVP) initially requiring medical management.

Methods:

We present a case report of a 28-year-old white man presenting with eye redness and soreness as a referral to the glaucoma service. He was diagnosed with idiopathic elevated EVP after systematic workup.

Results:

Unilateral elevated intraocular pressure was detected along with dilated episcleral vessels, mild cupping of optic nerve head, and blood in Schlemm’s canal, yet negative angiographic imaging and hypercoagulable labs. Topical antiglaucoma medication normalized intraocular pressure, which then maintained with resolution of episcleral vessel caliper and blood in Schlemm’s canal after discontinuation of medication.

Conclusions:

This is the first reported case of spontaneous resolution of presumed idiopathic elevated EVP, persisting after discontinuation of medical therapy and without surgical intervention.
Consistency of Bruch Membrane Opening Detection as Determined by Optical Coherence Tomography
Authors: Hwang Young Hoon , Kim Min K. , Ahn Sang I.
Published: June 2016

Purpose:

To investigate the consistency of Bruch membrane opening (BMO) detection as determined by Cirrus high-definition optical coherence tomography (OCT).

Materials and Methods:

This study enrolled 106 healthy eyes and 194 glaucomatous eyes who underwent OCT examinations. The location of BMO was evaluated by inspecting 72 cross-sectional optic nerve head (ONH) images (5 degrees intervals for 360 degrees) per eye in which BMO location is automatically detected by the OCT algorithm. The consistency of BMO detection was investigated by comparing consecutive cross-sectional ONH images. If the location of the BMO margin did not agree between images, it was considered as inconsistent BMO detection.

Results:

Among 300 eyes, 21 (7.0%) showed inconsistent BMO detection. Inconsistency in BMO detection was associated with a higher degree of myopia (P<0.001). All inconsistent BMO detection was found in areas with β-zone peripapillary atrophy. Eyes with inconsistent BMO detection showed greater changes in ONH parameters and retinal nerve fiber layer thickness than eyes with consistent BMO detection (P<0.001).

Conclusions:

Although BMO locations were consistent in most cases, in some cases, there were inconsistencies in BMO locations determined by OCT, especially in myopic eyes with peripapillary atrophy. Inconsistency in BMO detection resulted in changes in ONH parameters and retinal nerve fiber layer thickness. These finding should be considered when assessing glaucoma by using OCT.
Long-term Follow-up of a Case of Gold Shunt Surgery for Refractory Silicone Oil–induced Glaucoma
Authors: Le Ryan , Berger Alan R. , Gupta Neeru
Published: June 2016

Purpose:

To report the first case of gold shunt surgery for treatment of silicone oil–induced refractory glaucoma in a tertiary care academic center, with 5-year follow-up.

Design:

The study design is a case report.

Participants:

The participant was a patient who underwent gold shunt surgery.

Methods:

Institutional Research Ethics Board approval for the study was obtained. A diabetic patient was referred for refractory glaucoma with a history of proliferative diabetic retinal detachment, and surgery with silicone oil. She was uncontrolled on maximal medical therapy and following informed consent, gold shunt surgery was performed. Ocular outcomes and number of medications were reviewed over a 5-year period.

Results:

Following uncomplicated surgery, intraocular pressure was reduced from 41 to 14 mm Hg, and the number of medications was reduced from 4 to 1. Glaucomatous optic neuropathy remained stable.

Conclusions:

Gold shunt surgery in this challenging case of silicone oil refractory glaucoma provided long-term intraocular pressure control and reduced need for medication over a 5-year period.
Hyperostosis Following Orbital Exenteration
Authors: Elkhamary Sahar M. , Galindo-Ferreiro Alicia , Akaishi Patricia , Muiños-Diaz Yerena , Cechetti Sheila P. , Cintra Murilo B. , Cruz Antonio Augusto V.
Published: June 2016

Purpose:

To describe CT scan findings following orbital exenteration in 27 patients and to identify the factors involved in the development of post exenteration hyperostosis.

Methods:

Noncomparative case series. The authors reviewed the charts of 27 patients ranging in age from 33 to 99 years, who underwent unilateral exenteration at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia and at the School of Medicine of Ribeirão Preto, University of São Paulo, Brazil. Data regarding patient demographics, surgical procedure, clinical diagnosis, and preoperative and postoperative CT imaging of the orbits were obtained. The relationship between hyperostosis and postoperative time, gender, age, adjuvant radiotherapy, and cavity coverage was evaluated by multivariate stepwise logistic regression.

Results:

Seventeen (73.9 %) orbits had postoperative orbital hyperostosis. No soft tissue masses were detected in the affected orbits except in 2 cases with tumor recurrence. The only factor associated with hyperostosis was immediate intraoperative socket rehabilitation (odds ratio = 0.13, 95% confidence interval: 0.01–0.89). There was an 87.0% lower chance of hyperostosis in patients whose socket was covered with musculocutaneous flaps. Sequential CT scans showed that orbital hyperostosis followed a specific pattern. Initially, bone thickening appeared as either uniform or undulating endo-osteal minimal thickening along the roof and then on the lateral and medial walls. More advanced hyperostosis had a laminated/lamellated appearance progressing to homogeneous and diffuse circumferential bone thickening. New bone formation and bone overgrowth were late findings. Hyperostosis extended to involve the adjacent facial bone, more obviously on the maxilla. Some patients had minimal thickening of the adjacent frontal and squamous temporal bone. Over-pneumatization of the paranasal sinuses was evident in all cases of hyperostosis.

Conclusions:

Development of hyperostosis following exenteration is not rare. Radiologists and surgeons should be aware of the need to monitor the orbital healing process closely to avoid misdiagnoses of tumor recurrence/radionecrosis or infection. Obliteration of the orbital cavity with musculocutaneous flaps significantly reduces the chances of bone hyperostosis.
Early Childhood Inclusion in the United Kingdom
Authors: Blackburn Carolyn
Published: June 2016

A policy-to-practice paper is presented of early childhood inclusion in England. The article aims to report the benefits of early intervention services and early childhood inclusion for children with special educational needs and disabilities (SEND), document the chronology of policy development, and discuss research evidence about policy-to-practice considerations for early childhood inclusion. Policy development for children with SEND in England has been informed by international human rights and European inclusion agendas and has been significantly revised and reformed recently with a new Children and Families Act (2014), which places families at the center of individual education, health, and care plans for children SEND. The article discusses the practicalities of delivering policy initiatives for children with SEND in a diverse and fragmented early childhood market and suggests possible future directions for policy and practice.
The effect of pain on task switching: pain reduces accuracy and increases reaction times across multiple switching paradigms
Authors: Attridge Nina , Keogh Edmund , Eccleston Christopher
Published: June 2016

Pain disrupts attention, which may have negative consequences for daily life for people with acute or chronic pain. It has been suggested that switching between tasks may leave us particularly susceptible to pain-related attentional disruption, because we need to disengage our attention from one task before shifting it onto another. Switching tasks typically elicit lower accuracies and/or longer reaction times when participants switch to a new task compared with repeating the same task, and pain may exacerbate this effect. We present 3 studies to test this hypothesis. In study 1, participants completed 2 versions of an alternating runs switching task under pain-free and thermal pain–induction conditions. Pain did not affect performance on either task. In studies 2 and 3, we examined 7 versions of the switching task using large general population samples, experiencing a variety of naturally occurring pain conditions, recruited and tested on the internet. On all tasks, participants with pain had longer reaction times on both switch and repeat trials compared with participants without pain, but pain did not increase switch costs. In studies 2 and 3, we also investigated the effects of type of pain, duration of pain, and analgesics on task performance. We conclude that pain has a small dampening effect on performance overall on switching tasks. This suggests that pain interrupts attention even when participants are engaged in a trial, not only when attention has been disengaged for shifting to a new task set.
Sustained relief of ongoing experimental neuropathic pain by a CRMP2 peptide aptamer with low abuse potential
Authors: Xie Jennifer Y. , Chew Lindsey A. , Yang Xiaofang , Wang Yuying , Qu Chaoling , Wang Yue , Federici Lauren M. , Fitz Stephanie D. , Ripsch Matthew S. , Due Michael R. , Moutal Aubin , Khanna May , White Fletcher A. , Vanderah Todd W. , Johnson Philip L. , Porreca Frank , Khanna Rajesh
Published: June 2016

Uncoupling the protein–protein interaction between collapsin response mediator protein 2 (CRMP2) and N-type voltage-gated calcium channel (CaV2.2) with an allosteric CRMP2-derived peptide (CBD3) is antinociceptive in rodent models of inflammatory and neuropathic pain. We investigated the efficacy, duration of action, abuse potential, and neurobehavioral toxicity of an improved mutant CRMP2 peptide. A homopolyarginine (R9)-conjugated CBD3-A6K (R9-CBD3-A6K) peptide inhibited the CaV2.2–CRMP2 interaction in a concentration-dependent fashion and diminished surface expression of CaV2.2 and depolarization-evoked Ca2+influx in rat dorsal root ganglia neurons. In vitro studies demonstrated suppression of excitability of small-to-medium diameter dorsal root ganglion and inhibition of subtypes of voltage-gated Ca2+channels. Sprague-Dawley rats with tibial nerve injury had profound and long-lasting tactile allodynia and ongoing pain. Immediate administration of R9-CBD3-A6K produced enhanced dopamine release from the nucleus accumbens shell selectively in injured animals, consistent with relief of ongoing pain. R9-CBD3-A6K, when administered repeatedly into the central nervous system ventricles of naive rats, did not result in a positive conditioned place preference demonstrating a lack of abusive liability. Continuous subcutaneous infusion of R9-CBD3-A6K over a 24- to 72-hour period reversed tactile allodynia and ongoing pain, demonstrating a lack of tolerance over this time course. Importantly, continuous infusion of R9-CBD3-A6K did not affect motor activity, anxiety, depression, or memory and learning. Collectively, these results validate the potential therapeutic significance of targeting the CaV-CRMP2 axis for treatment of neuropathic pain.
A novel intrinsic analgesic mechanism: the enhancement of the conduction failure along polymodal nociceptive C-fibers
Authors: Wang Xiuchao , Wang Shan , Wang Wenting , Duan Jianhong , Zhang Ming , Lv Xiaohua , Niu Chunxiao , Tan Chao , Wu Yuanbin , Yang Jing , Hu Sanjue , Xing Junling
Published: June 2016

Although conduction failure has been observed in nociceptive C-fibers, little is known regarding its significance or therapeutic potential. In a previous study, we demonstrated that C-fiber conduction failure, which is regarded as an intrinsic self-inhibition mechanism, was reduced in circumstances of painful diabetic neuropathy. In this study, we extend this finding in the complete Freund's adjuvant model of inflammatory pain and validate that the degree of conduction failure decreased and led to a greater amount of pain signals conveyed to the central nervous system. In complete Freund's adjuvant–injected animals, conduction failure occurred in a C-fiber-selective, activity-dependent manner and was associated with an increase in the rising slope of the C-fiber after-hyperpolarization potential. To target conduction failure in a therapeutic modality, we used ZD7288, an antagonist of hyperpolarization-activated, cyclic nucleotide–modulated channels which are activated by hyperpolarization and play a pivotal role in both inflammatory and neuropathic pain. ZD7288 promoted conduction failure by suppressing I
h as a mechanism to reduce the rising slope of the after-hyperpolarization potential. Moreover, perineuronal injection of ZD7288 inhibited abnormal mechanical allodynia and thermal hyperalgesia without affecting motor function or heart rate. Our data highlight the analgesic potential of local ZD7288 application and identify conduction failure as a novel target for analgesic therapeutic development.
Optimization of Centrifugal Pump Characteristic Dimensions for Mechanical Circulatory Support Devices
Authors: Korakianitis Theodosios , Rezaienia Mohammad A. , Paul Gordon M. , Rahideh Akbar , Rothman Martin T. , Mozafari Sahand
Published: June 2016

The application of artificial mechanical pumps as heart assist devices impose power and size limitations on the pumping mechanism, and therefore requires careful optimization of pump characteristics. Typically new pumps are designed by relying on the performance of other previously designed pumps of known performance using concepts of fluid dynamic similarity. Such data are readily available for industrial pumps, which operate in Reynolds numbers region of 108. Heart assist pumps operate in Reynolds numbers of 105. There are few data available for the design of centrifugal pumps in this characteristic range. This article develops specific speed versus specific diameter graphs suitable for the design and optimization of these smaller centrifugal pumps concentrating in dimensions suitable for ventricular assist devices (VADs) and mechanical circulatory support (MCS) devices. A combination of experimental and numerical techniques was used to measure and analyze the performance of 100 optimized pumps designed for this application. The data are presented in the traditional Cordier diagram of nondimensional specific speed versus specific diameter. Using these data, nine efficient designs were selected to be manufactured and tested in different operating conditions of flow, pressure, and rotational speed. The nondimensional results presented in this article enable preliminary design of centrifugal pumps for VADs and MCS devices.
Electron Microscopy as a Tool for Assessment of Anticoagulation Strategies During Extracorporeal Life Support: The Proof Is on the Membrane
Authors: Beely Brendan M. , Campbell James E. , Meyer Andrew , Langer Thomas , Negaard Kathryn , Chung Kevin K. , Cap Andrew P. , Cancio Leopoldo C. , Batchinsky Andriy I.
Published: June 2016

Extracorporeal life support (ECLS) is fast becoming more common place for use in adult patients failing mechanical ventilation. Management of coagulation and thrombosis has long been a major complication in the use of ECLS therapies. Scanning electron microscopy (SEM) of membrane oxygenators (MOs) after use in ECLS circuits can offer novel insight into any thrombotic material deposition on the MO. In this pilot study, we analyzed five explanted MOs immediately after use in a sheep model of different acute respiratory distress syndrome (ARDS). We describe our methods of MO dissection, sample preparation, image capture, and results. Of the five MOs analyzed, those that received continuous heparin infusion showed very little thrombosis formation or other clot material, whereas those that were used with only initial heparin bolus showed readily apparent thrombotic material.