bluuebunny/crossref_metadata_2025 huggingface dataset:
6 Months of “Temporary” Support by Levitronix Left Ventricular Assist Device
Authors: Barbone Alessandro , Malvindi Pietro Giorgio , Sorabella Robert A. , Cortis Graziano , Tosi Paolo F. , Basciu Alessio , Ferrara Pietro , Raffa Giuseppe , Citterio Enrico , Settepani Fabrizio , Ornaghi Diego , Tarelli Giuseppe , Vitali Ettore
Published: March 2012

An otherwise healthy 47‐year‐old man presented to the emergency department in cardiogenic shock after suffering a massive myocardial infarction due to left main occlusion. He was initially supported by extracorporeal membrane oxygenation and subsequently was converted to paracorporeal support with a Levitronix left ventricular assist device. He experienced multiple postoperative complications including renal failure, respiratory failure, retroperitoneal hematoma requiring suspension of anticoagulation, and fungal bloodstream infection precluding transition to an implantable device. He was reconditioned and successfully underwent orthotopic heart transplant 183 days after presentation. A discussion of the relevant issues is included.
Secondarily generalized seizures in temporal lobe epilepsy
Authors: Bone Beata , Fogarasi András , Schulz Reinhard , Gyimesi Csilla , Kalmar Zsuzsanna , Kovacs Norbert , Ebner Alois , Janszky Jozsef
Published: March 2012

Purpose:  Secondarily generalized tonic–clonic seizure (SGTCS) may occur rarely in temporal lobe epilepsy (TLE), but SGTCS is the major risk factor for sudden death and for seizure‐related fatal injuries. Our aim was to investigate clinical factors associated with the occurrence of SGTCS in TLE by addressing two questions: (1) What clinical features differentiate patients with TLE who regularly had SGTCS from those who did not? (2) Is there an association of secondarily generalized seizures with preceding seizure elements and clinical data?

Methods:  We included 171 patients with TLE (mean age 34.4 ± 10) who participated in our presurgical evaluation program, which included continuous video–electroencephalography (EEG) and magnetic resonance imaging (MRI). Patients had a temporal lobectomy as a result of mesial or neocortical TLE. To reevaluate the archived seizures, we selected the consecutively recorded seizures of each patient. If the patient had more than three recorded seizures, then we reevaluated only the first three. Altogether video‐recorded seizures of 402 patients were reanalyzed.

Key Findings:  A positive association between the presence of hippocampal sclerosis on the MRI and SGTCS in the patient history was found, whereas ictal speech and pedal automatism showed a negative association with a SGTCS history. The age of patients showed a positive association, whereas patient’s reactivity before and during the seizure, oral/pedal automatisms, and vocalizations showed a negative association with secondary generalization of a focal‐onset seizure during video‐EEG monitoring.

Significance:  Clinical features associated with SGTCS may help clinicians during presurgical monitoring identify high‐risk patients for SGTCS. Our study may help in understanding the pathophysiology of secondary generalization.
The antidepressants citalopram and reboxetine reduce seizure frequency in rats with chronic epilepsy
Authors: Vermoesen Katia , Massie Ann , Smolders Ilse , Clinckers Ralph
Published: March 2012

Purpose:  For a long time, antidepressants have been thought to possess proconvulsant properties. This assumption, however, remains controversial, since anticonvulsant effects have been attributed to certain antidepressants. To date, it remains unclear which antidepressants can be used for the treatment of depression in patients with epilepsy. In this respect, studies investigating the convulsant liability of antidepressants in a chronic epilepsy model can give valuable information. The present study was designed to determine the seizure liability of citalopram and reboxetine in the kainic acid–induced post–status epilepticus model for temporal lobe epilepsy.

Methods:  Two months after the induction of status epilepticus, chronic epileptic rats (n = 16) were video‐electroencephalography (EEG) monitored during seven consecutive weeks. Weeks 1, 3, 5, and 7 served as sham weeks during which the rats received intraperitoneal saline injections for four consecutive days, followed by a 3‐day sham washout period during which no injections were given. During weeks 2, 4, and 6, rats received intraperitoneal injections with either citalopram (5, 10, and 15 mg/kg, once daily, n = 8) or reboxetine (10, 20, and 30 mg/kg, twice daily, n = 8) for 4 days, again followed by a washout period of 3 days. Drugs were administered in a randomly assigned fixed‐dose regimen per week. Each rat served as its own control. The drug doses were selected based on the doses reported to have antidepressant effects in rats.

Key Findings:  Citalopram significantly decreased the spontaneous seizure frequency at the highest dose tested, that is, the mean number of seizures decreased from 12.8 seizures to 8.8 seizures per week (31%) after treatment with 15 mg/kg citalopram. This dose also significantly decreased the cumulative seizure duration. Administration of 5 and 10 mg/kg citalopram did not alter the seizure frequency. The two highest doses of reboxetine significantly decreased the spontaneous seizure frequency, that is, 20 mg/kg reboxetine decreased the seizure frequency from 14.1 to 7.9 (44%) and 30 mg/kg reboxetine decreased the seizure frequency from 11.8 to 7.2 (39%). In addition, both doses significantly decreased the cumulative seizure duration. Administration of 10 mg/kg reboxetine did not alter seizure frequency. Citalopram and reboxetine had no effect on seizure severity and seizure duration in any of the doses tested.

Significance:  In general we can conclude that antidepressant doses of citalopram and reboxetine have, depending on the dose, an anticonvulsant effect or no effect on spontaneous seizures in the kainic acid–induced post–status epilepticus rat model.
Endogenous ACh effects on NMDA‐induced interictal‐like discharges along the septotemporal hippocampal axis of adult rats and their modulation by an early life generalized seizure
Authors: Mikroulis Apostolos V. , Psarropoulou Caterina
Published: March 2012

Purpose:  Our earlier findings of the modulation of cholinergic neurotransmission by an early life generalized seizure and the reported interaction between muscarinic and N‐methyl‐d‐aspartate (NMDA) receptors prompted us to investigate the effects of endogenous acetylcholine (ACh) on the frequency (Hz) of the epileptiform discharges following NMDA‐receptor activation in the hippocampal slice.

Methods:  A sustained (>20 min) generalized convulsion was induced in Sprague‐Dawley juvenile rats by intraperitoneal injection with pentylenetetrazole (PTZ, 70–90 mg/kg) at postnatal day (P) 20. Temporal and septal hippocampal slices were prepared of normal (N) and PTZ‐treated (PTZ) adult (≥P60) rats, and CA3 field potentials were recorded during perfusion with Mg2+‐free artificial cerebrospinal fluid (ACSF) or with ACSF containing 50 μm 4‐aminopyridine (4‐AP).

Key Findings:  In Mg2+‐free ACSF, spontaneous interictal‐like epileptiform discharges (IEDs) were recorded in all slices, with significantly higher frequencies in temporal (0.46 ± 0.03 Hz, n = 85) versus septal slices (0.20 ± 0.02 Hz, n = 47, p < 0.000001) but no consistent differences in any other group (i.e., male vs. female or N vs. PTZ). The anticholinesterase eserine (10 μm) increased their frequencies by 150–200% in N‐septal and in all temporal slices and by 300% in PTZ‐septal slices (p = 0.0028). In 60% of the slices the excitatory effect persisted throughout drug perfusion, whereas in the remaining ones it was distinguished in two phases: an early “transient” and a late “steady state.” The steady‐state frequencies resembled the predrug ones in N slices but remained significantly elevated in PTZ slices, especially in the septal group. The muscarinic antagonist atropine (1 μm) decreased IED frequency in all slices (n = 36, p = 0.005) and also fully reversed the eserine effect (n = 38, p < 0.0001). In 4‐AP ACSF, eserine increased spontaneous IED frequency (n = 21) in N and PTZ slices alike; IEDs were subsequently abolished by addition of the NMDA‐receptor antagonist D(−)‐2‐amino‐5‐phosphonopentanoic acid (AP5; 50 μm, n = 6).

Significance:  These results demonstrate an intrinsic tonic positive muscarinic acetylcholine receptor (mAChR) contribution to the frequency of NMDA receptor–dependent epileptiform discharges that is amplified following an elevation of endogenous ACh and is more pronounced in the septal hippocampus. Moreover, this positive mAChR contribution to the frequency of IEDs is even more pronounced and persistent in the septal extremity after an early life generalized sustained convulsion. This cholinergic enhancement of the excitatory septal hippocampal output may influence cognitive function and performance, and possibly the adult seizure threshold.
Depressive Symptoms and Subjective and Objective Sleep in Community‐Dwelling Older Women
Authors: Maglione Jeanne E. , Ancoli‐Israel Sonia , Peters Katherine W. , Paudel Misti L. , Yaffe Kristine , Ensrud Kristine E. , Stone Katie L.
Published: March 2012

Objectives

To examine the relationship between depressive symptoms and subjective and objective sleep in older women.

Design

Cross‐sectional.

Setting

Four U.S. clinical centers.

Participants

Three thousand forty‐five community‐dwelling women aged 70 and older.

Measurements

Depressive symptoms were assessed using the Geriatric Depression Scale, categorizing participants as normal (0–2, reference), some depressive symptoms (3–5), or depressed (≥6). Subjective sleep quality and daytime sleepiness were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Objective sleep measures were assessed using wrist actigraphy.

Results

In multivariable‐adjusted models, there were graded associations between greater level of depressive symptoms and worse subjective sleep quality and more subjective daytime sleepiness (P‐trends < .001). Women with some depressive symptoms (odds ratio (OR) = 1.82, 95% confidence interval (CI) = 1.48–2.24) and depressed (OR = 2.84, 95% CI = 2.08–3.86) women had greater odds of reporting poor sleep (PSQI>5). Women with some depressive symptoms (OR = 1.97, 95% CI = 1.47–2.64) and depressed women (OR = 1.70, 95% CI = 1.12–2.58) had greater odds of reporting excessive daytime sleepiness (ESS>10). There were also graded associations between greater level of depressive symptoms and objectively measured wake after sleep onset (WASO) (P‐trend = .03) and wake episodes longer than 5 minutes (P‐trend = .006). Depressed women had modestly higher odds of WASO of 1 hour or longer (OR = 1.37, 95% CI = 1.03–1.83). Women with some depressive symptoms (OR = 1.49, 95% CI = 1.19–1.86) and depressed women (OR = 2.04, 95% CI = 1.52–2.74) had greater odds of being in the highest quartile for number of nap episodes longer than 5 minutes. No associations between depressive symptom level and prolonged sleep latency, poor sleep efficiency, or short or long total sleep time were found.

Conclusion

Greater depressive symptom levels were associated with more subjective sleep disturbance and objective evidence of sleep fragmentation and napping.
Functional Status After Colon Cancer Surgery in Elderly Nursing Home Residents
Authors: Finlayson Emily , Zhao Shoujun , Boscardin W. John , Fries Brant E. , Landefeld C. Seth , Dudley R. Adams
Published: March 2012

Objectives

To determine functional status and mortality rates after colon cancer surgery in older nursing home residents.

Design

Retrospective cohort study.

Setting

Nursing homes in the United States.

Participants

Six thousand eight hundred twenty‐two nursing home residents aged 65 and older who underwent surgery for colon cancer in the United States between 1999 and 2005.

Measurements

Changes in functional status were assessed before and after surgery using the Minimum Data Set Activity of Daily Living (MDS‐ADL) summary scale, a 28‐point scale in which score increases as functional dependence increases. Regression techniques were used to identify patient characteristics associated with mortality and functional decline 1 year after surgery.

Results

On average, residents who underwent colectomy had a 3.9‐point worsening in MDS‐ADL score at 1 year. One year after surgery, rates of mortality and sustained functional decline were 53% and 24%, respectively. In multivariate analysis, older age (≥80 vs 65–69, adjusted relative risk (ARR) = 1.53, 95% confidence interval (CI) = 1.15–2.04, P < .001), readmission after surgical hospitalization (ARR = 1.15, 95% CI = 1.03–1.29, P = .02), surgical complications (ARR = 1.11, 95% CI = 1.02–1.21, P = .01), and functional decline before surgery (ARR = 1.21, 95% CI = 1.11–1.32, P < .001) were associated with functional decline at 1 year.

Conclusion

Mortality and sustained functional decline are common after colon cancer surgery in nursing home residents. Initiatives aimed at improving surgical outcomes are needed in this vulnerable population.
Hospital Transfers of Nursing Home Residents with Advanced Dementia
Authors: Givens Jane L. , Selby Kevin , Goldfeld Keith S. , Mitchell Susan L.
Published: March 2012

Objectives

To describe diagnoses and factors associated with hospital transfer in nursing home (NH) residents with advanced dementia.

Design

Prospective cohort study.

Setting

Twenty‐two Boston, Massachusetts‐area NHs.

Participants

Three hundred twenty‐three NH residents with advanced dementia.

Measurements

Data were collected quarterly for up to 18 months. Data regarding transfers were collected with regard to hospitalization or emergency department (ED) visit, diagnosis, and duration of inpatient admission. Information on the occurrence of any acute medical event (pneumonia, febrile episode, or other acute illness) in the prior 90 days was obtained quarterly. Logistic regression conducted at the level of the acute medical event identified characteristics associated with hospital transfer.

Results

The entire cohort experienced 74 hospitalizations and 60 ED visits. Suspected infections were the most common reason for hospitalization (44, 59%), most frequently attributable to a respiratory source (30, 41%). Feeding tube–related complications accounted for 47% of ED visits. In adjusted analysis conducted on acute medical events, younger resident age, event type (pneumonia or other event vs febrile episode), chronic obstructive pulmonary disease, and the lack of a do‐not‐hospitalize (DNH) order (adjusted odds ratio = 5.22, 95% confidence interval = 2.31–11.79) were associated with hospital transfer.

Conclusion

The majority of hospitalizations of NH residents with advanced dementia were due to infections and thus were potentially avoidable, because infections are often treatable in the NH. Feeding tube–related complications accounted for almost half of all ED visits, representing a common but underrecognized burden of this intervention. Advance care planning in the form of a DNH order was the only identified modifiable factor associated with avoiding hospitalization.
Portfolio Allocation as Leadership Strategy: Intraparty Bargaining in Japan
Authors: Ono Yoshikuni
Published: March 2012

How do the dynamics of portfolio allocation work within parties? While much of the existing literature focuses on portfolio allocation among parties in coalition governments, bargaining over cabinet portfolios also takes place within parties because many parties have internal divisions or factions that influence these decisions. By analyzing data on portfolio allocation in the Liberal Democratic Party of Japan from 1960 through 2007, this study demonstrates that, contrary to the proportionality proposition (Gamson's Law), substantial variance exists in allocation outcomes over time because party leaders allocate cabinet portfolios among factions as a means of preventing defections and challenges from their party's members. The resulting portfolio allocation reflects the bargaining dynamics within the party: I find that party leaders surrender more portfolios as they become more vulnerable to challenges posed by internal rivals.
Producing Evidence of a Miracle: Exemplars of Therapy Conversation With a Survivor of Torture
Authors: Charlés Laurie L.
Published: March 2012

本文阐述了对一位在祖籍国遭受迫害而移居美国的受折磨幸存者进行治疗案例的结束阶段会面。本文作者使用自然主义范式下的定性研究方法,通过客户对治疗过程的描述与评价考察这名客户的受折磨康复经历案例。本文突出了最后两次会面的对话摘录。在这两次对话中我们透过奇迹问题探讨了客户的过去与未来。本文提出对与这一特定人群的治疗对话作进一步的模态定性分析。
Culturally Adapting an Evidence‐Based Parenting Intervention for Latino Immigrants: The Need to Integrate Fidelity and Cultural Relevance
Authors: Parra Cardona Jose Ruben , Domenech‐Rodriguez Melanie , Forgatch Marion , Sullivan Cris , Bybee Deborah , Holtrop Kendal , Escobar‐Chew Ana Rocio , Tams Lisa , Dates Brian , Bernal Guillermo
Published: March 2012

拉丁裔构成美国最大的少数族群。然而,文化适应及循证养育干预的宣传在拉丁裔族群中依然不足,尽管有大量研究表明了这些干预的长期正面影响。本文有三重目的:(a)证明将文化适应研究作为在拉丁裔族群中推广有效干预关键措施的重要性;(b)描述针对拉丁裔移民进行的依照父母管理培训(PMT)原则,且目的为从文化上适应循证干预的一个预防研究项目的最初步骤;以及(c)根据本研究的初始可行性和文化接受发现探讨推进文化适应预防实践与研究的种种意义。
Scaffolding a Community of Competent Practitioners: Positioning and Agency in a Training Program for Narrative Counseling
Authors: Gremillion Helen , Cheshire Aileen , Lewis Dorothea
Published: March 2012

本文探讨新西兰一叙事咨询研究生培训项目的学习经历构架。本文作者利用定位理论识别学生在学习与行为能动性中的转变,这些转变有助于建立一个愈来愈有技巧性的、由同龄人一起创造的学习环境。我们描述了课程中按特定顺序出现的一组练习和一个关键任务;我们相信这些练习和任务可让学生踏上具有行为能动性的位置,从而最终促使一个有称职学员医师的社区出现。我们也描述了我们自己在这个项目中作为教师所经历的定位经历。我们建议,任何时候都应把我们自己的定向与学生定向的种种可能紧密联系起来。我们承认教室里的权力关系,并探索了种种将后结构主义咨询实践与这些实践的教学相匹配的方法。
Development and Dissemination of Collaborative Family‐Oriented Services: The Case of Community/Day Residential Care in Israel
Authors: Elizur Yoel
Published: March 2012

家庭导向项目的开创、发展及传播是突显家庭治疗对精神//身体健康和社会服务所作贡献的主线。这些具有挑战性的任务对生态系统型观念、支持性大环境,以及一系列技能都有要求。本文通过考察不同生态层次过程来描述以色列社区及日间住宿照顾的演变:国家社会政策的制定与执行、对两个家庭导向设施的持续跟踪(其中一个发展兴旺,另一个则最终关闭),以及为一个有三个孩子家庭提供的住宿照顾。对此多级数据的分析显示了四个对家庭导向项目有巨大影响的促进/阻碍因素:国家与地方社会政治职业管理的支持、项目管理自主性、工作人员的培训、支持和发展,以及建立并培育家庭导向组织结构与文化的有效设施领导。
Microvascular Flow Modeling using In Vivo Hemodynamic Measurements in Reconstructed 3D Capillary Networks
Authors: FRASER GRAHAM M. , GOLDMAN DANIEL , ELLIS CHRISTOPHER G.
Published: March 2012

Please cite this paper as: Fraser GM, Goldman D, Ellis CG. Microvascular flow modeling using in vivo hemodynamic measurements in reconstructed 3D capillary networks. Microcirculation 19: 510–520, 2012.

Objective:  We describe a systematic approach to modeling blood flow using reconstructed capillary networks and in vivo hemodynamic measurements. Our goal was to produce flow solutions that represent convective O2 delivery in vivo.

Methods:  Two capillary networks, I and II (84 × 168 × 342 and 70 × 157 × 268 μm3), were mapped using custom software. Total network red blood cell supply rate (SR) was calculated from in vivo data and used as a target metric for the flow model. To obtain inlet hematocrits, mass balances were applied recursively from downstream vessels. Pressure differences across the networks were adjusted to achieve target SR. Baseline flow solutions were used as inputs to existing O2 transport models. To test the impact of flow redistribution, asymmetric flow solutions (Asym) were generated by applying a ± 20% pressure change to network outlets.

Results:  Asym solutions produced a mean absolute difference in SR per capillary of 27.6 ± 33.3% in network I and 33.2 ± 40.1% in network II vs. baseline. The O2 transport model calculated mean tissue PO2 of 28.2 ± 4.8 and 28.1 ± 3.5 mmHg for baseline and 27.6 ± 5.2 and 27.7 ± 3.7 mmHg for Asym.

Conclusions:  This outcome illustrates that moderate changes in flow distribution within a capillary network have little impact on tissue PO2 provided that total SR remains unchanged.
It is Not Just Hardware and Software, Anymore! Human Systems Integration in US Submarines
Authors: HAMBURGER PATRICIA , MISKIMENS DAVID , TRUVER SCOTT
Published: March 2012

Until recently, the Navy's approach to designing, engineering, and acquiring complex weapon systems did not routinely or completely include the human “warrior” as an integral part of the system. Rather, the Navy viewed systems as combinations of hardware and software. The results were often less‐than‐optimal capability and high life‐cycle cost—and, sometimes, even mission failure. Given the high rate of technological change and the need to rein in cost in the face of increasingly constrained budgets, the Navy and the other services have increasingly embraced the need to consider human‐performance capabilities and limitations up front and on an equal footing with hardware and software—as integral elements in both new‐acquisition and technology‐refresh programs. The US Submarine Force has championed human systems integration (HSI). HSI is a specialized engineering discipline that takes human limitations and capabilities fully into account to influence system design and engineering early in the research, development, and acquisition process, thereby helping to ensure the highest overall performance at the lowest total ownership cost. Implementation of HSI has involved new partnerships with unlikely partners such as the audio equipment company Bose, game‐makers, the visual‐reality industry, physiologists, and psychologists. Nowhere has this been more apparent than in the Virginia (SSN‐774)‐Class Nuclear Attack Submarine Program.
The correlations between alteration of p16 gene and clinicopathological factors and prognosis in squamous cell carcinomas of the buccal mucosa
Authors: Dong Yuying , Wang Jie , Dong Fusheng , Wang Xu , Zhang Yinghuai
Published: March 2012

J Oral Pathol Med (2012) 41: 463–469

Objective:  To evaluate relationships between the alteration of p16 gene and the clinical status and prognosis of the patients with squamous cell carcinoma of the buccal mucosa.

Methods:  Thirty buccal cancers were included in the analysis. Deletion analysis was performed by PCR. Point mutation analysis was used by PCR‐SSCP and direct sequencing. Methylation‐specific PCR methods were adopted for the evaluation of p16 methylation. The correlation between alteration of p16 gene and clinicopathological factors buccal cancer was evaluated by Fisher’s exact test. Kaplan–Meier and Cox regression were used to investigate the relationship between p16 alteration and survival time.

Results:  The frequency of p16 alteration was 63.3% in buccal carcinomas. P16 deletion was associated significantly with tumor size (P = 0.01). P16 point mutation was associated significantly with differentiation (P = 0.006). P16 methylation was associated significantly with nodes metastasis (P = 0.027). The overall survival rate of 30 buccal carcinomas was 53.3%. The Log‐rank test (P = 0.021) and univariate Cox regression analysis (P = 0.030) revealed that p16 methylation was significantly associated with the overall survival rate. Multivariate analysis showed that p16 deletion, p16 mutation, and p16 methylation were not statistically significant.

Conclusions:  The alterations of p16 gene may play a major role in malignancy and development and metastases of buccal carcinoma and may be an excellent marker of aggressive clinical behavior. P16 methylation has a prognostic value in buccal carcinoma but not an independent prognosis factor. P16 point mutation and p16 deletion have not prognostic significance in buccal carcinoma.
Plant species richness: the world records
Authors: Wilson J. Bastow , Peet Robert K. , Dengler Jürgen , Pärtel Meelis
Published: March 2012

Questions

The co‐existence of high numbers of species has always fascinated ecologists, but what and where are the communities with the world records for plant species richness? The species–area relationship is among the best‐known patterns in community ecology, but does it give a consistent global pattern for the most saturated communities, the global maxima?

Location

The world.

Methods

We assembled the maximum values recorded for vascular plant species richness for contiguous areas from 1 mm2 up to 1 ha. We applied the power function to relate maximal richness to area and to make extrapolations to the whole Earth.

Results

Only two community types contain global plant species maxima. The maxima at smaller spatial grain were from oligo‐ to meso‐trophic, managed, semi‐natural, temperate grasslands (e.g. 89 species on 1 m2), those at larger grains were from tropical rain forests (e.g. 942 species on 1 ha). The maximum richness values closely followed a power function with z = 0.250: close to Preston's ‘canonical’ value of 0.262. There was no discernable difference between maxima using rooted presence (i.e. including only plants rooted in the plot) vs shoot presence (i.e. including any plant with physical cover over the plot). However, shoot presence values must logically be greater, with the curves flattening out at very small grain, and there is evidence of this from point quadrats. Extrapolating the curve to the terrestrial surface of the Earth gave a prediction of 219 204 vascular plant species, surprisingly close to a recent estimate of 275 000 actual species.

Conclusions

Very high richness at any spatial grain is found only in two particular habitat/community types. Nevertheless, these high richness values form a very strong, consistent pattern, not greatly affected by the method of sampling, and this pattern extrapolates amazingly well. The records challenge ecologists to consider mechanisms of species co‐existence, answers to the ‘Paradox of the Plankton’.
Additive effects of clofibric acid and pyruvate dehydrogenase kinase isoenzyme 4 (PDK4) deficiency on hepatic steatosis in mice fed a high saturated fat diet
Authors: Hwang Byounghoon , Wu Pengfei , Harris Robert A.
Published: March 2012

Although improving glucose metabolism by inhibition of pyruvate dehydrogenase kinase 4 (PDK4) may prove beneficial in the treatment of type 2 diabetes or diet‐induced obesity, it may have detrimental effects by inhibiting fatty acid oxidation. Peroxisome proliferator‐activated receptor α (PPARα) agonists are often used to treat dyslipidemia in patients, especially in type 2 diabetes. Combinational treatment using a PDK4 inhibitor and PPARα agonists may prove beneficial. However, PPARα agonists may be less effective in the presence of a PDK4 inhibitor because PPARα agonists induce PDK4 expression. In the present study, the effects of clofibric acid, a PPARα agonist, on blood and liver lipids were determined in wild‐type and PDK4 knockout mice fed a high‐fat diet. As expected, treatment of wild‐type mice with clofibric acid resulted in less body weight gain, smaller epididymal fat pads, greater insulin sensitivity, and lower levels of serum and liver triacylglycerol. Surprisingly, rather than decreasing the effectiveness of clofibric acid, PDK4 deficiency enhanced the beneficial effects of clofibric acid on hepatic steatosis, reduced blood glucose levels, and did not prevent the positive effects of clofibric acid on serum triacylglycerols and free fatty acids. The metabolic effects of clofibric acid are therefore independent of the induction of PDK4 expression. The additive beneficial effects on hepatic steatosis may be due to induction of increased capacity for fatty acid oxidation and partial uncoupling of oxidative phosphorylation by clofibric acid, and a reduction in the capacity for fatty acid synthesis as a result of PDK4 deficiency.
Characteristics of hospitalised US veterans with nosocomial pressure ulcers
Authors: Goodell Teresa Tarnowski , Moskovitz Zoe
Published: March 2012

The objective of this study was to describe demographic and clinical characteristics of hospitalised US veterans with nosocomial pressure ulcer (NPU) referred to a certified Wound, Ostomy & Continence Nurse (WOCN). We conducted a retrospective review of electronic records at a Veterans Affairs Medical Center in the northwestern USA. Records of veterans with NPU referred to a WOCN (n = 29) from May 2005 to June 2006 were reviewed. Location and stage of pressure ulcer(s), Braden score on admission and when the ulcer was first noted, day of hospital stay when the ulcer was first noted, medical diagnoses and clinical conditions and events such as surgery, hypoxemia, hypoalbuminemia and hypotension were recorded. Mean age of the patients was 69·8. The most common location was the sacrum/coccyx. Most ulcers were stage 1 when identified. Braden score during admission classified half of the sample at risk, but 81% of Braden scores at ulcer occurrence were <18. Ninety percent of the sample had three or more comorbidities. Over half had died in the 1–14 months after the reviewed hospitalisation. Hospitalised veterans referred for WOCN consultation had multiple risk factors and comorbid conditions, including hypoxemia, serum albumin depletion, anaemia and hypotension. Veterans cared for in Veterans Affairs Medical Centers are known to have multiple health problems, and those in this sample not only had nosocomial pressure ulcer, but also other physiological derangements that may shorten survival.
Effect on emergency department efficiency of an accelerated diagnostic pathway for the evaluation of chest pain
Authors: Meek Robert , Braitberg George , Nicolas Caroline , Kwok Gabriel
Published: March 2012

Objective: To compare ED efficiency measures between a trial period using an accelerated diagnostic pathway (ADP) for chest pain evaluation, and a control period using a traditional diagnostic pathway (TDP).

Methods: The TDP used cardiac Troponin I assays at arrival and 6 h. The ADP used point‐of‐care multimarker (myoglobin, creatine kinase‐MB fraction and cardiac Troponin I) assays at arrival and 2 h. Outcomes for consecutive eligible patients included ED length of stay (LOS), discharges and admissions within 4 and 8 h, ED occupancy and cardiac cubicle throughput.

Results: There were 413 and 258 eligible patients during the 81 day TDP and 66 day ADP periods. The ED LOS for chest pain patients was reduced in the ADP period for both discharged patients (median 297 [interquartile range {IQR} 230–437]vs 545 [IQR 457–677] min, P < 0.0001) and admitted patients (median 609.5 [IQR 464–857]vs 733.5 [IQR 532–1070] min, P= 0.007). For the whole ED, the percentage of patients discharged or admitted within 4 or 8 h and ED occupancy were similar between periods. Cardiac cubicle throughput increased during the ADP period (217 [95% confidence interval 209.6–224.4]vs 188 [95% confidence interval 174.5–201.8] patients per week, P= 0.005).

Conclusions: The ADP utilizing point‐of‐care multimarkers led to significantly shorter ED LOS for both discharged and admitted chest pain patients. This was associated with increased cardiac cubicle throughput, but improvements in other whole ED performance indicators were not demonstrated.
Sexual Dysfunctions in Men Affected by Autoimmune Addison's Disease Before and After Short-Term Gluco- and Mineralocorticoid Replacement Therapy
Authors: Granata Antonio , Tirabassi Giacomo , Pugni Valeria , Arnaldi Giorgio , Boscaro Marco , Carani Cesare , Balercia Giancarlo
Published: March 2012

Introduction

There is evidence suggesting that autoimmune Addison's disease (AD) could be associated with sexual dysfunctions probably caused by gluco- and mineralocorticoid deficiency; however, no study has yet treated this subject in males.

Aim

To evaluate male sexuality and psychological correlates in autoimmune AD before and after gluco- and mineralocorticoid replacement therapy.

Methods

Twelve subjects with a first diagnosis of autoimmune AD were studied before (baseline) and 2 months after (recovery phase) initiating hormone replacement therapy.

Main Outcome Measures

Erectile function (EF), orgasmic function (OF), sexual desire (SD), intercourse satisfaction (IS), overall satisfaction (OS), depression, and anxiety were studied using a number of questionnaires (International Index of Erectile Function, Beck Depression Inventory, and Spielberger State-Trait Anxiety Inventory); clinical, biochemical, and hormone data were included in the analysis.

Results

At baseline, low values were found for EF, OF, SD, IS, and OS and high values for depression and anxiety; all of these parameters improved significantly in the recovery phase compared with baseline. EF variation between the two phases correlated significantly and positively with the variation of serum cortisol, urinary free cortisol, systolic blood pressure, and diastolic blood pressure and inversely with that of upright plasma renin activity. Multiple linear regression analysis using EF variation as dependent variable confirmed the relationship of the latter with variation of serum cortisol, urinary free cortisol, and upright plasma renin activity but not with variation of systolic and diastolic blood pressure.

Conclusions

Our study showed that onset of autoimmune AD in males is associated with a number of sexual dysfunctions, all reversible after initiating replacement hormone therapy; cortisol and aldosterone deficiency seems to play an important role in the genesis of erectile dysfunction although the mechanism of their activity is not clear.
Postcoital Vaginal Rupture in a Young Woman with No Prior Pelvic Surgery
Authors: Austin Jennifer M. , Cooksey Christie M. , Minikel Laura L. , Zaritsky Eve F.
Published: March 2012

Introduction

Reports of postcoital vaginal rupture in the literature are limited to cases involving women who are postmenopausal, have recently undergone pelvic surgery, or have suffered genitourinary trauma.

Aim

We report a case of postcoital vaginal rupture in a 23-year-old woman with no prior surgical history who complained of acute onset, severe vaginal pain after consensual intercourse.

Results

Examination under anesthesia revealed a 6-cm laceration of the posterior fornix, which extended into the abdominal cavity. The laceration was repaired using a combined vaginal and laparoscopic approach.

Conclusions

Coitus-induced vaginal rupture in a reproductive aged woman with no prior pelvic surgery or other risk factors is a rare clinical presentation. Prior reports of rupture in premenopausal women have recommended repair via laparotomy. This case documents successful transvaginal and laparoscopic repair, and reviews the etiological mechanisms for coitus-induced injury.
Sexual Abuse History in GI Illness, How Do Gastroenterologists Deal with it?
Authors: Nicolai Melianthe P.J. , Fidder Herma H. , Beck Jack J.H. , Bekker Milou D. , Putter Hein , Pelger Rob C.M. , van Driel Mels F. , Elzevier Henk W.
Published: March 2012

Introduction

Data support an increased prevalence of sexual abuse (SA) among patients with gastrointestinal (GI) complaints. Sexual abuse causes multiple symptoms related to pelvic floor and stress mediated brain-gut dysfunctions. Treating these patients asks for a holistic approach, using centrally targeted interventions. However, gastroenterologists have never been surveyed regarding their practice patterns and constraints about inquiring into SA.

Aim

To evaluate whether gastroenterologists address SA in their daily practice and to evaluate their knowledge regarding the implications of SA in GI illness.

Methods

A 42-item anonymous questionnaire was mailed to all 402 members of the Dutch Society of Gastroenterology (gastroenterologists and fellows in training). The questionnaire addressed SA and pelvic-floor-related complaints.

Main Outcome Measures

The results of this survey.

Results

One hundred eighty-three of the 402 (45.2%) questionnaires were returned. Overall, 4.7% of the respondents asked their female patients regularly about SA; in males, this percentage was 0.6%. Before performing a colonoscopy, these percentages were even smaller (2.4% and 0.6%, respectively). When patients presented with specific complaints, such as chronic abdominal pain or fecal incontinence, 68% of the gastroenterologists asked females about SA and 29% of the males (P < 0.01). The majority of respondents stated it as rather important to receive more training on how to inquire about SA and its implications for treatment.

Conclusion

Gastroenterologists do not routinely inquire about a history of SA and they rarely ask about it before performing colonoscopy. There is a need for training to acquire the skills and knowledge to deal with SA.
Is Oral Sex Really a Dangerous Carcinogen? Let’s Take a Closer Look
Authors: Rosenquist Sara E.
Published: March 2012

Introduction

Questions have recently arisen in the popular press about the association between specific sexual behaviors, namely, fellatio and cunnilingus, with head and neck cancers. Although there has been an overall decline in the incidence of head and neck cancers over the past 25 years, there has been a shift in the distribution of these cancers toward a particular type known as oral squamous cell carcinomas (OSCCs), and a younger demographic. These particular cancers, OSCCs, have been shown to be associated with the human papillomavirus (HPV). Several researchers have suggested that this shift in the epidemiology of head and neck cancers might be attributable to changing sexual practices. While this speculation has caught on in the popular press, there are several interesting contradictions in the existing evidence that suggest this conclusion might be premature and overreached.

Aim

The intent of this article is to help clarify the issues so that sexual medicine professionals can give accurate and up-to-date information to their patients.

Main Outcome Measures

This is a review article; no outcome data are reported. This is a review article; no measures were collected.

Methods

Pubmed search on HPV, oral sex, oral cancers, and OSCCs.

Results

One hundred ninety-six articles on HPV were found; 63 articles on oral sex, 55 on oral cancer, and 5 articles on OSCCs were identified as relevant.

Conclusions

HPV infections occur commonly and are usually cleared within 18 months, thus HPV infection should not be a cause for concern among monogamous couples with a rich and varied sex life as long as the sexual system remains closed and other immune compromising factors are not present. HPV becomes a concern in the context of immune system compromise and infection persistence. Factors contributing to immune system compromise, HPV persistence, and oncogenesis are reviewed.
Discovery of a novel HLA‐B*51 variant, B*51:112, in a Taiwanese bone marrow donor and identification of the plausible HLA haplotype in association with B*51:112
Authors: Yang K. L. , Lee S. K. , Lin P. Y.
Published: March 2012

The sequence of B*51:112 is identical to the sequence of B*51:01:01 in exons 2, 3 and 4, except the nucleotides at positions 206 (C→A) and 213 (C→G). The nucleotide replacement caused one amino acid substitution at residue 45 (T→K). The plausible HLA‐A, ‐B and ‐DRB1 haplotype in association with B*51:112 may be deduced as HLA‐A*02‐B*51:112‐DRB1*12. The generation of B*51:112 was probably as the result of a DNA recombination event where B*40:01:01 acted as a sequence donor donating a segment of the DNA sequence to the recipient sequence B*51:01:01. The donor carrying B*51:112 was a Minna Taiwanese whose ancestor came to Taiwan from the southern region of China.
Towards an effective asteroseismology of solar-like stars: time-dependent convection effects on pulsation frequencies
Authors: Grigahcène A. , Dupret M.-A. , Sousa S. G. , Monteiro M. J. P. F. G. , Garrido R. , Scuflaire R. , Gabriel M.
Published: March 2012

Since the early days of helioseismology, adiabatic models have shown their limits for a precise fitting of individual oscillation frequencies. This discrepancy, which also exists for solar-type stars, is known to originate near the surface superadiabatic convective region where the interaction between oscillations and convection is likely to have a large effect on the frequencies. We present an asteroseismic study to address the adequacy of time-dependent convection (TDC) non-adiabatic models to better reproduce the observed individual frequencies. We select, for this purpose, three solar-like stars, in addition to the Sun, to which we fit the observed frequencies in a grid of TDC non-adiabatic models. The best model selection is done by applying a maximum likelihood method. The results are compared to pure adiabatic and near-surface corrected adiabatic models. We show that, first, TDC models give very good agreement for the mode frequencies and average lifetimes. In the solar case, the frequency discrepancy is reduced to <1.75 µHz over 95 per cent of the modes considered. Secondly, TDC models give an asteroseismic insight into the usually unconstrained ad hoc stellar parameters, such as the mixing-length parameter αMLT.
Fast evolving size of early-type galaxies at z > 2 and the role of dissipationless (dry) merging
Authors: Cimatti A. , Nipoti C. , Cassata P.
Published: March 2012

We present the analysis of a large sample of early-type galaxies (ETGs) at 0 < z < 3 aimed at tracing the cosmic evolution of their size and compare it with a model of pure dissipationless (dry) merging in the Λ cold dark matter (ΛCDM) framework. The effective radius Re depends on stellar mass as with α∼ 0.5 at all redshifts. The redshift evolution of the mass- or SDSS-normalized size can be reproduced as ∝(1 +z)β with β∼−1, with the most massive ETGs possibly showing the fastest evolutionary rate (β∼−1.4). This size evolution slows down significantly to β∼−0.6 if the ETGs at z > 2 are removed from the sample, suggesting an accelerated increase of the typical sizes at z > 2, especially for the ETGs with the largest masses. A pure dry merging ΛCDM model is marginally consistent with the average size evolution at 0 < z < 1.7, but predicts descendants too compact for z > 2 progenitor ETGs. This opens the crucial question on what physical mechanism can explain the accelerated evolution at z > 2, or whether an unclear observational bias is partly responsible for that.
Cross-correlation of WISE galaxies with the cosmic microwave background
Authors: Goto Tomotsugu , Szapudi István , Granett Benjamin R.
Published: March 2012

We estimated the cross-power spectra of a galaxy sample from the Wide-field Infrared Survey Explorer (WISE) survey with the 7-year Wilkinson Microwave Anisotropy Probe (WMAP) temperature anisotropy maps. A conservatively selected galaxy sample covers ∼13 000 deg2 with a median redshift of z= 0.15. Cross-power spectra show correlations between the two data sets with no discernible dependence on the WMAPQ, V and W frequency bands. We interpret these results in terms of the integrated Sachs—Wolfe (ISW) effect: for the |b| > 20° sample at l= 6–87, we measure the amplitude (normalized to be 1 for vanilla Λ cold dark matter expectation) of the signal to be 3.4 ± 1.1, i.e. 3.1σ detection. We discuss other possibilities, but at face value the detection of the linear ISW effect in a flat universe is caused by large-scale decaying potentials, a sign of accelerated expansion driven by dark energy.
The Effectiveness of Secondary Prevention Lifestyle Interventions Designed to Change Lifestyle Behavior following Stroke: Summary of a Systematic Review
Authors: Lawrence Maggie , Kerr Susan , McVey Caroline , Godwin Jon
Published: March 2012

Background

A feature of stroke is that it recurs (25% within five-years). Risk factors for stroke and recurrent stroke include smoking, alcohol consumption, poor diet, and physical inactivity.

Aim

To evaluate the effectiveness of secondary prevention lifestyle interventions designed to change lifestyle behavior following stroke. This short paper presents a summary of the systematic review process and findings.

Methods

Ten major databases were searched using subject headings and key words. Papers were screened using review-specific criteria. Critical appraisal and data extraction were conducted independently by two reviewers. Data were pooled in statistical meta-analysis; where this was not possible findings were presented in narrative form.

Results

Three studies involving 581 participants were reviewed. Two models of intervention delivery were reported: shared care and nurse-led. Interventions were delivered to groups or in one-to-one consultations. Metaanalyses of the pooled lifestyle data favored the interventions (2 P = 0.02). In terms of physiological outcomes, while overall treatment effect was not significant, pooled results did approach statistical significance (2 P = 0.08), however the test of heterogeneity was significant, suggesting differences in the variables that were pooled. Pooled secondary outcomes, including perceived health status and stroke knowledge, favored the interventions (2 P #< 0.00001), however, the test for heterogeneity was highly significant.

Conclusion

Stroke secondary prevention lifestyle interventions are effective in terms of effecting positive change in lifestyle behaviors and secondary outcomes, and appear promising in relation to physiological outcomes. There was insufficient evidence to determine the effect of intervention on incidence of stroke recurrence.
An Outcomes Approach to Stroke Care: The Importance of Teamwork and Evidence-Based Nursing Care
Authors: Middleton Sandy
Published: March 2012

The Quality in Acute Stroke Care (QASC) was a cluster randomised control trial (CRCT) which evaluated the effectiveness of evidence-based clinical treatment protocols for the management of fever, hyperglycaemia and swallowing, in conjunction with multidisciplinary team building workshops, and a standardised interactive staff education program (collectively known as the Fever, Sugar, Swallowing (FeSS) intervention) to improve patient outcomes 90-days. We found that patients cared for in stroke units who received our intervention were 15.7% more likely to be alive and independent 90 days following their stroke. They also had significantly: fewer episodes of fever, lower mean temperatures, lower mean blood glucose levels, and better screening for swallowing difficulties.
Ethnic Entrepreneurship Studies in Geography: A Review1
Authors: Wang Qingfang
Published: March 2012

Although geographers have profound interests in place and spatial dimensions of entrepreneurship, the social‐spatial process of entrepreneurship is studied as fragmented due to the gaps between sub‐disciplines in geography. While the social identities of entrepreneurs are largely missing from most economic geographic entrepreneurship studies, existing urban and ethnic geographic inquiries are dominated by studies of small‐scale, low‐skilled businesses bounded by ethnic neighborhoods. This paper makes a plea to re‐conceptualize entrepreneurship by incorporating race, ethnicity, and gender. It calls for a broader, non‐elite perspective of entrepreneurship with a multiscaled spatial approach. For the ethnic minority labor force in particular, immigration, which has transformed urban labor markets in many advanced economies of the world, needs to be included in the analytical framework. Both economic and non‐economic dimensions should be examined in the interaction between people and place through ethnic entrepreneurship as a continuous process.
Retinal Photodamage Mediated by All‐trans‐retinal†
Authors: Maeda Tadao , Golczak Marcin , Maeda Akiko
Published: March 2012

Accumulation of all‐trans‐retinal (all‐trans‐RAL), reactive vitamin A aldehyde, is one of the key factors in initiating retinal photodamage. This photodamage is characterized by progressive retinal cell death evoked by light exposure in both an acute and chronic fashion. Photoactivated rhodopsin releases all‐trans‐RAL, which is subsequently transported by ATP‐binding cassette transporter 4 and reduced to all‐trans‐retinol by all‐trans‐retinol dehydrogenases located in photoreceptor cells. Any interruptions in the clearing of all‐trans‐RAL in the photoreceptors can cause an accumulation of this reactive aldehyde and its toxic condensation products. This accumulation may result in the manifestation of retinal dystrophy including human retinal degenerative diseases such as Stargardt’s disease and age‐related macular degeneration. Herein, we discuss the mechanisms of all‐trans‐RAL clearance in photoreceptor cells by sequential enzymatic reactions, the visual (retinoid) cycle, and potential molecular pathways of retinal photodamage. We also review recent imaging technologies to monitor retinal health status as well as novel therapeutic strategies preventing all‐trans‐RAL‐associated retinal photodamage.