bluuebunny/crossref_metadata_2025 huggingface dataset:
When one becomes more: minimum renal artery length in laparoscopic live donor nephrectomy
Authors: Iype S. , David S. , Hilliard S. , Shaw A. , Jamieson N. V. , Praseedom R. K. , Butler A. J. , Huguet E. L. , Parker R. A. , Bradley J. A. , Watson C. J. E.
Published: May 2015

Background

Laparoscopic donor nephrectomy may convert short main arteries into multiple arteries, increasing the technical challenge of implantation. We evaluated our experience to identify factors predictive of multiple arteries after laparoscopic nephrectomy.

Methods

All laparoscopic nephrectomies from the start of our program in November 2002 until June 2013 were studied, and preoperative imaging reviewed for donor artery length and multiplicity together with operative findings.

Results

A total of 287 consecutive laparoscopic live donor nephrectomies (64 right and 223 left nephrectomies) were studied. Renal artery length was measured from preoperative donor magnetic resonance or computed tomography angiogram and nephrectomy performed using a laparoscopic stapling device. Nine left kidneys with a single artery (6, 7, 9, 10, 11, 12, 13, 14, and 16 mm in length) and five right kidneys with a single artery (5, 13, 15, 20, and 26 mm) on imaging resulted in multiple renal arteries at implantation. Complex renal vein anatomy was associated with multiple arteries following retrieval.

Conclusion

A main renal artery length of more than 16 mm on the left and 26 mm on the right is unlikely to result in multiple arteries to implant. The possibility of multiple arteries should be borne in mind when the donor renal artery is short.
Pre‐transplant angiotensin receptor II type 1 antibodies and risk of post‐transplant focal segmental glomerulosclerosis recurrence
Authors: Mujtaba Muhammad A. , Sharfuddin Asif A. , Book Benita L. , Goggins William C. , Khalil Ali A. , Mishler Dennis P. , Fridell Johnathan A. , Yaqub Muhammad S. , Taber Tim E.
Published: May 2015

Post‐kidney transplant recurrence of focal segmental glomerulosclerosis (FSGS) is a major problem. AT1R is expressed on podocyte; its expression is elevated in the proteinuric state. Using an ELISA, we tested pre‐transplant sera of 28 patients with history of idiopathic FSGS for anti‐AT1R levels and serum soluble urokinase‐type plasminogen activator receptor (suPAR) as a biomarker for risk of recurrence of FSGS. Sera from 11 patients with polycystic kidney disease (PKD) were used as controls. Twelve patients had biopsy proven post‐transplant FSGS recurrence at 1.5 months. No difference was found in the pre‐transplant suPAR levels of FSGS patients (5993 ± 2292 pg/mL) vs. PKD (7334 ± 4538 pg/mL) (p = 0.23). Serum suPAR levels in patients with FSGS recurrence (5786 ± 1899 pg/mL) vs. no FSGS recurrence (6149 ± 2598 pg/mL) (p = 0.69) were not different. Anti‐AT1R levels in patients with FSGS were 12.66 ± 11.85 U/mL vs. 8.69 ± 6.52 U/mL in PKD (p = 0.32); however, a difference was found in patients with and without FSGS recurrence 20.41 ± 14.36 U/mL 6.84 ± 4.181 U/mL, respectively (p < 0.01). Area under curve for suPAR and anti‐AT1R to predict post‐transplant FSGS recurrence was 0.51 and 0.84, respectively. Pre‐transplant anti‐AT1R levels appear to be a helpful biomarker in identifying patients at high risk of post‐transplant FSGS recurrence.
A clinicopathologic study of morphea in Korean patients
Authors: Hong Jeong Ho , Kim Jeong Eun , Ko Joo Yeon , Ro Young Suck
Published: May 2015

Background

The exact pathogenesis of morphea is poorly understood, and only a few clinical or histopathological studies have been conducted in Asian patients.

Objective

The aim of this study was to identify the clinical and histopathological characteristics of morphea in Korean patients.

Methods

We retrospectively reviewed the medical records of 101 patients whose clinicopathologic findings were compatible with morphea and analyzed demographic characteristics, number of lesions, disease subtype and histopathological findings.

Results

Overall, circumscribed morphea (52.5%) was the most common clinical type, followed by linear (28.7%), mixed (13.9%) and generalized (5.0%) type. Disease duration was positively correlated with increased thickness of the skin in 54 patients (p < 0.001). Inflammatory cell infiltration was absent in 54, mild in 30 and moderate in 14 patients. There was no significant difference in the mean ratio of lesional to normal skin thickness (L/N ratio) among four types of morphea. Disease duration was not correlated with the density of inflammatory cell infiltration (p = 0.68). There were statistically significant differences in the duration of disease according to plasma cell counts (p < 0.05).

Conclusions

A positive correlation was found between skin thickness and disease duration, but mean L/N ratio was not significantly different among various types of morphea.
Reliability and practicability of the straight leg raise test in children with cerebral palsy
Authors: Marsico Petra , Tal‐Akabi Amir , Van Hedel Hubertus J A
Published: May 2015

Aim

Preventing restrictions to lower limb movement is part of the treatment given to children with cerebral palsy (CP). Such restrictions can be assessed using the ‘straight leg raise’ (SLR) test. This study investigated the interrater reliability and practicability of the SLR test in children with CP.

Method

Experienced physiotherapists examined 23 children with CP (6–18y; eight females, 15 males) twice. The SLR hip range of motion (ROM) was measured using an electrogoniometer, and the test was rated based on sensitizing manoeuvres and biceps femoris muscle activity. Practicability was investigated by evaluating children's subjective feedback on the tolerable ROM.

Results

Intraclass correlation coefficients for the SLR hip ROM varied, ranging from 0.84 (95% CI 0.61–0.93) to 0.93 (95% CI 0.87–0.96). Physiotherapists substantially agreed on SLR ratings (Cohen's kappa=0.73). Biceps femoris muscle activity decreased significantly with the release of tension on the sciatic nerve. All children were able to communicate the location and sensation of the maximally tolerated position.

Interpretation

The SLR test proved to be reliable and practicable in children with CP and might improve clinical reasoning processes. Lower limb movement restrictions in these children may partly be related to limitations in sciatic nerve mobility. Further studies should investigate if the SLR test could estimate activities in children with CP.
Grey matter injury patterns in cerebral palsy: associations between structural involvement on MRI and clinical outcomes
Authors: Reid Susan M , Dagia Charuta D , Ditchfield Michael R , Reddihough Dinah S
Published: May 2015

Aims

In a population cohort of children with grey matter injury (GMI) and cerebral palsy (CP), we aimed to describe and classify magnetic resonance imaging characteristics specific to GMI, and to identify key structure–function associations that serve as a basis for rating GMI in clinically relevant ways.

Method

Symmetry, extent of cerebral injury, and pathological pattern for 54 children (37 males, 17 females) with CP and a predominant GMI pattern on chronic‐phase magnetic resonance imaging were related to gross motor function, motor type and topography, epilepsy, intellectual disability, blindness, and deafness.

Results

Relative to mild GMI where there was no pallidal abnormality, severe GMI, comprising pallidal abnormality alone or in conjunction with other deep nuclear and generalized cortical–subcortical involvement, was strongly associated with Gross Motor Function Classification System levels IV to V (OR 35.7 [95% CI 3.5, 368.8]). Involvement of the basal ganglia was associated with non‐spastic/mixed motor types, but predominantly where cortical–subcortical grey and white matter involvement was not extensive. The prevalence of epilepsy was highest where there was diffuse cortical–subcortical involvement and white matter loss.

Interpretation

Better understanding of structure–function relationships in CP and GMI, and how to rate the severity of GMI, will be helpful in the clinical context and also as a basis for investigation of causal pathways in CP.
Paediatric terminology in the Australian health and health‐education context: a systematic review
Authors: Clark Ramona , Locke Melissa , Bialocerkowski Andrea
Published: May 2015

Aim

This study aimed to identify paediatric terminology used in the Australian health and health‐education context, propose a standardized framework for Australian use, and compare it with a US‐based framework.

Method

Australian health and health‐education websites were systematically searched using a novel hierarchical domain‐specific search strategy to identify grey literature containing paediatric terminology. Webpages published from 2009 to February 2014, with a ‘.gov.au’ or ‘.edu.au’ domain and no advertising, were included. Paediatric terms were analysed with power‐law distributions. Age definitions were grouped using a chi‐squared test automatic interaction detection analysis (p<0.05).

Results

In total, 34 paediatric terms and 197 unique age definitions were identified in 613 webpages. Terms displayed a language distribution, although definitions had semantic and lexical ambiguity. Age definitions were divided into four statistically different groups (F=245.3, p<0.001). Four paediatric terms with distinct age definitions were proposed based on Australian data: ‘infant: 0 to <1 year’, ‘early childhood: 1 year to <5 years’, ‘child: 5 years to <13 years’, and ‘young person: 13 years to <22 years’. These recommendations were broader than the US‐based comparison.

Interpretation

This is a starting point for standardizing Australian paediatric terminology, and a method for exploring paediatric terminology in other countries.
Metabolic syndrome of weight change from pre‐pregnancy to 1–5 years post‐partum among Chinese women with prior gestational diabetes
Authors: Li W. , Liu H. , Qiao Y. , Lv F. , Zhang S. , Wang L. , Leng J. , Liu H. , Qi L. , Tuomilehto J. , Hu G.
Published: May 2015

Aims

Few studies have evaluated the effect of weight change from pre‐pregnancy to post‐partum with the risk of cardiometabolic diseases among women with a history of gestational diabetes mellitus. The aim of this study was to evaluate the association between weight change from pre‐pregnancy to 1–5 years post‐partum with metabolic syndrome among Chinese women with prior gestational diabetes mellitus.

Methods

We performed a retrospective cohort study in 1263 women with gestational diabetes mellitus at 1–5 years post‐partum. Participants were divided into four groups based on their weight change from pre‐pregnancy to 1–5 years post‐partum: loss of ≥ 3 kg, ± 3 kg, gain of 3–7 kg and gain of ≥7 kg.

Results

The prevalence of metabolic syndrome was 12.1%, 16.2%, 26.0% and 44.3% among women with weight loss ≥ 3 kg, stable weight ( ± 3 kg), weight gain 3–7 kg and weight gain ≥ 7 kg from pre‐pregnancy to post‐partum, respectively. The positive association between weight change and metabolic syndrome was observed among women with pre‐pregnancy normal weight (BMI < 24 kg/m2), overweight (BMI 24–27.9 kg/m2) and obesity (BMI ≥ 28 kg/m2). The prevalence of metabolic syndrome was almost similar among pre‐pregnancy normal weight women with weight gain ≥ 7 kg, pre‐pregnancy overweight women with stable weight ( ± 3 kg) and pre‐pregnancy obese women with weight loss ≥ 3 kg from pre‐pregnancy to post‐partum (P = 0.62).

Conclusions

Women with gestational diabetes mellitus who had large weight gain from pre‐pregnancy to post‐partum were more likely to develop metabolic syndrome. Women who are pre‐pregnancy overweight/obesity and also diagnosed as gestational diabetes mellitus during pregnancy need more weight control after delivery.
Differences in risk factors for the onset of albuminuria and decrease in glomerular filtration rate in people with Type 2 diabetes mellitus: implications for the pathogenesis of diabetic kidney disease
Authors: Takagi M. , Babazono T. , Uchigata Y.
Published: May 2015

Aims

To determine differences in predictors of albuminuria and decreased estimated GFR in Japanese people with Type 2 diabetes mellitus without chronic kidney disease.

Methods

This single‐centre observational cohort study involved 1802 Japanese people with Type 2 diabetes with normoalbuminuria and estimated GFR ≥ 60 ml/min/1.73 m2 (740 women; mean ± sd age 58 ± 12 years). Two separate outcomes were evaluated: onset of albuminuria ( ≥ 30 mg/g creatinine, albuminuria cohort; n = 1655) and decrease in estimated GFR ( < 60 ml/min/1.73 m2; estimated GFR cohort; n = 1777). A Cox proportional hazards model was used to identify significant predictors for each outcome.

Results

During a median follow‐up period of 6.9 years for the albuminuria cohort and 8.0 years for the estimated GFR cohort, 181 and 316 individuals reached the respective outcome. The 5‐year cumulative incidence of albuminuria was 8.3%, and that of decreased estimated GFR was 10.4%. In the multivariate Cox model, greater urinary albumin‐to‐creatinine ratio, presence of diabetic retinopathy and higher HbA1c levels were associated with both outcomes. Unique risk factors for onset of albuminuria were male gender and higher uric acid levels; those for decreased estimated GFR were older age, greater systolic blood pressure, and lower baseline estimated GFR and HDL cholesterol levels.

Conclusions

Identification of both common and distinct predictive factors for onset of albuminuria and decreased estimated GFR support the hypothesis that both common and distinct pathophysiological mechanisms are involved in the development of these two manifestations of chronic kidney disease in diabetes.
Performance of HbA1c for the prediction of diabetes in a rural community in Korea
Authors: Song B. M. , Kim H. C. , Lee J. Y. , Lee J.‐M. , Kim D. J. , Lee Y.‐H. , Suh I.
Published: May 2015

Aim

To investigate the performance of HbA1c in predicting incident diabetes among Korean adults with normal fasting glucose and impaired fasting glucose levels.

Methods

This study used data from the Korean Genome Epidemiology Study‐Kangwha Study. A prospective analysis was carried out on 2079 people (820 men and 1259 women) who completed follow‐up examinations up until 2013. Diabetes was defined as fasting blood glucose level ≥ 7.0 mmol/l, HbA1c level ≥ 48 mmol/mol (6.5%), or current treatment for diabetes. Areas under the receiver‐operating characteristic curves were used to assess the different performances of HbA1c, glucose and insulin in predicting diabetes.

Results

The median follow‐up time was 3.97 years, during which 7.7% of men and 6.3% of women developed incident diabetes. The areas under the receiver‐operating curves (95% CI) for diabetes prediction were 0.740 (0.692–0.787) for HbA1c, 0.716 (0.667–0.764) for glucose and 0.598 (0.549–0.648) for insulin. HbA1c showed better predictive power in people with impaired fasting glucose (area under the curve 0.753, 95% CI 0.685–0.821) than in those with normal glucose (area under the curve 0.648, 95% CI 0.577–0.719). An HbA1c threshold of 40 mmol/mol (5.8%) was found to have the highest predictive value for diabetes, with a relative risk of 6.30 (95% CI 3.49–11.35) in men and 3.52 (95% CI 2.06–6.03) in women after adjusting for age, waist circumference, triglycerides, hypertension, family history of diabetes, smoking, alcohol intake, exercise and baseline glucose level.

Conclusions

HbA1c can be used to identify people at high risk for the development of diabetes, especially in those with impaired fasting glucose levels.
Nuclear β‐catenin localization supports homology of feathers, avian scutate scales, and alligator scales in early development
Authors: Musser Jacob M. , Wagner Günter P. , Prum Richard O.
Published: May 2015

Feathers are an evolutionary novelty found in all extant birds. Despite recent progress investigating feather development and a revolution in dinosaur paleontology, the relationship of feathers to other amniote skin appendages, particularly reptile scales, remains unclear. Disagreement arises primarily from the observation that feathers and avian scutate scales exhibit an anatomical placode—defined as an epidermal thickening—in early development, whereas alligator and other avian scales do not. To investigate the homology of feathers and archosaur scales we examined patterns of nuclear β‐catenin localization during early development of feathers and different bird and alligator scales. In birds, nuclear β‐catenin is first localized to the feather placode, and then exhibits a dynamic pattern of localization in both epidermis and dermis of the feather bud. We found that asymmetric avian scutate scales and alligator scales share similar patterns of nuclear β‐catenin localization with feathers. This supports the hypothesis that feathers, scutate scales, and alligator scales are homologous during early developmental stages, and are derived from early developmental stages of an asymmetric scale present in the archosaur ancestor. Furthermore, given that the earliest stage of β‐catenin localization in feathers and archosaur scales is also found in placodes of several mammalian skin appendages, including hair and mammary glands, we hypothesize that a common skin appendage placode originated in the common ancestor of all amniotes. We suggest a skin placode should not be defined by anatomical features, but as a local, organized molecular signaling center from which an epidermal appendage develops.
Dual embryonic origin and patterning of the pharyngeal skeleton in the axolotl (Ambystoma mexicanum)
Authors: Sefton Elizabeth M. , Piekarski Nadine , Hanken James
Published: May 2015

The impressive morphological diversification of vertebrates was achieved in part by innovation and modification of the pharyngeal skeleton. Extensive fate mapping in amniote models has revealed a primarily cranial neural crest derivation of the pharyngeal skeleton. Although comparable fate maps of amphibians produced over several decades have failed to document a neural crest derivation of ventromedial elements in these vertebrates, a recent report provides evidence of a mesodermal origin of one of these elements, basibranchial 2, in the axolotl. We used a transgenic labeling protocol and grafts of labeled cells between GFP+ and white embryos to derive a fate map that describes contributions of both cranial neural crest and mesoderm to the axolotl pharyngeal skeleton, and we conducted additional experiments that probe the mechanisms that underlie mesodermal patterning. Our fate map confirms a dual embryonic origin of the pharyngeal skeleton in urodeles, including derivation of basibranchial 2 from mesoderm closely associated with the second heart field. Additionally, heterotopic transplantation experiments reveal lineage restriction of mesodermal cells that contribute to pharyngeal cartilage. The mesoderm‐derived component of the pharyngeal skeleton appears to be particularly sensitive to retinoic acid (RA): administration of exogenous RA leads to loss of the second basibranchial, but not the first. Neural crest was undoubtedly critical in the evolution of the vertebrate pharyngeal skeleton, but mesoderm may have played a central role in forming ventromedial elements, in particular. When and how many times during vertebrate phylogeny a mesodermal contribution to the pharyngeal skeleton evolved remain to be resolved.
Views of early psychosis clinicians on discontinuation of antipsychotic medication following symptom remission in first episode psychosis
Authors: Thompson Andrew , Singh Swaran , Birchwood Max
Published: May 2015

Aims

Discontinuation of antipsychotics following remission in first episode psychosis (FEP) is a contentious area of practice. We aimed to investigate the views of early psychosis clinicians on this important clinical question.

Methods

We designed an 11 question online survey on medication discontinuation following remission of symptoms in FEP. The questionnaire was distributed to early intervention team workers in England and Wales via members of the National Early Psychosis Network who were requested to distribute it to their teams.

Results

We received 172 questionnaire responses; 37% were nurses, 33% doctors, 11% psychologists and 19% were other allied health professionals. The average years of experience in psychiatry was 16.9. 75.4% of respondents thought that greater than 60% of patients would like to be considered for guided medication reduction/discontinuation. Only 31.4% of respondents said that medication should be continued for over a year following remission. 61.4% of respondents felt that the quality of life of individuals was better in those who stop medication following remission. There was a significant difference in the response of professional groups to this question. 82.6% of respondents said they would be happy to support their patients in participating in a randomized trial of graded antipsychotic reduction/discontinuation versus maintenance medication.

Conclusions

The views of clinicians regarding prophylactic antipsychotic medication following remission in FEP are much less conservative than those in current guidelines; concern was expressed by many about the impact of antipsychotic medication on quality of life. A randomized trial of maintenance antipsychotic medication versus graded reduction/discontinuation is feasible and has considerable clinician support.
Nonsuicidal self‐injury, suicidal thoughts and suicide attempts among sexual minority youth in Ireland during their emerging adult years
Authors: Power Emmet , Coughlan Helen , Clarke Mary , Kelleher Ian , Lynch Fionnuala , Connor Dearbhla , Fitzpatrick Carol , Harley Michelle , Cannon Mary
Published: May 2015

Aim

This study aimed to examine whether or not sexual minority youth constitute an at‐risk group for nonsuicidal self‐injury, suicidal ideation or suicide attempts during their emerging adult years.

Methods

Using data from the Challenging Times Study, a population‐based study of psychopathology and suicide in Ireland, analyses were conducted to test the associations between sexual minority status and the odds of any lifetime experience of nonsuicidal self‐injury, suicidal thoughts or suicide attempts among Irish youth aged 19–24 years.

Results

Sexual minority youth had 6.6‐fold (95% CI 1.7–24.7) increased risk of nonsuicidal self‐injury, a 5.0‐fold (95% CI 1.3–18.3) increased risk of suicidal ideation, a 7.7‐fold (95% CI 1.8–32.0) increased risk of suicide intent and a 6.8‐fold (95% CI 1.6–27.6) increased risk of a suicide attempt during their lifetime compared to their heterosexual peers.

Conclusions

This study shows that emerging adulthood is a period of risk for suicide and nonsuicidal self‐injurious behaviour among sexual minority youth.
Heterogeneous effects of antiepileptic drugs in an in vitro epilepsy model – a functional multineuron calcium imaging study
Authors: Hongo Yoshie , Takasu Keiko , Ikegaya Yuji , Hasegawa Minoru , Sakaguchi Gaku , Ogawa Koichi
Published: May 2015

Epilepsy is a chronic brain disease characterised by recurrent seizures. Many studies of this disease have focused on local neuronal activity, such as local field potentials in the brain. In addition, several recent studies have elucidated the collective behavior of individual neurons in a neuronal network that emits epileptic activity. However, little is known about the effects of antiepileptic drugs on neuronal networks during seizure‐like events (SLEs) at single‐cell resolution. Using functional multineuron Ca2+ imaging (fMCI), we monitored the activities of multiple neurons in the rat hippocampal CA1 region on treatment with the proconvulsant bicuculline under Mg2+‐free conditions. Bicuculline induced recurrent synchronous Ca2+ influx, and the events were correlated with SLEs. Other proconvulsants, such as 4‐aminopyridine, pentetrazol, and pilocarpine, also induced synchronous Ca2+ influx. We found that the antiepileptic drugs phenytoin, flupirtine, and ethosuximide, which have different mechanisms of action, exerted heterogeneous effects on bicuculline‐induced synchronous Ca2+ influx. Phenytoin and flupirtine significantly decreased the peak, the amount of Ca2+ influx and the duration of synchronous events in parallel with the duration of SLEs, whereas they did not abolish the synchronous events themselves. Ethosuximide increased the duration of synchronous Ca2+ influx and SLEs. Furthermore, the magnitude of the inhibitory effect of phenytoin on the peak synchronous Ca2+ influx level differed according to the peak amplitude of the synchronous event in each individual cell. Evaluation of the collective behavior of individual neurons by fMCI seems to be a powerful tool for elucidating the profiles of antiepileptic drugs.
Extended flowering intervals of bamboos evolved by discrete multiplication
Authors: Veller Carl , Nowak Martin A. , Davis Charles C.
Published: May 2015

Numerous bamboo species collectively flower and seed at dramatically extended, regular intervals – some as long as 120 years. These collective seed releases, termed ‘masts’, are thought to be a strategy to overwhelm seed predators or to maximise pollination rates. But why are the intervals so long, and how did they evolve? We propose a simple mathematical model that supports their evolution as a two‐step process: First, an initial phase in which a mostly annually flowering population synchronises onto a small multi‐year interval. Second, a phase of successive small multiplications of the initial synchronisation interval, resulting in the extraordinary intervals seen today. A prediction of the hypothesis is that mast intervals observed today should factorise into small prime numbers. Using a historical data set of bamboo flowering observations, we find strong evidence in favour of this prediction. Our hypothesis provides the first theoretical explanation for the mechanism underlying this remarkable phenomenon.
Vitamin D, vitamin D binding protein gene polymorphisms, race and risk of incident stroke: the Atherosclerosis Risk in Communities (ARIC) study
Authors: Schneider A. L. C. , Lutsey P. L. , Selvin E. , Mosley T. H. , Sharrett A. R. , Carson K. A. , Post W. S. , Pankow J. S. , Folsom A. R. , Gottesman R. F. , Michos E. D.
Published: May 2015

Background and purpose

Low vitamin D levels, measured by serum 25‐hydroxyvitamin D [25(OH)D], are associated with increased stroke risk. Less is known about whether this association differs by race or D binding protein (DBP) single nucleotide polymorphism (SNP) status. Our objective was to characterize the associations of and interactions between 25(OH)D levels and DBP SNPs with incident stroke. It was hypothesized that associations of low 25(OH)D with stroke risk would be stronger amongst persons with genotypes associated with higher DBP levels.

Methods

25(OH)D was measured by mass spectroscopy in 12 158 participants in the Atherosclerosis Risk in Communities (ARIC) study (baseline 1990–1992, mean age 57 years, 57% female, 23% black) and they were followed through 2011 for adjudicated stroke events. Two DBP SNPs (rs7041, rs4588) were genotyped. Cox models were adjusted for demographic/behavioral/socioeconomic factors.

Results

During a median of 20 years follow‐up, 804 incident strokes occurred. The lowest quintile of 25(OH)D (<17.2 ng/ml) was associated with higher stroke risk [hazard ratio (HR) 1.34 (1.06–1.71) versus highest quintile]; this association was similar by race (P interaction 0.60). There was weak evidence of increased risk of stroke amongst those with 25(OH)D < 17.2 ng/ml and either rs7041 TG/GG [HR = 1.29 (1.00–1.67)] versus TT genotype [HR = 1.19 (0.94–1.52)] (P interaction 0.28) or rs4588 CA/AA [HR = 1.37 (1.07–1.74)] versus CC genotype [HR = 1.14 (0.91–1.41)] (P interaction 0.11).

Conclusions

Low 25(OH)D is a risk factor for stroke. Persons with low 25(OH)D who are genetically predisposed to high DBP (rs7041 G, rs4588 A alleles), who therefore have lower predicted bioavailable 25(OH)D, may be at greater risk for stroke, although our results were not conclusive and should be interpreted as hypothesis generating.
Treatment of infants with epilepsy: Common practices around the world
Authors: Wilmshurst Jo M. , Burman Richard , Gaillard William D. , Cross J. Helen
Published: May 2015

Objectives

High quality data to guide recommendations for infants with epilepsy are lacking. This study aimed to develop an understanding of common practice and regional variations in the treatment interventions of infants with epilepsy, and also to identify areas for further study and to highlight where common practice occurs without sound evidence.

Method

A survey addressed clinical treatment practice for infants with epilepsy. Alternative interventions were included.

Results

The survey found that most regions had similar practice for first‐line interventions, except for North America, where more levetiracetam was prescribed. There was a preference for valproate as first‐line therapy for generalized seizures, myoclonic seizures, and Dravet syndrome; only Oceania differed for generalized and myoclonic seizures. Phenobarbital was used for generalized and focal seizures in resource‐poor and resource‐equipped regions. Carbamazepine and oxcarbazepine were the preferred agents for focal seizures from all regions except North America, which uses more levetiracetam. For second‐ and third‐line interventions, the range of choices was diverse, often with little correlation across regions. The ketogenic diet, vagus nerve stimulation, and epilepsy surgery were considered viable choices in most settings, but usually only once seizures were considered medically refractory. The survey highlighted the marked discrepancy in Africa, the one region that consistently confirmed a lack of access to these alternative interventions and to the newer antiepileptic drugs.

Significance

More randomized controlled trials in infants with seizures are needed to permit useful recommendations. The survey identified widespread use of levetiracetam in North America, which may be the result of effective marketing or based on good clinical practice. The widespread use of valproate may have safety implications. The lack of access to care in the African region highlighted the need for more sustained resources. Although the survey was not evidence based, the findings could be useful to support additional well‐designed studies.
Experimental evidence that the ecosystem effects of aquatic herbivory by moose and beaver may be contingent on water body type
Authors: Bergman Brenda Gail , Bump Joseph K.
Published: May 2015

Mammalian herbivores that consume both aquatic and terrestrial vegetation may have important but little understood effects on freshwater ecosystems. We assessed the effects of North American moose (Alces americanus) and/or beaver (Castor canadensis) on aquatic vegetation and abiotic conditions of three types of waterbodies.

We established year‐round aquatic exclosures and reference plots in glacial lakes, dammed lakes and riverine ponds (n = 3 in each case). Within plots, we monitored parameters including dissolved oxygen, light, plant diversity and species‐specific plant biomass.

The effects of herbivory by beaver and moose appear to be contingent upon abiotic and plant community characteristics. Exposure to herbivory decreased biomass in riverine ponds and dammed lakes but not in glacial lakes and decreased species richness in riverine ponds and glacial lakes but not in dammed lakes. Changes in macrophyte species diversity correlated with exposure to herbivory only in glacial lakes. Disaggregating the effects of herbivory according to abiotic conditions and plant community characteristics revealed outcomes that are not detectable when results are aggregated.

In some catchments, the response of the aquatic plant community to beaver and moose herbivory may substantially differ from the response of the surrounding terrestrial plant community. Five of the six waterbodies created by beavers (dammed lakes and riverine ponds) maintained >80% macrophyte cover, despite seasonal reduction in biomass by both moose and beaver. Herbivores appear to cause a short‐term reduction in plant biomass in dammed lakes, resulting in greater light availability, without depleting biomass over a number of years.
Income Migration and Income Convergence across U.S. States, 1995–2010
Authors: Shumway J. Matthew , Otterstrom Samuel M.
Published: May 2015

In this paper we examine how internal migration redistributes earned income across U.S. states between 1995 and 2010. We examine interregional income flows by first describing the movement of earned income between U.S. states. Second, we examine the effect of income migration on spatial patterns of income inequality. The question we ask is, “does migration increase or decrease convergence income across U.S. States?” A primary contribution of this paper is that instead of using only 1 year of income migration data to explore these issues, we use yearly data from the first year the Internal Revenue Service (IRS) data started including income (1995/1996) up to the most current data available (2009/2010). Results indicate that income convergence/divergence across states varies by whether or not there is general economic expansion or contraction. Nevertheless, some high‐amenity states continually attract high‐income households.
Predictors of regular exercise among older residents of long‐term care institutions
Authors: Chen Yuh‐Min , Li Yueh‐Ping , Yen Min‐Ling
Published: May 2015

The purpose of this study was to apply self‐efficacy theory to explore predictors of regular exercise among older residents of long‐term care institutions. Convenience sampling was used to collect data from 151 older adults residing in three residential care homes in Taiwan. Data collection instruments included a background data sheet, Self Efficacy for Exercise Scale, Outcome Expectations for Exercise Scale and self‐reported regular exercise. Results indicated that older residents who exercised regularly had fewer chronic diseases, better perceived health status and functional status, and higher self‐efficacy expectations and outcome expectations related to exercise. Older residents with a regular exercise habit prior to institutionalization were more likely to engage in regular exercise. Logistic regression analysis indicated past exercise participation and self‐efficacy expectations to be significant positive predictors of regular exercise. To promote regular exercise within this population, these can be potential target areas for interventions. These factors should be targeted in the development and implementation of interventions to promote regular exercise among older residents of long‐term care institutions.
Assessing Cognition after Stroke. Who Misses Out? A Systematic Review
Authors: Wall Kylie J. , Isaacs Megan L. , Copland David A. , Cumming Toby B.
Published: May 2015

Background

Cognitive impairments post-stroke are common. Assessment of cognition typically involves pen-and-paper tasks, which are often reliant on linguistic and motor function, creating barriers for many stroke survivors. The characteristics of stroke survivors excluded from cognitive assessments have never been investigated.

Aims

( 1 ) To determine if the stroke samples included in studies evaluating clinimetric properties of cognitive assessments represent the stroke population, ( 2 ) to identify the different modes of cognitive assessments, and ( 3 ) to ascertain whether the different modes of cognitive assessments influence the stroke samples used in the studies.

Summary of review

We systematically reviewed studies that evaluated at least one clinimetric property of a cognitive assessment in adult stroke survivors from January 2000 to October 2013. Eligibility criteria, reasons for drop-outs and missing data were extracted. A theming process was employed to synthesize the data. From the initial yield of 3731 articles, 109 were included. Six broad categories describing reasons for exclusion were identified. Cognitive impairments were the most common (68%), then communication issues (62%), endurance problems (42%), sensory loss (39%), psychiatric illness (38%) and motor limitations (27%). The most prevalent assessment mode was pen-and-paper (73%), then virtual reality (11%), computer (6%), observational functional performance (5%), informant (3%) and telephone (3%). Regardless of mode, issues with cognition and communication were the most frequently used exclusion criteria.

Conclusions

Our findings indicate that cognitive assessments are not tested in representative stroke samples. Research is needed to identify valid and reliable cognitive assessments that are feasible in a wider range of stroke survivors.
Virological characterization of influenza H1N1pdm09 in Vietnam, 2010‐2013
Authors: Nguyen Hang K. L. , Nguyen Phuong T. K. , Nguyen Thach C. , Hoang Phuong V. M. , Le Thanh T. , Vuong Cuong D. , Nguyen Anh P. , Tran Loan T. T. , Nguyen Binh G. , Lê Mai Q.
Published: May 2015

Objectives

Influenza A/H1N1pdm09 virus was first detected in Vietnam on May 31, 2009, and continues to circulate in Vietnam as a seasonal influenza virus. This study has monitored genotypic and phenotypic changes in this group of viruses during 2010–2013 period.

Design and setting

We sequenced hemagglutinin (HA) and neuraminidase (NA) genes from representative influenza A/H1N1pdm09 and compared with vaccine strain A/California/07/09 and other contemporary isolates from neighboring countries. Hemagglutination inhibition (HI) and neuraminidase inhibition (NAI) assays also were performed on these isolates.

Sample

Representative influenza A/H1N1pdm09 isolates (n = 61) from ILI and SARI surveillances in northern Vietnam between 2010 and 2013.

Main outcome measures and results

The HA and NA phylogenies revealed six and seven groups, respectively. Five isolates (8·2%) had substitutions G155E and N156K in the HA, which were associated with reduced HI titers by antiserum raised against the vaccine virus A/California/07/2009. One isolate from 2011 and one isolate from 2013 had a predicted H275Y substitution in the neuraminidase molecule, which was associated with reduced susceptibility to oseltamivir in a NAI assay. We also identified a D222N change in the HA of a virus isolated from a fatal case in 2013.

Conclusions

Significant genotypic and phenotypic changes in A/ H1N1pdm09 influenza viruses were detected by the National Influenza Surveillance System (NISS) in Vietnam between 2010 and 2013 highlighting the value of this system to Vietnam and to the region. Sustained NISS and continued virological monitoring of seasonal influenza viruses are required for vaccine policy development in Vietnam. 3
Quantitative observations on asexual reproduction of Aeolosoma viride (Annelida, Aphanoneura)
Authors: Falconi Rosanna , Gugnali Andrea , Zaccanti Francesco
Published: May 2015

Agametic reproductive activity (via paratomy) of Aeolosoma viride was analyzed throughout the life cycle in individually reared specimens. Aeolosoma viride is organized in linear chains of 3–4 zooids; the main zooid is anterior, and the secondary zooids are positioned posterior to the main zooid in inverse order with respect to their degree of growth, the most advanced being at the posterior end, and those less advanced nearer the main zooid. On average, worms lived 66±10 d and produced 57±6 offspring. A budding area located in the sub‐terminal part of the main zooid produced chaetigers that formed the origin of the secondary zooids. A growth zone was located in the posterior end of each secondary zooids. Fission occurred between the penultimate and the last zooid of the chain. Just before fission, the growth zone of each secondary zooid became a budding area. Agametic reproduction was via multiple paratomy with linear succession of the secondary zooid and terminal fission. The structure of the chain was therefore modulated by the interaction of the processes of budding, growth, cephalic differentiation, and fission, which occurred continuously and on different timescales. Values of parameters describing paratomic activity (interval between origin of the zooids, time to produce a chaetiger, growth time of the zooids, and interval between the fission of the filial chains) are low early in an individual's life, but increase during senescence. Due to its relatively rapid lifecycle and high reproductive activity, A. viride is a convenient experimental organism for the study of agametic reproduction.
The Evolution of Tissue Stiffness at Radiofrequency Ablation Sites During Lesion Formation and in the Peri‐Ablation Period
Authors: EYERLY STEPHANIE A. , VEJDANI‐JAHROMI MARYAM , DUMONT DOUGLAS M. , TRAHEY GREGG E. , WOLF PATRICK D.
Published: May 2015

Peri‐Ablation Monitoring of RFA Lesion Stiffness

Introduction

Elastography imaging can provide radiofrequency ablation (RFA) lesion assessment due to tissue stiffening at the ablation site. An important aspect of assessment is the spatial and temporal stability of the region of stiffness increase in the peri‐ablation period. The aim of this study was to use 2 ultrasound‐based elastography techniques, shear wave elasticity imaging (SWEI) and acoustic radiation force impulse (ARFI) imaging, to monitor the evolution of tissue stiffness at ablation sites in the 30 minutes following lesion creation.

Methods and Results

In 6 canine subjects, SWEI measurements and 2‐D ARFI images were acquired at 6 ventricular endocardial RFA sites before, during, and for 30 minutes postablation. An immediate increase in tissue stiffness was detected during RFA, and the area of the postablation region of stiffness increase (RoSI) as well as the relative stiffness at the RoSI center was stable approximately 2 minutes after ablation. Of note is the observation that relative stiffness in the region adjacent to the RoSI increased slightly during the first 15 minutes, consistent with local fluid displacement or edema. The magnitude of this increase, ∼0.5‐fold from baseline, was significantly less than the magnitude of the stiffness increase directly inside the RoSI, which was greater than 3‐fold from baseline.

Conclusions

Ultrasound‐based SWEI and ARFI imaging detected an immediate increase in tissue stiffness during RFA, and the stability and magnitude of the stiffness change suggest that consistent elasticity‐based lesion assessment is possible 2 minutes after and for at least 30 minutes following ablation.
Effects of a sodium glucose co‐transporter 2 selective inhibitor, ipragliflozin, on the diurnal profile of plasma glucose in patients with type 2 diabetes: A study using continuous glucose monitoring
Authors: Yamada Kentaro , Nakayama Hitomi , Yoshinobu Satoko , Kawano Seiko , Tsuruta Munehisa , Nohara Masayuki , Hasuo Rika , Akasu Shoko , Tokubuchi Ichiro , Wada Nobuhiko , Hirao Saori , Iwata Shinpei , Kaku Hiroo , Tajiri Yuji
Published: May 2015

Aims/Introduction

To assess the effects of sodium glucose co‐transporter 2 inhibitor therapy on the pathophysiology of type 2 diabetes.

Materials and Methods

We administered ipragliflozin to 21 inpatients with type 2 diabetes for 7 days, and analyzed the diurnal profiles of plasma glucose and 3‐hydroxybutyrate. A total of 21 age‐, sex‐ and body mass index‐matched diabetic patients served as controls.

Results

Continuous glucose monitoring showed that the 24‐h glucose curve was shifted downward without hypoglycemia by the administration of ipragliflozin. The average glucose level was reduced from 182 ± 54 mg/dL to 141 ± 33 mg/dL (P < 0.0001). The magnitude of the reduction was highly correlated with the baseline average glucose level. Homeostasis model assessment of insulin resistance was decreased, and homeostasis model assessment of β‐cell function was increased during the treatment. Urinary glucose excretion was correlated with the average glucose level both on day 0 and on day 7, although the regression line was steeper and shifted leftward on day 7. The ipragliflozin‐treated patients lost more weight than the control patients (1.4 ± 0.5 vs 0.5 ± 0.6 kg, P < 0.0001). Plasma levels of 3‐hydroxybutyrate were significantly increased with peaks before breakfast and before dinner. Patient age and bodyweight loss were negatively and positively correlated with the peak levels of 3‐hydroxybutyrate on day 7, respectively.

Conclusions

The ipragliflozin treatment improved the 24‐h glucose curve without causing hypoglycemia. The close correlation between the magnitude of glucose reduction and the baseline plasma glucose concentration suggests that the risk of hypoglycemia is likely low. It might be prudent to monitor ketone body levels in younger patients and in patients with rapid weight loss.
Dinoflagellate Gene Structure and Intron Splice Sites in a Genomic Tandem Array
Authors: Mendez Gregory S. , Delwiche Charles F. , Apt Kirk E. , Lippmeier J. Casey
Published: May 2015

Dinoflagellates are one of the last major lineages of eukaryotes for which little is known about genome structure and organization. We report here the sequence and gene structure of a clone isolated from a cosmid library which, to our knowledge, represents the largest contiguously sequenced, dinoflagellate genomic, tandem gene array. These data, combined with information from a large transcriptomic library, allowed a high level of confidence of every base pair call. This degree of confidence is not possible with PCR‐based contigs. The sequence contains an intron‐rich set of five highly expressed gene repeats arranged in tandem. One of the tandem repeat gene members contains an intron 26,372 bp long. This study characterizes a splice site consensus sequence for dinoflagellate introns. Two to nine base pairs around the 3′ splice site are repeated by an identical two to nine base pairs around the 5′ splice site. The 5′ and 3′ splice sites are in the same locations within each repeat so that the repeat is found only once in the mature mRNA. This identically repeated intron boundary sequence might be useful in gene modeling and annotation of genomes.
Effects of Seasonality and Dispersal on the Ciliate Community Inhabiting Bromeliad Phytotelmata in Riparian Vegetation of a Large Tropical River
Authors: Buosi Paulo R. B. , Cabral Adalgisa F. , Utz Laura R. P. , Vieira Ludgero C. G. , Velho Luiz F. M.
Published: May 2015

This study evaluated the influence of rainfall amount on the abundance, species richness, and species occurrence and abundance distribution of the ciliate community associated with the bromeliadAechmea distichantha. The plants were collected from a rock wall of about 10‐km long at the left bank of Paraná River. We assessed the effects of both spatial and temporal variables on the community attributes, as well as whether plants geographically closer have a similar abundance distribution and species composition. The ciliate community was substantially distinct between both hydrological periods, with greater values of species richness and abundance in the rainy period. No spatial structuring (differences in the species occurrence and abundance distribution among strata) or geographical similarity (similarity in ciliate species composition among the plants) was found. Multiple regression analysis showed a positive relationship only between the ciliate abundances and water volumes for both periods. Although few of the formulated predictions were confirmed, our study provides valuable information on the ecological aspects of the ciliate community inhabiting bromeliad phytotelmata.