bluuebunny/crossref_metadata_2025 huggingface dataset:
Time-saving screening for diabetes in patients with coronary artery disease: a report from EUROASPIRE IV
Authors: Gyberg Viveca , De Bacquer Dirk , Kotseva Kornelia , De Backer Guy , Schnell Oliver , Tuomilehto Jaakko , Wood David , Rydén Lars
Published: December 2016

Background

WHO advocates 2-hour oral glucose tolerance test (OGTT) for detecting diabetes mellitus (DM). OGTT is the most sensitive method to detect DM in patients with coronary artery disease (CAD). Considered time consuming, the use of OGTT is unsatisfactory. A 1-hour plasma glucose (1hPG) test has not been evaluated as an alternative in patients with CAD.

Objectives

To create an algorithm based on glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and 1hPG limiting the need of a 2-hour plasma glucose (2hPG) in patients with CAD.

Methods

951 patients with CAD without DM underwent OGTT. A 2hPG≥11.1 mmol/L was the reference for undiagnosed DM. The yield of HbA1c, FPG and 1hPG was compared with that of 2hPG.

Results

Mean FPG was 6.2±0.9 mmol/L, and mean HbA1c 5.8±0.4%. Based on 2hPG≥11.1 mmol/L 122 patients (13%) had DM. There was no value for the combination of HbA1c and FPG to rule out or in DM (HbA1c≥6.5%; FPG≥7.0 mmol/L). In receiver operating characteristic analysis a 1hPG≥12 mmol/L balanced sensitivity and specificity for detecting DM (both=82%; positive and negative predictive values 40% and 97%). A combination of FPG<6.5 mmol/L and 1hPG<11 mmol/L excluded 99% of DM. A combination of FPG>8.0 mmol/L and 1hPG>15 mmol/L identified 100% of patients with DM.

Conclusions

Based on its satisfactory accuracy to detect DM an algorithm is proposed for screening for DM in patients with CAD decreasing the need for a 2-hour OGTT by 71%.
Effect of aclidinium bromide on cough and sputum symptoms in moderate-to-severe COPD in three phase III trials
Authors: McGarvey Lorcan , Morice Alyn H , Smith Jaclyn A , Birring Surinder S , Chuecos Ferran , Seoane Beatriz , Jarreta Diana
Published: December 2016

Background

Cough and sputum are troublesome symptoms in chronic obstructive pulmonary disease (COPD) and are associated with adverse outcomes. The efficacy of aclidinium bromide 400 µg twice daily in patients with stable COPD has been established in two phase III studies (ACCORD COPD I and ATTAIN) and a phase IIIb active-comparator study. This analysis evaluated cough-related symptoms across these studies.

Method

Patients were randomised to placebo, aclidinium 200 µg or 400 µg twice daily in ACCORD (12 weeks) and ATTAIN (24 weeks), or to placebo, aclidinium 400 µg twice daily or tiotropium 18 µg once daily (6-week active-comparator study). Analysed end points included changes from baseline in Evaluating Respiratory Symptoms (E-RS; formerly known as EXAcerbations of Chronic pulmonary disease Tool), total and cough/sputum scores and frequency/severity of morning and night-time cough and sputum symptoms.

Results

Data for 1792 patients were evaluated. E-RS cough/sputum domain scores were significantly reduced with aclidinium 400 µg versus placebo in ATTAIN (−0.7 vs −0.3, respectively; p<0.01) and the active-comparator study (−0.6 vs −0.2, respectively; p<0.01). In the active-comparator study, significantly greater improvements were observed with aclidinium versus placebo for severity of morning cough (−0.19 vs −0.02; p<0.01) and phlegm (−0.19 vs −0.02; p<0.05). In ACCORD, aclidinium reduced night-time cough frequency (−0.36 vs 0.1 for placebo; p<0.001) and severity (−0.24 vs −0.1 for placebo; p<0.05), and frequency of night-time sputum production (−0.37 vs 0.05 for placebo; p<0.001).

Conclusions

Aclidinium 400 µg twice daily improves cough and sputum expectoration versus placebo in stable COPD.

Trial registration numbers

NCT00891462;NCT01001494;NCT01462929.
Lymph node yield is an independent predictor of survival in rectal cancer regardless of receipt of neoadjuvant therapy
Authors: Xu Zhaomin , Berho Mariana E , Becerra Adan Z , Aquina Christopher T , Hensley Bradley J , Arsalanizadeh Reza , Noyes Katia , Monson John R T , Fleming Fergal J
Published: December 2016

Aims

Lymph node yield (LNY) is used as a marker of adequate oncological resection. The American Joint Committee on Cancer (AJCC) currently recommends that at least 12 nodes are necessary to confirm node-negative disease for rectal cancer. A LNY of 12 is not always achieved, particularly in patients who have undergone neoadjuvant treatment. This study attempts to examine factors associated with LNY and its prognostic impact following neoadjuvant chemoradiation in rectal cancer.

Methods

The 2006–2011 National Cancer Data Base was queried for patients with clinical stage I–III rectal cancer who underwent a proctectomy. Suboptimal LNY was defined as <12 lymph nodes examined. A mixed-effects multinomial logistic regression model was used to identify independent factors associated with LNY. Mixed-effects Cox proportional hazards models were used to estimate the adjusted effect of LNY on 5-year overall survival.

Results

25 447 patients met inclusion criteria. Overall, 62% of the cohort received neoadjuvant chemoradiation and 32% had suboptimal LNY. The median LNY for patients who received neoadjuvant therapy was 13 (IQR: 9–18) and for patients who did not receive neoadjuvant therapy was 15 (IQR: 12–21). After risk adjustment, there was a 3.5-fold difference in the rate of suboptimal LNY among individual hospitals (27%–95%). Suboptimal LNY was independently associated with an 18% increased hazard of death among patients who did not receive neoadjuvant treatment and a 20% increased hazard of death among those who did receive neoadjuvant treatment when controlled for adjuvant treatment, staging, proximal/distal margins and other patient factors.

Conclusions

Suboptimal LNY is independently associated with worse overall survival regardless of neoadjuvant therapy, pathological staging and patient factors in rectal cancer. This finding underlies the importance and challenge of an optimal lymph node evaluation for prognostication, especially for patients receiving neoadjuvant therapy.
FISCAL POLICY, INSTITUTIONS AND GROWTH: NEW INSIGHTS
Authors: NAWAZ SAIMA , KHAWAJA M. IDREES
Published: December 2016

The paper attempts to analyze the impact of fiscal policy on economic growth while considering level of development and controlling for state of institutions. We extend the Solow growth model by incorporating fiscal policy and institutions through using total factor productivity. Our empirical analysis includes a panel of 56 countries. The empirics demonstrate that impact of fiscal policy on growth is statistically insignificant in the full sample. However, splitting the sample into developed and developing economies, positive association with economic growth in developed economies and negative association in developing economies observed. Our findings thus inform that fiscal policy contributes positively to growth only in developed economies. The reason for this seems to be an enabling institutional environment in developed economies. This kind of enabling institutional environment allows fiscal policy to play positive role in developed economies and absence of such environment contributes to the negative impact of fiscal policy in developing economies.
60 GHz-Band Low-Noise Amplifier
Authors: Amin Najam Muhammad , Shen Lianfeng , Wang Zhi-Gong , Akhter Muhammad Ovais , Afridi Muhammad Tariq
Published: December 2016

This paper presents the design of a 60[Formula: see text]GHz-band LNA intended for the 63.72–65.88[Formula: see text]GHz frequency range (channel-4 of the 60[Formula: see text]GHz band). The LNA is designed in a 65-nm CMOS technology and the design methodology is based on a constant-current-density biasing scheme. Prior to designing the LNA, a detailed investigation into the transistor and passives performances at millimeter-wave (MMW) frequencies is carried out. It is shown that biasing the transistors for an optimum noise figure performance does not degrade their power gain significantly. Furthermore, three potential inductive transmission line candidates, based on coplanar waveguide (CPW) and microstrip line (MSL) structures, have been considered to realize the MMW interconnects. Electromagnetic (EM) simulations have been performed to design and compare the performances of these inductive lines. It is shown that the inductive quality factor of a CPW-based inductive transmission line ([Formula: see text] is more than 3.4 times higher than its MSL counterpart @ 65[Formula: see text]GHz. A CPW structure, with an optimized ground-equalizing metal strip density to achieve the highest inductive quality factor, is therefore a preferred choice for the design of MMW interconnects, compared to an MSL. The LNA achieves a measured forward gain of [Formula: see text][Formula: see text]dB with good input and output impedance matching of better than [Formula: see text][Formula: see text]dB in the desired frequency range. Covering a chip area of 1256[Formula: see text][Formula: see text]m[Formula: see text]m including the pads, the LNA dissipates a power of only 16.2[Formula: see text]mW.
Design and Analysis of AMSCC for Piezoelectric Energy Harvesting
Authors: Chang Yuen-Haw , Wang Chun-Hung
Published: December 2016

This paper presents the analysis, design and implementation of a closed-loop adaptive multistage switched-capacitor converter (AMSCC) for step-down conversion applied to piezoelectric energy harvesting. Its power part consists of two cascaded sub-circuits: (i) Front: a bridge rectifier with a filter capacitor ([Formula: see text]), and (ii) Core: five-stage serial-parallel SC step-down converter with an output capacitor ([Formula: see text]). This rectifier converts piezoelectric AC source into DC type, and [Formula: see text] captures/stores the energy to build a supply [Formula: see text], and then the serial-parallel SCC transforms [Formula: see text] into five different levels as: [Formula: see text]/5, [Formula: see text]/4, [Formula: see text]/3, [Formula: see text]/2, or [Formula: see text] to charge the battery load. By using the proposed phase generator, a proper level can be manipulated adaptively according to the recent supply and battery voltages for realizing an adaptive multistage charging procedure. Such an adaptive multistage operation is helpful not only to protect the usage of battery, but also to handle the supply variation of piezoelectric device. Some theoretical analysis and design include: formulation, steady-state analysis, stability, capacitance selection, and multistage output response/power. Finally, the performance of AMSCC scheme is simulated and verified experimentally on the implemented prototype circuit, and the results are illustrated to show the efficacy of this scheme.
The polarized structure function from the nonextensive statistics
Authors: Trevisan Luis Augusto
Published: December 2016

In the present work, the effects of the nonextensivity are considered in a model to obtain the polarized structure function for the proton and neutron, including the strange contribution for each one. Any type of symmetry is made in consequence of the experimental data involved.
Axisymmetric Vibration of Rotating Annular Plate with Variable Thickness Subjected to Tensile Centrifugal Body Force
Authors: Kang Jae-Hoon
Published: December 2016

This paper is concerned with the axisymmetric free vibration analysis of a rotating annular plate with variable thickness by using the Ritz method. The rotating plate has a constant angular speed and subjected to a tensile centrifugal body force. The annular plate is fixed at the inner edge and free at the outer edge. Exact stresses, strains, and radial displacement of the rotating annular plate are obtained via plane elasticity. Presented herein are the natural frequencies and modes shapes for the rotating, nonuniform annular plate with various angular speeds and different ratios of the inner radius to the outer radius.
THE ORDER OF A 2-SEQUENCE AND THE COMPLEXITY OF DIGITAL IMAGES
Authors: TELKSNYS TADAS , NAVICKAS ZENONAS , VAIDELYS MARTYNAS , RAGULSKIS MINVYDAS
Published: December 2016

The concept of the order of a 2-sequence is introduced in this paper. The order of a 2-sequence is a natural but not trivial extension of the order of one-dimensional (1D) linear recurrent sequences. Necessary and sufficient conditions for the generation of 2-sequences with finite order from the minimal information subset are derived. It is demonstrated that the order of 2-sequences can be used to estimate the complexity of self-organizing patterns with respect to each spatial coordinate.
Geochemical prediction of arsenic attenuation from infiltrated heap leach drainage, Daisy Mine, Nevada
Authors: Bowell R. J. , Declercq J. , Warrender R. , Prestia A. , Parshley J. V. , Barber J. R.
Published: December 2016

At the former Daisy mine gold heap leach operations in Nevada, long term solution draindown is
c.
0.25 m
3
/day (0.045 gpm) and hosts arsenic concentrations in the order of 0.27 – 0.61 mg/L. This draindown solution is infiltrated into the ground where it eventually contacts groundwater. To assess the potential for natural attenuation of arsenic in the subsurface and to evaluate the interaction of the draindown solutions with groundwater, a series of predictive geochemical scenarios were undertaken using PHREEQC. These scenarios included varying the draindown rate to assess how this affects groundwater chemistry and varying the proportion of reactive sorbent mineral phases in the sub-surface to mimic the range observed in soil mineralogy.

The results of the geochemical predictions demonstrate that arsenic is effectively removed from draindown solutions by adsorption onto soil particles with the net effect that groundwater arsenic concentrations are not increased above baseline levels. The results denote a mass solubility control on solute concentrations during the interaction of heap draindown with groundwater without significant mineral precipitation. Draindown rates measured for the Daisy Heap continue to decline every year and are approaching steady state conditions. Therefore, at the current negligible draindown rates, this geochemical assessment indicates that the interaction of Daisy Heap draindown with groundwater will not alter baseline groundwater chemistry in the vicinity of the operations.

Supplementary material:
PHREEQC files that support the modelling are available at
https://doi.org/10.6084/m9.figshare.c.3587243
Archaean granitoids: an overview and significance from a tectonic perspective
Authors: Halla Jaana , Whitehouse Martin J. , Ahmad Talat , Bagai Zibisani
Published: December 2016

This special publication presents a collection of papers on Archaean igneous rocks which aim to provide evidence of a tectonic scenario that is increasingly accepted by scientists studying the evolution of the early Earth. Papers on diverse igneous rocks from the North Atlantic Craton, as well as Archaean terrains of the Fennoscandian, Indian and Ukrainian shields, have a common focus on crust–mantle interactions and granitoid diversification, especially at the end of the Archaean, accompanied by insights into metamorphic rocks. This volume, together with present research, provides evidence for a change in global tectonic regime close to the Archaean–Proterozoic boundary. After the long-term episodic formation of tonalite–trondhjemite–granodiorite (TTG) suites of oceanic origin, convergent continental margins with abundant batholiths of potassic granitoids appeared for the first time at 3.0–2.5 Ga. The batholiths involve both mantle-derived and recycled crustal material. It seems that the diversification of granitoids was caused by increased crust–mantle interactions, reflecting a significant change in mantle dynamics and plate tectonics during the Neoarchaean.
Prediction of Virality Timing Using Cascades in Social Media
Authors: Cheung Ming , She James , Junus Alvin , Cao Lei
Published: December 2016

Predicting content going viral in social networks is attractive for viral marketing, advertisement, entertainment, and other applications, but it remains a challenge in the big data era today. Previous works mainly focus on predicting the possible popularity of content rather than the timing of reaching such popularity. This work proposes a novel yet practical iterative algorithm to predict virality timing, in which the correlation between the timing and growth of content popularity is captured by using its own big data naturally generated from users’ sharing. Such data is not only able to correlate the dynamics and associated timings in social cascades of viral content but also can be useful to self-correct the predicted timing against the actual timing of the virality in each iterative prediction. The proposed prediction algorithm is verified by datasets from two popular social networks—Twitter and Digg—as well as two synthesized datasets with extreme network densities and infection rates. With about 50% of the required content virality data available (i.e., halfway before reaching its actual virality timing), the error of the predicted timing is proven to be bounded within a 40% deviation from the actual timing. To the best of our knowledge, this is the first work that predicts content virality timing iteratively by capturing social cascades dynamics.
The IX Operating System
Authors: Belay Adam , Prekas George , Primorac Mia , Klimovic Ana , Grossman Samuel , Kozyrakis Christos , Bugnion Edouard
Published: December 2016

The conventional wisdom is that aggressive networking requirements, such as high packet rates for small messages and μs-scale tail latency, are best addressed outside the kernel, in a user-level networking stack. We present
ix
, a dataplane operating system that provides high I/O performance and high resource efficiency while maintaining the protection and isolation benefits of existing kernels.

ix
uses hardware virtualization to separate management and scheduling functions of the kernel (control plane) from network processing (dataplane). The dataplane architecture builds upon a native, zero-copy API and optimizes for both bandwidth and latency by dedicating hardware threads and networking queues to dataplane instances, processing bounded batches of packets to completion, and eliminating coherence traffic and multicore synchronization. The control plane dynamically adjusts core allocations and voltage/frequency settings to meet service-level objectives.

We demonstrate that
ix
outperforms Linux and a user-space network stack significantly in both throughput and end-to-end latency. Moreover,
ix
improves the throughput of a widely deployed, key-value store by up to 6.4× and reduces tail latency by more than 2× . With three varying load patterns, the control plane saves 46%--54% of processor energy, and it allows background jobs to run at 35%--47% of their standalone throughput.
AI amusements
Authors: Davis Ernest
Published: December 2016

The sad tale tells how TAY, a maiden chatbot, of innocent heart, benevolent desires, and amiable disposition, was released to the Internet; and how an evil conspiracy corrupted her into a malevolent, foulmouthed crone.
Using Mobile Eye-Trackers to Unpack the Perceptual Benefits of a Tangible User Interface for Collaborative Learning
Authors: Schneider Bertrand , Sharma Kshitij , Cuendet Sébastien , Zufferey Guillaume , Dillenbourg Pierre , Pea Roy
Published: December 2016

In this study, we investigated the way users memorize, analyze, collaborate, and learn new concepts on a Tangible User Interface (TUI). Twenty-seven pairs of apprentices in logistics (
N
= 54) interacted with an interactive simulation of a warehouse. Their task was to discover efficient design principles for building storehouses. In a between-subjects experimental design, half of the participants used 3D physical shelves, whereas the other half used 2D paper shelves. This manipulation allowed us to control for the “representational effect” of 3D tangibles: the first group saw the warehouse as a small-scale model with realistic shelves, whereas the second group had access to a more abstract layout with rectangular pieces of paper. Both groups interacted with the system in the same way. We found that participants in the first group (i.e., who used 3D realistic shelves) better memorized a warehouse layout, built a more efficient model, and scored higher on a learning test. Additionally, students wore eye-tracking goggles while completing those tasks; preliminary results suggest that 3D interfaces increased joint visual attention, which was found to be a significant predictor for participants’ task performance and learning gains. Implications for designing TUIs in collaborative settings are discussed.
Projection mapping as a method to improve board game accessibility
Authors: Noble Kirsty , Crabb Michael
Published: December 2016

In this work, we explore the concept of using projected content on top of board game sessions in order to improve the overall accessibility of a board game session. In our work we use technology to add a secondary information layer that provides board game content on top of the physical board game that is being played. We present an initial study examining the types of problems that exist in board game sessions and provide guidance on how projection mapped systems can be used in order to increase accessibility in this area.
Computational Geometry Column 64
Authors: Dumitrescu Adrian
Published: December 2016

This column is devoted to minimum partitions of colored point sets into monochromatic parts with pairwise disjoint convex hulls. These partitions offer compact color signatures that in principle could be used for classification and retrieval of discretized images.
High aminopeptidase A activity contributes to blood pressure control in ob/ob mice by AT2 receptor-dependent mechanism
Authors: Morais Rafael L. , Hilzendeger Aline M. , Visniauskas Bruna , Todiras Mihail , Alenina Natalia , Mori Marcelo A. , Araújo Ronaldo C. , Nakaie Clovis R. , Chagas Jair R. , Carmona Adriana K. , Bader Michael , Pesquero João B.
Published: December 2016

Obesity is assumed to be a major cause of human essential hypertension; however, the mechanisms responsible for weight-related increase in blood pressure (BP) are not fully understood. The prevalence of hypertension induced by obesity has grown over the years, and the role of the renin-angiotensin-aldosterone system (RAAS) in this process continues to be elucidated. In this scenario, the ob/ob mice are a genetic obesity model generally used for metabolic disorder studies. These mice are normotensive even though they present several metabolic conditions that predispose them to hypertension. Although the normotensive trait in these mice is associated with the poor activation of sympathetic nervous system by the lack of leptin, we demonstrated that ob/ob mice present massively increased aminopeptidase A (APA) activity in the circulation. APA enzyme metabolizes angiotensin (ANG) II into ANG III, a peptide associated with intrarenal angiotensin type 2 (AT2) receptor activation and induction of natriuresis. In these mice, we found increased ANG-III levels in the circulation, high AT2 receptor expression in the kidney, and enhanced natriuresis. AT2 receptor blocking and APA inhibition increased BP, suggesting the ANG III-AT2 receptor axis as a complementary BP control mechanism. Circulating APA activity was significantly reduced by weight loss independently of leptin, indicating the role of fat tissue in APA production. Therefore, in this study we provide new data supporting the role of APA in BP control in ob/ob mouse strain. These findings improve our comprehension about obesity-related hypertension and suggest new tools for its treatment.

NEW & NOTEWORTHY In this study, we reported an increased angiotensin III generation in the circulation of ob/ob mice caused by a high aminopeptidase A activity. These findings are associated with an increased natriuresis found in these mice and support the role of renin-angiotensin-aldosterone system as additional mechanism regulating blood pressure in this genetic obese strain.
A LED-based phosphorimeter for measurement of microcirculatory oxygen pressure
Authors: Guerci Philippe , Ince Yasin , Heeman Paul , Faber Dirk , Ergin Bulent , Ince Can
Published: December 2016

Quantitative measurements of microcirculatory and tissue oxygenation are of prime importance in experimental research. The noninvasive phosphorescence quenching method has given further insight into the fundamental mechanisms of oxygen transport to healthy tissues and in models of disease. Phosphorimeters are devices dedicated to the study of phosphorescence quenching. The experimental applications of phosphorimeters range from measuring a specific oxygen partial pressure (Po2) in cellular organelles such as mitochondria, finding values of Po2distributed over an organ or capillaries, to measuring microcirculatory Po2changes simultaneously in several organ systems. Most of the current phosphorimeters use flash lamps as a light excitation source. However, a major drawback of flash lamps is their inherent plasma glow that persists for tens of microseconds after the primary discharge. This complex distributed excitation pattern generated by the flash lamp can lead to inaccurate Po2readings unless a deconvolution analysis is performed. Using light-emitting diode (LED), a rectangular shaped light pulse can be generated that provides a more uniformly distributed excitation signal. This study presents the design and calibration process of an LED-based phosphorimeter (LED-P). The in vitro calibration of the LED-P using palladium(II)-meso-tetra(4-carboxyphenyl)-porphyrin (Pd-TCCP) as a phosphorescent dye is presented. The pH and temperature were altered to assess whether the decay times of the Pd-TCCP measured by the LED-P were significantly influenced. An in vivo validation experiment was undertaken to measure renal cortical Po2in a rat subjected to hypoxic ventilation conditions and ischemia/reperfusion. The benefits of using LEDs as a light excitation source are presented.
Metabolic adaptations in skeletal muscle after 84 days of bed rest with and without concurrent flywheel resistance exercise
Authors: Irimia José M. , Guerrero Mario , Rodriguez-Miguelez Paula , Cadefau Joan A. , Tesch Per A. , Cussó Roser , Fernandez-Gonzalo Rodrigo
Published: December 2016

As metabolic changes in human skeletal muscle after long-term (simulated) spaceflight are not well understood, this study examined the effects of long-term microgravity, with and without concurrent resistance exercise, on skeletal muscle oxidative and glycolytic capacity. Twenty-one men were subjected to 84 days head-down tilt bed rest with (BRE; n = 9) or without (BR; n = 12) concurrent flywheel resistance exercise. Activity and gene expression of glycogen synthase, glycogen phosphorylase (GPh), hexokinase, phosphofructokinase-1 (PFK-1), and citrate synthase (CS), as well as gene expression of succinate dehydrogenase (SDH), vascular endothelial growth factor (VEFG), peroxisome proliferator-activated receptor gamma coactivator-1 (PGC-1α), and myostatin, were analyzed in samples from m. vastus lateralis collected before and after bed rest. Activity and gene expression of enzymes controlling oxidative metabolism (CS, SDH) decreased in BR but were partially maintained in BRE. Activity of enzymes regulating anaerobic glycolysis (GPh, PFK-1) was unchanged in BR. Resistance exercise increased the activity of GPh. PGC-1α and VEGF expression decreased in both BR and BRE. Myostatin increased in BR but decreased in BRE after bed rest. The analyses of these unique samples indicate that long-term microgravity induces marked alterations in the oxidative, but not the glycolytic, energy system. The proposed flywheel resistance exercise was effective in counteracting some of the metabolic alterations triggered by 84-day bed rest. Given the disparity between gene expression vs. enzyme activity in several key metabolic markers, posttranscriptional mechanisms should be explored to fully evaluate metabolic adaptations to long-term microgravity with/without exercise countermeasures in human skeletal muscle.
Recovery of central and peripheral neuromuscular fatigue after exercise
Authors: Carroll T. J. , Taylor J. L. , Gandevia S. C.
Published: December 2016

Sustained physical exercise leads to a reduced capacity to produce voluntary force that typically outlasts the exercise bout. This “fatigue” can be due both to impaired muscle function, termed “peripheral fatigue,” and a reduction in the capacity of the central nervous system to activate muscles, termed “central fatigue.” In this review we consider the factors that determine the recovery of voluntary force generating capacity after various types of exercise. After brief, high-intensity exercise there is typically a rapid restitution of force that is due to recovery of central fatigue (typically within 2 min) and aspects of peripheral fatigue associated with excitation-contraction coupling and reperfusion of muscles (typically within 3–5 min). Complete recovery of muscle function may be incomplete for some hours, however, due to prolonged impairment in intracellular Ca2+release or sensitivity. After low-intensity exercise of long duration, voluntary force typically shows rapid, partial, recovery within the first few minutes, due largely to recovery of the central, neural component. However, the ability to voluntarily activate muscles may not recover completely within 30 min after exercise. Recovery of peripheral fatigue contributes comparatively little to the fast initial force restitution and is typically incomplete for at least 20–30 min. Work remains to identify what factors underlie the prolonged central fatigue that usually accompanies long-duration single joint and locomotor exercise and to document how the time course of neuromuscular recovery is affected by exercise intensity and duration in locomotor exercise. Such information could be useful to enhance rehabilitation and sports performance.
Transspinal direct current stimulation modulates migration and proliferation of adult newly born spinal cells in mice
Authors: Samaddar Sreyashi , Vazquez Kizzy , Ponkia Dipen , Toruno Pedro , Sahbani Karim , Begum Sultana , Abouelela Ahmed , Mekhael Wagdy , Ahmed Zaghloul
Published: December 2016

Direct current electrical fields have been shown to be a major factor in the regulation of cell proliferation, differentiation, migration, and survival, as well as in the maturation of dividing cells during development. During adulthood, spinal cord cells are continuously produced in both animals and humans, and they hold great potential for neural restoration following spinal cord injury. While the effects of direct current electrical fields on adult-born spinal cells cultured ex vivo have recently been reported, the effects of direct current electrical fields on adult-born spinal cells in vivo have not been characterized. Here, we provide convincing findings that a therapeutic form of transspinal direct current stimulation (tsDCS) affects the migration and proliferation of adult-born spinal cells in mice. Specifically, cathodal tsDCS attracted the adult-born spinal cells, while anodal tsDCS repulsed them. In addition, both tsDCS polarities caused a significant increase in cell number. Regarding the potential mechanisms involved, both cathodal and anodal tsDCS caused significant increases in expression of brain-derived neurotrophic factor, while expression of nerve growth factor increased and decreased, respectively. In the spinal cord, both anodal and cathodal tsDCS increased blood flow. Since blood flow and angiogenesis are associated with the proliferation of neural stem cells, increased blood flow may represent a major factor in the modulation of newly born spinal cells by tsDCS. Consequently, we propose that the method and novel findings presented in the current study have the potential to facilitate cellular, molecular, and/or bioengineering strategies to repair injured spinal cords.

NEW & NOTEWORTHY Our results indicate that transspinal direct current stimulation (tsDCS) affects the migratory pattern and proliferation of adult newly born spinal cells, a cell population which has been implicated in learning and memory. In addition, our results suggest a potential mechanism of action regarding the functional effects of applying direct current. Thus tsDCS may represent a novel method by which to manipulate the migration and cell number of adult newly born cells and restore functions following brain or spinal cord injury.
Laparoscopic versus Open Surgery for Diverticulitis: A Systematic Review and Meta-Analysis
Authors: Wu Kuen-Lin , Lee Ko-Chao , Liu Chia-Cheng , Chen Hong-Hwa , Lu Chien-Chang
Published: December 2016

Background/Aims: The study aimed to perform a meta-analysis comparing laparoscopic and open surgery for diverticulitis. Methods: Studies comparing the outcomes of laparoscopic surgery versus open surgery for diverticulitis that reported quantitative data were included. Outcome measures were mortality and morbidity rates and length of hospital stay. Results: Four randomized controlled trials - 3 prospective and 21 retrospective - were included in the analysis. The total numbers of patients ranged from 5 to 14,562 in the laparoscopic groups and from 4 to 110,172 in the open surgery groups, and the mean patient age ranged from 38.9 to 78 years. Overall analysis revealed that laparoscopic surgery was associated with lower mortality (pooled OR 0.40, 95% CI 0.25-0.63, p < 0.001) and a lower overall morbidity rate (pooled OR 0.65, 95% CI 0.51-0.82, p < 0.001) than open surgery. Laparoscopic surgery was associated with a higher anastomotic bleeding rate, but lower rates of ileus, anastomotic leakage, small bowel obstruction, wound infection, fascial dehiscence and intra-abdominal abscesses. Length of hospital stay was less with laparoscopic surgery. Conclusions: The current meta-analysis supports the use of laparoscopy for the treatment of diverticulitis. The results, however, should be interpreted with caution.
Enhanced Recovery after Elective Colorectal Surgery - Reasons for Non-Compliance with the Protocol
Authors: Roulin Didier , Muradbegovic Mirza , Addor Valérie , Blanc Catherine , Demartines Nicolas , Hübner Martin
Published: December 2016

Background/Aims: Enhanced recovery after surgery (ERAS) protocols for elective colorectal surgery reduce the intensity of postoperative complications, hospital stays and costs. Improvements in clinical outcome are directly proportional to the adherence to the recommended pathway (compliance). The aim of the present study was to analyze reasons for the non-compliance of colorectal surgeries with the ERAS protocol. Methods: A consecutive cohort of patients undergoing elective colorectal surgery was prospectively analyzed with regards to the surgery's compliance with the ERAS protocol. The reason for every single protocol deviation was documented and the decision was categorized based on whether it was medically justified or not. Results: During the 8-month study period, 76 patients were included. The overall compliance with 22 ERAS items was 76% (96% in the preoperative, 82% in the perioperative, and 63% in the postoperative period). The decision to deviate from the clinical pathway was mainly a medical decision, while patients and nurses were responsible in 26 and 14% of the cases, respectively. However, reasons for non-compliance were medically justified in 78% of the study participants. Conclusion: ‘Non-compliance' with the ERAS protocol was observed mostly in the postoperative period. Most deviations from the pathway were decided by doctors and in a majority of cases it appeared that they were due to a medical necessity rather than non-compliance. However, almost a quarter of deviations that were absolutely required are still amenable to improvement.
The Utility of Neutrophil to Lymphocyte Ratio as a Predictor of Intervention in Acute Diverticulitis
Authors: Reynolds Ian S. , Heaney Roisin M. , Khan Waqar , Khan Iqbal Z. , Waldron Ronan , Barry Kevin
Published: December 2016

Background: Neutrophil to lymphocyte ratio (NLR) is a novel biomarker that has been recently studied in diverticulitis. The primary aim of this study was to assess the accuracy of NLR in predicting which patients had complicated diverticulitis and which patients required a radiological or surgical intervention. The accuracy of NLR was compared to C-reactive protein (CRP), white blood cell (WBC) count, neutrophil count and white cell to lymphocyte ratio (WLR). Methods: Details of all patients admitted with acute diverticulitis over an 18-month period were collected prospectively. Median CRP, WBC, neutrophil count, WLR and NLR values at initial presentation were compared using the Mann-Whitney U test. The diagnostic accuracy of each test was assessed using receiver operating characteristic curve analysis. Optimal cut-off points were determined for each biomarker using Youden's Index (J). Results: CRP, WBC, neutrophil count, WLR and NLR had variable accuracy in predicting complicated diverticulitis. NLR had the greatest accuracy of the 5 biomarkers in predicting the need for intervention with an area under the curve of 0.79 (p < 0.0001). The optimal cut-off point for NLR was 5.34 (J = 0.45). Conclusion: NLR was more accurate than CRP, WBC, neutrophil count and WLR in predicting the need for intervention. This cost-neutral, readily available biomarker can easily be calculated from the complete blood count and is a useful adjunct to CT.
Outcome of Gastric Cancer Surgery in Patients with Chronic Kidney Disease
Authors: Wakahara Tomoyuki , Ueno Nozomi , Komatsu Shohei , Ashitani Hiroshi , Tsuchida Shinobu , Toyokawa Akihiro
Published: December 2016

Background: The influence of chronic kidney disease (CKD) on the outcome of gastric cancer surgery has rarely been reported. Methods: Retrospectively collected clinicopathological data on patients who underwent elective gastrectomy between January 2007 and December 2014 were analyzed (n = 500). The patients were divided into 2 groups based on the preoperative estimated glomerular filtration rate (eGFR): a non-CKD group (eGFR ≥60 ml/min/1.73 m2, n = 392) and a CKD group (eGFR <60 ml/min/1.73 m2, n = 108). Short- and long-term results of the surgery were compared. Results: There was no significant difference between the 2 groups in terms of the overall morbidity rate (p = 0.215), and in any kind of postoperative complication, including infectious and cardiovascular complications. Additionally, there was no significant difference in the morbidity rate irrespective of the type of gastrectomy and the extent of lymph node dissection. The 3-year relapse-free survival rates in the non-CKD and CKD groups were 92.1 and 92.0%, respectively, in stage I disease (p = 0.640), 81.4 and 73.7%, respectively, in stage II disease (p = 0.825), and 35.9 and 31.9%, respectively, in stage III disease (p = 0.784). Conclusion: CKD did not affect the short- and long-term outcomes in patients after gastric cancer surgery.
Clinical Analysis of Stercoral Perforation without Mortality
Authors: Ryu Chun-Geun , Kim Pyeongsu , Cho Min Jeng , Shin Milljae , Jung Eun-Joo
Published: December 2016

Aims: This study was designed to review the clinical features of stercoral colonic perforation and to evaluate the appropriate intraoperative procedures and postoperative management to achieve the best surgical outcomes. Methods: Between January 2009 and December 2015, 12 patients with stercoral perforation confirmed surgically and pathologically were included in this study, and their medical records were reviewed retrospectively. Results: The enrolled patients included 2 men and 10 women; their mean age was 73.8 years. Abdomino-pelvic CT was an important diagnostic tool, which revealed fecalomas, extraluminal air and pericolic fat stranding in all patients. Hartmann's operation was performed in all patients, with a mean operation time of 239.3 min. Perforation site was in the left colon, mainly in the sigmoid colon. Intraoperative hypotension developed in 8 cases (66.7%). Postoperatively, all patients needed intensive care for 6.5 days and 6 patients needed the administration of inotropic agents for 3.0 days postoperatively. Disseminated intravascular coagulation developed in 10 cases (83.3%). There was no surgical mortality. Conclusion: Colorectal surgeons should be aware of the possibility of stercoral perforation, despite its rare incidence. Deep understanding of this potentially fatal disease by surgeons could reduce surgical mortality and improve postoperative outcomes.
Prospective Evaluation of Discharge Trends after Colorectal Surgery within an Enhanced Recovery after Surgery Pathway
Authors: Slieker Juliette C. , Clerc Daniel , Hahnloser Dieter , Demartines Nicolas , Hübner Martin
Published: December 2016

Introduction: Enhanced recovery after surgery (ERAS) pathways proved to reduce complications, length of hospital stay and costs after colorectal surgery. Standardized discharge criteria have been established that are fulfilled after complete medical recovery is achieved. This study aimed to assess the timing of complete medical recovery in relation to the timing of actual discharge, and to assess reasons for prolonged hospital stay within an ERAS pathway. Methods: One hundred fourteen consecutive patients undergoing elective colorectal surgery within an ERAS pathway were included in this prospective analysis. Fulfillment of discharge criteria was assessed daily and reasons for prolonged hospital stay were documented. Results: Thirty percent of patients went home on the day that all discharge criteria were met. Overall, patients were discharged at a median of 2 days (interquartile range 1-3) after fulfillment of discharge criteria. Reasons for delayed discharge were (1) organizational in 20%; (2) patient or surgeon unwilling in 29%; and (3) because the patient was deemed to be discharged too soon distance from the operation in 51%. Conclusion: In this observational study, only 30% of patients were discharged on the day all recovery criteria were met. The main reason for continued hospitalization was surgeon- or patient-related reluctance or ‘precaution'; thus, better and more of general information seems to be necessary.
Advantages of Early Preventive Ileostomy Closure after Total Mesorectal Excision Surgery for Rectal Cancer: An Institutional Retrospective Study of 123 Consecutive Patients
Authors: Zhou Min-Wei , Wang Zi-Hao , Chen Zong-You , Xiang Jian-Bin , Gu Xiao-Dong
Published: December 2016

Background/Aim: Preventive ileostomy is frequently constructed to minimizethe consequences of anastomotic leakage after resection of rectal cancer. There is no consensus regarding the best timing for temporary stoma closure after proctectomy for rectal cancer. This retrospective study sought to determine whether the timing of stoma closure influenced postoperative outcomes. Methods: Subjects were 123 patients with rectal cancer undergoing laparoscopic or open total mesorectal excision surgery with preventive ileostomy from 2012 to 2015. They were divided into 2 groups according the timing of stoma closure: the standard group who had closure within 90 (60-120) days (n = 78) and the late group who had closure after 180 (150-210) days (n = 45). Results: There was no significant difference in operative time, operative blood loss or postoperative complications between the 2 groups. Timing of postoperative fasting and length of hospital stay was similar in both groups. Adjuvant chemotherapy was not a risk factor for postoperative complications after stoma closure. Conclusions: There was no significant difference between different timings of temporary stoma closure in relation to postoperative complications. Delayed stoma closure showed no benefit in prevention of morbidity. Early closure is safe and can provide better quality of life for patients.
Arterial Iron Content Is Increased in Patients with High Plasma Ferritin Levels
Authors: Madsen Julie Bukh , Pedersen Lise , Kidholm Christina Lund , Rasmussen Lars Melholt
Published: December 2016

The association between increased amounts of stored iron and development of cardiovascular disease (CVD) has been recognized for many years. However, basic information on iron content in human arteries is limited. We envision that associations between body iron content and CVD are based on the accumulation of iron in the arteries, possibly leading to the dysfunction of cellular biochemical pathways. This study addresses the very fundamental question of whether there is a relation between body iron content and the level of iron accumulated in arterial tissue. The iron content in human nonatherosclerotic artery samples from patients with high and low body-iron contents estimated from the plasma ferritin concentration were determined by inductively coupled plasma mass spectroscopy in tissue extracts and by histological staining, using a modified Perls reaction to display iron deposits. We found that the arteries contained small but measurable levels of iron. The iron content was significantly higher in tissue from patients with high plasma ferritin (p = 0.026). Histological staining showed the presence of iron deposits. Our results suggest that iron does accumulate in arterial tissue in accordance to the level of stored body iron. Further studies are needed on the distribution of iron in excess to explain the relationship between stored iron and the development of atherosclerosis.
Early Detection of Desiccation and Curettage Failure in the Treatment of Basal Cell Carcinoma
Authors: Woldow Adam B. , Melvin Megan E.
Published: December 2016

Background/Aims: Basal cell carcinoma (BCC) is a malignant neoplasm of keratinocytes. Electrodessication and curettage (ED&C) published cure rates vary widely, and the authors of this study are unaware of any previous literature which has attempted to rapidly identify treatment failures. Objective: To identify BCC ED&C failures by histologically analyzing the fragments produced by the third round of curettage. Methods: The monitoring of routine therapy of 862 cases of BCC that were treated by ED&C followed by the submission of cautery fragments of the third round of curettage for histological and immunohistochemical testing. Results: Of the 862 cases, 764 (89%) had no residual BCC seen in their curetting. Of these patients, zero recurrences (0%) were noted. Forty-eight of the 862 cases had residual BCC seen in their curetting and elected to receive no additional therapy. Eighteen (38%) had a recurrence detected. Fifty of the 862 cases had residual BCC seen in their curetting and elected for immediate re-excision. Thirty-five (70%) had histological evidence of residual BCC. Limitations: The study was performed at a single center with 2 years of follow-up. Conclusion: Pathological examination of curettage fragments in combination with immunohistochemistry testing appears to be beneficial in predicting which patients are likely to have recurrence of BCC after ED&C.