bluuebunny/crossref_metadata_2025 huggingface dataset:
The Recognition of STEMI by Paramedics and the Effect of Computer inTerpretation (RESPECT): a randomised crossover feasibility study
Authors: Pilbery Richard , Teare M Dawn , Goodacre Steve , Morris Francis
Published: February 2016

Background

The appropriate management of patients with ST-segment elevation myocardial infarction (STEMI) depends on accurate interpretation of the 12-lead ECG by paramedics. Computer interpretation messages on ECGs are often provided, but the effect they exert on paramedics' decision-making is not known. The objective of this study was to assess the feasibility of using an online assessment tool, and collect pilot data, for a definitive trial to determine the effect of computer interpretation messages on paramedics' diagnosis of STEMI.

Methods

The Recognition of STEMI by Paramedics and the Effect of Computer inTerpretation (RESPECT) feasibility study was a randomised crossover trial using a bespoke, web-based assessment tool. Participants were randomly allocated 12 of 48 ECGs, with an equal mix of correct and incorrect computer interpretation messages, and STEMI and STEMI-mimics. The nature of the responses required a cross-classified multi-level model.

Results

254 paramedics consented into the study, 205 completing the first phase and 150 completing phase two. The adjusted OR for a correct paramedic interpretation, when the computer interpretation was correct (true positive for STEMI or true negative for STEMI-mimic), was 1.80 (95% CI 0.84 to 4.91) and 0.58 (95% CI 0.41 to 0.81) when the computer interpretation was incorrect (false positive for STEMI or false negative for STEMI-mimic). The intraclass correlation coefficient for correct computer interpretations was 0.33 for participants and 0.17 for ECGs, and for incorrect computer interpretations, 0.06 for participants and 0.01 for ECGs.

Conclusions

Determining the effect of computer interpretation messages using a web-based assessment tool is feasible, but the design needs to take clustered data into account. Pilot data suggest that computer messages influence paramedic interpretation, improving accuracy when correct and worsening accuracy when incorrect.
Veterinary treatment strategies for clinical mastitis in dairy cows in Sweden
Authors: Persson Waller K. , Hårdemark V. , Nyman A.‐K. , Duse A.
Published: February 2016

To evaluate if Swedish veterinary guidelines on use of antimicrobials in cases of clinical mastitis in dairy cows have been adopted by veterinary practitioners, their treatment strategies were evaluated in a cross‐sectional study using a web‐based questionnaire. Another aim was to study if the strategies differed among veterinarians due to year and country of exam, sex, region, numbers of mastitis cases per month, and postgraduate training in herd health using multivariable logistic regression models. In total, 267 of 741 (36 per cent) veterinarians contacted answered the questionnaire satisfactorily. Most considered bacteriological diagnostics important, but many veterinarians made treatment decisions without collecting information on antimicrobial susceptibility. Moreover, few veterinarians used measuring tape to assess bodyweight before dosing parenteral antimicrobials. Year of exam and postgraduate training were the veterinary demographic factors associated with most treatment routines. The questions associated with most demographic factors were if antimicrobial treatment is affected by knowledge on earlier udder pathogens in the herd, and how often NSAID and follow‐up of treatment using milk somatic cell count are used. Overall, the veterinarians followed the Swedish guidelines rather well, but discrepancies in need for improvement were found.
Comparison between parameters from maximal cycle ergometer test first without respiratory gas analysis and thereafter with respiratory gas analysis among healthy prepubertal children
Authors: Tompuri Tuomo T. , Lintu Niina , Soininen Sonja , Laitinen Tomi , Lakka Timo Antero
Published: February 2016

It is important to distinguish true and clinically relevant changes and methodological noise from measure to measure. In the clinical practice, maximal cycle ergometer tests are typically performed first without respiratory gas analysis and thereafter, if needed, with respiratory gas analysis. Therefore, we report a comparison of parameters from maximal cycle ergometer exercise tests that were done first without respiratory gas analysis and thereafter with it in 38 prepubertal and healthy children (20 girls, 18 boys). The Bland–Altman method was used to assess agreement in maximal workload (WMAX), heart rate (HR), and systolic blood pressure (SBP) between rest and maximum. Girls achieved higher WMAX in the exercise tests with respiratory gas analysis compared with exercise tests without respiratory gas analysis (p = 0.016), whereas WMAX was similar in the tests among boys. Maximal HR (proportional offset, –1%; coefficients of variation, 3.3%) and highest SBP (proportional offset, 3%; coefficients of variation, 10.6%) were similar in the tests among children. Precision and agreement for HR improved and precision for SBP worsened with increasing exercise intensity. Heteroscedasticity was not observed for WMAX, HR, or SBP. We conclude that maximal cycle ergometer tests without and with respiratory gas analysis can be used consecutively because measurement of respiratory gases did not impair performance or have a significant effect on the maximality of the exercise tests. Our results suggest that similar references can be used for children who accept or refuse using a mask during a maximal exercise test.
Detection of Intracranial Signatures of Interictal Epileptiform Discharges from Concurrent Scalp EEG
Authors: Spyrou Loukianos , Martín-Lopez David , Valentín Antonio , Alarcón Gonzalo , Sanei Saeid
Published: February 2016

Interictal epileptiform discharges (IEDs) are transient neural electrical activities that occur in the brain of patients with epilepsy. A problem with the inspection of IEDs from the scalp electroencephalogram (sEEG) is that for a subset of epileptic patients, there are no visually discernible IEDs on the scalp, rendering the above procedures ineffective, both for detection purposes and algorithm evaluation. On the other hand, intracranially placed electrodes yield a much higher incidence of visible IEDs as compared to concurrent scalp electrodes. In this work, we utilize concurrent scalp and intracranial EEG (iEEG) from a group of temporal lobe epilepsy (TLE) patients with low number of scalp-visible IEDs. The aim is to determine whether by considering the timing information of the IEDs from iEEG, the resulting concurrent sEEG contains enough information for the IEDs to be reliably distinguished from non-IED segments. We develop an automatic detection algorithm which is tested in a leave-subject-out fashion, where each test subject’s detection algorithm is based on the other patients’ data. The algorithm obtained a [Formula: see text] accuracy in recognizing scalp IED from non-IED segments with [Formula: see text] accuracy when trained and tested on the same subject. Also, it was able to identify nonscalp-visible IED events for most patients with a low number of false positive detections. Our results represent a proof of concept that IED information for TLE patients is contained in scalp EEG even if they are not visually identifiable and also that between subject differences in the IED topology and shape are small enough such that a generic algorithm can be used.
Precaution for volume conduction in rodent cortical electroencephalography using high-density polyimide-based microelectrode arrays on the skull
Authors: Stienen P. J. , Venzi M. , Poppendieck W. , Hoffmann K. P. , Åberg E.
Published: February 2016

In humans, significant progress has been made to link spatial changes in electroencephalographic (EEG) spectral density, connectivity strength, and phase-amplitude modulation to neurological, physiological, and psychological correlates. In contrast, standard rodent EEG techniques employ only few electrodes, which results in poor spatial resolution. Recently, a technique was developed to overcome this limitation in mice. This technique was based on a polyimide-based microelectrode (PBM) array applied on the mouse skull, maintaining a significant number of electrodes with consistent contact, electrode impedance, and mechanical stability. The present study built on this technique by extending it to rats. Therefore, a similar PBM array, but adapted to rats, was designed and fabricated. In addition, this array was connected to a wireless EEG headstage, allowing recording in untethered, freely moving rats. The advantage of a high-density array relies on the assumption that the signal recorded from the different electrodes is generated from distinct sources, i.e., not volume-conducted. Therefore, the utility and validity of the array were evaluated by determining the level of synchrony between channels due to true synchrony or volume conduction during basal vigilance states and following a subanesthetic dose of ketamine. Although the PBM array allowed recording with high signal quality, under both drug and drug-free conditions, high synchronization existed due to volume conduction between the electrodes even in the higher spectral frequency range. Discrimination existed only between frontally and centrally/distally grouped electrode pairs. Therefore, caution should be used in interpreting spatial data obtained from high-density PBM arrays in rodents.
Locomotor sequence learning in visually guided walking
Authors: Choi Julia T. , Jensen Peter , Nielsen Jens Bo
Published: February 2016

Voluntary limb modifications must be integrated with basic walking patterns during visually guided walking. In this study we tested whether voluntary gait modifications can become more automatic with practice. We challenged walking control by presenting visual stepping targets that instructed subjects to modify step length from one trial to the next. Our sequence learning paradigm is derived from the serial reaction-time (SRT) task that has been used in upper limb studies. Both random and ordered sequences of step lengths were used to measure sequence-specific and sequence-nonspecific learning during walking. In addition, we determined how age (i.e., healthy young adults vs. children) and biomechanical factors (i.e., walking speed) affected the rate and magnitude of locomotor sequence learning. The results showed that healthy young adults (age 24 ± 5 yr, n = 20) could learn a specific sequence of step lengths over 300 training steps. Younger children (age 6–10 yr, n = 8) had lower baseline performance, but their magnitude and rate of sequence learning were the same compared with those of older children (11–16 yr, n = 10) and healthy adults. In addition, learning capacity may be more limited at faster walking speeds. To our knowledge, this is the first study to demonstrate that spatial sequence learning can be integrated with a highly automatic task such as walking. These findings suggest that adults and children use implicit knowledge about the sequence to plan and execute leg movement during visually guided walking.
Optimum Tuning of a Gyroscopic Vibration Absorber Using Coupled Gyroscopes for Vibration Control of a Vertical Cantilever Beam
Authors: Ünker F. , Çuvalcı O.
Published: February 2016

This paper deals with the investigation of optimum values of the stiffness and damping which connect two gyroscopic systems formed by two rotors mounted in gimbal assuming negligible masses for the spring, damper, and gimbal support. These coupled gyroscopes use two gyroscopic flywheels, spinning in opposing directions to have reverse precessions to eliminate the forces due to the torque existing in the torsional spring and the damper between gyroscopes. The system is mounted on a vertical cantilever with the purpose of studying the horizontal and vertical vibrations. The equation of motion of the compound system (gyro-beam system) is introduced and solved to find the response measured on the primary system. This is fundamental to design, in some way, the dynamic absorber or neutralizer. On the other hand, the effect of the angular velocities of the gyroscopes are studied, and it is shown that the angular velocity (spin velocity) of a gyroscope has a significant effect on the behavior of the dynamic motion. Correctness of the analytical results is verified by numerical simulations. The comparison with the results from the derivation of the corresponding frequency equations shows that the optimized stiffness and damping values are very accurate.
Neighborhood Kalman Estimation for Distributed Localization in Wireless Sensor Networks
Authors: Wang Xiaochu , Sun Ting , Fan Chunshi
Published: February 2016

Accurate location information plays an important role in the performance of wireless sensor networks since many mission applications depend on it. This paper proposes a fully distributed localization algorithm based on the concept of data fusion, allowing the full intranodes information including the correlations among estimates to take part in the algorithm. By properly constructing and updating the estimates as well as the corresponding covariance matrices, the algorithm can fuse intranodes information to generate more accurate estimates on the sensor locations with a fast speed. Finally, numerical simulations are given as examples to demonstrate the effectiveness of the algorithm.
Optimal Design and Analysis of the Stepped Core for Wireless Power Transfer Systems
Authors: Zhang Xiu , Zhang Xin
Published: February 2016

The key of wireless power transfer technology rests on finding the most suitable means to improve the efficiency of the system. The wireless power transfer system applied in implantable medical devices can reduce the patients’ physical and economic burden because it will achieve charging in vitro. For a deep brain stimulator, in this paper, the transmitter coil is designed and optimized. According to the previous research results, the coils with ferrite core can improve the performance of the wireless power transfer system. Compared with the normal ferrite core, the stepped core can produce more uniform magnetic flux density. In this paper, the finite element method (FEM) is used to analyze the system. The simulation results indicate that the core loss generated in the optimal stepped ferrite core can reduce about 10% compared with the normal ferrite core, and the efficiency of the wireless power transfer system can be increased significantly.
[Retracted] The Effects of Positive or Neutral Communication during Acupuncture for Relaxing Effects: A Sham‐Controlled Randomized Trial
Authors: Rosén Annelie , Lekander Mats , Jensen Karin , Sachs Lisbeth , Petrovic Predrag , Ingvar Martin , Enblom Anna
Published: February 2016

Introduction. The link between patient‐clinician communication and its effect on clinical outcomes is an important clinical issue that is yet to be elucidated. Objective. Investigating if communication type (positive or neutral) about the expected treatment outcome affected (i) participants’ expectations and (ii) short‐term relaxation effects in response to genuine or sham acupuncture and investigating if expectations were related to outcome. Methods. Healthy volunteers (n = 243, mean age of 42) were randomized to one treatment with genuine or sham acupuncture. Within groups, participants were randomized to positive or neutral communication, regarding expected treatment effects. Visual Analogue Scales (0–100 millimeters) were used to measure treatment expectations and relaxation, directly before and after treatment. Results. Participants in the positive communication group reported higher treatment expectancy, compared to the neutral communication group (md 12 versus 6 mm, p = 0.002). There was no difference in relaxation effects between acupuncture groups or between communication groups. Participants with high baseline expectancy perceived greater improvement in relaxation, compared to participants with low baseline levels (md 27 versus 15 mm, p = 0.022). Conclusion. Our data highlights the importance of expectations for treatment outcome and demonstrates that expectations can be effectively manipulated using a standardized protocol that in future research may be implemented in clinical trials.
Transient Electromagnetic Field Coupling to Buried Thin Wire Configurations: Antenna Model versus Transmission Line Approach in the Time Domain
Authors: Poljak Dragan , Šesnić Silvestar , El-Khamlichi Drissi Khalil , Kerroum Kamal , Tkachenko Sergey
Published: February 2016

The paper examines the antenna model for the transient analysis of electromagnetic field coupling to straight wire configurations buried in a lossy half-space. The wire antenna theory (AT) model is implemented directly in the time domain and it is based on the corresponding space-time Pocklington integrodifferential equation. The solution of the Pocklington equation is carried out analytically. The obtained results are compared against the results calculated via the transmission line (TL) approach. The TL approach is based on the telegrapher’s equations, which are solved using the modified transmission line method (MTLM) and Finite Difference Time Domain (FDTD) technique, respectively. Some illustrative computational examples for buried straight wire scatterer and horizontal grounding electrode are given throughout this work.
Impact of HIV Infection and Zidovudine Therapy on RBC Parameters and Urine Methylmalonic Acid Levels
Authors: Adediran Adewumi , Osunkalu Vincent , Wakama Tamunomieibi , John-Olabode Sarah , Akinbami Akinsegun , Uche Ebele , Akanmu Sulaimon
Published: February 2016

Background. Anaemia is a common complication of human immunodeficiency virus (HIV) infection. The aim of this study was to investigate the impact of HIV infection and zidovudine on red blood cells (RBC) parameters and urine methylmalonic acid (UMMA) levels in patients with HIV infection.Material and Methods. A cross-sectional study involving 114 subjects, 94 of which are HIV-infected nonanaemic and 20 HIV negative subjects (Cg) as control. Full blood count parameters and urine methylmalonic acid (UMMA) level of each subject were determined. Associations were determined by Chi-square test and logistic regression statistics where appropriate.Results. Subjects on zidovudine-based ART had mean MCV (93 fL) higher than that of control group (82.9 fL) and ART-naïve (85.9 fL) subjects and the highest mean RDW. Mean UMMA level, which reflects vitamin B12 level status, was high in all HIV-infected groups but was significantly higher in ART-naïve subjects than in ART-experienced subjects.Conclusion. Although non-zidovudine therapy may be associated with macrocytosis (MCV > 95 fL), zidovudine therapy and ART naivety may not. Suboptimal level of vitamin B12 as measured by high UMMA though highest in ART-naïve subjects was common in all HIV-infected subjects.
A Residual-Based Kernel Regression Method for Image Denoising
Authors: Wang Jiefei , Chen Yupeng , Li Tao , Lu Jian , Shen Lixin
Published: February 2016

We propose a residual-based method for denoising images corrupted by Gaussian noise. In the method, by combining bilateral filter and structure adaptive kernel filter together with the use of the image residuals, the noise is suppressed efficiently while the fine features, such as edges, of the images are well preserved. Our experimental results show that, in comparison with several traditional filters and state-of-the-art denoising methods, the proposed method can improve the quality of the restored images significantly.
The Dipeptides Ile-Tyr and Ser-Tyr Exert Distinct Effects on Catecholamine Metabolism in the Mouse Brainstem
Authors: Moriyasu Kazuki , Ichinose Takashi , Nakahata Akane , Tanaka Mitsuru , Matsui Toshiro , Furuya Shigeki
Published: February 2016

Catecholamine synthesis and transmission in the brain are influenced by the availability of Tyr in the body. In this study, we compared the effects of oral administration of Tyr-containing dipeptides Ile-Tyr, Ser-Tyr, and Tyr-Pro with Tyr alone on catecholamine metabolism in the mouse brainstem. Among these dipeptides, Ile-Tyr administration led to increases in dopamine, the dopamine metabolites homovanillic acid, and 3,4-dihydroxyphenylacetic acid, compared to administration of Ser-Tyr, Tyr-Pro, or Tyr alone. In comparison, administration of Ser-Tyr induced significantly increasing noradrenaline turnover, while Tyr-Pro administration suppressed dopamine turnover. Therefore, oral administration of Ile-Tyr, Ser-Tyr, and Tyr-Pro differentially affected metabolism of dopamine and noradrenaline. These observations strongly suggest that Tyr-containing dipeptides exert distinct effects on catecholamine metabolism in the brainstem when ingested orally.
Neck Circumference May Be a Better Alternative to Standard Anthropometric Measures
Authors: Joshipura Kaumudi , Muñoz-Torres Francisco , Vergara José , Palacios Cristina , Pérez Cynthia M.
Published: February 2016

This paper evaluates neck circumference as a metabolic risk marker. Overweight/obese, nondiabetic Hispanics, 40–65 years old, who are free of major cardiovascular diseases, were recruited for the San Juan Overweight Adults Longitudinal Study (SOALS). Baseline exams were completed by 1,206 participants. Partial correlation coefficients (r) and logistic models adjusted for age, gender, smoking status, and physical activity were computed. Neck circumference was significantly correlated with waist circumference (r=0.64), BMI (r=0.66), and body fat % (r=0.45). Neck circumference, highest (compared to lowest) tertile, had higher association with prediabetes: multivariable OR = 2.30 (95% CI: 1.71–3.06) compared to waist circumference OR = 1.97 (95% CI: 1.48–2.66) and other anthropometric measures. Neck circumference showed higher associations with HOMA, low HDL-C, and triglycerides, multivariable OR = 8.42 (95% CI: 5.43–13.06), 2.41 (95% CI: 1.80–3.21), and 1.52 (95% CI: 1.14–2.03), but weaker associations with hs-CRP and hypertension, OR = 3.61 (95% CI: 2.66–4.90) and OR = 2.58 (95% CI: 1.90–3.49), compared to waist circumference. AIC for model fit was generally similar for neck or waist circumference. Neck circumference showed similar or better associations with metabolic factors and is more practicable than waist circumference. Hence, neck circumference may be a better alternative to waist circumference.
The Use of Computer-Assisted Home Exercises to Preserve Physical Function after a Vestibular Rehabilitation Program: A Randomized Controlled Study
Authors: Smaerup Michael , Laessoe Uffe , Grönvall Eric , Henriksen Jens-Jacob , Damsgaard Else Marie
Published: February 2016

Objective.The purpose of this study was to evaluate whether elderly patients with vestibular dysfunction are able to preserve physical functional level, reduction in dizziness, and the patient’s quality of life when assistive computer technology is used in comparison with printed instructions.Materials and Methods. Single-blind, randomized, controlled follow-up study. Fifty-seven elderly patients with chronic dizziness were randomly assigned to a computer-assisted home exercise program or to home exercises as described in printed instructions and followed for tree month after discharge from an outpatient clinic.Results. Both groups had maintained their high functional levels three months after finishing the outpatient rehabilitation. No statistically significant difference was found in outcome scores between the two groups. In spite of moderate compliance levels, the patients maintained their high functional level indicating that the elderly should not necessarily exercise for the first three months after termination of the training in the outpatient clinic.Conclusion. Elderly vestibular dysfunction patients exercising at home seem to maintain their functional level, level of dizziness, and quality of life three months following discharge from hospital. In this specific setup, no greater effect was found by introducing a computer-assisted training program, when compared to standard home training guided by printed instructions. This trial is registered withNCT01344408.
Characteristic Profiles of an Original Drink Sap from Male and Female Deglet Nour Palm (Phoenix dactyliferaL.) during Collection Period
Authors: Makhlouf-Gafsi Ines , Mokni-Ghribi Abir , Attia Hamadi , Blecker Christophe , Besbes Souhail
Published: February 2016

This work aimed to evaluate the nutritional quality of a typical natural drink from male and female Deglet Nour (DN) date palm (Phoenix dactyliferaL.) during the collection period. Dry matter, protein, amino acids, and sugar profiles were determined using AFNOR norm, Kjeldahl method, HPLC, and HPAEC-PAD, respectively. The male sap dry matter content was higher than that of the female. It decreased significantly through the tapping period. During the harvest, the male sap protein content decreased but increased significantly in the female sap. Finally, sugar fraction, for both male and female DN sap, was dominated by sucrose, glucose, fructose, and a small amount of myo-inositol. During the collection time, sugar content is affected by the sex especially for myo-inositol content that increased significantly in the female date sap, unlike that of the male one. This may be related to the fact that the male palm is more resistant to physiological stress, inducing myo-inositol formation during tapping.
Ensuring Reliable Communication in Disaster Recovery Operations with Reliable Routing Technique
Authors: Menon Varun G. , Pathrose Joe Prathap , Priya Jogi
Published: February 2016

The purpose of this research paper is to ensure reliable and continuous communication between the rescue officers and other people during disaster recovery and reconstruction operations. Most of the communication infrastructure gets damaged during the disaster and proper communication cannot be established in the area which leads to longer delays in emergency operations and increased damage to life and property. Various methods proposed to enable communication between the people using wireless ad hoc networks do not guarantee reliable delivery of data with fast moving devices. This paper presents a Reliable Routing Technique (RRT) that ensures reliable data delivery at the destination device even when the people with the mobile devices are moving in the network. We make use of the broadcasting property of the wireless network and create a priority list of probable forwarding candidates at each device. With this technique, RRT ensures that if a forwarder device is unable to forward the data packet due to movement of mobile devices, the next priority candidate forwards the data packet to the destination device, thus ensuring reliability of data delivery in the network. Simulation results show that RRT achieves significant performance improvement with better data delivery in ad hoc networks.
Inhibition of P38 MAPK Downregulates the Expression of IL-1βto Protect Lung from Acute Injury in Intestinal Ischemia Reperfusion Rats
Authors: Zheng De-Yi , Zhou Min , Jin Jiao , He Mu , Wang Yi , Du Jiao , Xiao Xiang-Yang , Li Ping-Yang , Ye Ai-Zhu , Liu Jia , Wang Ting-Hua
Published: February 2016

Acute lung injury (ALI) induced by intestinal ischemia/reperfusion (II/R) has high incidence and mortality, in which IL-1βwas essential for the full development of ALI. However, the detailed regulating mechanism for this phenomenon remains to be unclear. The purpose of this study was to investigate whether inhibition of P38 MAPK could downregulate the expression of IL-1βto protect lung from acute injury in II/R rats. Here, we found that the level of pulmonary edema at 16 hours after operation (hpo) was obviously enhanced compared to that in 8hpo and sham groups. Immunofluorescent staining demonstrated that IL-1βand P38 MAPK were detected in lung tissues. And rats with II/R have the highest translation level for IL-1βand phosphorylation of P38 MAPK in lung tissues at 16hpo compared with 8hpo and sham groups. Moreover, administration of SB239063, an inhibitor of P38αandβ, could effectively downregulate the expressions of IL-1βand protects lung tissues from injury in II/R rats. Our findings indicate that the inhibition of P38αandβmay downregulate the expression of IL-1βto protect lung from acute injury in II/R, which could be used as a potential target for reducing ALI induced by II/R in the future clinical trial.
Effects of Standardised Fermented Papaya Gel on Clinical Symptoms, Inflammatory Cytokines, and Nitric Oxide Metabolites in Patients with Chronic Periodontitis: An Open Randomised Clinical Study
Authors: Kharaeva Zaira F. , Zhanimova Lyana R. , Mustafaev Magomet Sh. , De Luca Chiara , Mayer Wolfgang , Chung Sheun Thai Jeffrey , Tiew Siok Tuan Rebecca , Korkina Liudmila G.
Published: February 2016

The clinical efficacy of topical administration of standardised fermented papaya gel (SFPG), known to have antioxidant and anti-inflammatory properties,versusconventional therapy was evaluated in a group of 84 patients with moderate-to-severe periodontitis, randomly assigned to control group (n=45) undergoing traditional pharmacologic/surgical protocols or to experimental group (n=39), additionally treated with intragingival pocket SFPG (7 g) applications (15 min daily for 10 days). Patients undergoing SFPG treatment showed significant (P<0.05), durable improvement of three major clinical indices of disease severity: reduced bleeding (day 7), plaque and gingival conditions (day 14), and consistent gingival pocket depth reduction (day 45). Proinflammatory nitric oxide metabolites reached normal values in plasma (day 14) and gingival crevicular fluid (GCF) at day 45 with SFPG applications compared to controls that did not reach normalisation. Levels of highly increased proinflammatory (IL-1B, IL-6) and suppressed anti-inflammatory (IL-10) cytokines normalised in the SFPG group by days 14 (plasma) and 45 (GCF), but never in the control group. Although not acting directly as antibiotic, SFPG acted in synergy with human granulocytes blocking adaptive catalase induction inS. aureusin response to granulocyte-derived oxidative stress, thus enhancing intracellular bacterial killing.
Metastasis of Pregnancy-Associated Breast Cancer (Suspected to Be Hereditary Breast and Ovarian Cancer) to the Brain, Diagnosed at 18 Weeks’ Gestation: A Case Report and Review of the Literature
Authors: Okuda Tomohiro , Yamamoto Sakura , Matsuo Seiki , Kataoka Hisashi , Kitawaki Jo
Published: February 2016

We report a case of pregnancy-associated breast cancer with metastasis to the brain, likely resulting from hereditary breast and ovarian cancer (HBOC). A 35-year-old woman (gravida 2, para 0-1-0-1) underwent a right mastectomy and right axillary dissection after a cesarean section at 30 years of age; her mother died at 47 years of age due to breast cancer. Histopathological examination indicated an invasive ductal carcinoma with triple-negative cancer (cancer stage 2B [pT3N0M0]). The patient refused adjuvant therapy because of the risk of infertility. After 4 years, she became pregnant naturally. At 18 weeks’ gestation, she experienced aphasia and dyslexia due to brain metastasis. The pregnancy was terminated at 21 weeks’ gestation after thorough counseling. Her family history, young-onset disease, and histopathological findings suggested HBOC. She declined genetic testing for BRCA1/2, though genetic counseling was provided. In cases of pregnancy-related breast cancer, consideration must be given to whether the pregnancy should be continued and to posttreatment fertility. HBOC should also be considered. Genetic counseling should be provided and the patient should be checked for theBRCAmutation, as it is meaningful for the future of any potential children. Genetic counseling should be provided even if the cancer is advanced or recurrent.
Anti–PD-1 Inhibitor–Related Pneumonitis in Non–Small Cell Lung Cancer
Authors: Nishino Mizuki , Chambers Emily S. , Chong Curtis R. , Ramaiya Nikhil H. , Gray Stacy W. , Marcoux J. Paul , Hatabu Hiroto , Jänne Pasi A. , Hodi F. Stephen , Awad Mark M.
Published: February 2016

The recent approval of two PD-1 inhibitors for the treatment of non–small cell lung cancer (NSCLC) has rapidly led to the widespread use of these agents in oncology practices. Pneumonitis has been recognized as a potentially life-threatening adverse event among NSCLC patients treated with PD-1 inhibitors; however, the detailed clinical and radiographic manifestations of this entity remain to be described. We report on two cases of anti–PD-1 pneumonitis in advanced NSCLC patients treated with nivolumab after its FDA approval. Both patients presented with ground-glass and reticular opacities and consolidations in a peripheral distribution on CT, demonstrating a radiographic pattern of cryptogenic organizing pneumonia. Consolidations were extensive and rapidly developed within 8 weeks of therapy in both cases. Both patients were treated with corticosteroids with subsequent improvement of respiratory symptoms and radiographic findings. One patient experienced recurrent pneumonitis after completing corticosteroid taper, or a “pneumonitis flare,” in the absence of nivolumab retreatment, with subsequent improvement upon corticosteroid readministration. With the increasing use of immune checkpoint inhibitors in a growing number of tumor types, awareness of the radiographic and clinical manifestations of PD-1 inhibitor–related pneumonitis will be critical for the prompt diagnosis and management of this potentially serious adverse event. Cancer Immunol Res; 4(4); 289–93. ©2016 AACR.
Population-Based Evidence that Survival in Amyotrophic Lateral Sclerosis Is Related to Weight Loss at Diagnosis
Authors: Marin Benoît , Arcuti Simona , Jesus Pierre , Logroscino Giancarlo , Copetti Massimiliano , Fontana Andrea , Nicol Marie , Raymondeau Marie , Desport Jean Claude , Preux Pierre Marie , Couratier Philippe ,   on behalf of the French register of ALS in Limousin (FRALim)
Published: February 2016

Background/Aims: In a population-based setting, we aimed to (i) describe weight loss (WL) of amyotrophic lateral sclerosis (ALS) patients at the time of diagnosis and (ii) evaluate the association between WL and survival. Methods: All patients recruited in the FRALim register (2000-2013) were considered to be included in this study. Time-to-death analyses were performed using a multivariable Cox model. Model discrimination and calibration were assessed. Results: Among 322 patients in the register, 261 (81%) were included. At the time of diagnosis, 50.6% of patients reported a WL of more than 5%: 14.6% with WL between 5 and 10% and 36.0% with a WL of more than 10%. WL was independently associated with survival (p = 0.002). Patients with a WL of 10% or more experienced a 45% increase in the risk of death (95% CI 6-99) with respect to patients with a WL lower than 5% or no WL. The introduction of WL significantly improved the model's discrimination achieving a survival C statistic of 79.5% (95% CI 75.6-83.5, p = 0.006) at 12 months. Conclusion: More than 50% of ALS patients experience a WL of more than 5% at the time of diagnosis. This finding highlights the need for randomized trials to evaluate the effect of nutritional interventions to improve ALS survival.
Novel Candidate Biomarkers of Chemoradiosensitivity in Esophageal Squamous Cell Carcinoma: A Systematic Review
Authors: Sato Yusuke , Motoyama Satoru , Saito Hajime , Minamiya Yoshihiro
Published: February 2016

There is no doubt that, along with surgery, chemoradiotherapy is an important treatment for esophageal squamous cell carcinoma (ESCC). Patients who respond well to chemoradiotherapy obtain great benefits toward overcoming their cancer, and so a more favorable prognosis. On the other hand, patients who do not respond well have wasted valuable time and experienced severe toxicity and seriously diminished quality of life, only to have their cancer recur with an unfavorable prognosis. For this reason, a reliable biomarker of chemoradiosensitivity in ESCC has long been sought. In this review, we will enumerate recently reported candidate biomarkers of chemoradiosensitivity in ESCC that have the potential for future clinical application.
Sequential Hypothesis Testing to Characterise the Learning Curve and Monitor Surgical Performance in Retinal Detachment Surgery
Authors: Keller Johannes , Haynes Richard J. , Sparrow John M.
Published: February 2016

Purpose: To characterise the learning curve of primary retinal detachment (RD) repair for trainee surgeons and monitor the outcomes of surgery for established surgeons. Procedures: Primary RD operations were analysed sequentially using the cumulative sum (CUSUM) and the sequential probability ratio test (SPRT). Results: 359 analysed cases of primary RD were audited with a recurrent RD (ReRD) rate of 14.7%. The individual rate of ReRD ranged from 9.4 to 17.4% (p = 0.74). SPRT and CUSUM analyses showed that ReRD occurred at random when operated by senior surgeons but a learning curve was discernible for junior surgeons. There was a trend for a higher proportion of ReRD caused by untreated breaks in cases operated by junior surgeons (p = 0.75). Conclusion: SPRT and CUSUM are useful methods to monitor surgical outcomes and should be included in audits of sequential operations such as RD. Trainee surgeons experience a quantifiable learning curve.
Endovascular Management of Acute Ischemic Strokes with Tandem Occlusions
Authors: Fahed Robert , Redjem Hocine , Blanc Raphaël , Labreuche Julien , Robert Thomas , Ciccio Gabriele , Smadja Didier , Smajda Stanislas , Piotin Michel
Published: February 2016

Background: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Also, the indications and effects of carotid stenting remain unclear. Methods: From a prospectively gathered registry, we analyzed data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, National Institutes of Health Stroke Scale (NIHSS), and stroke etiology), imaging (including diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score), and endovascular treatment data were assessed and reviewed in consensus by 2 observers. Good clinical outcome was defined as a modified Rankin Scale of ≤2 at 3-month follow-up. Results: At 3-month follow-up, 50.8% had a poor clinical outcome, including death in 13.4%. Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (thrombolysis in cerebral infarction 2b-3) were associated with a good clinical outcome (p < 0.05). There were no statistically significant differences between patients with a good or poor clinical outcome in terms of intravenous (IV) tissue plasminogen activator use, delay between symptom onset and recanalization, and endovascular technique including the carotid stenting. Conclusions: Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to IV thrombolysis, is also difficult to treat by endovascular means. Guidelines for the endovascular management of tandem occlusions are needed.
Survival after Radical Cystectomy for Bladder Cancer in Relation to Prior Non-Muscle Invasive Disease in Quebec
Authors: Zakaria Ahmed S. , Santos Fabiano , Kassouf Wassim , Tanguay Simon , Aprikian Armen
Published: February 2016

Introduction and Objectives: The aim of this study was to assess if there is a difference in survival after radical cystectomy (RC) when examined in relation to prior non-muscle invasive bladder cancer (NMIBC) disease vs. invasive cancer de novo at time of diagnosis. Methods: We conducted a retrospective study of all patients who underwent RC within Quebec health insurance medical services database during the years (2000-2009). Overall survival (OS) outcome was assessed with Kaplan-Meier curves and hazard ratios (HRs) adjusted for age and gender. Results: A total of 2,671 subjects met the eligibility criteria. Among them, 19.8% had presumed prior NMIBC that further progressed to invasive disease. Median survival after RC for patients with presumed prior NMIBC was 4.3 years as compared to patients with presumed invasive disease de novo 3.7 years (p = 0.007, Wilcoxon test). Patients with presumed NMIBC at the time of diagnosis had a 16% decrease in the risk of mortality after RC, when compared to patients with presumed invasive BC de novo (HR 0.84, 95% CI 0.73-0.96 (p = 0.0166)). Conclusion: Our results suggest a slightly better prognosis, regarding OS after RC for patients with presumed NMIBC who progressed to invasive disease, when compared to patients with presumed invasive disease de novo at the time of diagnosis.
Multimodality Imaging Strategies for the Assessment of Aortic Stenosis
Authors: Dulgheru Raluca , Pibarot Philippe , Sengupta Partho P. , Piérard Luc A. , Rosenhek Raphael , Magne Julien , Donal Erwan , Bernard Anne , Fattouch Khalil , Cosyns Bernard , Vannan Mani , Gillam Linda , Lancellotti Patrizio
Published: February 2016

Aortic stenosis is the most frequent valvular heart disease. In aortic stenosis, therapeutic decision essentially depends on symptomatic status, stenosis severity, and status of left ventricular systolic function. Surgical aortic valve replacement or transcatheter aortic valve implantation is the sole effective therapy in symptomatic patients with severe aortic stenosis, whereas the management of asymptomatic patients remains controversial and is mainly based on individual risk stratification. Imaging is fundamental for the initial diagnostic work-up, follow-up, and selection of the optimal timing and type of intervention. The present review provides specific recommendations for utilization of multimodality imaging to optimize risk stratification and therapeutic decision-making processes in aortic stenosis.
Long-Term Safety and Efficacy of Lowering Low-Density Lipoprotein Cholesterol With Statin Therapy
Authors: Ford Ian , Murray Heather , McCowan Colin , Packard Chris J.
Published: February 2016

Background—

Extended follow-up of statin-based low-density lipoprotein cholesterol lowering trials improves the understanding of statin safety and efficacy. Examining cumulative cardiovascular events (total burden of disease) gives a better appreciation of the clinical value of statins. This article evaluates the long-term impact of therapy on mortality and cumulative morbidity in a high-risk cohort of men.

Methods and Results—

The West of Scotland Coronary Prevention Study was a primary prevention trial in 45- to 64-year-old men with high low-density lipoprotein cholesterol. A total of 6595 men were randomized to receive pravastatin 40 mg once daily or placebo for an average of 4.9 years. Subsequent linkage to electronic health records permitted analysis of major incident events over 20 years. Post trial statin use was recorded for 5 years after the trial but not for the last 10 years. Men allocated to pravastatin had reduced all-cause mortality (hazard ratio, 0.87; 95% confidence interval, 0.80–0.94;
P
=0.0007), attributable mainly to a 21% decrease in cardiovascular death (hazard ratio, 0.79; 95% confidence interval, 0.69–0.90;
P
=0.0004). There was no difference in noncardiovascular or cancer death rates between groups. Cumulative hospitalization event rates were lower in the statin-treated arm: by 18% for any coronary event (
P
=0.002), by 24% for myocardial infarction (
P
=0.01), and by 35% for heart failure (
P
=0.002). There were no significant differences between groups in hospitalization for noncardiovascular causes.

Conclusion—

Statin treatment for 5 years was associated with a legacy benefit, with improved survival and a substantial reduction in cardiovascular disease outcomes over a 20-year period, supporting the wider adoption of primary prevention strategies.
The Rise and Fall of the Great Powers in the Twenty-first Century: China's Rise and the Fate of America's Global Position
Authors: Brooks Stephen G. , Wohlforth William C.
Published: February 2016

Unipolarity is arguably the most popular concept used to analyze the U.S. global position that emerged in 1991, but the concept is totally inadequate for assessing how that position has changed in the years since. A new framework that avoids unipolarity's conceptual pitfalls and provides a systematic approach to measuring how the distribution of capabilities is changing in twenty-first-century global politics demonstrates that the United States will long remain the only state with the capability to be a superpower. In addition, China is in a class by itself, one that the unipolarity concept cannot explain. To assess the speed with which China's rise might transform this into something other than a one-superpower system, analogies from past power transitions are misleading. Unlike past rising powers, China is at a much lower technological level than the leading state, and the gap separating Chinese and U.S. military capabilities is much larger than it was in the past. In addition, the very nature of power has changed: the greatly enhanced difficulty of converting economic capacity into military capacity makes the transition from a great power to a superpower much harder now than it was in the past. Still, China's rise is real and change is afoot.
Recording and Reading Alchemy and Art-Technology in Medieval and Premodern German Recipe Collections
Authors: Neven Sylvie
Published: February 2016

In the Middle Ages and the premodern period knowledge of alchemical practices and materials was transmitted via collections of recipes often grouped concomitantly with art-technological instructions. In both alchemy and chemical technology particular importance is placed on artisanal and craft practices. Both are concerned with the description of colours. Both require procedures involving precise and specifically defined actions, prescriptions and ingredients. Assuming that alchemical and artistic texts have the same textual format, this raises the question: were they produced, diffused and read by the same people? This paper investigates the authorship and the context of production behind a sample of German alchemical manuscripts dating from the fourteenth to the sixteenth century. It scrutinizes their process of production, compilation and dissemination. This paper also sheds light on the various types of marginalia, and correlates them with their diverse functions. It thus delivers significant information about the readers and users of these manuscripts.
Eurafrasiachronologies
Authors: Beecroft Alexander
Published: February 2016

Critical accounts of World Literature theory often speak of the dangers of “Eurochronology,” of the tendency to impose the narrative (and teleology) of the history of European cultures upon other regions of the world. This temporal dimension of Eurocentrism is of course to be avoided assiduously. At the same time, a synthetic reading of the literary histories of many of the larger cultures of premodern Eurasia suggests that there may in fact be room for a “Eurasiachronology,” or indeed a “Eurafrasiachronology,” which would identify parallels and connections across the entire so-called “Old World,” and offer a chronological basis for thinking about world literary history in a comparative way.
Major/Minor in World Literature
Authors: D’haen Theo
Published: February 2016

The actual practice of the study of world literature has almost invariably limited itself to studying the literatures of a very few major literatures. In fact, for the longest time world literature seemed to consist of only a few European literatures. Of late, this practice has come to be challenged from the perspective of other, non-European or non-Western, major literatures. But what in fact makes a literature qualify as major, or, inversely, as minor? What factors are involved: quantitative, qualitative, or yet other?