bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of grass hay proportion in a corn silage‐based diet on rumen digesta kinetics and digestibility in dairy cows
Authors: Win Kyaw San , Ueda Koichiro , Kondo Seiji
Published: January 2015

In this study, we aimed to evaluate the effects of six levels of orchardgrass hay (GH) proportion (0%, 10%, 20%, 30%, 40% or 50% of dry matter) in finely chopped corn silage (CS)‐based diets on digesta kinetics of CS and GH in the rumen. Six non‐lactating, rumen‐cannulated Holstein cows were used in a 6 × 6 Latin square design. Ruminal digesta kinetics was measured by ruminal dosing of feed particle markers (dysprosium for CS, erbium for GH) followed by fecal sampling. The increase of GH proportion had a quadratic effect (P < 0.01) on total tract digestibility of neutral detergent fiber (NDF) and acid detergent fiber. The proportion of GH did not affect the particle size distribution of rumen digesta, total weight of dry matter or NDF in the rumen. The rates of large particle size reduction in the rumen for CS tended to increase linearly with increasing GH proportion (P = 0.077). A quadratic effect (P < 0.05) was found with increasing the GH proportion for the ruminal passage rate of small GH particles, but not for CS particles. The results suggested that associative effects between CS and GH could be generated on rumen digesta kinetics when cows were fed a CS‐based diet with an increased proportion of GH.
Controversial Discussions: Independent Women Analysts and Thoughts About Listening to Experience
Authors: Antonis Barbie
Published: January 2015

The aim of this paper is to identify central ideas described by Ella Freeman Sharpe, Marjorie Brierley and Sylvia Payne during the Controversial Discussions 1941–45 as presented in their Memoranda on Technique. These women, who have been described as the architects of the Middle Group (later renamed The Group of Independent Psychoanalysts) offer recommendations from their own clinical experience as psychoanalysts. I bring illustrations of their particular approaches relating to patients' history and experience. Each of these women took issue in certain ways with the concepts and assertions brought by Melanie Klein and Anna Freud and in articulating their reservations became positioned somewhat ‘independently’, bringing different emphases both conceptually and clinically. In the second part of the paper I ask how their ideas and recommendations may have influenced later psychoanalysts within the Independent Tradition such as Marion Milner, Enid Balint, Pearl King and Ann Hayman. My focus concerns the development of a theory of clinical technique that privileges what I term ‘listening to experience’. I highlight the contributions made by Michael Parsons whose writing has been central in giving voice to contemporary theorizing on the clinical technique of the Independent Tradition.
Controversies Terminable Or Interminable? Some Notes on the Training Committee's Documents on Training and Education and on the Papers on Technique Presented During the Freud–Klein Controversies 1941–1945
Authors: Steiner Riccardo
Published: January 2015

My intervention briefly addresses the long, complex debate on technical and educational issues within British psychoanalysis during the late 1930s and 1940s. I hope to show that some of the problems discussed and the resolutions proposed by the Training Committee of the British Society during the years of the Controversies which we are commemorating are still a source of food for thought today, in spite of the fact that they belong to a specific past. I stress the importance of Strachey's ideas about an open psychoanalytic forum. This would not be the solution to all our problems, as crises and dissent are an inevitable part of the development of our discipline. However, the more transparent and the more informed we are about our past, and about the whole internal history of our discipline, including the wider cultural, scientific and socio‐political context within which psychoanalysis developed and is developing, the better chance we have of understanding our present.
Guideline of guidelines: a review of urological trauma guidelines
Authors: Bryk Darren J. , Zhao Lee C.
Published: January 2015

Objective

To review the guidelines released in the last decade by several organisations for the optimal evaluation and management of genitourinary injuries (renal, ureteric, bladder, urethral and genital).

Methods

This is a review of the genitourinary trauma guidelines from the European Association of Urology (EAU) and the American Urological Association (AUA), and renal trauma guidelines from the Société Internationale d'Urologie (SIU).

Results

Most recommendations are guided by the American Association for the Surgery of Trauma (AAST) organ injury severity system. Grade A evidence is rare in genitourinary trauma, and most recommendations are based on Grade B or C evidence. The findings of the most recent urological trauma guidelines are summarised. All guidelines recommend conservative management for low‐grade injuries. The major difference is for haemodynamically stable patients who have high‐grade renal trauma; the SIU guidelines recommend exploratory laparotomy, the EAU guidelines recommend renal exploration only if the injury is vascular, and the AUA guidelines recommend initial conservative management.

Conclusion

There is generally consensus among the three guidelines. Recommendations are based on observational or retrospective studies, as well as clinical principles and expert opinions. Multi‐institutional collaborative research can improve the quality of evidence and direct more effective evaluation and management of urological trauma.
The accuracy of magnetic resonance imaging (MRI) in predicting the invasion of the tunica albuginea and the urethra during the primary staging of penile cancer
Authors: Hanchanale Vishwanath , Yeo Lehana , Subedi Nawraj , Smith Jonathan , Wah Tze , Harnden Patricia , Bhattarai Selina , Chilka Sameer , Eardley Ian
Published: January 2015

Objectives

To assess the accuracy of magnetic resonance imaging (MRI) in predicting invasion of the tunica albuginea (TA) and the urethra during the primary staging of penile cancer.

Patients and Methods

In all, 104 consecutive patients with clinical T1–T3 penile cancer had a penile MRI as a part of local staging protocol. An artificial erection was induced before MRI by injecting alprostadil (prostaglandin E1). Four men with poor quality MRI images were excluded from the study. The preoperative MRI was compared with final histology to assess its accuracy in predicting the invasion of the TA and urethra.

Results

Data of 100 patients who underwent penile MRI before definitive surgery for invasive penile carcinoma were available for analysis. The mean age was 65 years and number of patients with pathological stage T1, T2 and T3 was 32, 52, and 16, respectively. The sensitivity and specificity of MRI in predicting the invasion of TA and urethra was 82.1% and 73.6%, and 62.5% and 82.1%, respectively. There were no MRI‐related complications.

Conclusions

This study shows that penile MRI is an accurate method for assessing TA invasion but is less sensitive in assessing urethral invasion. These results support the use of MRI in the local staging of penile cancer.
External urethral sphincter electromyography in asymptomatic women and the influence of the menstrual cycle
Authors: Tawadros Cecile , Burnett Katherine , Derbyshire Laura F. , Tawadros Thomas , Clarke Noel W. , Betts Christopher D.
Published: January 2015

Objective

To investigate by electromyography (EMG), the presence of complex repetitive discharges (CRDs) and decelerating bursts (DBs) in the striated external urethral sphincter during the menstrual cycle in female volunteers with no urinary symptoms and complete bladder emptying.

Subjects and Methods

Healthy female volunteers aged 20–40 years, with regular menstrual cycles and no urinary symptoms were recruited. Volunteers completed a menstruation chart, urinary symptom questionnaires, pregnancy test, urine dipstick, urinary free flow and post‐void ultrasound bladder scan. Exclusion criteria included current pregnancy, use of hormonal medication or contraception, body mass index of >35 kg/m2, incomplete voiding and a history of pelvic surgery. Eligible participants underwent an external urethral sphincter EMG, using a needle electrode in the early follicular phase and the mid‐luteal phase of their menstrual cycles. Serum oestradiol and progesterone were measured at each EMG test.

Results

In all, 119 women enquired about the research and following screening, 18 were eligible to enter the study phase. Complete results were obtained in 15 women. In all, 30 EMG tests were undertaken in the 15 asymptomatic women. Sphincter EMG was positive for CRDs and DBs at one or both phases of the menstrual cycle in eight (53%) of the women. Three had CRDs and DBs in both early follicular and mid‐luteal phases. Five had normal EMG activity in the early follicular phase and CRDs and DBs in the mid‐luteal phase. No woman had abnormal EMG activity in the early follicular phase and normal activity in the luteal phase. There was no relationship between EMG activity and age, parity or serum levels of oestradiol and progesterone.

Conclusions

CRDs and DB activity in the external striated urethral sphincter is present in a high proportion of asymptomatic young women. This abnormal EMG activity has been shown for the first time to change during the menstrual cycle in individual women. CRDs and DBs are more commonly found in the luteal phase of the menstrual cycle. The importance of CRDs and DBs in the aetiology of urinary retention in young women remains uncertain. The distribution and or quantity of abnormal EMG activity in the external urethral sphincter may be important. In a woman with urinary retention the finding of CRDs and DBs by needle EMG does not automatically establish Fowler's syndrome as the explanation for the bladder dysfunction. Urethral pressure profilometry may be helpful in establishing a diagnosis. Opiate use and psychological stress should be considered in young women with urinary retention.
Design, Synthesis, and Biological Evaluation of γ‐Aminopropyl Silatrane–Acyclovir Hybrids with Immunomodulatory Effects
Authors: Ye Faqing , Song Xiaoqin , Liu Jianmin , Xu Xuemei , Wang Yuewu , Hu Lichuan , Wang Yi , Liang Guang , Guo Ping , Xie Zixin
Published: January 2015

Several derivatives of γ‐aminopropyl silatrane containing acyclovir in their molecular structure were synthesized and evaluated for their immunomodulatory and antiviral activities. The structures of all these derivatives were confirmed by mass spectra, IR, and 1H NMR. Based on WST‐1 assay in vitro, these compounds could stimulate proliferation of splenic lymphocytes at certain concentrations. Furthermore, compound 3d could also potentiate the expression of IFN‐γ, IL‐2, CD4+, CD8+, and CD4+/CD8+ in vivo. Our results show that these derivatives possess antiviral activity against herpes simplex viruses with a similar potency to acyclovir without a cellular immune response.
Early coupled up-regulation of interleukin-12 receptor beta-1 in CD8+ central memory and effector T cells for better clinical outcomes in liver transplant recipients
Authors: Uemoto S , Ozawa K , Kaido T , Mori A , Fujimoto Y , Ogawa K
Published: January 2015

This study aimed to investigate the role of initial priming of interleukin (IL)-12 receptor beta-1 in CD8+central memory T cells (initial IL-12RTCM priming) and CCR7-negative subsets (CNS) in effector cell expansion and clinical outcome after living donor liver transplantation (LDLT). One hundred and six patients who underwent LDLT were classified into the following three groups according to hierarchical clustering of CD8+CD45 isoforms before LDLT: I, naive-dominant; II, effector memory-dominant; and III, effector-dominant. The pre-existing CD8+effector cells (TE) and activated immune status increased progressively from group I to group II to group III. Groups I, II and III received tacrolimus (Tac)/glucocorticoid (GC) regimens. Eighteen group III recipients received Tac/mycophenolate mofetil (MMF) and were defined as group IV. Initial IL-12RTCM priming was slightly, moderately and markedly decreased in droups I, II, and III, respectively. Initial priming of IL-12Rβ1 in CNS was decreased markedly in the three groups with marked decreases of TE, perforin and interferon (IFN)-γ; all parameters were restored by up-regulation of IL-12Rβ1+TCM through the self-renewal of TCM. The lag time required until coupled up-regulation of IL-12Rβ1 of TCM and CNS to above baseline was 12, 20 and 32 days in groups I, II and III, respectively. Inferior clinical outcomes were associated with increasing lag time. In contrast, the initial priming of IL-12Rβ1 in TCM and CNS remained above baseline in group IV due to MMF-mediated increase of IL-12Rβ1. Early coupled up-regulation of TCM and CNS leads to efficient TE differentiation and optimal clinical outcomes.
Contact allergy trends in Sweden – a retrospective comparison of patch test data from 1992, 2000, and 2009
Authors: Fall Sofia , Bruze Magnus , Isaksson Marléne , Lidén Carola , Matura Mihaly , Stenberg Berndt , Lindberg Magnus
Published: January 2015

Background

Contact allergy prevalence rates change over time as a result of variations in allergen exposure. Data from patch test clinics are often used as markers for allergy trends.

Objectives

The aim of the present retrospective study was to describe trends in rates of sensitization to allergens in the Swedish baseline series.

Patients/materials/methods

Prevalence rates are described by comparing consecutive patch test data from 1992, 2000 and 2009 in Swedish patch test clinics. In total, 3680 patients were included in 1992, 3825 in 2000, and 3112 in 2009.

Results

Among test substances with a sensitization rate above 2% in 2009, significant decreases were noted for nickel sulfate, cobalt chloride, colophonium, and methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI), and a significant increase for p‐phenylenediamine, as compared with 1992. Potassium dichromate reactions had increased among younger women, whereas reactions to nickel and cobalt had decreased in this group. Sensitization to chromium, cobalt and fragrance mix I had decreased among older men, and sensitization to nickel had decreased among younger men.

Conclusions

It is probable that these changes in 1992–2009 reflect both changes in regulations for nickel, lower levels of chromium in cement and of MCI/MI in cosmetics, and increasing use of hair dyes.
Well‐Hidden Regularities: Abstract Uses ofinandonRetain an Aspect of Their Spatial Meaning
Authors: Jamrozik Anja , Gentner Dedre
Published: January 2015

Prepositions name spatial relationships (e.g., bookona table). But they are also used to convey abstract, non‐spatial relationships (e.g., Adrian isona roll)—raising the question of how the abstract uses relate to the concrete spatial uses. Despite considerable success in delineating these relationships, no general account exists for the two most frequently extended prepositions:inandon. We test the proposal that what is preserved in abstract uses of these prepositions is the relative degree ofcontrolbetween the located object (the figure) and the reference object (the ground). Across four experiments, we find a continuum of greater figure control foron(e.g., Jordan isona roll) and greater ground control forin(e.g., Casey isina depression). These findings bear on accounts of semantic structure and language change, as well as on second language instruction.
Vital sites and actions: an integrated framework for prioritizing conservation actions and reporting achievement
Authors: Overton Jacob McC. , Walker Susan , Price Robbie , Stephens R. T. Theo , Henson Sarah , Earl Richard , Wright Elaine
Published: January 2015

Aim

We describe the Vital Sites and Actions (Vital Sites) model and computational framework for prioritizing conservation actions, describing biodiversity trends and reporting the difference made to biodiversity by conservation management.

Location

We demonstrate the model in New Zealand using ecological integrity as a national biodiversity goal.

Methods

Vital Sites implements a model of biodiversity, pressures on biodiversity and the benefits to biodiversity of management. Effects of pressures on biodiversity are used to predict vulnerability and future biodiversity patterns over a given time period (e.g. a decade), and management actions affect future biodiversity patterns by reducing pressures. A generalized expression ofsignificance(the marginal contribution to conservation goals) is combined with vulnerability to estimate thebenefits of management(BOM), defined as the marginal contribution to goals achieved by conservation action. Because of their dependence on biodiversity and management context,BOMis estimated relative to a defined biodiversity configuration and management scenario.

Results

Conservation actions with the highestBOMare those that make the largest gains or avert the most loss to national ecological integrity. The 2009 pest control operations are predicted to decreaseBOMfrom additional operations – even far beyond operational boundaries – becauseBOMdepends on the expected future biodiversity configuration. National ecological integrity was predicted to decline, with the 2009 operations making only a small reduction in this predicted decline.

Main conclusions

Vital Sites provides important advantages for conservation planning and reporting by: (1) incorporating threats, effects of management and future vulnerabilities into identifying conservation priorities, (2) accounting for fundamental contextual and scaling relationships in conservation reporting, and (3) providing a shared conceptual and computational platform for conservation planning and performance reporting. This demonstrates the feasibility of a shared platform for planning and reporting, providing many advantages for conservation agencies.
Multicenter outpatient dinner/overnight reduction of hypoglycemia and increased time of glucose in target with a wearable artificial pancreas using modular model predictive control in adults with type 1 diabetes
Authors: Del Favero S. , Place J. , Kropff J. , Messori M. , Keith‐Hynes P. , Visentin R. , Monaro M. , Galasso S. , Boscari F. , Toffanin C. , Di Palma F. , Lanzola G. , Scarpellini S. , Farret A. , Kovatchev B. , Avogaro A. , Bruttomesso D. , Magni L. , DeVries J. H. , Cobelli C. , Renard E. ,   on behalf of the AP@home Consortium
Published: January 2015

Aims

To test in an outpatient setting the safety and efficacy of continuous subcutaneous insulin infusion (CSII) driven by a modular model predictive control (MMPC) algorithm informed by continuous glucose monitoring (CGM) measurement.

Methods

13 patients affected by type 1 diabetes participated to a non‐randomized outpatient 42‐h experiment that included two evening meals and overnight periods (in short, dinner & night periods). CSII was patient‐driven during dinner & night period 1 and MMPC‐driven during dinner&night period 2. The study was conducted in hotels, where patients could move around freely. A CGM system (G4 Platinum; Dexcom Inc., San Diego, CA, USA) and insulin pump (AccuChek Combo; Roche Diagnostics, Mannheim, Germany) were connected wirelessly to a smartphone‐based platform (DiAs, Diabetes Assistant; University of Virginia, Charlottesville, VA, USA) during both periods.

Results

A significantly lower percentage of time spent with glucose levels <3.9 mmol/l was achieved in period 2 compared with period 1: 1.96 ± 4.56% vs 12.76 ± 15.84% (mean ± standard deviation, p < 0.01), together with a greater percentage of time spent in the 3.9–10 mmol/l target range: 83.56 ± 14.02% vs 62.43 ± 29.03% (p = 0.04). In addition, restricting the analysis to the overnight phases, a lower percentage of time spent with glucose levels <3.9 mmol/l (1.92 ± 4.89% vs 12.7 ± 19.75%; p = 0.03) was combined with a greater percentage of time spent in 3.9–10 mmol/l target range in period 2 compared with period 1 (92.16 ± 8.03% vs 63.97 ± 2.73%; p = 0.01). Average glucose levels were similar during both periods.

Conclusions

The results suggest that MMPC managed by a wearable system is safe and effective during evening meal and overnight. Its sustained use during this period is currently being tested in an ongoing randomized 2‐month study.
An open‐label phase I/II study of cyclophosphamide, bortezomib, pegylated liposomal doxorubicin, and dexamethasone in newly diagnosed myeloma
Authors: Nishihori Taiga , Baz Rachid , Shain Kenneth , Kim Jongphil , Ochoa‐Bayona Jose L. , Yue Binglin , Sullivan Daniel , Dalton William , Alsina Melissa
Published: January 2015

We conducted a phase 1/2 trial evaluating the combination of cyclophosphamide, bortezomib, pegylated liposomal doxorubicin, and dexamethasone (CVDD) for newly diagnosed multiple myeloma (MM). The primary objective of the phase 1 was to evaluate the safety and tolerability of maximum planned dose (MPD) and the phase 2 was to assess the overall response rate. Patients received 6–8 cycles of CVDD at four dose levels. There were no dose‐limiting toxicities. The MPD was cyclophosphamide 750 mg/m2 IV on day 1, bortezomib 1.3 mg/m2 IV on days 1, 4, 8, 11, pegylated liposomal doxorubicin 30 mg/m2 IV on day 4, and dexamethasone 20 mg orally on the day of and after bortezomib (21‐d cycle). Forty‐nine patients were treated at the MPD of which 22% had high‐risk myeloma. The most common grade ≥3 toxicities included myelosuppression, infection, and fatigue. Overall response and complete response rates were 91% and 26% in standard‐risk, and 100% and 58% in high‐risk cohort, respectively. After a median follow‐up of 34 months, the median progression‐free survival was 31.3 months. The 2‐yr overall survival was 91.1% in the standard‐risk and 88.9% in the high‐risk cohort, respectively. CVDD regimen was well tolerated and was highly active in newly diagnosed MM.
Climate‐driven extinctions shape the phylogenetic structure of temperate tree floras
Authors: Eiserhardt Wolf L. , Borchsenius Finn , Plum Christoffer M. , Ordonez Alejandro , Svenning Jens‐Christian
Published: January 2015

When taxa go extinct, unique evolutionary history is lost. If extinction is selective, and the intrinsic vulnerabilities of taxa show phylogenetic signal, more evolutionary history may be lost than expected under random extinction. Under what conditions this occurs is insufficiently known. We show that late Cenozoic climate change induced phylogenetically selective regional extinction of northern temperate trees because of phylogenetic signal in cold tolerance, leading to significantly and substantially larger than random losses of phylogenetic diversity (PD). The surviving floras in regions that experienced stronger extinction are phylogenetically more clustered, indicating that non‐random losses of PD are of increasing concern with increasing extinction severity. Using simulations, we show that a simple threshold model of survival given a physiological trait with phylogenetic signal reproduces our findings. Our results send a strong warning that we may expect future assemblages to be phylogenetically and possibly functionally depauperate if anthropogenic climate change affects taxa similarly.
Stress singularity analysis for orthotropic V‐notches in the generalised plane strain state
Authors: Cheng C. Z. , Zhou W. , Niu Z. R. , Recho N.
Published: January 2015

The singularity for the V‐notch under the generalised plane deformation is investigated by the combination of the asymptotic analysis with the interpolating matrix method developed by part of the authors before. The displacement asymptotic expansions at the vicinity of the V‐notch vertex are introduced into the equilibrium equations, which are transformed into a set of characteristic ordinary differential equations with respect to the notch singularity orders. The boundary conditions and interfacial compatibility conditions are also represented by the combination of the singularity orders and characteristic angular functions. The determination of the singularity orders and characteristic angular functions are transformed into solving the ordinary differential equations with variable coefficients, which are solved by the interpolating matrix method. The present method is suitable for the singularity analysis for isotropic and orthotropic V‐notches. It is versatile for analysing the stress singularity of single material V‐notches, bi‐material V‐notches, interface edges and cracks. The correctness of the results by the proposed method is ensured by the comparison with the published ones.
Genomic copy number alterations of primary and secondary metastasizing pleomorphic adenomas
Authors: Mariano Fernanda Viviane , Gondak Rogério de Oliveira , Martins Antonio Santos , Coletta Ricardo Della , Paes de Almeida Oslei , Kowalski Luiz Paulo , Krepischi Ana Cristina Victorino , Altemani Albina
Published: January 2015

Aims

Metastasizing pleomorphic adenoma (MPA) is a rare tumour, and its mechanism of metastasis still is unknown. To date, there has been no study on MPA genomics. We analysed primary and secondary MPAs with array comparative genomic hybridization to identify somatic copy number alterations and affected genes.

Methods and results

Tumour DNA samples from primary (parotid salivary gland) and secondary (scalp skin) MPAs were subjected to array comparative genomic hybridization investigation, and the data were analysed with NEXUS COPY NUMBER DISCOVERY. The primary MPA showed copy number losses affecting 3p22.2p14.3 and 19p13.3p123, and a complex pattern of four different deletions at chromosome 6. The 3p deletion encompassed several genes: CTNNB1, SETD2, BAP1, and PBRM1, among others. The secondary MPA showed a genomic profile similar to that of the primary MPA, with acquisition of additional copy number changes affecting 9p24.3p13.1 (loss), 19q11q13.43 (gain), and 22q11.1q13.33 (gain).

Conclusion

Our findings indicated a clonal origin of the secondary MPA, as both tumours shared a common profile of genomic copy number alterations. Furthermore, we were able to detect in the primary tumour a specific pattern of copy number alterations that could explain the metastasizing characteristic, whereas the secondary MPA showed a more unbalanced genome.
Preliminary identification of key coral species from New Caledonia (Southwest Pacific Ocean), their significance to reef formation, and responses to environmental change
Authors: Hongo Chuki , Wirrmann Denis
Published: January 2015

The recognition of key coral species (KCS) in the geological record, i.e. those that contribute to reef formation and maintenance of coral reef ecosystems, is important for understanding the development and evolution of reef ecosystems and for forecasting their responses to climate change and anthropogenic impacts in the near future. This study examined the contribution to reef formation and maintenance of KCS from Pleistocene and Holocene barrier reefs in New Caledonia, based on analyses of six cores retrieved from three different reefs: Islets Kendec, Amédée, and Bayes. Our results indicate that at least 19 genera and 33 species of corals contributed to reef formation and maintenance during the Holocene in New Caledonia. Among them, Goniastrea retiformis, Isopora palifera, Dipsastraea pallida/speciosa complex, corymbose Acropora sp., massive Porites sp., and encrusting Porites sp. were KCS during the Holocene. This observation suggests that KCS will potentially contribute to the formation and persistence of reefs in the near future under conditions of estimated global sea‐level rise of 0.2–0.6 m/100 years. However, the distributions and abundances of these species are currently decreasing. This study emphasizes the need for further research on the restoration and conservation of potential KCS.
Transcutaneous electrical nerve stimulation for chronic post‐herpetic neuralgia
Authors: Ing Malcolm R. , Hellreich Philip D. , Johnson Douglas W. , Chen John J.
Published: January 2015

Postherpetic neuralgia remains a therapeutic challenge for the clinician. Many modalities have been utilized with limited success. In this pilot randomized study of patients who were refractory to previous medicinal treatment, the patients were treated with transcutaneous nerve stimulation with a biofeedback capability. After every two treatments with the sham and true device, the patients were required to fill out a standard neuropathic pain scale score. The patients were allowed to select the other device after three consecutive treatments if they felt an inadequate decrease in their pain. The true device was chosen over the sham device by all patients. The majority of these patients treated by the true device reported a statistically significant decrease in pain scores (P < 0.001). Further investigation of this Food and Drug Administration, class 2 accepted, electronic device for relief of pain is warranted for patients with a history of recalcitrant postherpetic neuralgia.
The therapeutic impact of HNP‐1 in condyloma acuminatum
Authors: Zhao Shuyun , Zhou Hong Ying , Li Huijuan , Yi Tao , Zhao Xia
Published: January 2015

Background

Condyloma acuminatum is one of the most commonly occurring sexually transmitted diseases. HNP1 is a small antimicrobial peptide that has been reported to have antiviral activities.

Aim

Using the condyloma acuminatum tissue culture to resemble the situation more closely in vivo, we investigate the therapeutic effect of a recombinant plasmid encoding HNP1 gene in condyloma acuminatum tissue.

Methods

Recombinant plasmid DNA carrying HNP1 cDNA was constructed and identified. Then the recombinant plasmid was transfected into a condyloma acuminatum tissue fragment, and the HNP1 expression was determined on these tissue fragments by immunohistochemistry. TUNEL staining and flow cytometry techniques were used to examine cell apoptosis of condyloma acuminatum tissue. Relative real‐time polymerase chain reaction was used to validate antihuman papillomavirus therapeutics of the treatment groups.

Results

Transfected HNP1 gene was expressed mainly in the cytoplasmic granules of the condyloma acuminatum tissues. Positive apoptotic cells were observed in condyloma acuminatum tissues transfected with the HNP1 gene. In addition, the HPV expression was lower in the HNP1 treatment tissues as compared to their corresponding control tissues.

Conclusion

The results indicate that HNP1 can directly promote condyloma acuminatum cell apoptosis and play an antivirus role in the condyloma acuminatum tissue by limiting viral replication. These observations suggest a possible application for human HNP1 on condyloma acuminatum therapy.
Daily National Institutes of Health Stroke Scale Examinations at Stroke Centers: Why Not Do Them?
Authors: Siegler James E. , Martin-Schild Sheryl
Published: January 2015

The National Institutes of Health Stroke Scale was originally designed to stratify patients according to stroke severity for clinical trials, and now it is used to predict disposition and prognosticate functional outcome. Many researchers have also adopted it to trend patient progress over time and detect early neurologic deterioration. However, few investigators have reported its utility in monitoring the daily progress of patients hospitalized for stroke. In the present article, the authors discuss the advantages of daily National Institutes of Health Stroke Scale assessments and our clinical experience with this invaluable tool.
Revisiting Cerebral Postischemic Reperfusion Injury: New Insights in Understanding Reperfusion Failure, Hemorrhage, and Edema
Authors: Bai Jilin , Lyden Patrick D.
Published: January 2015

Cerebral postischemic reperfusion injury is defined as deterioration of ischemic brain tissue that parallels and antagonizes the benefits of restoring cerebral circulation after therapeutic thrombolysis for acute ischemic stroke. To understand the paradox of injury caused by treatment, we first emphasize the phenomenon in which recanalization of an occluded artery does not lead to tissue reperfusion. Additionally, no-reflow after recanalization may be due to injury of the neurovascular unit, distal microthrombosis, or both, and certainly worsens outcome. We examine the mechanism of molecular and sub-cellular damage in the neurovascular unit, notably oxidative stress, mitochondrial dysfunction, and apoptosis. At the level of the neurovascular unit, which mediates crosstalk between the damaged brain and systemic responses in blood, we summarize emerging evidence demonstrating that individual cell components play unique and cumulative roles that lead to damage of the blood–brain barrier and neurons. Furthermore, we review the latest developments in establishing a link between the immune system and microvascular dysfunction during ischemic reperfusion. Progress in assessing reperfusion injury has also been made, and we review imaging studies using various magnetic resonance imaging modalities. Lastly, we explore potential treatment approaches, including ischemic preconditioning, postconditioning, pharmacologic agents, and hypothermia.
Preoperative factors predicting spontaneous clearance of residual stone fragments after flexible ureteroscopy
Authors: Ito Hiroki , Kuroda Shinnosuke , Kawahara Takashi , Makiyama Kazuhide , Yao Masahiro , Matsuzaki Junichi
Published: January 2015

Objective

To investigate factors predicting spontaneous clearance of residual renal fragments after flexible ureteroscopy.

Methods

Among 546 patients who underwent lithotripsy with flexible ureteroscopy, 81 had residual renal fragments, as determined by kidney–ureter–bladder films on postoperative day 1. The final outcome was determined at 3 months after the last flexible ureteroscopy session using non‐contrast computed tomography. Patient characteristics and preoperative factors were analyzed using the unpaired t‐test and χ2‐test. Correlations between the possible predictive factors and the spontaneous clearance of residual renal fragments after flexible ureteroscopy were analyzed using a multivariate logistic regression model with backward selection.

Results

Non‐contrast computed tomography at postoperative month 3 showed that 33 cases (40.7%) had spontaneous clearance of residual renal fragments, whereas 48 (59.3%) showed non‐clearance. Significant differences were found between these cases in terms of stone number, stone location, presence of lower pole calculi and preoperative stent placement. Multivariate assessment showed that stone number (P = 0.004), presence of lower pole calculi (P = 0.021) and presence of hydronephrosis (P = 0.024) were independent predictors of the spontaneous clearance of residual renal fragments after flexible ureteroscopy.

Conclusions

Stone number, presence of lower pole calculi and presence of hydronephrosis are independent predictive factors of the spontaneous clearance of residual renal fragments after flexible ureteroscopy.
How Do We Diagnose Syncope?
Authors: FARWELL DAVID , SULKE NEIL
Published: January 2015

Diagnosis of Syncope. Introduction: The Eastbourne Syncope Assessment Study aims to increase diagnostic yield in unexplained syncope while reducing investigational costs. The initial study phase was a retrospective analysis of every presentation to the Eastbourne General Hospital (a busy nontertiary center in the United Kingdom serving a population of 250,000; 24% are older than 65 years) with syncope for the year 1998.

Methods and Results: A total of 1,334 cases with syncopal codes were identified. Six hundred sixty patients (mean age 64 years) had actually suffered an episode of syncope. Forty percent had recurrent syncope, with a mean of 4.7 previous episodes. Twenty‐nine percent of syncope cases remained undiagnosed. Forty‐four percent were diagnosed as vasovagal, 12% neurologic, 6% due to an arrhythmia, 2% drug related, and 2% due to hemorrhage. Thirteen different types of investigation were undertaken, with an overall total of 3,264 investigations performed at a cost of £104285. Diagnosis was achieved by history and examination alone in 61% of cases. Excluding history and examination, the most cost‐effective diagnostic tools were the 7‐day patient‐activated recorder (R test) and tilt testing (£260 and £401 per diagnosis, respectively). Investigations also were graded by their relative diagnostic power. Hospital admission alone accounted for 67% of the cost of investigating syncope.

Conclusion: In syncope, diagnostic rates can be improved and investigational costs reduced by concentrating on the most specific, sensitive, and cost‐effective investigations and by minimizing hospital stay. Such a protocol currently is under investigation at our institution.
How and When to Pace in Vasovagal Syncope
Authors: SUTTON RICHARD
Published: January 2015

Pacing in Vasovagal Syncope. This article discusses the indications for pacing in vasovagal syncope. It also reviews the literature on pacing results; notably, there are two small randomized controlled trials of pacing versus no therapy (or continued nondevice therapy) that show a clear benefit for pacing. The mode of benefit is, as yet, unclear. Pacing has to be dual chamber with some form of rate hysteresis. Ways of improving pacemaker therapy delivery in vasovagal syncope are anticipated.
Mortality and Incidence of Atrial Fibrillation in Paced Patients
Authors: NIELSEN JENS COSEDIS
Published: January 2015

Mortality and AF Incidence in Paced Patients. This review presents and discusses available data from randomized controlled trials on the prognosis of pacemaker patients, especially the incidences of atrial fibrillation (AF) and death, the impact of pacing mode selection, and the impact of AF on prognosis. The incidence of AF is several times higher in paced patients than in the nonpaced population. The annual incidences of AF and chronic AF are at least 5% and 3%, respectively, after pacemaker implantation. Mean lifetime cumulative incidences of AF and chronic AF can be estimated at approximately 30% to 40% and 20%, respectively. The most important predictors of AF are brady‐tachy syndrome, sick sinus syndrome, and selection of VVI(R) pacing mode. The expected lifespan in paced patients is shorter than in the age‐matched nonpaced population. One of the factors decreasing lifespan in paced patients most likely is the high incidence and prevalence of AF. In patients with sick sinus syndrome, VVI pacing significantly increases AF and mortality compared with AAI pacing. In a mixed population of patients with bradycardia, DDD(R) pacing causes AF less often than does VVI(R) pacing. Survival does not differ between these pacing modes within the first 3.5 years after pacemaker implantation. At the present time, AAI(R) should be the preferred pacing mode in patients with sick sinus syndrome, and DDD(R) should be used for other patients without chronic AF for prevention of AF. It is not clear whether prevention of AF will improve survival of paced patients.
Selection of Endpoints in Atrial Fibrillation Studies
Authors: WYSE D. GEORGE
Published: January 2015

Endpoints in AF Studies. Atrial fibrillation (AF) is the tachyarrhythmia of the new millennium. There has been a dramatic increase in research on the management of this problem over the last 10 years. Presently, there is no clear consensus on the most appropriate endpoints to be used in studies of therapy for AF, particularly those concerning rhythm management itself. Endpoints for studies of rhythm management should be based firmly on the objectives of therapy for AF. Some objectives of therapy are obvious, but others, such as reduction of mortality, are not and are somewhat controversial. Clinically relevant endpoints are to be preferred but have been underutilized. Using clinical events as endpoints is complicated by the fact that event rates are low and large sample sizes are needed. Cost and cost‐effectiveness are endpoints that are becoming increasingly important but also have been underutilized. Clinical classification of AF is an important factor to be considered in planning studies of AF rhythm management. Patient selection can have a profound effect on the outcome of certain surrogate endpoints. The main limitation of these endpoints is that they assume improvement in the surrogate measurement is closely correlated to a good clinical outcome. In fact, there is ample evidence that such a correlation is quite poor at times. Potential solutions to the problems discussed here include wider appreciation of the problem, use of carefully crafted composite clinical endpoints, and better calibration of surrogate endpoints against clinical endpoints. More research on these issues is urgently needed.
Automatic External Defibrillator: Key Link in the Chain of Survival
Authors: KOSTER RUDOLPH W.
Published: January 2015

Automatic External Defibrillator. Introduction: Sudden cardiac death is a major health problem. Worldwide success of resuscitation from out‐of‐hospital cardiac arrest is modest, with 5% to 10% survival to hospital discharge.

Methods and Results: In the chain of survival, early defibrillation (goal <5 min after collapse) is a major determinant of successful outcome of resuscitation. This goal is rarely achieved, but the automatic external defibrillator (AED) is a promising tool for lay defibrillation. The AED is a safe and effective device with nearly 100% accurate detection of ventricular fibrillation and nearly 100% accurate detection of a nonshockable rhythm. A large uncontrolled experience suggests improved outcome in nontraditional responders such as police. Controlled studies of community application of the AED are under way.

Conclusion: The AED is a promising tool in the fight against sudden cardiac death and should be studied and supported by all scientists involved, including electrophysiologists.
Second Phase‐Induced Degradation of Fused MgO Partially Stabilized Zirconia Aggregates
Authors: Quadling Amanda , Vandeperre Luc , Parkes Maria , Lee William E.
Published: January 2015

Magnesia‐partially stabilized zirconia (Mg‐PSZ) fired refractory crucibles used under vacuum induction melting (VIM) furnaces, are routinely cycled above 1500°C in service, sometimes experiencing failure in under a dozen cycles. This has negative financial implications, given the high value Ni–Co superalloys melted in them. To evaluate aggregate response to cycling, the microstructural evolution of two commercial varieties of fused Mg‐PSZ aggregate has been studied within their host refractories, over eight cycles to 1700°C. The aggregates contain 0.1–0.2 wt% alumina and silica impurities and at 1700°C, these generate a liquid phase which on cooling, crystallizes segregated secondary phases of spinel, forsterite, and cordierite. These minerals have thermal expansion coefficients that are markedly different to zirconia and the mismatch in volume change rates between adjacent phases leads to aggregate breakdown. Micro‐Raman mapping reveals internal boundaries within the aggregates which are attributed to retention of original surface concentrations of alumina and silica on zircon sand particles at the time of conversion into zirconia and which act as the main location for secondary phase development. Crucibles made with aggregates containing higher concentrations of stabilizer (>2 wt% MgO) and MgO fines in their matrix phase, show significantly greater aggregate breakdown.
Molecular Evidence for the Polyphyly of Macrotrichomonas (Parabasalia: Cristamonadea) and a Proposal for Macrotrichomonoides n. gen.
Authors: Gile Gillian H. , James Erick R. , Okamoto Noriko , Carpenter Kevin J. , Scheffrahn Rudolf H. , Keeling Patrick J.
Published: January 2015

Macrotrichomonas (Cristamonadea: Parabasalia) is an anaerobic, amitochondriate flagellate symbiont of termite hindguts. It is noteworthy for being large but not structurally complex compared with other large parabasalians, and for retaining a structure similar in appearance to the undulating membrane (UM) of small flagellates closely related to cristamonads, e.g. Tritrichomonas. Here, we have characterised the SSU rDNA from two species described as Macrotrichomonas: M. restis Kirby 1942 from Neotermes jouteli and M. lighti Connell 1932 from Paraneotermes simplicicornis. These species do not form a clade: M. lighti branches with previously characterised Macrotrichomonas sequences from Glyptotermes, while M. restis branches with the genus Metadevescovina. We examined the M. restis UM by light microscopy, scanning electron microscopy, and transmission electron microscopy, and we find common characteristics with the proximal portion of the robust recurrent flagellum of devescovinids. Altogether, we show the genus Macrotrichomonas to be polyphyletic and propose transferring M. restis to a new genus, Macrotrichomonoides. We also hypothesise that the macrotrichomonad body plan represents the ancestral state of cristamonads, from which other major forms evolved.
Are Related‐Party Sales Value‐Adding or Value‐Destroying? Evidence from China
Authors: Wong Raymond M. K. , Kim Jeong‐Bon , Lo Agnes W. Y.
Published: January 2015

Prior literature provides mixed and relatively little evidence on the economic consequences of related‐party transactions. We examine a hitherto underexplored issue of whether transactions among firms within the same business group increase or reduce firm value. Using a large sample of Chinese listed firms, we find that related‐party sales increase firm value. However, this value enhancement disappears for firms with (i) large percentage of parent directors, (ii) high government ownership, or (iii) tax avoidance incentives that often couple with management's rent extraction activities. Although we find that intragroup sales improve firm value in general, we also find that corporate insiders use intragroup sales to deprive value from minority shareholders. Overall, our findings highlight the interplay between ownership structure and tax avoidance incentives in determining the economic consequences of related‐party transactions.
A Mixed‐Methods Study of Secondary Traumatic Stress in Certified Nurse‐Midwives: Shaken Belief in the Birth Process
Authors: Beck Cheryl Tatano , LoGiudice Jenna , Gable Robert K.
Published: January 2015

Introduction

Secondary traumatic stress (STS) is an occupational hazard for clinicians who can experience symptoms of posttraumatic stress disorder (PTSD) from exposure to their traumatized patients. The purpose of this mixed‐methods study was to determine the prevalence and severity of STS in certified nurse‐midwives (CNMs) and to explore their experiences attending traumatic births.

Methods

A convergent, parallel mixed‐methods design was used. The American Midwifery Certification Board sent out e‐mails to all their CNM members with a link to the SurveyMonkey study. The STS Scale was used to collect data for the quantitative strand. For the qualitative strand, participants were asked to describe their experiences of attending one or more traumatic births. IBM SPSS 21.0 (Version 21.0, Armonk, NY) was used to analyze the quantitative data, and Krippendorff content analysis was the method used to analyze the qualitative data.

Results

The sample consisted of 473 CNMs who completed the quantitative portion and 246 (52%) who completed the qualitative portion. In this sample, 29% of the CNMs reported high to severe STS, and 36% screened positive for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnostic criteria for PTSD due to attending traumatic births. The top 3 types of traumatic births described by the CNMs were fetal demise/neonatal death, shoulder dystocia, and infant resuscitation. Content analysis revealed 6 themes: 1) protecting my patients: agonizing sense of powerlessness and helplessness; 2) wreaking havoc: trio of posttraumatic stress symptoms; 3) circling the wagons: it takes a team to provide support … or not; 4) litigation: nowhere to go to unburden our souls; (5) shaken belief in the birth process: impacting midwifery practice; and 6 moving on: where do I go from here?

Discussion

The midwifery profession should acknowledge STS as a professional risk.