bluuebunny/crossref_metadata_2025 huggingface dataset:
PERIORBITAL CELLULITIS: AMBULATORY CARE THAT IS SAFE AND COST EFFECTIVE
Authors: Yule E J , Fryer J , Ross J
Published: September 2013

Objectives & Background

Increasing ambulatory care is a goal of the College of Emergency Medicine. It reduces burden on inpatient wards, and is well received by patients and parents. Ambulatory care of children with periorbital cellulitis is not universally accepted, and warrants evaluation.

Methods

We reviewed all patients less than 16 years old diagnosed with periorbital cellulitis in a paediatric emergency department (PED) between April 2009 and April 2013. We identified the treatment received, length of stay in those admitted and number of visits to the ED in those ambulated. We compared each year since 2009 (when ambulation was written into local guidelines) looking at treatment given and patient outcomes. We calculated an estimated cost of care for each case using local tariffs.

Results

353 cases were identified. 63 (17.8%) were admitted from first assessment. 194 (54.9%) received ambulatory intravenous antibiotics, of those 5 (1.4%) were subsequently admitted. No children who received ambulatory care developed a significant complication e.g. orbital cellulitis. Comparison of the first and last 12 months demonstrated a falling admission rate from 32.9% to 10.3% (p<0.05). During the same period ambulatory intravenous antibiotic use rose from 32.9% to 67.9% (p<0.05). There was a reduction in initial treatment with oral antibiotics (31.2% to 21.8% p>0.05). This is a less significant trend but has important implications considering the morbidity and patient/parent acceptability of cannulation. We estimate an average saving of £2,420 per patient ambulated.

Conclusion

Ambulatory care of periorbital cellulitis is safe and cost effective, with very low rate of complication. We postulate that the availability of ambulatory intravenous antibiotics may be affecting clinical decision making, resulting in more children with mild periorbital cellulitis receiving intravenous rather than oral antibiotics. We suggest there is a role for developing a periorbital cellulitis scoring system to assess severity and guide treatment.Abstract 031 Figure 1

Periorbital Cellulitis.

Abstract 032 Figure 1

Street Doctors.
USING EXISTING PAEDIATRIC PRE-HOSPITAL TRAUMA TRIAGE TOOLS TO IDENTIFY CHILDREN WITH SEVERE TRAUMATIC BRAIN INJURY–AN ANALYSIS OF NATIONAL TRAUMA REGISTRY DATA
Authors: Lyttle M D , Ardolino A , Berry K , Bouamra O , Cheung R , Lawrence T , Lecky F , Maconochie I K
Published: September 2013

Objectives & Background

Severe traumatic brain injury (TBI) in childhood causes long term neurodisability and death, though early neurosurgical intervention may improve outcome. Primary transfer to a neurosurgical centre reduces the time from initial Emergency Department arrival to performance of time critical procedures. Paediatric trauma and neurosurgery services in England have recently undergone reconfiguration. To assist pre-hospital clinicians in determining the most suitable destination for an injured child a number of trauma triage tools have been developed. We aimed to assess the performance of these tools in identifying children with severe TBI.

Methods

Eight paediatric pre-hospital trauma triage tools were identified via survey and literature review. Retrospective clinical registry data for children <16 years were obtained from the Trauma Audit and Research Network during 2007–2012. Severe TBI was defined as Abbreviated Injury Score ≥3 in the head region as less severe injuries are unlikely to require neurosurgery. Performance of the tools in identifying severe TBI was assessed, with clinically acceptable cut-offs for under and over-triage assigned at the level of ≤5% and ≤50% respectively.

Results

338 (30%) of 1118 patients had severe TBI. None of the tools demonstrated an acceptable under-triage rate (range 7–68%). Two had acceptable over-triage rates of 90% and 82%, though these displayed the highest rates of under-triage. The remaining tools had over-triage rates of 56–83%.

Conclusion

None of the existing paediatric pre-hospital trauma triage tools perform adequately in identifying severe TBI. Given the incidence of severe TBI in this population, and the benefits of appropriate disposition, any such tools subsequently derived should pay particular attention to their performance in regard to severe TBI with particular focus on optimising under triage rates.
ISOLATED VOMITING–A POOR INDICATION FOR CT SCAN IN HEAD INJURY?
Authors: Fryer J , Pusapati S , Abrahamson E
Published: September 2013

Objectives & Background

Minor head injuries account for a significant number of paediatric presentations to the Emergency Department. In 2007 NICE produced national guidelines to improve and standardise practice across the UK. One indication for CT head scanning is vomiting ≥3 times, even in the absence of any other risk factors. In this study we reviewed CT outcomes with specific focus on children with isolated vomiting.

Methods

All CT Heads performed by Chelsea and Westminster Hospital Paediatric ED for minor head injury in patients under 16 years of age between July 2007 and May 2013 were reviewed. We identified those in whom the sole indication for CT head was vomiting ≥3 times post head injury.

Results

8096 children attended our department with head injury during the study period. Of these 516 (6.4%) underwent CT of the head. In 104 patients (20.2%) the indication for the CT was isolated vomiting, as the sole indication. Of this group, only one child had an abnormal CT (a minor finding requiring no intervention). The remaining 412 patients in the study had other NICE indications for a CT (sometimes multiple). Of these 67 (16.3%) had an abnormal scan.

Conclusion

This study looks at practice in our unit over a 6 year period, starting 6 months after the 2007 NICE guidelines were introduced. This clearly shows that a large percentage of CTs are being performed on children following minor head injury on the basis of vomiting alone (20.2%). The yield of this is however extremely low with only 0.96% of the patients scanned having an abnormality. There are other clinical decision making algorithms in use internationally which do not have isolated vomiting as an indicator. We believe the current NICE guideline is exposing children‘s' heads to unnecessary ionising radiation.
EARLY MRI FOR CLINICAL SCAPHOID FRACTURES IN CHILDREN; A BETTER PATIENT JOURNEY? A 12 YEAR REVIEW FROM BIRMINGHAM CHILDREN'S HOSPITAL
Authors: Cantonsmith B , Stanhope B
Published: September 2013

Objectives & Background

Traditional management of Clinical Scaphoid Fractures has been to immobilise the wrist for 10–21 days and then reassess the injury. Birmingham Children's Hospital (BCH) has offered an Early MRI service for these patients for 12 years. The aim is to MRI the wrist within a few days of injury to get a definitive diagnosis and reduce unnecessary immobilisation. The objective of this review of the Early MRI service, was to analyse:

Age, Sex and Hand dominance

Percentage of actual scaphoid fractures & other carpal/radial fractures

Time from presentation to MRI scan

Methods

Data was retrieved for all patients (aged 0–18 years) who had had a Scaphoid Xray or MRI from January 1999 until March 2012 from the Xray reporting system. Patients were included if they had presented to the Emergency Department at BCH, and had normal Scaphoid Xrays followed by an MRI scan.

Results

137 patients were included. Boys were significantly more likely to actually have a scaphoid fracture (p<0.001) even though the sex distribution of Clinical Scaphoid Fractures was equal. 22.6% had a fractured scaphoid, 18.6% fractured other carpals, 7.3% a fractured radius, 29.1% had another diagnosis and 22.6% were normal. Time from presentation until MRI scan ranged from 1–54 days with a mode of 3 days, median 11 days and mean of 14 days.

Conclusion

It is possible to offer Early MRI scanning for Clinical Scaphoid Fractures, and most commonly our patients waited 3 days, reducing the length of immobilisation. A large number of other injuries were identified which were missed on initial Xrays. Half of all subjects have a fracture, however only half of these were scaphoid fractures. Only approximately a quarter of scans were normal, and therefore immobilised unnecessarily. Boys are more likely to actually have a scaphoid fracture on MRI than girls.
RESOURCE ALLOCATION FOR THE TREATMENT OF RARE DISEASES
Authors: Gosain Sheena , Coyle Doug , Clifford Tammy , Jones Barry
Published: September 2013

Introduction

Drugs for rare diseases are often associated with extremely high costs which can be a barrier to patients' accessibility. Due to scarce healthcare resources, funding for expensive orphan therapies is a predicament for policy-makers and patients. In Canada, funding decisions for drugs for rare diseases are made at the provincial and regional level primarily on an individual basis, and are typically made on the grounds of historical and political factors. In many cases, limited reflection is given to the collective costs or the alternative applications of these resources. To ensure that equitable decisions are made, formal and transparent processes for the reimbursement of orphan drugs are needed.

Objectives

Given the unique economic and ethical challenges associated with orphan drugs, the applicability of existing approaches used for the priority setting of health care resources may be limited. This study will consider existing priority setting frameworks in order to identify the decision criteria that can be applied for the funding of drugs for rare diseases.

Methods

A systematic review will be conducted to identify the available frameworks used when making healthcare resource allocation decisions. A case study of an orphan drug therapy will be used to assess the varying funding decisions that may result from applying different frameworks and decision criteria.

Results

Work in progress.

Conclusions

This research will help establish an understanding of the available priority setting frameworks and the decision criteria that can be applied when making reasonable conclusions related to the reimbursement of orphan drugs. An in depth understanding of the factors to consider when making priority setting decisions may help in the development of a standardized framework for the funding of drugs for rare diseases.
EFFECTS OF SUBSTITUTIONAL DOPING IN ELECTRONIC TRANSPORT PROPERTIES OF CARBON NANOTUBES
Authors: TSUYUKI HIROYOSHI , SHIIBASHI TOMOHIRO , SAKAMOTO SHOICHI , TOMIYA MITSUYOSHI
Published: September 2013

We have numerically investigated electronic transport properties in single-walled carbon nanotubes (SWCNTs) doped with boron (B) and nitrogen (N) substitutional impurities. Our calculations are performed by the ab initio density functional theory (DFT) and the nonequilibrium Green's function (NEGF) approach. We show that the electronic transmissions are moderated after the doping on both metallic and semiconducting CNTs. In B and N codoping nanotubes, depending on the arrangements of B and N substitutions, electronic and transport properties have been also modified. Calculating from electronic transmissions under bias, I–V characteristics of doped CNTs are demonstrated. In our simulations, we find that the substituting impurities in the semiconducting CNT raise the conductivity regardless of p- or n-type doping, whereas the conductivity of metallic CNTs is reduced by doping.
6-Mercaptopurine augments glucose transport activity in skeletal muscle cells in part via a mechanism dependent upon orphan nuclear receptor NR4A3
Authors: Liu Qinglan , Zhu Xiaolin , Xu Lusheng , Fu Yuchang , Garvey W. Timothy
Published: September 2013

The purine anti-metabolite 6-mercaptopurine (6-MP) is widely used for the treatment of leukemia and inflammatory diseases. The cellular effects of 6-MP on metabolism remain unknown; however, 6-MP was recently found to activate the orphan nuclear receptor NR4A3 in skeletal muscle cell lines. We have reported previously that NR4A3 (also known as NOR-1, MINOR) is a positive regulator of insulin sensitivity in adipocytes. To further explore the role of NR4A3 activation in insulin action, we explored whether 6-MP activation of NR4A3 could modulate glucose transport system activity in L6 skeletal muscle cells. We found that 6-MP increased both NR4A3 expression and NR4A3 transcriptional activity and enhanced glucose transport activity via increasing GLUT4 translocation in both basal and insulin-stimulated L6 cells in an NR4A3-dependent manner. Furthermore, 6-MP increased levels of phospho-AS160, although this effect was not modulated by NR4A3 overexpression or knockdown. These primary findings provide a novel proof of principle that 6-MP, a small molecule NR4A3 agonist, can augment glucose uptake in insulin target cells, although this occurs via both NR4A3-dependent and -independent actions; the latter is related to an increase in phospho-AS160. These results establish a novel target for development of new treatments for insulin resistance.
Is there diurnal variation of the vestibulosympathetic reflex: implications for orthostatic hypotension
Authors: Ray Chester A. , Sauder Charity L. , Chin-Sang Stephanie A. , Cook Jonathan S.
Published: September 2013

Incidences of adverse cardiac events and orthostatic hypotension are associated with diurnal variations. The primary purpose of the present study was to determine if the vestibulosympathetic reflex (VSR) follows a diurnal variation in humans. We hypothesized that the VSR would be attenuated at night based on the relation between melatonin and the VSR. Arterial blood pressure, heart rate, calf blood flow, and muscle sympathetic nerve activity (MSNA) were measured in nine healthy subjects (28 ± 1 yr, 5 men and 4 women) at rest and during head-down rotation. Each subject was tested during the day at 11:34 ± 13 and again at night 22:10 ± 5. MSNA was significantly decreased at night compared with day (8 ± 1 vs. 11 ± 2 bursts/min, respectively, P < 0.02). Heart rate and arterial blood pressure at rest were significantly increased at night compared with day (heart rate: 70 ± 4 vs. 66 ± 4 beats/min and mean arterial blood pressure: 91 ± 2 vs. 87 ± 1 mmHg, respectively). MSNA and hemodynamic responses to head-down rotation were not significantly altered at night compared with day (changes of 3 ± 1 bursts/min and 25 ± 6% for MSNA and calf blood flow, respectively). The data indicate that MSNA at rest decreases during the late evening hours and exhibits a diurnal variation, whereas the VSR does not. In summary, diurnal variation of orthostatic hypotension in humans does not appear to be associated with changes in the VSR and MSNA at rest.
Upregulation of heme oxygenase-1 potentiates EDH-type relaxations in the mesenteric artery of the spontaneously hypertensive rat
Authors: Li Zhuoming , Wang Yu , Man Ricky Y. K. , Vanhoutte Paul M.
Published: September 2013

Heme oxygenase (HO) converts heme to carbon monoxide, bilirubin, and free iron. The present study investigated whether or not HO-1 induction improves vascular relaxations attributable to endothelium-dependent hyperpolarization (EDH). Thirty-six-week-old spontaneously hypertensive rats were treated with the HO-1 inducer hemin, the HO inhibitor zinc protoporphyrin IX (II) (ZnPP), the antioxidant apocynin, or combinations of these compounds. Isolated mesenteric arteries were prepared for measurement of isometric tension, protein presence, and production of reactive oxygen species (ROS). Hemin potentiated acetylcholine-evoked EDH-type relaxations in the presence of Nω-nitro-l-arginine methyl ester (l-NAME) and indomethacin, while the combined treatment with ZnPP plus hemin prevented these improvements. The intermediate conductance Ca2+-activated K+ channel (IKCa) blocker TRAM-34 and the Na+-K+-ATPase blocker ouabain significantly impaired these hemin-potentiated relaxations. NS309-induced TRAM-34- and ouabain-sensitive relaxations were enhanced by hemin. K+-induced ouabain-sensitive relaxations and the expression of Na+-K+-ATPase were increased by hemin. Thus HO-1 induction improves EDH-type relaxations by augmented activation of IKCa and the downstream Na+-K+-ATPase. Treatment with apocynin showed a similar effect as hemin in impairing ROS production, enhancing K+-induced relaxations, and increasing Na+-K+-ATPase expression, without affecting the expression of HO-1. The effects of hemin and apocynin were not additive. These observations suggest that the effect of HO-1 induction on EDH-type relaxations is possibly due to its antioxidant properties. In vitro treatment with bilirubin, but not carbon monoxide, enhanced EDH-type relaxations and K+-induced ouabain-sensitive relaxations, suggesting that the production of bilirubin may be also involved. The present findings reveal that HO-1 may be a potential vascular-specific therapeutic strategy for endothelial dysfunction in hypertension.
Mesenchymal stromal cell turnover in the normal adult lung revisited
Authors: Seyed-Razavi Yashar , Williams Brenda , Winkler David A , Bertoncello Ivan
Published: September 2013

We have employed a simple and robust noninvasive method of continuous in vivo long-term bromodeoxyuridine (BrdU) labeling to analyze lung mesenchymal stromal cell turnover in adult mice in the steady state. Mathematical modeling of BrdU uptake in flow cytometrically sorted CD45negCD31negSca-1poslung cells following long-term feeding of BrdU to mice in their drinking water reveals that lung mesenchymal stromal cells cycle continuously throughout life. Analysis of BrdU incorporation during long-term feeding and during chasing (delabeling) following replacement of BrdU-water with normal water shows that the CD45negCD31negSca-1poslung mesenchymal stromal cell compartment turns over at a rate of ∼2.26% per day with a time to half-cycled of 44 days, an estimated cell proliferation rate of 0.004/day, and a cell death rate of 0.018/day.
Pile-Reinforcement Behavior of Cohesive Soil Slopes: Numerical Modeling and Centrifuge Testing
Authors: Wang Liping , Zhang Ga
Published: September 2013

Centrifuge model tests were conducted on pile-reinforced and unreinforced cohesive soil slopes to investigate the fundamental behavior and reinforcement mechanism. A finite element analysis model was established and confirmed to be effective in capturing the primary behavior of pile-reinforced slopes by comparing its predictions with experimental results. Thus, a comprehensive understanding of the stress-deformation response was obtained by combining the numerical and physical simulations. The response of pile-reinforced slope was indicated to be significantly affected by pile spacing, pile location, restriction style of pile end, and inclination of slope. The piles have a significant effect on the behavior of reinforced slope, and the influencing area was described using a continuous surface, denoted asW-surface. The reinforcement mechanism was described using two basic concepts,compression effectandshear effect, respectively, referring to the piles increasing the compression strain and decreasing the shear strain of the slope in comparison with the unreinforced slope. The pile-soil interaction induces significantcompression effectin the inner zone near the piles; this effect is transferred to the upper part of the slope, with theshear effectbecoming prominent to prevent possible sliding of unreinforced slope.
The Analytical Solution of Some Fractional Ordinary Differential Equations by the Sumudu Transform Method
Authors: Bulut Hasan , Baskonus Haci Mehmet , Belgacem Fethi Bin Muhammad
Published: September 2013

We introduce the rudiments of fractional calculus and the consequent applications of the Sumudu transform on fractional derivatives. Once this connection is firmly established in the general setting, we turn to the application of the Sumudu transform method (STM) to some interesting nonhomogeneous fractional ordinary differential equations (FODEs). Finally, we use the solutions to form two-dimensional (2D) graphs, by using the symbolic algebra package Mathematica Program 7.
Is There a Limitation of RECIST Criteria in Prediction of Pathological Response, in Head and Neck Cancers, to Postinduction Chemotherapy?
Authors: Patil V. , Noronha V. , Joshi A. , Muddu Krishna Vamshi , Juvekar S. , Pantvaidya Gauri , Chaturvedi Pankaj , Chaukar D. , Arya Supreeta , Patil Aswari , Bhosale B. , Dongre A. , Dcruz A. K. , Prabhash K.
Published: September 2013

This study studied the coorelation between radiological response to induction chemotherapy and acheivement of pCR or near pCR. It was a retrospective analysis in which all patients who received NACT from 2008 till april 2012 were subjected to inclusion criteria. Coorelation analysis was performed between CR + PR and acheivement of pCR or near pCR. Twenty four patients were identified.The primary site of tumor was oral cavity in 19 patients (79.2%), maxilla in 2 patients (4.2%), laryngopharynx in 2 patients (4.2%) and oropharynx in 1 patient (4.2%). The clinical stage was stage IVA in 16 patients ( 66.7%) and IVB in 8 patients (33.3%). The overall response rates ie a combination of CR and PR was seen in 11patients (45.8%). The pCR was seen in 15 patients (62.5%) and rest had near pCR. There was no linear coorelation between radiological size decrement and tumor response. On coorelation analysis the spearman correlation coefficent was −0.039 (). This suggest that presently used radiological response criterias for response assesment in head and neck cancers severly limit our ability to identify patients who would have pCR or near pCR.
The Use of Bedside Ultrasound in the Evaluation of Patients Presenting with Signs and Symptoms of Pulmonary Embolism
Authors: Patel Adarsh N. , Nickels L. Connor , Flach F. Eike , De Portu Giuliano , Ganti Latha
Published: September 2013

Evaluation of patients that present to the emergency department with concerns for the diagnosis of pulmonary embolism can be difficult. Modalities including computerized tomography (CT) of the chest, pulmonary angiography, and ventilation perfusion scans can expose patients to large quantities of radiation especially if the study has to be repeated due to poor quality. This is particularly a concern in the pregnant population that has an increased incidence of pulmonary embolism and may not be able to undergo multiple radiographic studies due to fetal radiation exposure. This paper presents a case of a pregnant patient with signs and symptoms concerning pulmonary embolism. The paper discusses the use of bedside ultrasound in the evaluation of patients with pulmonary embolism.
The Intersection of Upper and Lower Semi-Browder Spectrum of Upper-Triangular Operator Matrices
Authors: Zhang Shifang , Zhong Huaijie , Long Long
Published: September 2013

WhenA∈B(H)andB∈B(K)are given, we denote byMCthe operator acting on the infinite-dimensional separable Hilbert spaceH⊕Kof the formMC=(AC0B). In this paper, it is proved that there exists some operatorC∈B(K,H)such thatMCis upper semi-Browder if and only if there exists some left invertible operatorC∈B(K,H)such thatMCis upper semi-Browder. Moreover, a necessary and sufficient condition forMCto be upper semi-Browder for someC∈G(K,H)is given, whereG(K,H)denotes the subset of all of the invertible operators ofB(K,H).
Preoperative and Postoperative Optical Coherence Tomography Findings in Patients with Rhegmatogenous Retinal Detachment Involving the Macular Region
Authors: Matsui Asaki , Toshida Hiroshi , Honda Rio , Seto Takahiko , Ohta Toshihiko , Murakami Akira
Published: September 2013

Purpose. To evaluate morphologic changes of the macula, we observed eyes with rhegmatogenous retinal detachment (RRD) involving the macular region by optical coherence tomography (OCT). Subjects and Methods. We studied 26 eyes with RRD before and after surgery, assessing visual acuity, the height of retinal detachment at the fovea (HRD), and morphologic changes of the macular region. The interval between the onset and surgery was also determined. We examined the external limiting membrane (ELM) after surgery and the continuity of the inner segment-outer segment junction (IS/OS junction) of the photoreceptor layer. Results. Impairment of visual acuity was observed when HRD was over 1,000 μm, when there was outer nuclear layer edema before surgery, and when there was IS/OS junction disruption 3 months after surgery. However, 67% of eyes with a continuous ELM and IS/OS junction disruption 3 months after surgery eventually showed restoration of the continuity of IS/OS junction at 6 months. Conclusions. Impairment of visual acuity was observed in eyes with HRD  μm, preoperative outer nuclear layer edema, and IS/OS junction disruption 3 months postoperatively. It is suggested that continuity of ELM might affect restoration of IS/OS junction after surgery for retinal detachment.
Morganella morganiiPericarditis in a Patient with Multiple Myeloma
Authors: Nakao Takafumi , Yoshida Masahiro , Kanashima Hiroshi , Yamane Takahisa
Published: September 2013

Purulent pericarditis caused byMorganella morganiiis extremely rare. We report herein a case of a 61-year-old man who presented with chest pain and dyspnea fourteen days after chemotherapy for multiple myeloma. Echocardiogram and computed tomography revealed a massive pericardial effusion and associated cardiac tamponade. Pericardiocentesis was performed. Pericardial fluid was found to be purulent, andMorganella morganiiwas isolated from the fluid. The patient was successfully treated with antibiotic therapy and surgical drainage of the fluid.Morganella morganiishould be considered a possible pathogen when immunocompromised patients develop purulent pericarditis.
Aberrant Alternative Splicing Is Another Hallmark of Cancer
Authors: Ladomery Michael
Published: September 2013

The vast majority of human genes are alternatively spliced. Not surprisingly, aberrant alternative splicing is increasingly linked to cancer. Splice isoforms often encode proteins that have distinct and even antagonistic properties. The abnormal expression of splice factors and splice factor kinases in cancer changes the alternative splicing of critically important pre-mRNAs. Aberrant alternative splicing should be added to the growing list of cancer hallmarks.
The Influence of User Protection Behaviors on the Control of Internet Worm Propagation
Authors: Li Yihong , Pan Jinxiao , Song Lipeng , Jin Zhen
Published: September 2013

Computer users’ reactions to the outbreak of Internet worm directly determine the defense capability of the computer and play an important role in the spread of worm. In this paper, in order to characterize the impacts of adaptive user protection behaviors, an improved SIS model is proposed to describe the Internet worm propagation. The results of theoretical analysis indicate that the protective campaigns of users can indeed reduce the worm’s reproduction number to values less than one. But it may not be sufficient to eradicate the worm. In certain condition, a backward bifurcation leading to bistability can occur. These are new findings in the worm propagation model that bring new challenges to control the spread of the worm and further demonstrate the importance of user behaviors in controlling the worm propagation. Corresponding to the analysis results, defense and control strategies are provided.
On Singular Dissipative Fourth-Order Differential Operator in Lim-4 Case
Authors: Uğurlu Ekin , Bairamov Elgiz
Published: September 2013

A singular dissipative fourth-order differential operator in lim-4 case is considered. To investigate the spectral analysis of this operator, it is passed to the inverse operator with the help of Everitt's method. Finally, using Lidskiĭ's theorem, it is proved that the system of all eigen- and associated functions of this operator (also the boundary value problem) is complete.
Familiar Music as an Enhancer of Self-Consciousness in Patients with Alzheimer’s Disease
Authors: Arroyo-Anlló Eva M. , Díaz Juan Poveda , Gil Roger
Published: September 2013

The main objective of this paper is to examine the impact of familiar music on self-consciousness (SC) in patients with Alzheimer’s disease (AD). For this purpose, two AD groups of 20 patients matched by age, educational level, gender, illness duration, and cognitive state were assessed using an SC questionnaire before and after music intervention. The SC questionnaire measured several aspects: personal identity, anosognosia, affective state, body representation, prospective memory, introspection and moral judgments. One AD group received familiar music stimulation and another AD group unfamiliar music stimulation over three months. The AD patients who received a familiar music intervention showed a stabilization or improvement in aspects of SC. By contrast, control AD group showed a deterioration of most of the SC aspects after unfamiliar music stimulation, except the SC aspects of body representation and affective state. Familiar music stimulation could be considered as an enhancer of SC in patients with Alzheimer’s disease.
Solutions of Fractional Konopelchenko-Dubrovsky and Nizhnik-Novikov-Veselov Equations Using a Generalized Fractional Subequation Method
Authors: Liu Yanqin , Yan Limei
Published: September 2013

A new generalized fractional subequation method based on the relationship of fractional coupled equations is proposed. This method is applied to the space-time fractional coupled Konopelchenko-Dubrovsky equations and Nizhnik-Novikov-Veselov equations. As a result, many exact solutions are obtained including hyperbolic function solutions, trigonometric function solutions, and rational solutions. It is observed that the proposed approach provides a simple and reliable tool for solving many other fractional coupled differential equations.
Effect of Deformation and Aging on Properties of Al-4.1%Cu-1.4%Mg Aluminum Alloy
Authors: Wang Hao , Li Changsheng , Li Jing , Wei Xinglong , Mei Ruibin
Published: September 2013

Deformation scheme and preheat treatment of Al-4.1%Cu-1.4%Mg aluminum alloy are chosen, homogenizing annealing at 430°C for 1.5 h, cooling to 250°C in furnace at a cooling rate of less than 30°C/h and then cooling to room temperature to make Al-4.1%Cu-1.4%Mg aluminum alloy annealed fully. Heat treatment tests of Al-4.1%Cu-1.4%Mg aluminum alloy mainly consisting of rolling and aging were conducted, and the optimum peak of aging mechanism is 190°C/12 h. Through comparison of microstructure and mechanical properties with different deformation rates and aging mechanisms, effect of deformation rates and aging mechanism on properties of Al-4.1%Cu-1.4%Mg aluminum alloy was analyzed, and the optimum double peak of aging mechanism is 135°C/7 h + 185°C/14 h. Orthogonal experiments were carried out to analyze mechanical and electrical properties of tested materials before and after deformation, and the effect of aging mechanism on Al-4.1%Cu-1.4%Mg Al alloy was analyzed, and the optimum regression of aging mechanism is 190°C/12 h + 240°C/40 min + 190°C/12 h. Aging scheme is closely related to corrosion resistance of Al-4.1%Cu-1.4%Mg aluminum alloy, and three different aging schemes can improve the corrosion resistance. The exfoliation corrosion evaluation results show that the aging effect on exfoliation corrosion ability order is RRA > two-step aging > peak aging.
Synthesis and Biological Evaluation of Novel γ‐Alkylidene Butenolides
Authors: Liu Gai-Zhi , Guan Yan-Bin , Wu Ya , Liu Hong-Min
Published: September 2013

Three new series of 4‐substituted‐5‐alkylidene‐2,5‐dihydrofuran‐2‐ones were synthesized. The in vitro activity test results showed that some of them exhibited good antibacterial and cytotoxic activities. Among them compound 5c showed the most potent antibacterial activity against Escherichia coli with the MIC value of 20.00 μg/mL. Compound 9c showed good cytotoxic activity against Ec9706 cells with IC50 value of 19.39 μM, better than that of the reference compound fluorouracil (IC50 = 37.74 μM).
Correlation between PPAR Gene Polymorphisms and Primary Nephrotic Syndrome in Children
Authors: Jin Jiaping , Ding Guixia , Bao Huaying , Chen Ying , Han Yuan , Zhao Fei , Huang Songming , Zhang Aihua
Published: September 2013

Pediatric primary nephrotic syndrome (PNS) is a chronic disease promoted by metabolic and immune dysfunctions. Peroxisome proliferator-activated receptor (PPAR) polymorphisms have been associated with a variety of metabolic and kidney disorders. We therefore hypothesized that PPAR polymorphisms might be involved in the pathophysiology of PNS. We compared the distributions of the PPAR-γPro12Ala and Val290Met, PPAR-γcoactivator-α(PGC-1α) Gly482Ser, and PPAR-αLeu162Val single nucleotide polymorphisms (SNPs) between children with PNS and normal controls and analyzed their correlations with clinical and metabolic indicators and steroid responsiveness. There were no significant differences in distributions of any of the polymorphisms between PNS cases and controls. However, PNS patients with the PPAR-γ(Pro12Ala) PP genotype had significantly higher fasting serum insulin, IgA, and HOMA-IR levels and lower insulin sensitivity than did patients with PA and AA genotypes. Additionally, the PGC-1α(Gly482Ser) A allele was associated with lower CD8+ T-cell counts and higher triglyceride and complement C3 levels compared with the G allele. No polymorphisms were related to hormone sensitivity. These results suggest that the PPAR-γ(Pro12Ala) and PGC-1α(Gly482Ser) SNPs may influence insulin and triglyceride metabolism in children with PNS and may thus be relevant to the prognosis of this chronic condition.
Role of the Endocannabinoid System in the Central Regulation of Nonmammalian Vertebrate Reproduction
Authors: Cottone Erika , Pomatto Valentina , Bovolin Patrizia
Published: September 2013

The endocannabinoid system (ECS) has a well-documented pivotal role in the control of mammalian reproductive functions, by acting at multiple levels, that is, central (CNS) and local (gonads) levels. Since studies performed in animal models other than mammals might provide further insight into the biology of these signalling molecules, in the present paper we review the comparative data pointing toward the endocannabinoid involvement in the reproductive control of non-mammalian vertebrates, focussing in particular on the central regulation of teleost and amphibian reproduction. The morphofunctional distribution of brain cannabinoid receptors will be discussed in relation to other crucial signalling molecules involved in the control of reproductive functions, such as GnRH, dopamine, aromatase, and pituitary gonadotropins.
Cooperative Object Manipulation by a Space Robot with Flexible Appendages
Authors: Zarafshan P. , Moosavian S. Ali A.
Published: September 2013

Modelling and control of rigid-flexible multibody systems is studied in this paper. As a specified application, a space robotic system with flexible appendages during a cooperative object manipulation task is considered. This robotic system necessitates delicate force exertion by several end-effectors to move an object along a desired path. During such maneuvers, flexible appendages like solar panels may get stimulated and vibrate. This vibrating motion will cause some oscillatory disturbing forces on the spacecraft, which in turn produces error in the motion of the end-effectors of the cooperative manipulating arms. In addition, vibration control of these flexible members to protect them from fracture is another challenging problem in an object manipulation task for the stated systems. Therefore, the multiple impedance control algorithm is extended to perform an object manipulation task by such complicated rigid-flexible multibody systems. This extension in the control algorithm considers the modification term which compensates the disturbing forces due to vibrating motion of flexible appendages. Finally, a space free-flying robotic system which contains two 2-DOF planar cooperative manipulators, appended with two highly flexible solar panels, is simulated. Obtained results reveal the merits of the developed model-based controller which will be discussed.
Die Tibetische Rezeptur Padma Lax in der ärztlichen Praxis: Eine retrospektive Fallstudie bei Obstipation mit 174 Patienten
Authors: Uehleke Bernhard , Zahradnicek Simona , Vennos Cecile
Published: September 2013

Hintergrund: Das Tibetische Arzneimittel Padma Lax ist seit über 40 Jahren in der Schweiz bei Obstipation und Blähungen zugelassen. In dieser Studie wurden Daten zur Anwendung im Praxisumfeld und zur Wirksamkeit bei verschiedenen obstipationsbedingten Beschwerden sowie zu Sicherheit und Verträglichkeit erhoben und bewertet. Material und Methoden: In der Schweiz praktizierende Ärztinnen und Ärzte dokumentierten retrospektiv den Behandlungsverlauf bei chronischer Obstipation mittels eines eigens entwickelten Fragebogens. Neben der Stuhlfrequenz wurde unter anderem auch die Intensität von 12 spezifischen Verstopfungssymptomen erhoben. Ergebnisse: 17 teilnehmende Ärzte lieferten Daten von insgesamt 174 Patientenfällen, wobei rund 30% aus der gynäkologischen Praxis stammten. Als Obstipationsursachen wurden unter anderem Lifestyle-Faktoren und verschiedene Grunderkrankungen angegeben, z.B. neurologische oder hormonelle Störungen. Sicherheit und Verträglichkeit wurden als sehr gut beurteilt, es wurde nur 1 unerwünschtes Ereignis (eine Verschlechterung der Flatulenz) angegeben. Die Stuhlfrequenz stieg im Behandlungsverlauf deutlich, 97% erreichten eine Frequenz von >2 pro Woche. Durchschnittlich verringerten sich die Häufigkeit und die Intensität aller Symptome, mit Ausnahme des Symptoms weicher/dünner Stuhl, das sich bei ebenso vielen Patienten erhöhte wie erniedrigte. Die Gesamtintensität über alle Symptome sank von durchschnittlich 15,8 um 63% auf 5,8. Der Anteil der Patienten mit starken Beschwerden (Gesamtscore >20) sank von 20,1% auf 1,7%, was in der Folge die Gruppe mit «kaum Beschwerden» (Gesamtscore ≤5) von 1,2% auf 57% ansteigen ließ. 86% der Ärzte und der Patienten beurteilten die Wirksamkeit als gut. Schlussfolgerungen: Padma Lax wurde bei Verstopfung unterschiedlicher Ursache bei einem breiten Patientenspektrum eingesetzt. Die Einschätzung der Wirksamkeit und Verträglichkeit war gut oder sehr gut. Trotz der Limitierung durch den retrospektiven Studientyp weisen die Daten darauf hin, dass Padma Lax bei chronischer Verstopfung unterschiedlicher Ursache, insbesondere auch in der gynäkologischen Praxis, bei geriatrischen Patienten und bei Patienten mit neurogener Obstipation, eine wirksame und verträgliche Therapieoption darstellt.
Microcompartments and Protein Machines in Prokaryotes
Authors: Saier Jr. Milton H.
Published: September 2013

The prokaryotic cell was once thought of as a ‘bag of enzymes' with little or no intracellular compartmentalization. In this view, most reactions essential for life occurred as a consequence of random molecular collisions involving substrates, cofactors and cytoplasmic enzymes. Our current conception of a prokaryote is far from this view. We now consider a bacterium or an archaeon as a highly structured, nonrandom collection of functional membrane-embedded and proteinaceous molecular machines, each of which serves a specialized function. In this article we shall present an overview of such microcompartments including (1) the bacterial cytoskeleton and the apparati allowing DNA segregation during cell division; (2) energy transduction apparati involving light-driven proton pumping and ion gradient-driven ATP synthesis; (3) prokaryotic motility and taxis machines that mediate cell movements in response to gradients of chemicals and physical forces; (4) machines of protein folding, secretion and degradation; (5) metabolosomes carrying out specific chemical reactions; (6) 24-hour clocks allowing bacteria to coordinate their metabolic activities with the daily solar cycle, and (7) proteinaceous membrane compartmentalized structures such as sulfur granules and gas vacuoles. Membrane-bound prokaryotic organelles were considered in a recent Journal of Molecular Microbiology and Biotechnology written symposium concerned with membranous compartmentalization in bacteria [J Mol Microbiol Biotechnol 2013;23:1-192]. By contrast, in this symposium, we focus on proteinaceous microcompartments. These two symposia, taken together, provide the interested reader with an objective view of the remarkable complexity of what was once thought of as a simple noncompartmentalized cell.
Clinical Assessment of Amyloid Imaging in Alzheimer's Disease: A Systematic Review of the Literature
Authors: Wahlster Philip , Niederländer Charlotte , Kriza Christine , Schaller Sandra , Kolominsky-Rabas Peter L.
Published: September 2013

Background/Aims: Healthcare systems face an increased prevalence of Alzheimer's disease and increasing costs. The use of molecular biomarkers and imaging could offer an effective solution for these issues. The objective of this study was to assess amyloid imaging regarding clinical utility and impact. Methods: A literature search was performed in several databases, searching articles between 2008 and January 2013 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The results are reported according to the clinical correlates of amyloid imaging. Results: Thirty-three studies were included in the final analysis. Five studies evaluated amyloid imaging for diagnosis. Nine studies assessed the prognostic value. Twenty-two studies provided correlations to cognitive measures. Amyloid imaging provides a high reliability in diagnosis and prognosis, but cognitive measures only showed weak correlations. Conclusion: The evidence clearly indicated that amyloid imaging has not arrived yet in clinical practice. However, it can provide substantial benefits in special aspects of diagnostic accuracy and for a diagnosis up to 10 years before clinical diagnosis. This can be a base for early preventive treatment strategies such as anti-amyloid therapy. In this context, amyloid imaging is crucial to understand the early pathologic process in Alzheimer's disease.
Clinical Studies on the Efficacy and Safety of Padma 28, a Complex Herbal Formulation from Tibetan Medicine: An Overview
Authors: Vennos Cecile , Melzer Jörg , Saller Reinhard
Published: September 2013

Background: Padma 28 is an herbal formula from Tibetan Medicine, which since 35 years has been registered in Switzerland as a drug for the symptoms of circulatory disorders. Over this time, a large body of scientific literature has accumulated. The aim of this article was to give an overview of the clinical studies. Methods: A systematic literature search was done in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CCRCT). The clinical trials found were assessed regarding fields of application, efficacy, and safety, as well as methodological quality and level of evidence. Results: 29 trials (1 meta-analysis, 21 controlled trials, 7 open trials) and 3 retrospective case studies were found. They deal with different indications and include a total of 1,704 verum (of these, 697 children), 333 placebo, and 394 untreated or healthy patients. Dropouts and withdrawals were 2.5 and 3.5 times higher in the placebo than in the verum group, respectively. The highest level of evidence for the use of Padma 28 was found in the indication of intermittent claudication (11 trials). Indications of efficacy were also found in other vascular (6 trials) and different inflammatory diseases (12 trials). Conclusions: The results suggest a favorable safety profile for Padma 28, also in the children examined (41% of the study population). Furthermore, the results show a broad field of applications. According to clinical evidence, Padma 28 has shown to be a safe and effective symptomatic treatment option for atherosclerosis-related diseases such as intermittent claudication. It also seems to have a potential for application in certain chronic inflammatory diseases such as recurrent respiratory tract infections, viral hepatitis, and multiple sclerosis. However, further randomized controlled trials (RCT) are needed to confirm these findings.
Neue Ansätze zur Wirkmusteraufklärung pflanzlicher Mehrstoffgemische
Authors: Gostner Johanna M. , Gruber Peter , Becker Kathrin , Naschberger Martina , Überall Florian
Published: September 2013

Obwohl die Hauptwirkungen traditioneller Präparate größtenteils seit langem bekannt sind, sind die molekularen Hintergründe der Aktivitätsmechanismen häufig nicht im Detail erforscht. Die pharmakorelevanten Aktivitäten botanischer Therapeutika resultieren oft aus der additiven oder synergistischen Wirkung einer Vielzahl von Inhaltsstoffen. Unterschiedliche Studien wurden publiziert, in denen die Effekte solcher Mehrkomponentengemische an ausgewählten In-vitro-Zellmodellen mittels Genexpressionsanalyse untersucht wurden. Hier erwähnte Beispiele umfassen Transkriptionsanalysen mit Extrakten aus Ginkgo biloba und Echinacea sowie der Tibetischen Rezeptur Padma 28. Transkriptionsprofile können verwendet werden, um Moleküle und Signalwege herauszufiltern, die durch eine bestimmte Behandlung beeinflusst sind. Differenziell exprimierte Gensets können mit Informationen aus Interaktionsdatenbanken integriert werden, um Einsichten in betroffene biologische Prozesse zu erhalten. Die Methode der Transkriptionsanalyse mittels Mikroarray-Technologie ist in unterschiedlichen Bereichen der Naturstoff-Forschung anzutreffen, wobei die Einsatzgebiete von der Wirkmusterbeschreibung bis hin zum Toxizitätsprofiling reichen.
Comparison of the European and Japanese Guidelines for the Acute Management of Intracerebral Hemorrhage
Authors: Toyoda Kazunori , Steiner Thorsten , Epple Corina , Kern Rolf , Nagayama Masao , Shinohara Yukito , Hennerici Michael G.
Published: September 2013

Background: Different aspects of acute stroke management and strategies for stroke prevention derive from two viewpoints: specific traditional and historical backgrounds and evidence-based medicine from modern randomized controlled trials (RCTs), meta-analysis and authorized clinical practice guidelines (GLs). Regarding intracerebral hemorrhage (ICH), Cerebrovascular Diseases published the 2006 European stroke initiative recommendations for the management of ICH. In 2009, the revised Japanese GLs for the management of stroke, including that of ICH, appeared in Japanese. Whereas GLs for the prevention and treatment of ischemic stroke were presented in detail, recommendations with regard to ICH are relatively rare both in Japan and Europe. Methods: Since 2011, the authors have met repeatedly and have compared the latest versions of published European and Japanese GLs for ischemic and hemorrhagic strokes. Many aspects have only been addressed in one but left out in the other GLs, which consequently founded the basis for the comparison. Classification of evidence levels and recommendation grades defined by the individual committees differed between both original GLs. Results: Aspects of major importance were similar and hence did not need extensive interpretation, mostly due to a lack of evidence from appropriate RCTs worldwide. The target level to which systolic blood pressure should be lowered is quite high; <170 mm Hg for patients with known hypertension in Europe and <180 mm Hg in Japan. The results of ongoing clinical trials are awaited for the optimal target level and optimal medications. Concerning ICH associated with oral anticoagulant therapy, both guidelines give similar recommendations, namely that anticoagulation should be discontinued and the international normalized ratio of prothrombin time should be normalized with prothrombin complex concentrate or fresh-frozen plasma and additional vitamin K. Patients with ICH were treated surgically, often based on individual decisions - more frequently in Japan, depending on the association with hypertension. Patients with large or intraventricular bleedings were only treated if a life-saving performance was considered, irrespective of the neurological outcome. Infra- and supratentorial differences were similarly addressed in both GLs. Conclusion: This brief survey - when compared with the lengthy original recommendations - provides a stimulating basis for an extended interest among Japanese and European stroke clinicians to learn from their individual experiences and to strengthen efforts for joint cooperation in treating and preventing stroke all around the globe.