bluuebunny/crossref_metadata_2025 huggingface dataset:
Modifiable barriers to meeting care and support needs of patients with advanced chronic obstructive pulmonary disease (COPD) and their informal carers
Authors: Moore Caroline , Ewing Gail , Gardener Carole , White Patrick , Burge Peter , Mahadeva Ravi , Howson Sophie , Booth Sara , Ling Tom , Farquhar Morag ,   on behalf of the Living with Breathlessness study team
Published: August 2016

Introduction

COPD is a progressive condition with high symptom burden. Advanced COPD management should relieve symptoms, optimise daily functioning and reduce carer burden. Our knowledge of clinician barriers and facilitators to meeting the needs of these patients and their informal carers is limited.

Aim

To identify modifiable barriers to meeting care and support needs of patients with advanced COPD and their carers.

Methods

Purposively-sampled clinicians nominated by a population-based cohort of patients with advanced COPD participating in the Living with Breathlessness Study, took part in Longitudinal qualitative interviews on barriers and facilitators to meeting needs, and analysed using a Framework approach. Identified barriers were reviewed and recommendations to overcome them presented to stakeholders via workshop and online survey methods.

Results

Identification and assessment of patient need, and barriers and facilitators to doing so, were largely driven by organisational and medical agendas, rather than person-centred care models. There was little evidence of clinician engagement with patients’ informal carers. There was a mismatch between clinicians’ perceptions of changes in patient need during the 18-month study duration and those of patients and carers. Clinicians felt unprepared for end-of-life care discussions and found patient readiness for these conversations difficult to assess. Clinician-identified patient, organisational and professional facilitators included trust, time and accessibility.

Conclusion

Actioning recommendations such as stopping focusing on the challenge of prognostication as a barrier to meeting need, changing targets to incentivise person-centred care and identifying and supporting carers could improve care and support of patients and carers living with advanced COPD.

This report is independent research supported by the National Institute for Health Research (Career Development Fellowship, CDF-2012-05-218). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
POST ROSC OXYGENATION STUDY
Authors: Kirby Kim , Voss Sarah , Thomas Matthew , Elder Georgina , Nolan Jerry , Benger Jonathan
Published: August 2016

Abstracts selected through the 999 EMS Research Forum peer review process and presented orally and by poster at the ‘Making it Happen: Delivering Research in Pre-hospital Care’ Conference 2016.

Background

There is evidence that systematic cardiac arrest care after return of spontaneous circulation (ROSC) improves chances of survival with a good quality of life. Post cardiac arrest care is a critical component of advanced life support. It is postulated that exposing ischaemic brain tissue to significant hyperoxaemia during this period increases the possibility of oxidative injury and cellular death.

This study was designed to demonstrate the feasibility of completing a cluster-randomised clinical trial to determine if oxygen therapy titrated to oxygen saturation as measured by a pulse oximeter (target SpO294–98%) for 1 hour after a sustained return of spontaneous circulation (ROSC) is superior in improving outcome following non traumatic out of hospital cardiac arrest (OHCA) in adults, compared with the use of non-titrated, 100% oxygen.

Methods

Paramedics were randomly allocated to one of two trial arms (100% oxygen or titrated oxygen to a target SpO2of 94–98%). The intervention was initiated in adult non-traumatic OHCA once the patient achieved a sustained (>2 minutes) ROSC. Interventions were either the administration of 100% oxygen or oxygen titrated to a target SpO2of 94–98% for 60 minutes, continued in the receiving Emergency Department if necessary.

Results

In the intervention arm of the study, paramedics were able to titrate the inspired oxygen concentration in 72% of patients and obtain a reliable reading of oxygen saturation immediately after ROSC in 61% of patients.

The assigned oxygen therapy was continued for 60 minutes after ROSC in 74% of patients for whom the intervention was initiated. Legitimate reasons for discontinuation (e.g. death) occurred in a further 11%.

Conclusion

This study indicates that a future full scale trial to determine if titrated oxygen therapy is superior to 100% oxygen in improving patient outcome after non traumatic OHCA is feasible.
A CROSS-SECTIONAL SURVEY EVALUATING FACTORS AFFECTING ACCURACY AND SELF-PERCEIVED CONFIDENCE OF PARAMEDICS WHEN APPLYING THE MAJOR TRAUMA DECISION TREE
Authors: Durham Mark
Published: August 2016

Background

Since 2008, Britain has been developing trauma networks, and ambulance services have been adopting triage tools to support these. So far there has been no published work on how UK paramedics use these algorithms. This study aims to evaluate factors affecting accuracy and self-perceived confidence of paramedics from one UK Ambulance Trust when applying the Major Trauma Decision Tree (MTDT).

Methods

A quantitative cross-sectional survey design was used; a questionnaire sent to every paramedic within one Trust. The questionnaire asked for basic demographic data, then describing four case studies. Respondents applied the MTDT to the case studies, stating which algorithm steps (if any) they triggered, and their appropriate destination. Finally, a Likert scale explored respondent views on the MTDT. Descriptive and inferential statistics were used to look for any linked factors affecting accuracy/confidence.

Results

Population N=1,132, sample size n=178 (response rate=16%). Sensitivity with the MTDT was 77% (95%CI 72%–81%), specificity 61% (95% CI 56–66%). The trigger most commonly missed was patient age >56. Respondents reported transport time to MTC/TU influencing algorithm compliance.

Self-perceived confidence was low. Self-reported exposure to trauma correlated positively with confidence (rs [178] =0.323,p<0.0005). Respondents' concerns about reception received from hospital staff showed significant negative correlation with confidence (rs [178] =−0.459,p<0.0005).

Conclusion

Respondent sensitivity was low. Paramedic concerns about transport time are prevalent and could affect sensitivity. The most commonly missed trigger was age. Future training may benefit from addressing these points.

Respondents' confidence with the MTDT was low. Confidence was closely linked with exposure to trauma, and the reception anticipated from hospital staff.
SUCCESSES AND CHALLENGES IN COMMISSIONING FOR AMBULANCE NON-CONVEYANCE: THE COMMISSIONER PERSPECTIVE
Authors: Bishop-Edwards Lindsey , O'Cathain Alicia , Knowles Emma
Published: August 2016

Background

Ambulance services are experiencing increasing demand for response to emergency calls. In response, they have increased the proportion of patients not conveyed to an emergency department (ED). Alternatives to transporting patients to an ED include the provision of telephone advice rather than dispatching a vehicle (‘hear and treat’), treatment at the scene (‘see and treat’) and transport to other facilities (‘see and convey elsewhere’). There is considerable variation in the rates of different types of non-conveyance, and in non-conveyance overall, between ambulance services in England. Understanding the reasons for this variation between services can help identify ways of improving service delivery across all ambulance services. Approaches to commissioning may influence the amount of non-conveyance undertaken in different ambulance services.

Methods

As part of a larger study we undertook qualitative interviews with ambulance service commissioners (or appropriate commissioning support staff) in the 10 larger ambulance services in England, to identify potential factors that may explain variation in rates of ambulance non-conveyance. 10 commissioners took part in the interviews. Telephone interviews were conducted and transcribed verbatim. Framework analysis was used to analyse the data.

Results

Ambulance commissioners reported a range of successes and challenges in relation to commissioning non-conveyance services. Successes often related to engaging, collaborative and motivational working relationships between the commissioner and the ambulance service. A range of challenges were reported including access to information to enable decision making, the scale of the geographical commissioning area, collaborative working, complexity, lack of resource and their role as quality enforcers and reporters. There was variation in how different commissioners reported their approaches to commissioning for non-conveyance.

Conclusions

These findings highlight the challenges facing commissioners. This variation in commissioning approaches will be included in a wider model of factors affecting variation in non-conveyance.
RAPID ANALGESIA FOR PREHOSPITAL HIP DISRUPTION (RAPID): A FEASIBILITY STUDY
Authors: Bulger Jenna , Seagrove Anne , Snooks Helen , Evans Bridie , Ford Simon , Pallister Ian , Guy Katy , Brown Alan , Jones Sian , Keen Leigh , Rees Nigel
Published: August 2016

Background

Adequate pain relief at the point of injury and during transport to hospital is a major challenge in all acute trauma, but especially so for those with hip fractures, whose injuries are difficult to immobilise and who may be particularly sensitive to opiate analgesics. Fascia Iliaca Compartment Block (FICB), a procedure involving injection of local anaesthetic into tissues surrounding the hip, is routinely administered by doctors and nurses in Emergency Departments for patients with hip fracture, but its use has not been tested by paramedics at the scene of the patient's injury.

Aim of the research

This study aims to assess whether FICB administered by paramedics at the scene is feasible, safe and acceptable. The outcome will determined the need for a full randomised controlled trial to decide whether the procedure is effective for patients and worthwhile for the NHS.

Methods

We will recruit ten paramedics in the Swansea locality who will be trained to administer FICB. Eligible patients will be randomly allocated to FICB or usual care using sealed envelopes carried on ambulances, a method currently successfully being used by the Welsh Ambulance Service in another study – PARAMEDIC 2 (the ‘Adrenaline trial’). We will assess compliance of paramedics; pain scores; side effects; length of hospital stay; quality of life; and acceptability to patients and paramedics by conducting interviews and focus groups.

Outputs

We will recommend whether a full randomised controlled trial of FICB by paramedics for hip fracture is warranted and, if so, a proposal for research funding will be submitted.

This project is funded by Health and Care Research Wales, through their Research for Patient and Public Benefit funding call (1003). The views and opinions expressed are those of the authors and do not necessarily reflect those of Health and Care Research Wales or the National Health Service.
FRAILTY AS LIVED, FRAILTY AS APPLIED: EXPLORING LIVED EXPERIENCES IN OLDER PATIENTS WHO HAVE FALLEN AND CALLED 999
Authors: Robertson Duncan , Cooke Mary
Published: August 2016

Rationale

The aim of this pilot study was to explore the personal meanings of frailty within a purposive sample of older patients who had fallen, needed an Emergency Ambulance Service response and were subsequently referred to a falls service. A systematic literature review indicated that no qualitative studies had been carried out within such a sample previously.

Methods

The qualitative methodology used Interpretative Phenomenological Analysis; which explored the essential nature of frailty as a phenomenon though a series of subjective narrative accounts generated by focused interviews. Employing a reflexive approach to the analysis allowed completion of a participant-centred and ethically sound study.

Results

Analysis of six focused interviews with older adults provided a thick description which highlighted five themes: Adaptations to frailty, Focus on confidence as psychological frailty, A changing lifeworld-towards social frailty, Reconciling a frail future and Frailty as stigma. These themes were discussed in relation to sociological literature including theories concerning transitions from the third to fourth age, liminality and social death, frailty as stigma and frailty as lived and frailty as applied.

Implications

This sample of patients represented a group in transition. They occupied a liminal zone situated between the third and fourth age and while acknowledging oldness, they actively challenged biomedical assumptions of frailty through an emphasis on control and individual agency. This study enables paramedics to modulate their communications when encountering elders who reject the notion of frailty as a term applied. For service design, the results allow the voice of the patient group to be heard, so that solutions can be designed in an inclusive, rather than hierarchical fashion. Significantly, this thesis forms part of an emerging body of evidence that questions the usefulness of the term frailty as experienced by this sample of participants.
Abstracts from international Emergency Medicine journals
Authors: Weber Ellen J
Published: August 2016

Editor's note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors.
The diagnosis of adult-onset haemophagocytic lymphohistiocytosis: lessons learned from a review of 29 cases of bone marrow haemophagocytosis in two large academic institutions
Authors: Rosado Flavia G , Rinker Elizabeth B , Plummer W D , Dupont William D , Spradlin Natalie M , Reichard Kaaren K , Kim Annette S
Published: August 2016

Aims

Haemophagocytic lymphohistiocytosis (HLH) is divided into paediatric (primary) and adult (secondary) types. While paediatric-HLH has been extensively characterised, similar studies in adults are limited. This study aims to evaluate the significance of the HLH diagnostic criteria as well as other clinical parameters in adults with bone marrow evidence of haemophagocytosis.

Methods

We conducted a 10-year retrospective search of the pathology archives of two institutions for cases with bone marrow haemophagocytosis. We included those cases that fulfilled the currently established HLH diagnostic criteria. For the 29 cases that met inclusion criteria, we assessed clinical features, co-morbidities, therapy and clinical outcome. The effect of 19 clinical variables on mortality outcomes was assessed using logistic and hazard regression analyses.

Results

Of cases for which an aetiology could be identified, infectious diseases were the most common association (14 of 19, 74%). Fever and elevated ferritin were the most frequently available criteria used to establish HLH. The overall mortality rate was 61% despite HLH-specific therapy, which had been initiated in 48% of the cases. The remaining cases were treated with supportive therapy and antibiotics. The most statistically significant marker of mortality was an elevated absolute neutrophil count (ANC), a feature not typical of HLH.

Conclusions

Since elevated ANC correlates with poor outcomes in sepsis, and not HLH, we postulate that many of the patients fulfilling HLH diagnostic criteria in this study likely had sepsis/systemic inflammatory response syndrome rather than HLH. Our results highlight the need to define HLH diagnostic criteria specific to the adult population.
A study in high-risk, maximally pretreated patients to determine the potential use of PCSK9 inhibitors at various thresholds of total and LDL cholesterol levels
Authors: Groves Carl , Shetty Chandrashekar , Strange Richard C , Waldron Julian , Ramachandran Sudarshan
Published: August 2016

Purpose of the study

Statins and ezetimibe reduce low-density lipoprotein cholesterol (LDL-c) and cardiovascular disease (CVD) risk. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors lower LDL-c by 50%–70% and might be useful in refractory patients. The National Institute for Health and Care Excellence (NICE) technology appraisal guidance (TAG) recommends use of these drugs in secondary prevention and familial hypercholesterolaemia (FH) at differing LDL-c thresholds. We have estimated the proportion of patients in whom this third-line drug might be useful.

Study design

We used data from a lipid-lowering audit programme to study 72 with FH and/or CVD of 271 patients referred over 12 months who failed to achieve target total cholesterol (TC) and LDL-c levels. All 72 patients were treated with ezetimibe, and 69 cases also received statins. We used LDL-c thresholds 1.5–5.5 mmol/L to estimate how many of these refractory patients could benefit from PCSK9 inhibitors.

Results

In 72 patients, TC and LDL-c targets were not met by 64 and 53 patients, respectively. We judged using the NICE TAG that only one patient (1.4% ezetimibe requiring and 0.4% total referrals) required a PCSK9 inhibitor.

Conclusions

We determined that the proportion of patients eligible for a PCSK9 inhibitor at various TC and LDL-c levels is modest. This may reflect the use of all available statins in UK lipid clinics often at non-daily frequency. We suggest that cost-effective use of PCSK9 inhibitors requires prescribing being restricted to clinicians working in specialised lipid clinics.
Assessment of cardiovascular disease in the donkey: clinical, echocardiographic and pathological observations
Authors: Roberts S. L. , Dukes‐McEwan J.
Published: August 2016

The Donkey Sanctuary (DS) owns 3500–4000 donkeys, estimated to be about 35 per cent of the UK population. Although postmortem surveys suggest a high prevalence of cardiovascular disease in donkeys, there is sparse clinical information about cardiovascular examination findings and echocardiographic findings in health and disease. In this cross‐sectional study, auscultation findings were recorded, and in a subset of donkeys, echocardiography was used to screen for structural and functional cardiac disease. 202 donkeys were examined; 117 geldings and 85 females. Heart sounds S1 and S2 were detected in all donkeys, but none had audible S3. S4 was detected in nine (4.5 per cent; significantly older than those without S4; P<0.001). A heart murmur was detected in four donkeys. Echocardiography identified these to be due to a ventricular septal defect in one, and aortic regurgitation in three. An additional 43 donkeys had echocardiography. A further 10 donkeys were identified to have aortic insufficiency, but no other valvular regurgitation. 76/202 donkeys subsequently underwent postmortem examination. Three showed degenerative aortic valve changes. One donkey had nodular lesions in the intima of proximal aorta and sinus of Valsalva. Histopathology showed multifocal chronic nodular eosinophilic arteritis, consistent with verminous arteritis. The DS pathology database identified other similar cases.
l-Carnitine supplement reduces skeletal muscle atrophy induced by prolonged hindlimb suspension in rats
Authors: Jang Jiwoong , Park Jonghoon , Chang Hyukki , Lim Kiwon
Published: August 2016

l-Carnitine was recently found to downregulate the ubiquitin proteasome pathway (UPP) and increase insulin-like growth factor 1 concentrations in animal models. However, the effect of l-carnitine administration on disuse muscle atrophy induced by hindlimb suspension has not yet been studied. Thus, we hypothesized that l-carnitine may have a protective effect on muscle atrophy induced by hindlimb suspension via the Akt1/mTOR and/or UPP. Male Wistar rats were assigned to 3 groups: hindlimb suspension group, hindlimb suspension with l-carnitine administration (1250 mg·kg−1·day−1) group, and pair-fed group adjusted hindlimb suspension. l-Carnitine administration for 2 weeks of hindlimb suspension alleviated the decrease in weight and fiber size in the soleus muscle. In addition, l-carnitine suppressed atrogin-1 mRNA expression, which has been reported to play a pivotal role in muscle atrophy. The present study shows that l-carnitine has a protective effect against soleus muscle atrophy caused by hindlimb suspension and decreased E3 ligase messenger RNA expression, suggesting the possibility that l-carnitine protects against muscle atrophy, at least in part, through the inhibition of the UPP. These observations suggest that l-carnitine could serve as an effective supplement in the decrease of muscle atrophy caused by weightlessness in the fields of clinical and rehabilitative research.
Quark–hadron duality: Pinched kernel approach
Authors: Dominguez C. A. , Hernandez L. A. , Schilcher K. , Spiesberger H.
Published: August 2016

Hadronic spectral functions measured by the ALEPH collaboration in the vector and axial-vector channels are used to study potential quark–hadron duality violations (DV). This is done entirely in the framework of pinched kernel finite energy sum rules (FESR), i.e. in a model independent fashion. The kinematical range of the ALEPH data is effectively extended up to s = 10 GeV2 by using an appropriate kernel, and assuming that in this region the spectral functions are given by perturbative QCD. Support for this assumption is obtained by using e[Formula: see text] e[Formula: see text] annihilation data in the vector channel. Results in both channels show a good saturation of the pinched FESR, without further need of explicit models of DV.
Cosmic magnetization out from the vacuum
Authors: Campanelli Leonardo
Published: August 2016

The large-scale magnetic fields we observe today in galaxies and galaxy clusters could be the result of a pure quantum effect taking place during inflation, to wit, the creation of particles (photons) out from the vacuum in a curved spacetime. We show that, whenever the conformal invariance of electromagnetism is broken during inflation, the actual magnetic field spectrum, in the classical limit, is given by [Formula: see text], where [Formula: see text] is the number of created photons with wave number [Formula: see text]. In particular, a scale-invariant magnetic field of order of 10[Formula: see text] G can emerge in the simplest model of cosmic magnetogenesis, the one where the inflaton is kinetically coupled to the photon. Moreover, and contrarily to the general belief, we show that such a model is free from the so-called strong-coupling and backreaction problems. This conclusion follows, indirectly, from the observation that post-inflationary electric currents, which in the literature are incorrectly supposed to freeze superhorizon magnetic fields after inflation, are indeed vanishing on superhorizon scales due to causality.
Hybrid Artificial Bee Colony Algorithm with Differential Evolution and Free Search for Numerical Function Optimization
Authors: Lian Lian , Zaifeng Fu , Guangfei Yang , Yi Huang
Published: August 2016

Artificial bee colony (ABC) algorithm invented by Karaboga has been proved to be an efficient technique compared with other biological-inspired algorithms for solving numerical optimization problems. Unfortunately, convergence speed of ABC is slow when working with certain optimization problems and some complex multimodal problems. Aiming at the shortcomings, a hybrid artificial bee colony algorithm is proposed in this paper. In the hybrid ABC, an improved search operator learned from Differential Evolution (DE) is applied to enhance search process, and a not-so-good solutions selection strategy inspired by free search algorithm (FS) is introduced to avoid local optimum. Especially, a reverse selection strategy is also employed to do improvement in onlooker bee phase. In addition, chaotic systems based on the tent map are executed in population initialization and scout bee's phase. The proposed algorithm is conducted on a set of 40 optimization test functions with different mathematical characteristics. The numerical results of the data analysis, statistical analysis, robustness analysis and the comparisons with other state-of-the-art-algorithms demonstrate that the proposed hybrid ABC algorithm provides excellent convergence and global search ability.
Understanding ghost interference
Authors: Qureshi Tabish , Chingangbam Pravabati , Shafaq Sheeba
Published: August 2016

The ghost interference observed for entangled photons is theoretically analyzed using wave-packet dynamics. It is shown that ghost interference is a combined effect of virtual double-slit creation due to entanglement, and quantum erasure of which-path information for the interfering photon. For the case where the two photons are of different color, it is shown that fringe width of the interfering photon depends not only on its own wavelength, but also on the wavelength of the other photon which it is entangled with.
Central GIP signaling stimulates peripheral GIP release and promotes insulin and pancreatic polypeptide secretion in nonhuman primates
Authors: Higgins Paul B. , Shade Robert E. , Rodríguez-Sánchez Irám P. , Garcia-Forey Magdalena , Tejero M. Elizabeth , Voruganti V. Saroja , Cole Shelley A. , Comuzzie Anthony G. , Folli Franco
Published: August 2016

Glucose-dependent insulinotropic polypeptide (GIP) has important actions on whole body metabolic function. GIP and its receptor are also present in the central nervous system and have been linked to neurotrophic actions. Metabolic effects of central nervous system GIP signaling have not been reported. We investigated whether centrally administered GIP could increase peripheral plasma GIP concentrations and influence the metabolic response to a mixed macronutrient meal in nonhuman primates. An infusion and sampling system was developed to enable continuous intracerebroventricular (ICV) infusions with serial venous sampling in conscious nonhuman primates. Male baboons ( Papio sp.) that were healthy and had normal body weights (28.9 ± 2.1 kg) were studied ( n = 3). Animals were randomized to receive continuous ICV infusions of GIP (20 pmol·kg−1·h−1) or vehicle before and over the course of a 300-min mixed meal test (15 kcal/kg, 1.5g glucose/kg) on two occasions. A significant increase in plasma GIP concentration was observed under ICV GIP infusion (66.5 ± 8.0 vs. 680.6 ± 412.8 pg/ml, P = 0.04) before administration of the mixed meal. Increases in postprandial, but not fasted, insulin ( P = 0.01) and pancreatic polypeptide ( P = 0.04) were also observed under ICV GIP. Effects of ICV GIP on fasted or postprandial glucagon, glucose, triglyceride, and free fatty acids were not observed. Our data demonstrate that central GIP signaling can promote increased plasma GIP concentrations independent of nutrient stimulation and increase insulin and pancreatic polypeptide responses to a mixed meal.
Hypoxia-induced contraction of chicken embryo mesenteric arteries: mechanisms and developmental changes
Authors: Brinks Leonie , Moonen Rob M. J. , Moral-Sanz Javier , Barreira Bianca , Kessels Lilian , Perez-Vizcaino Francisco , Cogolludo Angel , Villamor Eduardo
Published: August 2016

The fetal cardiovascular responses to acute hypoxia include a redistribution of the cardiac output toward the heart and the brain at the expense of other organs, such as the intestine. We hypothesized that hypoxia exerts a direct effect on the mesenteric artery (MA) that may contribute to this response. Using wire myography, we investigated the response to hypoxia (Po2 ~2.5 kPa for 20 min) of isolated MAs from 15- to 21-day chicken embryos (E15, E19, E21), and 1- to 45-day-old chickens (P1, P3, P14, P45). Agonist-induced pretone or an intact endothelium were not required to obtain a consistent and reproducible response to hypoxia, which showed a pattern of initial rapid phasic contraction followed by a sustained tonic contraction. Phasic contraction was reduced by elimination of extracellular Ca2+ or by presence of the neurotoxin tetrodotoxin, the α1-adrenoceptor antagonist prazosin, or inhibitors of L-type voltage-gated Ca2+ channels (nifedipine), mitochondrial electron transport chain (rotenone and antimycin A), and NADPH oxidase (VAS2870). The Rho-kinase inhibitor Y27632 impaired both phasic and tonic contraction and, when combined with elimination of extracellular Ca2+, hypoxia-induced contraction was virtually abolished. Hypoxic MA contraction was absent at E15 but present from E19 and increased toward the first days posthatching. It then decreased during the first weeks of life and P45 MAs were unable to sustain hypoxia-induced contraction over time. In conclusion, the results of the present study demonstrate that hypoxic vasoconstriction is an intrinsic feature of chicken MA vascular smooth muscle cells during late embryogenesis and the perinatal period.
Adult Primary Spinal Epidural Extraosseous Ewing’s Sarcoma: A Case Report and Review of the Literature
Authors: Bustoros Mark , Thomas Cheddhi , Frenster Joshua , Modrek Aram S. , Bayin N. Sumru , Snuderl Matija , Rosen Gerald , Schiff Peter B. , Placantonakis Dimitris G.
Published: August 2016

Background. Extraosseous Ewing’s sarcoma in the spinal epidural space is a rare malignancy, especially in adults.Case Presentation. A 40-year-old male presented with back pain and urinary hesitancy. MRI revealed a thoracic extradural mass with no osseous involvement. He underwent surgery for gross total resection of the mass, which was diagnosed as Ewing’s sarcoma. He was subsequently treated with chemoradiotherapy. He remains disease-free 1 year after surgery. Review of the literature indicated only 45 previously reported cases of spinal epidural extraosseous Ewing’s sarcoma in adults.Conclusions. Extraosseous Ewing’s sarcoma in the spinal epidural space is a rare clinical entity that should be included in the differential for spinal epidural masses. Its treatment is multidisciplinary but frequently requires surgical intervention due to compressive neurologic symptoms. Gross total resection appears to correlate with improved outcomes.
Uncovering Driver DNA Methylation Events in Nonsmoking Early Stage Lung Adenocarcinoma
Authors: Zhang Xindong , Gao Lin , Liu Zhi-Ping , Jia Songwei , Chen Luonan
Published: August 2016

As smoking rates decrease, proportionally more cases with lung adenocarcinoma occur in never-smokers, while aberrant DNA methylation has been suggested to contribute to the tumorigenesis of lung adenocarcinoma. It is extremely difficult to distinguish which genes play key roles in tumorigenic processes via DNA methylation-mediated gene silencing from a large number of differentially methylated genes. By integrating gene expression and DNA methylation data, a pipeline combined with the differential network analysis is designed to uncover driver methylation genes and responsive modules, which demonstrate distinctive expressions and network topology in tumors with aberrant DNA methylation. Totally, 135 genes are recognized as candidate driver genes in early stage lung adenocarcinoma and top ranked 30 genes are recognized as driver methylation genes. Functional annotation and the differential network analysis indicate the roles of identified driver genes in tumorigenesis, while literature study reveals significant correlations of the top 30 genes with early stage lung adenocarcinoma in never-smokers. The analysis pipeline can also be employed in identification of driver epigenetic events for other cancers characterized by matched gene expression data and DNA methylation data.
Safety, Efficiency, and Outcomes of Perineoplasty: Treatment of the Sensation of a Wide Vagina
Authors: Ulubay Mustafa , Keskin Ugur , Fidan Ulas , Ozturk Mustafa , Bodur Serkan , Yılmaz Ali , Kinci Mehmet Ferdi , Yenen Mufit Cemal
Published: August 2016

Background. The sensation of a wide vagina is a common problem for women after childbirth. As its etiology is unknown, there is no uniform management strategy. We hypothesized that, rather than vaginal laxity, the cause was level 3 pelvic support deficiency.Methods. This retrospective study compared preoperative and postoperative genital hiatus length, perineal length, and total vaginal length in patients treated with perineoplasty for the sensation of a wide vagina. A telephone survey was used to determine postoperative patient and male partner satisfaction rates.Results. Mean age of patients was 48 (26–68) years; mean body mass index (BMI) was 25.3 (17.6–33.2); and mean parity was 2.5 (2–5). Preoperative and postoperative genital hiatus, perineal length, and total vaginal length were 4.62 and 3.18 (p<0.01), 3.06 and 4.04 (p<0.01), and 9.43 and 9.43 (p=0.882), respectively. At the 6-month follow-up, the success rate of the perineoplasty procedure was 87.9%; according to a visual analog scale, partner satisfaction rate was 92.6%. Ten percent (n=4) of patients said they experienced dyspareunia during sexual intercourse at the introitus of the vagina.Conclusion. With low dyspareunia rates, low complication rates, high patient satisfaction, and satisfactory anatomical success, perineoplasty can be considered successful for treatment of the sensation of a wide vagina.
Do Times until Treatment for Foreign Body Aspiration Relate to Complications?
Authors: Tatsanakanjanakorn Walailak , Suetrong Surapol
Published: August 2016

Introduction. Foreign body aspiration is an emergency condition and may be fatal. Delayed diagnosis and treatment may be associated with complications. This study evaluated the association between time until treatment and complications due to foreign body aspiration.Methods. This study was a retrospective study conducted at Khon Kaen University Hospital, Thailand. We enrolled patients diagnosed with foreign body aspiration with evidence of foreign body detected using direct laryngobronchoscopy at any area from the larynx to the bronchus. Descriptive statistics were used to analyze the association of times of treatment with complications of foreign body aspiration.Results. During the study period, there were 43 patients that met the study criteria. The most common age group was 0–2 years. Plant seeds were the most common foreign bodies (41.9%), and the right main bronchus was the most common site (16 patients, 37.2%). There were 30 patients (69.8%) that experienced complications from foreign body aspiration. Pneumonia was the most common complication (14 patients, 32.6%). The retention time was not significantly associated with the presence of complications (pvalue: 0.366). Two patients (4.7%) died due to complete airway obstruction and prolonged hypoxia.Conclusion. Times until treatment were not significantly associated with complications from foreign body aspiration.
Severe Bioprosthetic Mitral Valve Stenosis and Heart Failure in a Young Woman with Systemic Lupus Erythematosus
Authors: Wartak Siddharth , Akkad Isaac , Sadiq Adnan , Crooke Gregory , Moskovits Manfred , Frankel Robert , Hollander Gerald , Shani Jacob
Published: August 2016

A 23-year-old African American woman with a past medical history of systemic lupus erythematous (SLE), secondary hypertension, and end stage renal disease (ESRD) on hemodialysis for eight years was stable until she developed symptomatic severe mitral regurgitation with preserved ejection fraction. She underwent a bioprosthetic mitral valve replacement (MVR) at outside hospital. However, within a year of her surgery, she presented to our hospital with NYHA class IV symptoms. She was treated for heart failure but in view of her persistent symptoms and low EF was considered for heart and kidney transplant. This was a challenge in view of her history of lupus. We presumed that her stenosis of bioprosthetic valve was secondary to lupus and renal disease. We hypothesized that her low ejection fraction was secondary to mitral stenosis and potentially reversible. We performed a dobutamine stress echocardiogram, which revealed an improved ejection fraction to more than 50% and confirmed preserved inotropic contractile reserve of her myocardium. Based on this finding, she underwent a metallic mitral valve and tricuspid valve replacement. Following surgery, her symptoms completely resolved. This case highlights the pathophysiology of lupus causing stenosis of prosthetic valves and low ejection cardiomyopathy.
A Numerical Approach for the Quasi-Plane Strain-Softening Problem of Cylindrical Cavity Expansion Based on the Hoek-Brown Failure Criterion
Authors: Zou Jin-feng , Du Jia-min
Published: August 2016

This paper focuses on a novel approach for the quasi-plane strain-softening problem of the cylindrical cavity expansion based on generalized Hoek-Brown failure criterion. Because the intermediate principal stress is deformation-dependent, the quasi-plane strain problem is defined to implement the numerical solution of the intermediate principal stress. This approach assumes that the initial total strain in axial direction is a nonzero constant (ε0) and the plastic strain in axial direction is not zero. Based on 3D failure criterion, the numerical solution of plastic strain is given. Solution of the intermediate principal stress can be derived by Hooke’s law. The radial and circumferential stress and strain considering the intermediate principal stress are obtained by the proposed approach of the intermediate principal stress, stress equilibrium equation, and generalized H-B failure criterion. The numerical results can be used for the solution of strain-softening surrounding rock. In additional, the validity and accuracy of the proposed approach are verified with the published results. At last, parametric studies are carried out using MATLAB programming to highlight the influences of the out-of-plane stress on the stress and displacement of surrounding rock.
Preparation and Characterization of Polymer-Grafted Montmorillonite-Lignocellulose Nanocomposites by In Situ Intercalative Polymerization
Authors: Bunhu Tavengwa , Chaukura Nhamo , Tichagwa Lilian
Published: August 2016

Lignocellulose-clay nanocomposites were synthesized using an in situ intercalative polymerization method at 60°C and a pressure of 1 atm. The ratio of the montmorillonite clay to the lignocellulose ranged from 1 : 9 to 1 : 1 (MMT clay to lignocelluloses, wt%). The adsorbent materials were characterized by Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), transmission electron microscopy (TEM), and X-ray powder diffraction (XRD). FTIR results showed that the polymers were covalently attached to the nanoclay and the lignocellulose in the nanocomposites. Both TEM and XRD analysis showed that the morphology of the materials ranged from phase-separated to intercalated nanocomposite adsorbents. Improved thermal stability, attributable to the presence of nanoclay, was observed for all the nanocomposites. The nanocomposite materials prepared can potentially be used as adsorbents for the removal of pollutants in water treatment and purification.
A Modified Model of Failure Mode and Effects Analysis Based on Generalized Evidence Theory
Authors: Zhou Deyun , Tang Yongchuan , Jiang Wen
Published: August 2016

Due to the incomplete knowledge, how to handle the uncertain risk factors in failure mode and effects analysis (FMEA) is still an open issue. This paper proposes a new generalized evidential FMEA (GEFMEA) model to handle the uncertain risk factor, which may not be included in the conventional FMEA model. In GEFMEA, not only the conventional risk factors, the occurrence, severity, and detectability of the failure mode, but also the other incomplete risk factors are taken into consideration. In addition, the relative importance among all these risk factors is well addressed in the proposed method. GEFMEA is based on the generalized evidence theory, which is efficient in handling incomplete information in the open world. The efficiency and some merit of the proposed method are verified by the numerical example and a real case study on aircraft turbine rotor blades.
Vibration Characteristics of a Mistuned Bladed Disk considering the Effect of Coriolis Forces
Authors: Kan Xuanen , Zhao Bo
Published: August 2016

To investigate the influence of Coriolis force on vibration characteristics of mistuned bladed disk, a bladed disk with 22 blades is employed and the effects of different rotational speeds and excitation engine orders on the maximum forced response are discussed considering the effects of Coriolis forces. The results show that if there are frequency veering regions, the largest split of double natural frequencies of each modal family considering the effects of Coriolis forces appears at frequency veering region. In addition, the amplitude magnification factor considering the Coriolis effects is increased by 1.02% compared to the system without considering the Coriolis effects as the rotating speed is 3000 rpm, while the amplitude magnification factor is increased by 2.76% as the rotating speed is 10000 rpm. The results indicate that the amplitude magnification factor may be moderately enhanced with the increasing of rotating speed. Moreover, the position of the maximum forced response of bladed disk may shift from one blade to another with the increasing of the rotational speed, when the effects of Coriolis forces are considered.
Macro- and Microelemental Composition and Toxicity of Unsweetened Natural Cocoa Powder in Sprague-Dawley Rats
Authors: Asiedu-Gyekye Isaac Julius , Frimpong-Manso Samuel , N’guessan Benoit Banga , Abdulai Seidu Mahmood , Osei-Prempeh Paul , Kwaku Boamah Daniel
Published: August 2016

Unsweetened natural cocoa powder (UNCP) is a pulverized high-grade powder of compressed solid blocks which remains after extraction. Little scientific data is available concerning its safety despite the presence of potential toxic elements. Elemental composition in UNCP was analyzed with ED-XRF spectroscopy. Single oral high dose toxicity study was conducted on adult male Sprague-Dawley rats (150 g) by the limit test method. One group received water and the test group 2000 mg/kg UNCP. All animals were observed for 14 days and then euthanized for haematological, biochemical, and histopathological examinations. Thirty-eight (38) elements were found in UNCP. There was an increase in HDL cholesterol (p<0.05), reduction in LDL cholesterol (p>0.05), alkaline phosphatase (p<0.05), and creatinine levels, and slight increase in urea levels (p>0.05). Haematological changes were not significant. Histopathological analysis showed no toxic effect on the heart, liver, kidney, lungs, testis, and spleen. Intestinal erosion was observed in the test group. UNCP appears to be relatively safe when taken as a single oral high dose of 2000 mg/kg b.w.t. in rats. Caution should however be exercised at high doses due to the high elemental content of copper and high possibility of intestinal lining erosion.
QuaBingo: A Prediction System for Protein Quaternary Structure Attributes Using Block Composition
Authors: Tung Chi-Hua , Chen Chi-Wei , Guo Ren-Chao , Ng Hui-Fuang , Chu Yen-Wei
Published: August 2016

Background. Quaternary structures of proteins are closely relevant to gene regulation, signal transduction, and many other biological functions of proteins. In the current study, a new method based on protein-conserved motif composition in block format for feature extraction is proposed, which is termed block composition.Results. The protein quaternary assembly states prediction system which combines blocks with functional domain composition, called QuaBingo, is constructed by three layers of classifiers that can categorize quaternary structural attributes of monomer, homooligomer, and heterooligomer. The building of the first layer classifier uses support vector machines (SVM) based on blocks and functional domains of proteins, and the second layer SVM was utilized to process the outputs of the first layer. Finally, the result is determined by the Random Forest of the third layer. We compared the effectiveness of the combination of block composition, functional domain composition, and pseudoamino acid composition of the model. In the 11 kinds of functional protein families, QuaBingo is 23% of Matthews Correlation Coefficient (MCC) higher than the existing prediction system. The results also revealed the biological characterization of the top five block compositions.Conclusions. QuaBingo provides better predictive ability for predicting the quaternary structural attributes of proteins.
Geographical Variation in Dementia Mortality in Italy, New Zealand, and Chile: The Impact of Latitude, Vitamin D, and Air Pollution
Authors: Russ Tom C. , Murianni Laura , Icaza Gloria , Slachevsky Andrea , Starr John M.
Published: August 2016

Background: Dementia risk is reported as being higher in the north compared to the south, which may be related to vitamin D deficiency. If this were the case, an opposite gradient of risk would be observed in the southern hemisphere, but this has not been investigated previously. Methods: We calculated standardised mortality ratios (SMRs) for deaths in 2012 where dementia (Alzheimer's disease, vascular or unspecified dementia) was recorded as the underlying cause for 20 regions in Italy, 20 District Health Board areas in New Zealand and 29 Health Service areas in Chile. Results: Dementia SMRs were higher in northern than central or southern Italy. The inverse pattern was seen in women in New Zealand, with rates higher on South Island than North Island. However, dementia risk was raised in eight regions in the north and centre of Chile in both men and women. Conclusions: Geographical variation plays a key role in dementia risk, but patterns vary in men and women. In the northern hemisphere, dementia mortality is higher in the north, but the pattern in the southern hemisphere is more complex.
Prostate-Specific Membrane Antigen PET/CT: False-Positive Results due to Sarcoidosis
Authors: Hermann Robert M. , Djannatian Manoutschehr , Czech Norbert , Nitsche Mirko
Published: August 2016

We report on a 72-year-old male patient who developed sarcoidosis of the mediastinal lymph nodes, the liver, and the prostate 11 years ago. Seven years later, he underwent transurethral resection of the prostate by laser due to hematuria. Pathology of the resected chips showed a ‘granulomatous prostatitis with epitheloid cells’. Malignancy was histologically excluded at that time. Four years later, he was diagnosed with an undifferentiated prostate carcinoma, with a Gleason score of 5 + 4 = 9. After initiation of antihormonal therapy, he underwent radical prostatectomy and pelvic lymphadenectomy, which revealed a pT3b pN1 carcinoma with infiltrated resection margins. Three months later, the prostate-specific antigen level was 1.4 ng/ml, and a local recurrence was suspected by ultrasound; consequently, a 68Ga-prostate-specific membrane antigen (PSMA) PET/CT was performed. This examination seemed to confirm the local recurrence, a right pelvic lymph node metastasis, and a hepatic metastasis. However, ultrasound with contrast medium could not confirm the metastatic spread to the liver. In palliative intention, radiotherapy of the pelvis was done. After 50 Gy, the supposed recurrence had markedly shrunk, and an additional boost dose with 16.2 Gy was applied. Two years later, the patient is still free of disease. Due to this clinical development, we doubt the diagnosis of a fulminant progression of the prostate cancer as suspected by PSMA-PET/CT. Instead, we suspect a recurrence of the previously proven sarcoidosis leading to false-positive results. Our focus in this report is on the interaction between PSMA-PET/CT and sarcoidosis. Another report on a case of sarcoidosis of the spleen seems to confirm this possibility [Kobe et al: Clin Nucl Med 2015;40: 897–898].