bluuebunny/crossref_metadata_2025 huggingface dataset:
Recovery of hexagonal Si-IV nanowires from extreme GPa pressure
Authors: Smith Bennett E. , Zhou Xuezhe , Roder Paden B. , Abramson Evan H. , Pauzauskie Peter J.
Published: May 2016

We use Raman spectroscopy in tandem with transmission electron microscopy and density functional theory simulations to show that extreme (GPa) pressure converts the phase of silicon nanowires from cubic (Si-I) to hexagonal (Si-IV) while preserving the nanowire's cylindrical morphology. In situ Raman scattering of the longitudinal transverse optical (LTO) mode demonstrates the high-pressure Si-I to Si-II phase transition near 9 GPa. Raman signal of the LTO phonon shows a decrease in intensity in the range of 9–14 GPa. Then, at 17 GPa, it is no longer detectable, indicating a second phase change (Si-II to Si-V) in the 14–17 GPa range. Recovery of exotic phases in individual silicon nanowires from diamond anvil cell experiments reaching 17 GPa is also shown. Raman measurements indicate Si-IV as the dominant phase in pressurized nanowires after decompression. Transmission electron microscopy and electron diffraction confirm crystalline Si-IV domains in individual nanowires. Computational electromagnetic simulations suggest that heating from the Raman laser probe is negligible and that near-hydrostatic pressure is the primary driving force for the formation of hexagonal silicon nanowires.
Alignment of CH3F in para-H2 crystal studied by IR quantum cascade laser polarization spectroscopy
Authors: Kawasaki Hiroyuki , Mizoguchi Asao , Kanamori Hideto
Published: May 2016

In order to investigate the alignment of CH3F in para-H2 crystals, high resolution polarization spectroscopy of the ν3 vibrational band is studied using a quantum cascade laser at 1040 cm−1. It is found that the main and satellite series of peaks in the ν3 vibrational band of CH3F have the same polarization dependence. This result supports the previously proposed cluster model with ortho-H2 in first and second nearest neighbor sites. The observed polarization dependence function is well described by a simple six-axis void model in which CH3F is not aligned along the c-axis of the crystal but tilted to 64.9(3)° from it.
Dual-band high-efficiency polarization converter using an anisotropic metasurface
Authors: Lin Baoqin , Wang Buhong , Meng Wen , Da Xinyu , Li Wei , Fang Yingwu , Zhu Zihang
Published: May 2016

In this work, a dual-band and high-efficiency reflective cross-polarization converter based on an anisotropic metasurface for linearly polarized electromagnetic waves is proposed. Its unit cell is composed of an elliptical disk-ring mounted on grounded dielectric substrate, which is an anisotropic structure with a pair of mutually perpendicular symmetric axes u and v along ±45° directions with respect to y-axis direction. Both the simulation and measured results show that the polarization converter can convert x- or y-polarized incident wave to its cross polarized wave in the two frequency bands (6.99–9.18 GHz, 11.66–20.40 GHz) with the conversion efficiency higher than 90%; moreover, the higher frequency band is an ultra-wide one with a relative bandwidth of 54.5% for multiple plasmon resonances. In addition, we present a detailed analysis for the polarization conversion of the polarization converter, and derive a formula to calculate the cross- and co-polarization reflections at y-polarized incidence according to the phase differences between the two reflected coefficients at u-polarized and v-polarized incidences. The simulated, calculated, and measured results are all in agreement with the entire frequency regions.
Resonant terahertz radiation from warm collisional inhomogeneous plasma irradiated by two Gaussian laser beams
Authors: Niknam A. R. , Banjafar M. R. , Jahangiri F. , Barzegar S. , Massudi R.
Published: May 2016

Terahertz (THz) radiation generation by the interaction of two co-propagating high intensity laser beams with a warm collisional inhomogeneous plasma is analytically investigated. By presenting the dielectric permittivity of plasma and taking into account the ponderomotive force, the nonlinear current at THz frequency is obtained. A secondary resonant enhancement of THz radiation is observed, in addition to that occurs at the plasma frequency, which can be tuned by plasma density and temperature. Moreover, we show that for each beat frequency, there exists an optimum temperature at which THz radiation is maximized. It is also shown that the power and efficiency of THz radiation decrease by increasing the collision frequency.
Ultrafast electron diffraction optimized for studying structural dynamics in thin films and monolayers
Authors: Badali D. S. , Gengler R. Y. N. , Miller R. J. D.
Published: May 2016

A compact electron source specifically designed for time-resolved diffraction studies of free-standing thin films and monolayers is presented here. The sensitivity to thin samples is achieved by extending the established technique of ultrafast electron diffraction to the “medium” energy regime (1–10 kV). An extremely compact design, in combination with low bunch charges, allows for high quality diffraction in a lensless geometry. The measured and simulated characteristics of the experimental system reveal sub-picosecond temporal resolution, while demonstrating the ability to produce high quality diffraction patterns from atomically thin samples.
Microarray-integrated optoelectrofluidic immunoassay system
Authors: Han Dongsik , Park Je-Kyun
Published: May 2016

A microarray-based analytical platform has been utilized as a powerful tool in biological assay fields. However, an analyte depletion problem due to the slow mass transport based on molecular diffusion causes low reaction efficiency, resulting in a limitation for practical applications. This paper presents a novel method to improve the efficiency of microarray-based immunoassay via an optically induced electrokinetic phenomenon by integrating an optoelectrofluidic device with a conventional glass slide-based microarray format. A sample droplet was loaded between the microarray slide and the optoelectrofluidic device on which a photoconductive layer was deposited. Under the application of an AC voltage, optically induced AC electroosmotic flows caused by a microarray-patterned light actively enhanced the mass transport of target molecules at the multiple assay spots of the microarray simultaneously, which reduced tedious reaction time from more than 30 min to 10 min. Based on this enhancing effect, a heterogeneous immunoassay with a tiny volume of sample (5 μl) was successfully performed in the microarray-integrated optoelectrofluidic system using immunoglobulin G (IgG) and anti-IgG, resulting in improved efficiency compared to the static environment. Furthermore, the application of multiplex assays was also demonstrated by multiple protein detection.
Physiological response cascade of spring wheat to soil warming and drought
Authors: Weldearegay D. F. , Yan F. , Rasmussen S. K. , Jacobsen S.-E. , Liu F.
Published: May 2016

Climate change is affecting wheat production in Northern Europe; in particular, drought and soil warming during anthesis may cause significant yield losses of the crop. In a search for genotypes tolerant to these stresses, the physiological responses of three spring wheat cultivars to increased soil temperature (3°C above normal) (H), drought (D) and their combination (HD) were investigated. The plants were grown in pots in a climate-controlled greenhouse. Stomatal conductance (gs), photosynthesis (A), leaf water potential (Ψl), and relative water content (RWC) were measured during the treatment period. The responses of these variables to soil drying (for both D and HD) were described by a linear–plateau model, indicating the soil water thresholds at which the variables started to decrease in relation to the control plants. The H treatment alone hardly affected the variables, whereas both D and HD had significant effects. The variable most sensitive to soil drying was gs, followed by A, Ψl, and RWC. Among the three cultivars, earlier stomatal closure during drought in Alora could be a good adaptive strategy to conserve soil water for a prolonged drought, but may not be of benefit under intermittent drought conditions. Later stomatal closure and decline in A for Scirocco under HD and D stresses would be a favourable trait to sustain productivity under intermittent drought. A lower soil-water threshold of gs associated with a later decrease in A for Scirocco implies that the cultivar was less susceptible to HD and D stresses at anthesis.
A glycoside hydrolase family 31 dextranase with high transglucosylation activity from Flavobacterium johnsoniae
Authors: Gozu Yoshifumi , Ishizaki Yuichi , Hosoyama Yuhei , Miyazaki Takatsugu , Nishikawa Atsushi , Tonozuka Takashi
Published: May 2016

Glycoside hydrolase family (GH) 31 enzymes exhibit various substrate specificities, although the majority of members are α-glucosidases. Here, we constructed a heterologous expression system of a GH31 enzyme, Fjoh_4430, from Flavobacterium johnsoniae NBRC 14942, using Escherichia coli, and characterized its enzymatic properties. The enzyme hydrolyzed dextran and pullulan to produce isomaltooligosaccharides and isopanose, respectively. When isomaltose was used as a substrate, the enzyme catalyzed disproportionation to form isomaltooligosaccharides. The enzyme also acted, albeit inefficiently, on p-nitrophenyl α-D-glucopyranoside, and p-nitrophenyl α-isomaltoside was the main product of the reaction. In contrast, Fjoh_4430 did not act on trehalose, kojibiose, nigerose, maltose, maltotriose, or soluble starch. The optimal pH and temperature were pH 6.0 and 60 °C, respectively. Our results indicate that Fjoh_4430 is a novel GH31 dextranase with high transglucosylation activity.
Regulation of the yeast triacylglycerol lipases Tgl4p and Tgl5p by the presence/absence of nonpolar lipids
Authors: Klein Isabella , Klug Lisa , Schmidt Claudia , Zandl Martina , Korber Martina , Daum Günther , Athenstaedt Karin
Published: May 2016

Tgl3p, Tgl4p, and Tgl5p are the major triacylglycerol lipases of the yeast Saccharomyces cerevisiae. Recently we demonstrated that properties of Tgl3p are regulated by the formation of nonpolar lipids. The present study extends these investigations to the two other yeast triacylglycerol lipases, Tgl4p and Tgl5p. We show that Tgl4p and Tgl5p, which are localized to lipid droplets in wild type, are partially retained in the endoplasmic reticulum in cells lacking triacylglycerols and localize exclusively to the endoplasmic reticulum in a mutant devoid of lipid droplets. In cells lacking steryl esters, the subcellular distribution of Tgl4p and Tgl5p is unaffected, but Tgl5p becomes unstable, whereas the stability of Tgl4p increases. In cells lacking nonpolar lipids, Tgl4p and Tgl5p lose their lipolytic activity but retain their side activity as lysophospholipid acyltransferases. To investigate the regulatory network of yeast triacylglycerol lipases in more detail, we also examined properties of Tgl3p, Tgl4p, and Tgl5p, respectively, in the absence of the other lipases. Surprisingly, lack of two lipases did not affect expression, localization, and stability of the remaining Tgl protein. These results suggest that Tgl3p, Tgl4p, and Tgl5p, although they exhibit similar functions, act as independent entities.
Rabin8 regulates neurite outgrowth in both GEF activity–dependent and –independent manners
Authors: Homma Yuta , Fukuda Mitsunori
Published: May 2016

Many aspects of membrane-trafficking events are regulated by Rab-family small GTPases. Neurite outgrowth requires massive addition of proteins and lipids to the tips of growing neurites by membrane trafficking, and although several Rabs, including Rab8, Rab10, and Rab11, have been implicated in this process, their regulatory mechanisms during neurite outgrowth are poorly understood. Here, we show that Rabin8, a Rab8-guanine nucleotide exchange factor (GEF), regulates nerve growth factor (NGF)–induced neurite outgrowth of PC12 cells. Knockdown of Rabin8 results in inhibition of neurite outgrowth, whereas overexpression promotes it. We also find that Rab10 is a novel substrate of Rabin8 and that both Rab8 and Rab10 function during neurite outgrowth downstream of Rabin8. Surprisingly, however, a GEF activity–deficient isoform of Rabin8 also promotes neurite outgrowth, indicating the existence of a GEF activity–independent role of Rabin8. The Arf6/Rab8-positive recycling endosomes (Arf6/Rab8-REs) and Rab10/Rab11-positive REs (Rab10/Rab11-REs) in NGF-stimulated PC12 cells are differently distributed. Rabin8 localizes on both RE populations and appears to activate Rab8 and Rab10 there. These localizations and functions of Rabin8 are Rab11 dependent. Thus Rabin8 regulates neurite outgrowth both by coordinating with Rab8, Rab10, and Rab11 and by a GEF activity–independent mechanism.
Myt1 inhibition of Cyclin A/Cdk1 is essential for fusome integrity and premeiotic centriole engagement inDrosophilaspermatocytes
Authors: Varadarajan Ramya , Ayeni Joseph , Jin Zhigang , Homola Ellen , Campbell Shelagh D.
Published: May 2016

Regulation of cell cycle arrest in premeiotic G2 phase coordinates germ cell maturation and meiotic cell division with hormonal and developmental signals by mechanisms that control Cyclin B synthesis and inhibitory phosphorylation of the M-phase kinase, Cdk1. In this study, we investigated how inhibitory phosphorylation of Cdk1 by Myt1 kinase regulates premeiotic G2 phase of Drosophila male meiosis. Immature spermatocytes lacking Myt1 activity exhibit two distinct defects: disrupted intercellular bridges (fusomes) and premature centriole disengagement. As a result, the myt1 mutant spermatocytes enter meiosis with multipolar spindles. These myt1 defects can be suppressed by depletion of Cyclin A activity or ectopic expression of Wee1 (a partially redundant Cdk1 inhibitory kinase) and phenocopied by expression of a Cdk1F mutant defective for inhibitory phosphorylation. We therefore conclude that Myt1 inhibition of Cyclin A/Cdk1 is essential for normal fusome behavior and centriole engagement during premeiotic G2 arrest of Drosophila male meiosis. The novel meiotic functions we discovered for Myt1 kinase are spatially and temporally distinct from previously described functions of Myt1 as an inhibitor of Cyclin B/Cdk1 to regulate G2/MI timing.
Atrial Dilatation Development in Hypertensive Treated Patients: The Campania-Salute Network
Authors: Losi Maria-Angela , Izzo Raffaele , Canciello Grazia , Giamundo Alessandra , Manzi Maria V. , Strisciuglio Teresa , Stabile Eugenio , De Luca Nicola , de Simone Giovanni , Trimarco Bruno
Published: May 2016

BACKGROUND

Left atrial (LA) dilatation is associated with unfavorable outcome in hypertension. However, there are few data on clinical, demographic, and echocardiographic findings correlated with LA dilatation development.

METHODS

From the Campania-Salute Network registry, we identified 5,375 hypertensive patients (52±11 years, 38% women) in normal sinus rhythm, with normal LA diameter (parasternal short-axis <24.0 in women and <25.4mm/m in men), with normal left ventricular (LV) ejection fraction, and with at least 12 months of echocardiographic follow-up. We included in the clinic evaluation type of antihypertensive drugs.

RESULTS

Follow-up duration was of 70±48 months. During follow-up, 647 patients (12%) showed LA dilatation. Patients with incident LA dilatation were older, most likely to be women, more obese, more diabetics, with lower Modification of Diet in Renal Disease, higher total cholesterol, lower uric acid, higher pulse pressure, lower heart rate, higher LV mass, concentric geometry and lower E/A ratio at mitral level, longer E deceleration time, and higher intima–media carotid thickness. They take more drugs, and follow-up was longer (overall P < 0.05). In the Cox analysis, age, female gender, obesity, higher LV mass, LA diameter at baseline, and longer E deceleration time were determinants of LA dilatation. Furthermore, the use of diuretics protected against LA dilatation.

CONCLUSIONS

Our data identify a risk profile for LA dilatation, characterized by older age, female sex, obesity, higher LV mass, and worse diastolic function. In this subgroup of patients, the use of diuretics seems to protect against LA dilatation.
Electronic Healthcare's Relationship With Patient Satisfaction and Communication
Authors: Mitchell Jordan P.
Published: May 2016

Healthcare information technology (HIT) has been examined and shown to be a tool to improve patient healthcare quality. This study seeks to define the relationship between HIT applications such as computerized physician order entry, clinical decision support systems, and handheld device use and select Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures (doctor and nurse communication, discharge instructions, and whether the patient would highly recommend the hospital). Several control variables were used that represent the hospital level and contextual hospital service area level. The analysis had mixed results: the aforementioned HIT applications may add and support certain HCAHPS measures (Always Given Discharge Information), whereas there were no significant findings for the more interpersonal quality measures (nurse and doctor communication, recommendation). These results show that although patients may not score doctors and nurses significantly higher for their communication in hospitals that use HIT, they did receive discharge instructions significantly at a higher rate than the non-HIT hospitals.
Improving Accuracy and Relevance of Race/Ethnicity Data: Results of a Statewide Collaboration in Hawaii
Authors: Pellegrin Karen L. , Miyamura Jill B. , Ma Carolyn , Taniguchi Ronald
Published: May 2016

Current race/ethnicity categories established by the U.S. Office of Management and Budget are neither reliable nor valid for understanding health disparities or for tracking improvements in this area. In Hawaii, statewide hospitals have collaborated to collect race/ethnicity data using a standardized method consistent with recommended practices that overcome the problems with the federal categories. The purpose of this observational study was to determine the impact of this collaboration on key measures of race/ethnicity documentation. After this collaborative effort, the number of standardized categories available across hospitals increased from 6 to 34, and the percent of inpatients with documented race/ethnicity increased from 88 to 96%. This improved standardized methodology is now the foundation for tracking population health indicators statewide and focusing quality improvement efforts. The approach used in Hawaii can serve as a model for other states and regions. Ultimately, the ability to standardize data collection methodology across states and regions will be needed to track improvements nationally.
Characterizations of Temporal Postoperative Pain Signatures With Symbolic Aggregate Approximations
Authors: Tighe Patrick J. , Nickerson Paul , Fillingim Roger B. , Rashidi Parisa
Published: May 2016

Objectives:

The primary aim was to characterize the temporal dynamics of postoperative pain intensity using symbolic aggregate approximation (SAX). The secondary aim was to explore the effects of sociodemographic and clinical factors on the SAX representations of postoperative pain intensity.

Materials and Methods:

We applied SAX to a large-scale time series database of 226,808 acute postoperative pain intensity ratings. Pain scores were stratified by patient age, sex, type of surgery, home opioid use, and postoperative day (POD), and costratified by age and sex. Cosine similarity, a metric that measures distance using vector angle, was applied to these motif data to compare pain behavior similarities across strata.

Results:

Across age groups, SAX clusters revealed a shift from low-to-low pain score transitions in older patients to high-to-high pain score transitions in younger patients, whereas analyses stratified by sex showed that males had a greater focus of pain score transitions among lower-intensity pain scores compared with females. Surgical stratification, using cardiovascular surgery as a reference, demonstrated that pulmonary surgery had the highest cosine similarity at 0.855. With POD stratification, POD 7 carried the greatest cosine similarity to POD 0 (0.611) after POD 1 (0.765), with POD 3 (0.419) and POD 4 (0.441) carrying the lowest cosine similarities with POD 0.

Discussion:

SAX offers a feasible and effective framework for characterizing large-scale postoperative pain within the time domain. Stratification of SAX representations demonstrate unique temporal dynamic profiles on the basis of age group, sex, type of surgery, preoperative opioid use, and across PODs 1 to 7.
Staff Nurse Utilization of Kangaroo Care as an Intervention for Procedural Pain in Preterm Infants
Authors: Benoit Britney , Campbell-Yeo Marsha , Johnston Celeste , Latimer Margot , Caddell Kim , Orr Talia
Published: May 2016

Background:

Skin-to-skin contact between mother and infant, commonly referred to as Kangaroo Care (KC), has demonstrated efficacy as a pain-relieving strategy for infants, yet, it remains underutilized in clinical practice.

Purpose:

To evaluate changes in neonatal intensive care unit staff nurse beliefs, utilization, and challenges related to practice change in implementing KC as an intervention for management of procedural pain in preterm infants between 2 time points.

Methods:

Nurses who participated in a larger clinical trial examining the sustained efficacy of KC were asked to complete a questionnaire at 2 time points: 1- and 6 month(s) following study initiation. Identified benefits, expectations, frequency of use, and challenges related to practice change uptake were described using frequencies and percentages. Data from the 2 different time points were compared using χ2 analysis.

Results:

Of the 40 nurses approached, all completed the questionnaire (19 at the 1-month and 21 at the 6-month time point). Of the sample (n = 40), 97% of participants indicated that they expected KC to provide good pain relief or better. Staff nurses reported significantly improved preconceived ideas (χ2 = 22.68, P < .01) and significantly fewer concerns (χ2 = 22.10, P = .01) related to using KC as a pain-relieving intervention between the 2 time points. No significant differences were seen in the frequency of using KC as an intervention between time points.

Implications for Research and Practice:

Despite increasingly positive preconceived ideas and reduced concerns, the frequency of using KC for procedural pain relief remained unchanged. Further research addressing ways to overcome barriers to utilizing KC as an intervention for procedural pain is warranted.
Cultural Meanings of Mothering Through the Eyes of African American Adolescent Mothers
Authors: Dole Debora M. , Shambley-Ebron Donna
Published: May 2016

The life-course perspective considers the effects of chronic, high levels of stress as contributing to the disparity in infant mortality between African Americans and all other groups. Many young mothers are mothering their children in isolation without benefit of the cultural safety net that once existed, further contributing to a state of chronic stress. This study explored the cultural meanings of mothering for African American adolescent mothers using Photovoice, a participatory research methodology. Results suggested a network consisting of extended kin and “other mothers” is integral in providing support and identifying cultural strengths used in coping and reducing effects of chronic stress.
Evaluation of 3 Behavioral Theories for Application in Health Promotion Strategies for Hispanic Women
Authors: Garcia Daisy S.
Published: May 2016

Hispanic/Latina women often fare poorly when attempting to access the health care that they need in the United States. Using an established criterion, this article analyzes the application of the health belief model (HBM), social cognitive theory (SCT), and health promotion model (HPM) in the context of Hispanic women's limited access to, and use of, health resources to promote their health. An individual's perceptions and the likelihood of taking action are the focus of HBM. SCT is regarded as important sociostructural and personal determinants in the regulation of human behavior. Finally, HPM centers on the unique characteristics and experiences of an individual that motivate him or her toward positive health behavior. The analysis suggests that HPM is a better fit to explore the relationship among sociocultural factors, lifestyle practices, and the positive perceived affect of Hispanic women engaging in healthy behaviors and utilizing health care in the United States. HPM can guide the design of both health-enhancing and disease-prevention strategies that specifically address Hispanic women's unique health needs.
Proton pump inhibitors and osteoporosis
Authors: Andersen Bjarne Nesgaard , Johansen Per Birger , Abrahamsen Bo
Published: May 2016

Purpose of review

The purpose of the review is to provide an update on recent advances in the evidence based on proton pump inhibitors (PPI) as a possible cause of osteoporosis and osteoporotic fractures. This review focuses, in particular, on new studies published in the last 18 months and a discussion of these findings and how this has influenced our understanding of this association, the clinical impact and the underlying pathophysiology.

Recent findings

New studies have further strengthened existing evidence linking use of PPIs to osteoporosis. Short-term use does not appear to pose a lower risk than long-term use. There is a continued lack of conclusive studies identifying the pathogenesis. Direct effects on calcium absorption or on osteoblast or osteoclast action cannot at present plausibly explain the mechanism.

The use of PPIs is a risk factor for development of osteoporosis and osteoporotic fractures. However, as the direct pathogenesis remains unclear, specific points of intervention are lacking, other than being vigilant in regard to the indication for prescribing PPIs and to use the lowest effective dose where PPIs cannot be avoided.
Rare variants, autoimmune disease, and arthritis
Authors: Chung Sharon A. , Shum Anthony K.
Published: May 2016

Purpose of review

We review select studies of newly discovered rare variants in autoimmune diseases with a focus on newly described monogenic disorders, rheumatoid arthritis, and systemic lupus erythematosus.

Recent findings

Two new monogenic syndromes of inflammatory arthritis were discovered using whole exome sequencing: the coatomer subunit alpha syndrome because of rare mutations in coatomer subunit alpha and haploinsufficiency of A20 resulting from rare mutations in TNFAIP3. Targeted exon sequencing identified rare variants in IL2RA and IL2RB associated with rheumatoid arthritis. Rare variants in TREX1 and other genes associated with monogenic interferonopathies are also associated with systemic lupus erythematosus.

Rare genetic variants contribute to the heritability of autoimmunity and provide key insight into both novel and previously implicated immunological pathways that are disrupted in autoimmune diseases.
Viral myocarditis
Authors: Rose Noel R.
Published: May 2016

Purpose of review

The article traces the pathways leading from viral infection of the heart by coxsackievirus B3 to autoimmune myocarditis in its various manifestations.

Recent findings

Myocarditis can be induced by a number of different infectious agents and represents a significant cause of death especially in young individuals. Following infection, patients may develop lymphocytic, eosinophilic, or giant cell/granulomatous myocardial inflammation. It can lead to infectious dilated cardiomyopathy, a disease frequently requiring cardiac transplantation. Although acute viral myocarditis is frequently subclinical and recovery may be spontaneous, treatment of chronic myocarditis is currently unsatisfactory. Ongoing disease may be because of persistent virus in the heart or to immunopathic attack. Depending on the cause, treatment may be antiviral or immunosuppressive. Endomyocardial biopsy is proving of value in determining cause and deciding future therapy. A great deal of information about the pathogenesis of myocarditis has been gained from experimental models in rodents using heart disease induced by infection using coxsackievirus B3 or by immunization with cardiac myosin.

Treatment of myocarditis is still problematic and may depend on etiologic diagnosis to distinguish infectious from immune-mediated disease. Both pathogenic mechanisms may co-occur in individual patients. In the future, treatment may depend upon endomyocardial biopsy, immunohistologic testing, improved imaging, and molecular genetic analysis for providing more precise diagnoses.
Modified Iliac Oblique—Outlet View: A Novel Radiographic Technique for Antegrade Anterior Column Screw Placement
Authors: Cunningham Bryce A. , Ficco Ryan P. , Swafford Rachel E. , Nowotarski Peter J.
Published: May 2016

Percutaneous fixation of acetabular fractures can be challenging because of the complex anatomy of the anterior column. We have used a modified iliac oblique–outlet image view in conjunction with more traditional radiographic views to place antegrade anterior column screws. This technique does not replace the pelvic inlet but is a good alternative in the lateral decubitus position because it helps to mitigate the difficulties of obtaining the pelvic inlet radiograph in this position. The purpose of this study is to describe the radiographic technique, demonstrate proper and aberrant screw placement using Sawbones, and present a review of patients in which this technique was used in clinical practice.
Evaluating the Impact of Antibiotic Exposures as Time-Dependent Variables on the Acquisition of Carbapenem-Resistant Acinetobacter baumannii*
Authors: Munoz-Price L. Silvia , Rosa Rossana , Castro Jose G. , Laowansiri Panthipa , Latibeaudiere Rachel , Namias Nicholas , Tarima Sergey
Published: May 2016

Objectives:

To determine the time-dependent effect of antibiotics on the initial acquisition of carbapenem-resistant Acinetobacter baumannii.

Design:

Retrospective cohort study.

Setting:

Forty-bed trauma ICU in Miami, FL.

Patients:

All consecutive patients admitted to the unit from November 1, 2010, to November 30, 2011.

Interventions:

None.

Measurements and Main Results:

Patients underwent surveillance cultures at admission to the unit and weekly thereafter. The primary outcome was the acquisition of carbapenem-resistant A. baumannii on surveillance cultures. Daily antibiotic exposures during the time of observation were used to construct time-dependent variables, including cumulative exposures (in grams and daily observed doses [defined daily doses]). Among 360 patients, 45 (12.5%) became colonized with carbapenem-resistant A. baumannii. Adjusted Cox models showed that each additional point in the Acute Physiologic and Chronic Health Evaluation score increased the hazard by 4.8% (hazard ratio, 1.048; 95% CI, 1.010–1.087; p = 0.0124) and time-dependent exposure to carbapenems quadrupled the hazard (hazard ratio, 4.087; 95% CI, 1.873–8.920; p = 0.0004) of acquiring carbapenem-resistant A. baumannii. Additionally, adjusted Cox models determined that every additional carbapenem defined daily dose increased the hazard of acquiring carbapenem-resistant A. baumannii by 5.1% (hazard ratio, 1.051; 95% CI, 1.007–1.093; p = 0.0243).

Conclusions:

Carbapenem exposure quadrupled the hazards of acquiring A. baumannii even after controlling for severity of illness.
Molecular oncogenesis of chondrosarcoma: impact for targeted treatment
Authors: Speetjens Frank M. , de Jong Yvonne , Gelderblom Hans , Bovée Judith V.M.G.
Published: May 2016

Purpose of review

The prognosis of patients with unresectable or metastatic chondrosarcoma of the bone is poor. Chondrosarcomas are in general resistant to chemotherapy and radiotherapy. This review discusses recent developments in the characterization of molecular pathways involved in the oncogenesis of chondrosarcoma that should be explored to improve prognosis of patients with advanced chondrosarcoma.

Recent findings

The different oncogenic pathways for chondrosarcoma have become better defined. These include alterations in pathways such as isocitrate dehydrogenase mutation, hedgehog signalling, the retinoblastoma protein and p53 pathways, apoptosis and survival mechanisms, and several tyrosine kinases. These specific alterations can be employed for use in clinical interventions in advanced chondrosarcoma.

As many different genetic alterations in chondrosarcoma have been identified, it is of the utmost importance to classify druggable targets that may improve the prognosis of chondrosarcoma patients. In recent years an increased number of trials evaluating targeted therapies are being conducted. As chondrosarcoma is an orphan disease consequently all studies are performed with small numbers of patients. The results of clinical studies so far have been largely disappointing. Therapeutic intervention studies of these new targets emerging from preclinical studies are of highest importance to improve prognosis of chondrosarcoma patients with advanced disease.
Technological advances in radiotherapy of rectal cancer: opportunities and challenges
Authors: Appelt Ane L. , Sebag-Montefiore David
Published: May 2016

Purpose of review

This review summarizes the available evidence for the use of modern radiotherapy techniques for chemoradiotherapy for rectal cancer, with specific focus on intensity-modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) techniques.

Recent findings

The dosimetric benefits of IMRT and VMAT are well established, but prospective clinical studies are limited, with phase I–II studies only. Recent years have seen the publication of a few larger prospective patient series as well as some retrospective cohorts, several of which include much needed late toxicity data. Overall results are encouraging, as toxicity levels – although varying across reports – appear lower than for 3D conformal radiotherapy. Innovative treatment techniques and strategies which may be facilitated by the use of IMRT/VMAT include simultaneously integrated tumour boost, adaptive treatment, selective sparing of specific organs to enable chemotherapy escalation, and nonsurgical management.

Few prospective studies of IMRT and VMAT exist, which causes uncertainty not just in regards to the clinical benefit of these technologies but also in the optimal use. The priority for future research should be subgroups of patients who might receive relatively greater benefit from innovative treatment techniques, such as patients receiving chemoradiotherapy with definitive intent and patients treated with dose escalation.
“Professional Helper” or “Helping Professional?” The Patient–Physician Relationship in the Chronic Pain Setting, With Special Reference to the Current Opioid Debate
Authors: Bäckryd Emmanuel
Published: May 2016

There seems to be a strong cultural expectation among patients for effective pain relief. As a result, physicians often find themselves trying to bridge the gap between the chronic pain patient's expectations and harsh biomedical reality. The typology of Emanuel and Emanuel of four models for the patient–physician relationship is used in this article as a conceptual tool to examine the possible roles of physicians in the context of chronic noncancer pain. Their typology is reconceptualized as a “pathway” along which the physician is able to walk more or less far, starting from the “information” end of the path. The other end of the pathway is “caring deliberation.” I then propose that, in pain medicine today, consumerism is a powerful incentive for physicians to stay at the information end of the spectrum. Against this background, I discuss the current opioid epidemic in the United States and the need for what has been called a new medical professionalism. I conclude by challenging educators involved in pain medicine continuing professional development to not only design adequate biomedical–educational programs, but also consider issues like professionalism, personal development, critical self-reflection, and the ethics of engaging in caring deliberation with chronic pain patients.
Redirecting T-Cell Specificity to EGFR Using mRNA to Self-limit Expression of Chimeric Antigen Receptor
Authors: Caruso Hillary G. , Torikai Hiroki , Zhang Ling , Maiti Sourindra , Dai Jianliang , Do Kim-Anh , Singh Harjeet , Huls Helen , Lee Dean A. , Champlin Richard E. , Heimberger Amy B. , Cooper Laurence J.N.
Published: May 2016

Potential for on-target, but off-tissue toxicity limits therapeutic application of genetically modified T cells constitutively expressing chimeric antigen receptors (CARs) from tumor-associated antigens expressed in normal tissue, such as epidermal growth factor receptor (EGFR). Curtailing expression of CAR through modification of T cells by in vitro-transcribed mRNA species is one strategy to mitigate such toxicity. We evaluated expression of an EGFR-specific CAR coded from introduced mRNA in human T cells numerically expanded ex vivo to clinically significant numbers through coculture with activating and propagating cells (AaPC) derived from K562 preloaded with anti-CD3 antibody. The density of AaPC could be adjusted to affect phenotype of T cells such that reduced ratio of AaPC resulted in higher proportion of CD8+ and central memory T cells that were more conducive to electrotransfer of mRNA than T cells expanded with high ratios of AaPC. RNA-modified CAR+ T cells produced less cytokine, but demonstrated similar cytolytic capacity as DNA-modified CAR+ T cells in response to EGFR-expressing glioblastoma cells. Expression of CAR by mRNA transfer was transient and accelerated by stimulation with cytokine and antigen. Loss of CAR abrogated T-cell function in response to tumor and normal cells expressing EGFR. We describe a clinically applicable method to propagate and modify T cells to transiently express EGFR-specific CAR to target EGFR-expressing tumor cells that may be used to limit on-target, off-tissue toxicity to normal tissue.
Thyroid Paraganglioma
Authors: Pelizzo Maria Rosa , Conti Christian , Pennelli Gianmaria , Bellan Elena , Cook Gary J. , Wong Ka Kit , Colletti Patrick M. , Merante Boschin Isabella , Rubello Domenico
Published: May 2016

Introduction:

Primary paraganglioma (PG) of the thyroid gland is an extremely rare neuroendocrine tumor with potential for misdiagnosis. We describe 2 cases of thyroid PG, suggest a possible diagnostic and therapeutic management strategy, and present a systematic review of the literature.

Case Reports:

Two 67-year-old women presented similarly with asymptomatic but rapidly growing thyroid nodules in which malignancy was suspected after fine needle aspiration biopsy, “THY 4” according to the 2014 SIAPEC classification, both undergoing total thyroidectomy. Unexpectedly, immunohistochemistry showed neuroendocrine cellular architecture that was negative for common markers of well-differentiated follicular neoplasms, thyroglobulin, thyroid transcription factor 1, cytokeratins and medullary thyroid cancer, calcitonin, carcinoembryonic antigen, whereas neuron-specific enolase, synaptophysin, chromogranin A, and S-100 protein were highly expressed, confirming the diagnosis of primary thyroid PG. The patients were both discharged on postoperative day 2, without any other therapy and are currently well without evidence of local recurrence of metastatic disease, after 4 years and 3 months of follow-up, respectively.

Discussion:

These are the only 2 cases of thyroid PG experienced in our center which specializes in thyroid surgery. Thyroid PG is a rare neuroendocrine neoplasm first described by Van Miert in 1964 with just over 50 cases reported in the literature. Our experience is concordant with the literature that the diagnosis of the primary PG of the thyroid is challenging, due to its low prevalence and the cytologic and histopathologic similarities with other more frequently diagnosed benign and malignant thyroid tumors. Immunohistochemistry is required for definitive diagnosis but gross tumor characteristics are also helpful for diagnosis. Surgical resection is the recommended standard treatment.
Tolvaptan for Heart Failure, Systematic Review and Meta-Analysis of Trials
Authors: Alskaf E. , Tridente A. , Al-Mohammad A.
Published: May 2016

The vasopressin type 2 receptor antagonist tolvaptan (TLV) is available to treat congestion in patients with heart failure. However, there is paucity of evidence guiding its use, and lack of evidence of its long-term efficacy. Our objectives are to perform a systematic review of studies examining the effects of TLV in patients with heart failure; and a quantitative meta-analysis comparing primary and secondary outcomes between TLV and placebo. Only double-blinded randomized controlled trials, with no restriction on the language or the time of publication, were included. Our main outcome measures were all-cause mortality, change in body weight, change in urine volume, and change in serum sodium. Extracted summary estimates included mean difference and SD for change in body weight, change in urine volume and change in serum sodium levels, and hazard ratio with 95% confidence interval for all-cause mortality. We found 8 double-blinded randomized controlled trials, seven of which were included in this meta-analysis. Assessment of risk of bias was conducted by investigating random sequence generation, allocation concealment, blinding, completeness of outcome data, and potential for selective reporting. We found no evidence of significant bias. TLV showed benefits in reducing body weight, increasing urine volume, and increasing serum sodium. No reduction in mortality was detected. However, the subgroup of patients with hyponatremia might have better mortality outcome with TLV. TLV seemed to be safe, as it did not cause worsening of the renal function or hypotension. In conclusion, a meta-analysis of the published literature suggests short-term benefits of TLV. However, the impact on mortality is inconclusive.
Clinical Value of Mercaptopurine After Failing Azathioprine Therapy in Patients With Inflammatory Bowel Disease
Authors: Meijer Berrie , Seinen Margien L. , Leijte Niek N. W. , Mulder Chris J. J. , van Bodegraven Adriaan A. , de Boer Nanne K. H.
Published: May 2016

Background:

Thiopurines have been widely accepted as immunosuppressive therapy in inflammatory bowel disease. However, many patients have to discontinue thiopurines due to intolerance or ineffectiveness. A therapeutically beneficial effect of switching from azathioprine (AZA) to mercaptopurine (MP) after developing adverse events (AEs) has been reported. The authors assessed the clinical value of MP therapy after AZA discontinuation due to intolerance and, secondary, due to ineffectiveness.

Methods:

In this retrospective single-center study, the authors analyzed data from patients in whom AZA therapy had failed and who were subsequently treated with MP.

Results:

Thirty-eight patients initiated MP therapy after intolerance to AZA. Intolerance reoccurred in 22 (58%) patients and the remaining 16 (42%) tolerated MP. In 18 out of 48 patients (38%), the AEs that led to discontinuation of MP were similar to those of AZA. A longer duration of prior AZA use was more common in patients who were subsequently tolerant for MP (5.3 versus 1.2 months; P = 0.04). Twenty-two patients discontinued AZA due to ineffectiveness. Eight (36%) patients had clinical benefit from a switch to MP. Six out of these 8 (75%) patients used allopurinol alongside MP, due to ineffectiveness based on a skewed thiopurine metabolism. Patients were more likely to have clinical benefit if the interval between both thiopurines was longer (4.4 versus 0.01 months; P < 0.05).

Conclusions:

The authors showed that a noteworthy number of patients benefitted therapeutically from a switch from AZA to MP when failing due to intolerance or ineffectiveness; however, the percentage was lower than previously reported in literature.
Prosthetic Breast Reconstruction With Acellular Dermal Matrices: Achieving Predictability and Reproducibility
Authors: Nahabedian Maurice Y.
Published: May 2016

The use of acellular dermal matrices in the setting of prosthetic breast reconstruction has captured the attention of many plastic surgeons. The regenerative capacity of these materials has provided additional tissue support to the mastectomy skin flaps with the ultimate result of improving surgical and aesthetic outcomes. Despite the benefits, there remains a significant diversity with regard to outcomes with some surgeons reporting increased morbidity. The reasons for this are varied but ultimately related to differences in patient selection and surgical techniques. The purpose of this article is to provide strategies for using acellular dermal matrix to achieve success in a manner that is usually associated with outcomes that are predictable and reproducible.
Tumoral Calcinosis: An Uncommon Cause for a Mass in a Reconstructed Breast
Authors: Koh Eugene , Dean Nicola R. , Watson David I. , Carter Christopher D.
Published: May 2016

Tumoral calcinosis is a rare clinical and histopathological syndrome whose exact etiology is unknown. We present a case of a 57-year-old woman who presents with a painful lump in her right chest after bilateral breast reconstructions for bilateral asynchronous breast cancers. It is important to be aware of all possible differential diagnoses in a patient presenting with a chest mass after mastectomy and reconstruction for breast cancer as not all lesions of this type represent recurrent cancer.
Keyhole Flap Nipple Reconstruction
Authors: Chen Joseph I. , Cash Camille G. , Iman Al-Haj , Spiegel Aldona J. , Cronin Ernest D.
Published: May 2016

Nipple-areola reconstruction is often one of the final but most challenging aspects of breast reconstruction. However, it is an integral and important component of breast reconstruction because it transforms the mound into a breast. We performed 133 nipple-areola reconstructions during a period of 4 years. Of these reconstructions, 76 of 133 nipple-areola complexes were reconstructed using the keyhole flap technique. The tissue used for the keyhole dermoadipose flap technique include transverse rectus abdominus myocutaneous flaps (60/76), latissimus dorsi flaps (15/76), or mastectomy skin flaps after tissue expanders (1/76). The average patient follow-up was 17 months. The design of the flap is based on a keyhole configuration. The base of the flap determines the width of the future nipple, whereas the length of the flap determines the projection. We try to match the projection of the contralateral nipple if present. The keyhole flap is simple to construct yet reliable. It provides good symmetry and projection and avoids the creation of new scars. The areola is then tattooed approximately 3 months after the nipple reconstruction.
Aquatic Exercise and Thermoregulation in Pregnancy
Authors: SOULTANAKIS HELEN N.
Published: May 2016

Aquatic exercise, in a general sense, is any type of movement performed in the water for the purpose of improving health and fitness. Water, with its properties, provides buoyancy to lighten the “load” of pregnancy, hydrostatic pressure to alleviate pregnancy-induced edema, and many other benefits. Sports in extreme temperatures may involve some risks. The fact that a person’s conductivity increases about 25 times in water comes with a great loss, which is the depression of the evaporative mechanism. Altered thermal control mechanisms in water, both in the gravid and the nongravid state, will be addressed in this review. convenience.