bluuebunny/crossref_metadata_2025 huggingface dataset:
Genome-Based Risk Prediction for Early Stage Breast Cancer
Authors: Adaniel Christina , Jhaveri Komal , Heguy Adriana , Esteva Francisco J.
Published: September 2014

Tests to better characterize tumor genomic architecture are quickly becoming a standard of care in oncology. For breast cancer, the use of gene expression assays for early stage disease is already common practice. These tests have found a place in risk stratifying the heterogeneous group of stage I–II breast cancers for recurrence, for predicting chemotherapy response, and for predicting breast cancer-related mortality. In the last 5 years, more assays have become available to the practicing oncologist. Given the rapidity with which this field has evolved, it is prudent to review the tests, their indications, and the studies from which they have been validated. We present a comprehensive review of the available gene expression assays for early stage breast cancer. We review data for several individual tests and comparative studies looking at risk prediction and cost-effectiveness.
How to Implement a Geriatric Assessment in Your Clinical Practice
Authors: Sattar Schroder , Alibhai Shabbir M.H. , Wildiers Hans , Puts Martine T.E.
Published: September 2014

Cancer is a disease that mostly affects older adults. Other health conditions, changes in functional status, and use of multiple medications change the risks and benefits of cancer treatment for older adults. Several international organizations, such as the International Society of Geriatric Oncology, the European Organization for Research and Treatment of Cancer, recommend the conduct of a geriatric assessment (GA) for older adults with cancer to help select the most appropriate treatment and identify any underlying undetected medical, functional, and psychosocial issues that can interfere with treatment. The aim of this review is to describe what a GA is and how to implement it in daily clinical practice for older adults with cancer in the oncology setting. We provide an overview of commonly used tools. Key considerations in performing the GA include the resources available (staff, space, and time), patient population (who will be assessed), what GA tools to use, and clinical follow-up (who will be responsible for using the GA results for developing care plans and who will provide follow-up care). Important challenges in implementing GA in clinical practice include not having easy and timely access to geriatric expertise, patient burden of the additional hospital visits, and establishing collaboration between the GA team and oncologists regarding expectations of the population referred for GA and expected outcomes of the GA. Finally, we provide some possible interventions for problems identified during the GA.
Life cycle assessment of spider silk nonwoven meshes in an air filtration device
Authors: Lauterbach Anja Yvonne , Scheibel Thomas
Published: September 2014

Spider silk is a highly interesting protein fiber with outstanding properties. Since natural spider silk is not available for technical applications due to spiders’ cannibalism, the production of recombinant spider silk proteins has been established. The goal of this study was to examine the ecological impact of spider silk nonwoven layers in an air filtration device using comparative life cycle assessment. The investigation focused on the environmental benefits of using recombinantly produced spider silk proteins processed into nonwoven meshes in comparison to melt-blown synthetic polymer filter layers in dust bags. The considered functional unit was one dust bag containing spider silk in comparison to one commercially available dust bag. In case of spider silk dust bags, 9 kg of CO2-equivalents could be saved per domestic home and year in the category of global warming potential in comparison to commercially available ones. Assuming that all used dust bags would be furnished with spider silk nonwoven meshes, the overall benefit for exemplary Germany would be 241 million kg CO2-equivalents. This article contains supporting information that will be made available online once the issue is published.
Statistical mixture design of ternary blends for controlling ASR
Authors: Bektas Fatih , Wang Xuhao
Published: September 2014

Supplementary cementitious materials (SCMs) are long proven to control alkali–silica reaction (ASR) in concrete. Some SCMs such as slag and high-calcium fly ash are less effective than others and need high replacement levels, which may not be practical for various construction purposes. Combining two SCMs with Portland cement (i.e. ternary blend) offers design flexibility for the desired performance. This study investigates the use of statistical mix design in formulating ternary blends for ASR. Thirty-one mixtures were prepared based on statistical mixture design and tested using the accelerated mortar bar method. Five groups of ternary blends were investigated: Portland cement/metakaolin/brick powder, Portland cement/metakaolin/high-calcium fly ash, Portland cement/metakaolin/low-calcium fly ash, Portland cement/high-calcium fly ash/low-calcium fly ash and Portland cement/high-calcium fly ash/slag. The performances of the ternary blends were analysed using statistical models. The results showed that SCMs can be effectively combined in ternary blends to control ASR and the statistical mixture design can be a beneficial tool in formulating ternary blends for ASR performance. It was also found that 0·20% expansion at 28 d in an accelerated mortar bar test can be used as a second threshold for mixes containing SCM.
Low‐to‐moderate nitrogen and phosphorus concentrations accelerate microbially driven litter breakdown rates
Authors: Kominoski John S. , Rosemond Amy D. , Benstead Jonathan P. , Gulis Vladislav , Maerz John C. , Manning David W. P.
Published: September 2014

Particulate organic matter (POM) processing is an important driver of aquatic ecosystem productivity that is sensitive to nutrient enrichment and drives ecosystem carbon (C) loss. Although studies of single concentrations of nitrogen (N) or phosphorus (P) have shown effects at relatively low concentrations, responses of litter breakdown rates along gradients of low‐to‐moderate N and P concentrations are needed to establish likely interdependent effects of dual N and P enrichment on baseline activity in stream ecosystems. We established 25 combinations of dissolved inorganic N (DIN; 55–545 μg/L) and soluble reactive P (SRP; 4–86 μg/L) concentrations with corresponding N:P molar ratios of 2–127 in experimental stream channels. We excluded macroinvertebrates, focusing on microbially driven breakdown of maple (Acer rubrum L.) and rhododendron (Rhododendron maximum L.) leaf litter. Breakdown rates, k, per day (d−1) and per degree‐day (dd−1), increased by up to 6× for maple and 12× for rhododendron over our N and P enrichment gradient compared to rates at low ambient N and P concentrations. The best models of k (d−1 and dd−1) included litter species identity and N and P concentrations; there was evidence for both additive and interactive effects of N and P. Models explaining variation in k dd−1 were supported by N and P for both maple and rhododendron ( = 0.67 and 0.33, respectively). Residuals in the relationship between k dd−1 and N concentration were largely explained by P, but residuals for k dd−1 and P concentration were less adequately explained by N. Breakdown rates were more closely related to nutrient concentrations than variables associated with measurements of two mechanistic parameters associated with C loss (fungal biomass and microbial respiration rate). We also determined the effects of nutrient addition on litter C : nutrient stoichiometry and found reductions in litter C:N and C:P along our experimental nutrient gradient. Our results indicate that microbially driven litter processing rates increase across low‐to‐moderate nutrient gradients that are now common throughout human‐modified landscapes.
Signalling Pathways Implicated in Obesity Associated Cancers
Authors: Drew Janice E.
Published: September 2014

Intensive research over recent years has provided irrefutable evidence of links between obesity and the risk of
an increasing number of human cancers. The predicted economic burden is causing significant concern. This has
prompted investigation of the underlying mechanisms with a focus on deregulated metabolic pathways. A number of
metabolic processes and associated signalling pathways are associated with the development of obesity. These include a
number of interlinking pathways regulating endocrine, redox, inflammation, immunity and lipogenic processes. The
identification of deregulated metabolic pathways in obesity with promotion of carcinogenesis has targeted research on the
signalling molecules involved. Consequently this mini review is focused on aberrant signalling of deregulated pathways
provoked by diets that lead to obesity and their role in carcinogenesis. Knowledge of the signalling molecules involved
will assist in directing and establishing dietary manipulation strategies to restore metabolic health in obese individuals.
Importantly the identified diversity of signalling pathways linked to obesity related cancers will permit design of more
effective combinatorial and multi-targeted cancer therapies in the future.
Outreach and Identity Development: New Perspectives on College Student Persistence
Authors: Bergerson Amy Aldous , Hotchkins Bryan K. , Furse Cynthia
Published: September 2014

College student persistence continues to pose challenges for higher education institutions, despite over 40 years of research. Although persistence is studied from many different angles, the majority of studies examining the causes of and cures for students' departure from college reflect the importance of engagement in the higher education environment. An innovative type of engagement is involving college students in high school outreach. This article reports on a study involving 19 college students who participated in a National Science Foundation (NSF)-funded project intended to increase the enrollment and persistence of engineering students, specifically examining how engaging in outreach activities developed participants' views of themselves as engineers. We found that outreach activities incorporated several types of engagement and that participants engaged in outreach began to develop a professional engineering identity, both of which are linked to college student persistence. The study's implications for research and practice are discussed.
Examining the Predictive Validity of Gre Scores on Doctoral Education: Students' Success and Methodology Choices in the Dissertation Process
Authors: Rockinson-Szapkiw Amanda J. , Bray Oliver R. , Spaulding Lucinda S.
Published: September 2014

This study examines how GRE scores can be used to better understand Education doctoral candidates' methodology choices for the dissertation as well as their persistence behaviors. Candidates' of one online doctoral education program were examined. Results of a MANOVA suggested that there is no difference in GRE scores based on doctoral candidates' choice of methodology. Although GRE scores did not differ based on methodology choice, results of the regression analysis indicated that the linear combination of candidates' verbal reasoning scores, quantitative reasoning scores, writing scores, and methodology choices accounted for significant variability in the number of semesters it took for them to complete their dissertations. The GRE writing score and methodology choice were the strongest predictors of time to completion.
Using Self-Regulated Learning Methods to Increase Native American College Retention
Authors: Patterson David A. , Waya Silver Wolf (Adelv Unegv) , Ahuna Kelly H. , Tinnesz Christine Gray , Vanzile-Tamsen Carol
Published: September 2014

A big challenge facing colleges and university programs across the United States is retaining students to graduation. This is especially the case for Native American students, who have had one of the highest dropout rates over the past several decades. Using data from a large university that implemented a self-regulated learning course for undergraduates' academic success, the authors measured students who participated, with a specific focus on Native American student outcomes. The analyses in this study are based on data of cohorts entering freshmen from fall 2000 through fall 2010 with a sample of 29,319 students, 4,681 (16.0%) who successfully completed the SRL course. Results show that the completers are more likely to be retained with specific retention benefits and overall academic success of Native American completers.
Improving Student Retention in Online College Classes: Qualitative Insights from Faculty
Authors: Russo-Gleicher Rosalie J.
Published: September 2014

This article provides qualitative insights into addressing the issue of student retention in online classes in higher education. Semi-structured, in-depth interviews were conducted at random with 16 faculty who teach online courses at a large community college in the Northeast about how to improve online student retention. Qualitative analysis using grounded theory methodology revealed participants discussed that student retention in online courses could be increased by making changes to the screening process for potential online students, improving the student orientation for online courses, the college administration providing additional support to faculty who do online teaching, and online faculty being more responsible to students. Administrators should be aware that changes made in any of these areas may improve student retention in online classes.
Short-and Long-Term Validity of High School GPA for Admission to Colleges outside the United States
Authors: Al-Hattami Abdulghani
Published: September 2014

High school GPA is the only admission criterion that is currently used by many colleges in Yemen to select their potential students. Its predictive validity was investigated to ensure the accuracy of the admission decisions in these colleges. The relationship between students' persistence in the 4 years of college and high school GPA was studied as well. The sample in the study consisted of 1603 cohort students from two public universities in Yemen. The data analysis included simple, multiple, and logistic regression analyses. Results showed that high school GPA was a significant predictor of academic performance as measured by first-year college GPA and 4-year cumulative GPA. However, it explained a very small portion of the total variance in these academic variables. It was also found that it has no relationship with students' persistence. Therefore, a comprehensive review of the use of high school GPA for admission decisions is strongly recommended.
New Archaeobotanical and Feature-Use Data from Post-A.D. 1550 Contexts at the Madisonville Site, Ohio
Authors: Purtill Matthew P. , Leone Karen L.
Published: September 2014

In 2004-2005, salvage excavations at the Madisonville Village and Cemetery Site, a Late Fort Ancient settlement in southwestern Ohio, provided an opportunity to gather new information concerning post-A.D. 1550 occupation at the site. This article documents the use histories of excavated features and their resultant archaeobotanical remains. Results indicate that Madisonville features have incredibly complex formation histories which reflect continual reuse of a geographically restricted landform. Archaeobotanical analysis indicates a high reliance on maize by site inhabitants, although such reliance was not constant but instead increased threefold over time. Maize agriculture was supplemented by a diversity of additional cultigens (e.g., beans, erect knotweed, little barley, sunflower, and squash) and wild foods, especially nut resources, which remained an important dietary component throughout Madisonville's long occupation.
The effect of iron oxidation in the groundwater of the alluvial aquifer of the Velika Morava River, Serbia, on the clogging of water supply wells
Authors: Majkic-Dursun Brankica , Petkovic Andjelka , Dimkic Milan
Published: September 2014

The oxidation of dissolved iron(II) in groundwater and precipitation on the
screens and discharge pipes of water wells that tap shallow alluvial aquifers
leads to the formation of well encrustations. Well clogging has a number of
adverse impacts reflected in declining production capacity, increasing
parasitic drawdown and growing maintenance costs of the water supply source.
Chemical clogging rarely occurs as a stand-alone process in the groundwater
of shallow alluvial aquifers; it is generally catalyzed by micro-organisms,
the role of which is important to explain rapid blocking. This paper presents
a calculation of the rate of homogeneous chemical oxidation of iron in wells
that tap the alluvial aquifer of the Velika Morava River in Serbia, where
there are pronounced iron hydroxide clogging issues. When the dynamic
groundwater level drops to such an extent that the pumps need to be shut
down, or when the well capacity is very low, the results show that there is
enough time for iron encrustation to form. Iron oxidation does not occur
solely inside the well; the process tends to extend into a much wider zone,
beyond the well.
The effectiveness of potassium phosphite and captan mixture in controlling Venturia inaequalis in apple orchards
Authors: Aleksic Goran , Popovic Tatjana , Starovic Mira , Kuzmanovic Slobodan , Dolovac Nenad , Josic Dragana , Gavrilovic Veljko
Published: September 2014

Venturia inaequalis is a common apple disease in Serbia and its intensity
depends on weather conditions. The most successful method of combating apple
scab is to use a lower dose of an active ingredient and increase its
effectiveness by adding substances that do not cause environmental damage.
The effectiveness of a fungicide mixture of captan and potassium phosphite
against V. inaequalis was investigated in apple orchards in 2008 and 2009. A
relevant EPPO standard method was used in all trials. Captan 50 WP was used
as a standard fungicide. In order to determine the exact conditions marking
the onset of apple infection, key meteorological conditions were monitored in
the orchards using an automated iMetos weather station and a Lufft electronic
instrument. The results showed high efficacy of the tested fungicides which
remained similar in both years of investigation. The intensity of leaf
infection after treatment with the mixture of captan and potassium phosphite
was 0.7-2.4%, while fruit infection was 0.5-3.0%. The efficacy of this
mixture ranged from 96.3-97.9% on leaves and 87.4-98.7% on fruits. The
standard fungicide Captan 50 WP showed an efficacy ranging from 95.3-96.7% on
leaves and from 87.8-99.3% on fruits. No statistically significant
differences were found between the fungicide tested and the standard
fungicide.
Interleukin-10+ Regulatory B Cells Arise Within Antigen-Experienced CD40+ B Cells to Maintain Tolerance to Islet Autoantigens
Authors: Kleffel Sonja , Vergani Andrea , Tezza Sara , Ben Nasr Moufida , Niewczas Monika A. , Wong Susan , Bassi Roberto , D’Addio Francesca , Schatton Tobias , Abdi Reza , Atkinson Mark , Sayegh Mohamed H. , Wen Li , Wasserfall Clive H. , O’Connor Kevin C. , Fiorina Paolo
Published: September 2014

Impaired regulatory B cell (Breg) responses are associated with several autoimmune diseases in humans; however, the role of Bregs in type 1 diabetes (T1D) remains unclear. We hypothesized that naturally occurring, interleukin-10 (IL-10)–producing Bregs maintain tolerance to islet autoantigens, and that hyperglycemic nonobese diabetic (NOD) mice and T1D patients lack these potent negative regulators. IgVH transcriptome analysis revealed that islet-infiltrating B cells in long-term normoglycemic (Lnglc) NOD, which are naturally protected from diabetes, are more antigen-experienced and possess more diverse B-cell receptor repertoires compared to those of hyperglycemic (Hglc) mice. Importantly, increased levels of Breg-promoting CD40+ B cells and IL-10–producing B cells were found within islets of Lnglc compared to Hglc NOD. Likewise, healthy individuals showed increased frequencies of both CD40+ and IL-10+ B cells compared to T1D patients. Rituximab-mediated B-cell depletion followed by adoptive transfer of B cells from Hglc mice induced hyperglycemia in Lnglc human CD20 transgenic NOD mouse models. Importantly, both murine and human IL-10+ B cells significantly abrogated T-cell–mediated responses to self- or islet-specific peptides ex vivo. Together, our data suggest that antigen-matured Bregs may maintain tolerance to islet autoantigens by selectively suppressing autoreactive T-cell responses, and that Hglc mice and individuals with T1D lack this population of Bregs.
Arachidonate 12/15-Lipoxygenase–Induced Inflammation and Oxidative Stress Are Involved in the Development of Diabetic Cardiomyopathy
Authors: Suzuki Hirofumi , Kayama Yosuke , Sakamoto Masaya , Iuchi Hiroyuki , Shimizu Ippei , Yoshino Takuya , Katoh Daisuke , Nagoshi Tomohisa , Tojo Katsuyoshi , Minamino Tohru , Yoshimura Michihiro , Utsunomiya Kazunori
Published: September 2014

Diabetes affects cardiac structure and function, and it has been suggested that diabetes leads to cardiomyopathy. Arachidonate 12/15-lipoxygenase (LOX) has been suggested to play an important role in atherogenesis and heart failure. However, the role of 12/15-LOX in diabetic cardiomyopathy has not been examined. In this study, we investigated the effects of cardiac 12/15-LOX on diabetic cardiomyopathy. We created streptozotocin (STZ)-induced diabetic mice and compared them with Alox15-deficient mice. Expression of 12/15-LOX and inflammatory cytokines such as tumor necrosis factor (TNF)-α and nuclear factor (NF)-κB were upregulated in STZ-induced diabetic hearts. Disruption of 12/15-LOX significantly improved STZ-induced cardiac dysfunction and fibrosis. Moreover, deletion of 12/15-LOX inhibited the increases of TNF-α and NF-κB as well as the production of STZ-induced reactive oxygen species in the heart. Administration of N-acetylcysteine in diabetic mice prevented STZ-induced cardiac fibrosis. Neonatal cultured cardiomyocytes exposed to high glucose conditions induced the expression of 12/15-LOX as well as TNF-α, NF-κB, and collagen markers. These increases were inhibited by treatment of the 12/15-LOX inhibitor. Our results suggest that cardiac 12/15-LOX–induced inflammation and oxidative stress are involved in the development of diabetic cardiomyopathy and that inhibition of 12/15-LOX could be a novel treatment for this condition.
Foxo1 Inhibits Diabetic Mucosal Wound Healing but Enhances Healing of Normoglycemic Wounds
Authors: Xu Fanxing , Othman Badr , Lim Jason , Batres Angelika , Ponugoti Bhaskar , Zhang Chenying , Yi Leah , Liu Jian , Tian Chen , Hameedaldeen Alhassan , Alsadun Sarah , Tarapore Rohinton , Graves Dana T.
Published: September 2014

Re-epithelialization is an important part in mucosal wound healing. Surprisingly little is known about the impact of diabetes on the molecular events of mucosal healing. We examined the role of the transcription factor forkhead box O1 (Foxo1) in oral wounds of diabetic and normoglycemic mice with keratinocyte-specific Foxo1 deletion. Diabetic mucosal wounds had significantly delayed healing with reduced cell migration and proliferation. Foxo1 deletion rescued the negative impact of diabetes on healing but had the opposite effect in normoglycemic mice. Diabetes in vivo and in high glucose conditions in vitro enhanced expression of chemokine (C-C motif) ligand 20 (CCL20) and interleukin-36γ (IL-36γ) in a Foxo1-dependent manner. High glucose–stimulated Foxo1 binding to CCL20 and IL-36γ promoters and CCL20 and IL-36γ significantly inhibited migration of these cells in high glucose conditions. In normal healing, Foxo1 was needed for transforming growth factor-β1 (TGF-β1) expression, and in standard glucose conditions, TGF-β1 rescued the negative effect of Foxo1 silencing on migration in vitro. We propose that Foxo1 under diabetic or high glucose conditions impairs healing by promoting high levels of CCL20 and IL-36γ expression but under normal conditions, enhances it by inducing TGF-β1. This finding provides mechanistic insight into how Foxo1 mediates the impact of diabetes on mucosal wound healing.
Human Muscle Fiber Type–Specific Insulin Signaling: Impact of Obesity and Type 2 Diabetes
Authors: Albers Peter H. , Pedersen Andreas J.T. , Birk Jesper B. , Kristensen Dorte E. , Vind Birgitte F. , Baba Otto , Nøhr Jane , Højlund Kurt , Wojtaszewski Jørgen F.P.
Published: September 2014

Skeletal muscle is a heterogeneous tissue composed of different fiber types. Studies suggest that insulin-mediated glucose metabolism is different between muscle fiber types. We hypothesized that differences are due to fiber type–specific expression/regulation of insulin signaling elements and/or metabolic enzymes. Pools of type I and II fibers were prepared from biopsies of the vastus lateralis muscles from lean, obese, and type 2 diabetic subjects before and after a hyperinsulinemic-euglycemic clamp. Type I fibers compared with type II fibers have higher protein levels of the insulin receptor, GLUT4, hexokinase II, glycogen synthase (GS), and pyruvate dehydrogenase-E1α (PDH-E1α) and a lower protein content of Akt2, TBC1 domain family member 4 (TBC1D4), and TBC1D1. In type I fibers compared with type II fibers, the phosphorylation response to insulin was similar (TBC1D4, TBC1D1, and GS) or decreased (Akt and PDH-E1α). Phosphorylation responses to insulin adjusted for protein level were not different between fiber types. Independently of fiber type, insulin signaling was similar (TBC1D1, GS, and PDH-E1α) or decreased (Akt and TBC1D4) in muscle from patients with type 2 diabetes compared with lean and obese subjects. We conclude that human type I muscle fibers compared with type II fibers have a higher glucose-handling capacity but a similar sensitivity for phosphoregulation by insulin.
Anorexia and Impaired Glucose Metabolism in Mice With Hypothalamic Ablation of Glut4 Neurons
Authors: Ren Hongxia , Lu Taylor Y. , McGraw Timothy E. , Accili Domenico
Published: September 2014

The central nervous system (CNS) uses glucose independent of insulin. Nonetheless, insulin receptors and insulin-responsive glucose transporters (Glut4) often colocalize in neurons (Glut4 neurons) in anatomically and functionally distinct areas of the CNS. The apparent heterogeneity of Glut4 neurons has thus far thwarted attempts to understand their function. To answer this question, we used Cre-dependent, diphtheria toxin–mediated cell ablation to selectively remove basal hypothalamic Glut4 neurons and investigate the resulting phenotypes. After Glut4 neuron ablation, mice demonstrate altered hormone and nutrient signaling in the CNS. Accordingly, they exhibit negative energy balance phenotype characterized by reduced food intake and increased energy expenditure, without locomotor deficits or gross neuronal abnormalities. Glut4 neuron ablation affects orexigenic melanin-concentrating hormone neurons but has limited effect on neuropeptide Y/agouti-related protein and proopiomelanocortin neurons. The food intake phenotype can be partially normalized by GABA administration, suggesting that it arises from defective GABAergic transmission. Glut4 neuron–ablated mice show peripheral metabolic defects, including fasting hyperglycemia and glucose intolerance, decreased insulin levels, and elevated hepatic gluconeogenic genes. We conclude that Glut4 neurons integrate hormonal and nutritional cues and mediate CNS actions of insulin on energy balance and peripheral metabolism.
An Early Pregnancy HbA1c ≥5.9% (41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes
Authors: Hughes Ruth C.E. , Moore M. Peter , Gullam Joanna E. , Mohamed Khadeeja , Rowan Janet
Published: September 2014

OBJECTIVE

Pregnant women with undiagnosed diabetes are a high-risk group that may benefit from early intervention. Extrapolating from nonpregnancy data, HbA1c ≥6.5% (48 mmol/mol) is recommended to define diabetes in pregnancy. Our aims were to determine the optimal HbA1c threshold for detecting diabetes in early pregnancy as defined by an early oral glucose tolerance test (OGTT) at <20 weeks’ gestation and to examine pregnancy outcomes relating to this threshold.

RESEARCH DESIGN AND METHODS

During 2008–2010 in Christchurch, New Zealand, women were offered an HbA1c measurement with their first antenatal bloods. Pregnancy outcome data were collected. A subset completed an early OGTT, and HbA1c performance was assessed using World Health Organization criteria.

RESULTS

HbA1c was measured at a median 47 days’ gestation in 16,122 women. Of those invited, 974/4,201 (23%) undertook an early OGTT. In this subset, HbA1c ≥5.9% (41 mmol/mol) captured all 15 cases of diabetes, 7 with HbA1c <6.5% (<48 mmol/mol). This HbA1c threshold was also 98.4% (95% CI 97–99.9%) specific for gestational diabetes mellitus (GDM) before 20 weeks (positive predictive value = 52.9%). In the total cohort, excluding women referred for GDM management, women with HbA1c of 5.9–6.4% (41–46 mmol/mol; n = 200) had poorer pregnancy outcomes than those with HbA1c <5.9% (<41 mmol/mol; n = 8,174): relative risk (95% CI) of major congenital anomaly was 2.67 (1.28–5.53), preeclampsia was 2.42 (1.34–4.38), shoulder dystocia was 2.47 (1.05–5.85), and perinatal death was 3.96 (1.54–10.16).

CONCLUSIONS

HbA1c measurements were readily performed in contrast to the low uptake of early OGTTs. HbA1c ≥5.9% (≥41 mmol/mol) identified all women with diabetes and a group at significantly increased risk of adverse pregnancy outcomes.
The Use of Chitosan–Dextran Gel Shows Anti-Inflammatory, Antibiofilm, and Antiproliferative Properties in Fibroblast Cell Culture
Authors: Paramasivan Sathish , Jones Damien , Baker Leonie , Hanton Lyall , Robinson Simon , Wormald Peter J. , Tan Lorwai
Published: September 2014

Background

Chitosan-dextran gel has been used as an antihemostatic agent and antiadhesive agent after endoscopic sinus surgery. Because Staphylococcus aureus biofilms have been implicated in recalcitrant chronic rhinosinusitis, this study aimed to further investigate the (i) anti-inflammatory, (ii) bacterial biofilm inhibition, (iii) antiproliferative effects, and (iv) wound-healing properties of chitosan and chitosan-dextran gel.

Methods

Fibroblasts were isolated from human nasal tissue and were used to determine the effects of chitosan and chitosan-dextran gel on (i) cell proliferation, (ii) wound healing, (iii) inflammation in fibroblast cultures challenged with superantigens S. aureus enterotoxin B (SEB) and toxic shock syndrome toxin (TSST), and (iv) on S. aureus biofilms.

Results

Chitosan was highly effective at reducing IL-8 expression after TSST and SEB challenge. Chitosan was also effective at reducing IL-8 expression of nonchallenged fibroblasts showing its anti-inflammatory effects on fibroblasts in a diseased state. Chitosan-dextran gel showed strong antibiofilm properties at 50% (v/v) concentration in vitro. Dextran, on its own, showed antibiofilm properties at 1.25% (w/v) concentration. Chitosan, on its own, reduced proliferation of fibroblasts to 82% of control proliferation and chitosan-dextran gel reduced proliferation of the fibroblasts to 0.04% of control proliferation. Relative to the no treatment controls, chitosan-dextran gel significantly delayed the wound-healing rate over the first 48 hours of the experiment.

Conclusion

Chitosan-dextran gel reduced fibroblast proliferation and wound-healing time, showing a possible mechanism of reducing adhesions in the postsurgical period. Chitosan reduced IL-8 levels, showing its anti-inflammatory properties. Chitosan-dextran gel and dextran treatment showed antibiofilm properties in our model.
Impact of Intraoperative Hydrodebrider Treatment on Postoperative Sinonasal Inflammation
Authors: Banglawala Sarfaraz M. , Mulligan Jennifer K. , Psaltis Alkis J. , Wang Eric W. , Nguyen Shaun A. , Mulligan Ryan M. , Crosby Brittany L , Schlosser Rodney J.
Published: September 2014

Background

The impact of intraoperative hydrodebrider sinus irrigation (HSI) during endoscopic sinus surgery (ESS) on postoperative inflammation, endoscopy, and patient-reported outcomes has not been studied.

Methods

A clinical trial of 12 patients with symmetric chronic rhinosinusitis were prospectively randomized to HSI on one side after undergoing bilateral ESS. The contralateral side was not treated with any irrigation and served as an internal control. Preoperative computed tomography, endoscopic, 22-item Sino-Nasal Outcome Test (SNOT-22), and symptom visual analog scale (VAS) scores for each side were obtained. At 1 and 3 months postsurgery, endoscopy, SNOT-22, and sinus VAS were recorded. Sinonasal mucus levels of interleukin (IL)-6, IL-10, IL-17a, and tumor necrosis factor (TNF) alpha were measured at the time of surgery, 1 and 3 months, postoperatively, from each side.

Results

VAS scores improved on both sides (p < 0.05) and SNOT-22 improved at all postoperative time points (p < 0.05). Endoscopic scores of HSI-treated sides did not improve compared with baseline. HSI had no additional significant impact on postoperative VAS at any time point. HSI significantly decreased IL-17a levels when compared with the control side at 1 month (p = 0.034) and 3 months ( = 0.031). No significant change was seen in TNF-alpha, IL-6, or IL-10 on either side at any time point.

Conclusion

Intraoperative HSI at the time of ESS failed to establish any improvement in postoperative endoscopy or most local cytokine levels after ESS.
A Comparative and Descriptive Study of Asthma in Chronic Rhinosinusitis with Nasal Polyps
Authors: Håkansson Kåre , Thomsen Simon Francis , Konge Lars , Mortensen Jann , Backer Vibeke , von Buchwald Christian
Published: September 2014

Background

Chronic rhinosinusitis (CRS) is a common health problem that is subclassified as CRS with nasal polyps (CRSwNPs) or CRS without NPs (CRSsNP). In accordance with the united airways concept, CRSwNPs frequently coexists with asthma but to date, this association remains unexplained and its strength is uncertain. Here, we aimed to examine the association between CRSwNPs and asthma in collaboration between the neighboring specialities: otorhinolaryngology and respiratory medicine.

Methods

A prospective clinical study was performed comprising 40 CRS patients scheduled for functional endoscopic sinus surgery and 21 control persons. We performed nasal endoscopy, peak expiratory flow, spirometry, and bronchodilation tests. In selected cases, additional pulmonary tests were performed. Atopy was assessed by skin-prick test or by measuring specific IgE in serum.

Results

Asthma was diagnosed in 26 patients with CRSwNPs (65%; odds ratio = 5.9 [1.79,19.65]; p = 0.003), and 5 control persons (24%). Twenty-five percent of the CRSwNP patients had undiagnosed asthma. Atopy was not significantly associated with CRSwNPs (p = 0.39) or with coexisting asthma within the CRSwNP group (p = 0.50).

Conclusion

Compared with previous studies, we found a very high prevalence of asthma and, frequently, asthma was undiagnosed. Furthermore, CRSwNPs was associated with chronic bronchitis and, in those with asthma, lower airway obstruction. These results call for a closer collaboration between otorhinolaryngology and respiratory medicine in relation to patients with CRSwNPs, in research as well as in clinical practice.
Prevalence of Uncontrolled Allergic Rhinitis in Wuhan, China: A Prospective Cohort Study
Authors: Wang Youna , Zhu Rongfei , Liu Guanghui , Li Wenjing , Chen Hao , Daurès Jean-Pierre , Chiriac Anca Mirela , Demoly Pascal
Published: September 2014

Background

Allergic rhinitis (AR) is a highly prevalent disease that affects the quality of life, especially in the “severe chronic upper airway disease” (SCUAD) group of patients who still have severe symptoms after adequate treatment. This study investigated the prevalence of uncontrolled AR and SCUAD consulting in the Allergy Department of Tongji Hospital, Wuhan, China.

Methods

In this prospective cohort study, all patients consulting for AR were prospectively assessed using visual analog scale (VAS) and Allergic Rhinitis Control Test (ARCT) and put on standardized treatment based on the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines. After 15 days, they were reevaluated by a telephone interview using a numerical scale (NS) and ARCT. A score of ARCT of <20 defined uncontrolled AR and a score of NS of ≥ 5 at day 15 defined SCUAD patients.

Results

A total of 252 patients were included. Moderate/severe AR (VAS ≥ 5) was diagnosed in 82.9 of the patients which had an impact on sleep (86.9%), work life (84.9%), social activities (81%), and physical activities (90.1%). Patients with uncontrolled AR (27.7%) at day 15 more frequently presented a higher weight (p = 0.042), history of ear, nose, and throat (ENT) infection or antibiotics intake for respiratory infection in the last 12 months (62.3% versus 45.6%; p = 0.018), smoking (15.9% versus 6.7%; p = 0.024), and smell disturbance (26.1% versus 11.7%; p = 0.005). Patients with SCUAD (24.5%) more frequently presented a history of ENT infection or antibiotics intake for respiratory infection in the last 12 months (63.9% versus 45.7%; p = 0.014) and smell disturbance (27.9% versus 11.7%; p = 0.003), and less commonly had atopic dermatitis (13.1% versus 28.2%; p = 0.017).

Conclusion

Uncontrolled AR and SCUAD patients are numerous. VAS and ARCT are simple and quantitative methods and self-completion questionnaires that can be used for a global evaluation of the severity and control of AR.
House Dust Mite Allergen Levels in Households and Correlation with Allergic Rhinitis Symptoms
Authors: Wang Yanjun , Xiong Liyan , Yin Xiaoyan , Wang Jinghui , Zhang Quanming , Yu Zizhong , Gong Guoqing , Zheng Yiwu , Chen Jianjun , Kong Weijia
Published: September 2014

Background

House dust mite (HDM) allergen is a risk factor for the development of allergic rhinitis (AR).

Objectives

To determine the levels of indoor allergens in the households of patients with AR in Wuhan city, identify the environmental risk factors for high allergen exposure, and investigate the correlations between allergen exposure and specific immunoglobulin E levels and symptoms.

Methods

The study examined 50 patients with AR. Two dust samples were collected from the bedding of each patient, one in summer and one in winter. Major allergens Der p 1 and Der f 1, from Dermatophagoides pteronyssinus and Dermatophagoides farinae, were measured with an enzyme-linked immunosorbent assay. Participants completed a standardized questionnaire about their living environments, and their rhinitis symptom scores were calculated. Specific immunoglobulin E levels against Der p and Der f were measured.

Results

The percentage of bedding samples with high HDM allergen (Der f 1 + Der p 1) levels (>10 μg/g) was 44% in summer and 46% in winter. There was no significant difference between the level of mite allergens in summer and winter; however, the level of Der f 1 was higher than that of Der p 1 (p < 0.05). The age of the mattress and pillow was significantly correlated with allergen concentration. Indoor HDM allergen level affected the severity of nasal itching.

Conclusions

HDMs are important indoor allergens in Wuhan. Mattresses and pillows that have been used for a long time contain high levels of allergens. High levels of exposure to HDM allergens correlates with the severity of nasal itching.
Utility of Apparent Diffusion Coefficient in Characterization of Different Sinonasal Pathologies
Authors: Taha Mohamed S. , Fiky Lobna M. El , Taha Togan M. , Sabra Reda M. , Youssef Tamer A. , Nada Ihab M.
Published: September 2014

Background

Sinonasal lesions are a heterogeneous group of lesions that span from a tumor to tumor-like nature. Characterization of such cases preoperatively can improve the surgical control and the overall outcome of these patients.

Objective

In this prospective study, we aimed at evaluation of the role of apparent diffusion coefficient (ADC) in the differentiation between benign and malignant sinonasal lesions.

Subjects and methods

All patients scheduled to have sinonasal surgical intervention at Ain Shams University Hospitals, Cairo, Egypt, were enrolled. Diffusion-weighted (DW) magnetic resonance imaging (MRI) with calculation of ADC were done for all cases. Radiologic findings were then compared with histologic findings, and the sensitivity, specificity, negative and positive predictive values (PPVs) of the conventional MRI, DW-MRI, and ADC value in differentiation of benign from malignant sinonasal lesions were then calculated.

Results

There were 59 patients with median age of 43 years old. There were 20 cases of inflammatory lesions, 16 cases of benign tumors, and 23 cases of malignant lesions. The ADC values of all cases ranged from 0.4 x 10−3 to 2 x 10−3 ( median .5 x 10−3). The median ADC value for the malignant lesions was 0.6 x 10−3, whereas that for the inflammatory conditions was 1.6 x 10−3 and that for the benign tumors was 1.5 x 10−3 with a highly significant difference (p < .001). Analysis of the conventional MRI and DW-MRI to differentiate between malignant and benign lesions showed that the sensitivity, specificity, PPV, and negative predictive value (NPV) were 100%, 97%, 96%, and 100% and 91%, 97%, 95%, and 95%, respectively.

Conclusion

DW-MRI did not add significantly to the information gained from conventional MRI. It should be considered complimentary only to standard MRI in uncertain cases when malignancy is still a concern.
Radiographic measurements of C-2 in patients with atlas assimilation
Authors: Aoyama Tatsuro , Yasuda Muneyoshi , Yamahata Hitoshi , Takeuchi Mikinobu , Joko Masahiro , Hongo Kazuhiro , Takayasu Masakazu
Published: September 2014

Object

The object of this study was to evaluate the radiographic characteristics of C-2 using multiplanar CT measurements for anchor screw placement in patients with C-1 assimilation (C1A). Insertion of a C-2 pedicle screw in the setting of C1A is relatively difficult and technically demanding, and there has been no report about the optimal sizes of the pedicles and laminae of C-2 for screw placement in C1A.

Methods

An institutional database was searched for all patients who had undergone cervical CT scanning and cervical spine surgery between April 2006 and December 2012. Two neurosurgeons reviewed the CT scans from 462 patients who met these criteria, looking for C1A and other anomalies of the craniocervical junction such as high-riding vertebral artery (VA), basilar invagination, and VA anomaly. The routine axial images were reloaded on a workstation, and reconstruction CT images were used to measure parameters: the minimum width of bilateral pedicles and laminae and the length of bilateral laminae of the atlas.

Results

Seven patients with C1A were identified, and 14 sex-matched patients without C1A were randomly selected from the same database as a control group. The mean minimum pedicle width was 5.21 mm in patients with C1A and 7.17 mm in those without. The mean minimum laminae width was 5.29 mm in patients with C1A and 6.53 mm in controls. The mean minimum pedicle and laminae widths were statistically significantly smaller in the patients with C1A (p < 0.05).

Conclusions

In patients with C1A, the C-2 bony structures are significantly smaller than normal, making C-2 pedicle screw or translaminar screw placement more difficult.
First report of major vascular injury due to lateral transpsoas approach leading to fatality
Authors: Assina Rachid , Majmundar Neil J. , Herschman Yehuda , Heary Robert F.
Published: September 2014

Extreme lateral interbody fusion (XLIF) has gained popularity among spine surgeons for treating multiple conditions of the lumbar spine. In contrast to the anterior lumbar interbody fusion (ALIF) approach, the minimally invasive XLIF approach affords wide access to the lumbar disc space without an access surgeon and causes minimal tissue disruption. The XLIF approach offers many advantages over other lumbar spine approaches, with a reportedly low complication profile. The authors describe the first fatality reported in the literature following an XLIF approach. They describe the case of a 50-year-old woman who suffered a fatal intraoperative injury to the great vessels during a lateral transpsoas approach to the L4–5 disc space.
Hochlagenaufforstungen in Lawinenverbauungen im Berner Oberland
Authors: Ryter Ueli
Published: September 2014

Regeneration at high altitude in avalanche control stands in the Bernese Oberland

Since the 1950s, high altitude regeneration projects have been carried out in the avalanche control areas of the Bernese Oberland, using site-appropriate seedlings of domestic provenance from the cantonal nurseries. These plantations are intended to prevent, in the medium to long term, the start of avalanches. On the one hand, the article presents an analysis of the measures taken since 1995, and the field measurements made in the high altitude plantation at Schwanderort (1730–1780 m) above Brienz. This provides information on the development of young Spruce under extreme external conditions. On the other hand, the article investigates from what age the regeneration can provide avalanche protection functions, based on the growth characteristics of 112 trees of different ages, from 24 avalanche protection projects. Site conditions at high altitude are much more extreme and vary more from year to year than at lower altitude. Nineteen years after the plantation at Schwanderort, 60% of the Spruce are still alive; over this period, their average height has increased from 19 cm to 152 cm. Because of the short vegetative period, their height growth takes place between 20 June and end of July, and is stopped or strongly reduced when average temperatures are below 10°C. Analysis shows that at the upper forest limit, one must wait 45–50 years before regeneration can fulfil its avalanche protection function.
Methode zur standardisierten Beurteilung der Schutzwälder im Kanton Freiburg
Authors: Eyer Willy , Mazotti Benoît
Published: September 2014

Method for a standardised assessment of protection forests in the canton of Fribourg

The canton of Fribourg has developed a method to monitor protection forests based on available data: site maps, stand maps, map of protection forests (SilvaProtect; with the corresponding hazardous processes) and silvicultural references. In all, eight different indicators issued from a GIS environment are interpreted according to a “traffic light” system (three categories). The analysis can be applied at different scales: catchment areas, forest management units, forest districts and the canton as a whole. The results are used to set priorities and facilitate the planning of silvicultural interventions and logging operations. Moreover, this monitoring method 1) assesses the degree to which a forest fulfils its protection function and 2) identifies the satisfactory and the potentially deficient areas of protection forests.