bluuebunny/crossref_metadata_2025 huggingface dataset:
Staffing and resource adequacy strongly related to RNs’ assessment of patient safety: a national study of RNs working in acute-care hospitals in Sweden
Authors: Smeds Alenius Lisa , Tishelman Carol , Runesdotter Sara , Lindqvist Rikard
Published: October 2013

Introduction

Although registered nurses (RNs) are central in patient care, we have not found prior research that specifically addresses how RNs assess the safety of patient care at their workplace and how factors in RNs’ work environment are related to their assessments. This study aims to address these issues.

Methods

9236 RNs working with inpatient care in 79 acute-care hospitals in Sweden completed a national population-based survey, including Practice Environment Scale of the Nursing Work Index—Revised and items from Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture. Correlation coefficients (Pearson and Spearman) and proportional odds regression were used for analysis.

Results

Nursing work environment factors were strongly related to RNs’ assessments of patient safety. RNs’ perception of having adequate staffing and resources improved their assessment of patient safety by at least two and a half times (OR 2.74 CI 2.52 to 2.97). RNs with a higher level of involvement in direct patient care gave a better patient safety grade than RNs with a more supervisory role. Most, but not all, patient safety culture items were related to RNs’ assessed patient safety grade. We found that work experience seemed to have no influence on RNs’ patient safety assessment.

Conclusions

While previous research emphasises patient-to-nurse ratios in strengthening patient safety practices, this study complements this by emphasising RNs’ own perception of having enough staff and resources to provide quality nursing care, as well as having good collegial nurse–physician relations and the presence of visible and competent nursing leadership—all factors highly related to RNs’ assessment of the safety of patient care at their workplace.
Relative effectiveness of dominant versus non-dominant hand position for rescuer's side of approach during chest compressions between right-handed and left-handed novice rescuers
Authors: You Je Sung , Kim Hoon , Park Jung Soo , Baek Kyung Min , Jang Mun Sun , Lee Hye Sun , Chung Sung Phil , Kim SeungWhan
Published: October 2013

Introduction

The major components affecting high quality cardiopulmonary resuscitation (CPR) have been defined as the ability of the rescuer, hand position, position of the rescuer and victim, depth and rate of chest compressions, and fatigue. Until now, there have been no studies on dominant versus non-dominant hand position and the rescuer's side of approach. This study was designed to evaluate the effectiveness of hand position and approach side on the quality of CPR between right-handed (RH) and left-handed (LH) novice rescuers.

Material and methods

44 health science university students with no previous experience of basic life support (BLS) volunteered for the study. We divided volunteers into two groups by handedness. Adult BLS was performed on a manikin for 2 min in each session. The sequences were randomly performed on the manikin's left side of approach (Lap) with the rescuer's left hand in contact with the sternum (Lst), Lap/Rst, Rap/Lst and Rap/Rst.

Results

We compared the quality of chest compressions between the RH and LH groups according to predetermined positions. A significant decrease in mean compression depth between the two groups was only observed when rescuers performed in the Rap/Lst scenario, regardless of hand dominance. The frequency of correct hand placement also significantly decreased in the Lap/Rst position for the LH group.

Conclusions

The performance of novice rescuers during chest compressions is influenced by the position of the dominant hand and the rescuer's side of approach. In CPR training and real world situations, a novice rescuer, regardless of handedness, should consider hand positions for contacting the sternum identical to the side of approach after approaching from the nearest and most accessible side, for optimal CPR performance.
Internet usage and knowledge of radiation health effects and preventive behaviours among workers in Fukushima after the Fukushima Daiichi nuclear power plant accident
Authors: Kanda Hideyuki , Takahashi Kenzo , Sugaya Nagisa , Mizushima Shunsaku , Koyama Kikuo
Published: October 2013

Background

The Fukushima Daiichi nuclear power plant accident (FDNPPA) was the world's second largest nuclear power plant accident. At the time that it occurred, internet usage prevalence in Japan was as high as 80%.

Objectives

To compare health knowledge on radiation and preventive behaviour between internet users and non-users among adults employed in industries in Fukushima after the nuclear disaster.

Methods

We conducted a cross-sectional questionnaire study among adults employed in industries in Fukushima 3–5 months after the FDNPPA. Targets were 1394 regular workers who took part in health seminars provided by the Fukushima Occupational Health Promotion Center. After applying the selection criteria, there were 1119 eligible participants. The questionnaire asked for personal characteristics and main sources of information about the FDNPPA, as well as health knowledge on radiation and preventive behaviours following the nuclear accident. We assessed the contribution of each variable using logistic regression analysis.

Results

Among the eligible respondents, 637 workers (56.9%) were internet users and 482 (43.1%) were non-users. Internet users had more health knowledge than non-users (average 4.6 radiation-related health conditions in internet users vs 3.6 conditions in non-users) and more preventive behaviours (average 2.6 behaviours in internet users vs 1.9 in non-users). According to logistic regression analyses, internet usage was positively associated with greater health knowledge on radiation (OR 1.13; 95% CI 1.08 to 1.20) and more preventive behaviours (OR 1.14; 95% CI 1.07 to 1.23).

Conclusions

Internet usage was significantly and positively associated with greater health knowledge and more preventive behaviours. The internet is a useful method of distributing information to the general public in emergency situations such as a nuclear disaster.
Brachial plexus palsy following a training run with a heavy backpack
Authors: McCulloch Robert , Sheena Y , Simpson C , Power D
Published: October 2013

A 23-year-old male British soldier developed a progressive sensory loss and weakness in his right arm during a 12 km training run with a load of approximately 70 kg. There was no recovery of his symptoms within 3 months and both MRI and USS did not demonstrate a site of compression within the brachial plexus. An infraclavicular brachial plexus exploration was performed 11 months after injury that indicated an ischaemic neuropathy with post-injury fibrosis. Injuries of the brachial plexus secondary to carrying a heavy backpack during prolonged periods of exercise are rare, particularly in the infraclavicular region. Cases such as this highlight that training regimens within the military population should be appraised due to the risk of similar injuries occurring.
Endovascular treatment of unruptured and ruptured brain arteriovenous malformations with Onyx18: a monocentric series of 84 patients
Authors: Consoli Arturo , Scarpini Giulia , Rosi Andrea , Renieri Leonardo , Chiarotti Ivano , Vignoli Chiara , Ciampa Iacopo , Nappini Sergio , Limbucci Nicola , Mangiafico Salvatore
Published: October 2013

Background

Brain arteriovenous malformations (AVMs) are a rare pathology, and their treatment is discussed. The development of techniques and materials in endovascular, radiosurgical, and neurosurgical fields led to higher rates of complete occlusions and good clinical outcomes.

Materials and methods

84 patients (52 men, 32 women; mean age 38.2 years; range, 9–70 years) were treated at our institution with Onyx18 from 2001 to 2011. Patients treated with other embolic agents, with micro-AVMs, were not included in the analysis.

Results

Complete occlusion was achieved in 27/84 patients (32.2%), in 40/84 (47.6%) brain AVMs occlusion of 80–90% of the nidus was obtained, and in 17/84 (20.3%) cases <80% of the nidus was occluded. Intraprocedural adverse events occurred in 11/84 patients (13.1%), and overall mortality and disabling permanent morbidity were 2.3% (2/84) and 4.7% (4/84), respectively.

Conclusions

Endovascular treatment may be considered a safe and effective approach in superficial small brain AVMs in addition to surgery, mostly in ruptured AVMs. The therapeutic strategy should be to cure small and medium AVMs with endovascular treatment alone or combined treatment. Large unruptured AVMs (Spetzler–Martin grades IV–V) should be treated with target embolization of high flow fistulas or intranidal aneurysms.
Republished: Stem cells, angiogenesis and muscle healing: a potential role in massage therapies?
Authors: Best Thomas M , Gharaibeh Burhan , Huard Johnny
Published: October 2013

Skeletal muscle injuries are among the most common and frequently disabling injuries sustained by athletes.

Repair of injured skeletal muscle is an area that continues to present a challenge for sports medicine clinicians and researchers due, in part, to complete muscle recovery being compromised by development of fibrosis leading to loss of function and susceptibility to re-injury.

Injured skeletal muscle goes through a series of coordinated and interrelated phases of healing including degeneration, inflammation, regeneration and fibrosis. Muscle regeneration initiated shortly after injury can be limited by fibrosis which affects the degree of recovery and predisposes the muscle to reinjury. It has been demonstrated in animal studies that antifibrotic agents that inactivate transforming growth factor (TGF)-β1 have been effective at decreasing scar tissue formation. Several studies have also shown that vascular endothelial growth factor (VEGF) can increase the efficiency of skeletal muscle repair by increasing angiogenesis and, at the same time, reducing the accumulation of fibrosis. We have isolated and thoroughly characterised a population of skeletal muscle-derived stem cells (MDSCs) that enhance repair of damaged skeletal muscle fibres by directly differentiating into myofibres and secreting paracrine factors that promote tissue repair. Indeed, we have found that MDSCs transplanted into skeletal and cardiac muscles have been successful at repair probably because of their ability to secrete VEGF that works in a paracrine fashion. The application of these techniques to the study of sport-related muscle injuries awaits investigation. Other useful strategies to enhance skeletal muscle repair through increased vascularisation may include gene therapy, exercise, neuromuscular electrical stimulation and, potentially, massage therapy. Based on recent studies showing an accelerated recovery of muscle function from intense eccentric exercise through massage-based therapies, we believe that this treatment modality offers a practical and non-invasive form of therapy for skeletal muscle injuries. However, the biological mechanism(s) behind the beneficial effect of massage are still unclear and require further investigation using animal models and potentially randomised, human clinical studies.
Observations on microstructure of pumice particles using computed tomography
Authors: Kikkawa Naotaka , Orense Rolando P. , Pender Michael J.
Published: October 2013

Pumice occurs widely in New Zealand and is important in infrastructure construction, but is not readily characterized in situ. It is a unique material, the particles of which crush easily under finger pressure, making it arguably the most delicate of the suite of crushable soils found in various locations around the world. In this study, we scanned pumice particles of different sizes using an X-ray computed tomography (CT) scanning machine to investigate particle microstructure. Using image analyses, we were able to determine the solid density of pumice more accurately than the standard method, which showed increasing density as particle size decreased. Results from the CT scanning showed a solid density of about 2.2 g/cm3, which is similar to the highest value obtained using the standard method. On the other hand, the apparent density from CT scanning was 0.89 g/cm3, which is lower than the density of water, therefore confirming that almost all pumice particles float on water. In addition, the volume of surface voids was observed to be much greater than that of internal voids. Moreover, the particle shape of pumice sand was analyzed and compared to other natural sands. Finally, analyses showed that pumice particles are very fragile not only because they are porous, but also because of their angular nature.
Physiological analysis of nitrogen-efficient rice overexpressing alanine aminotransferase under different N regimes
Authors: Beatty Perrin H. , Carroll Rebecka T. , Shrawat Ashok K. , Guevara David , Good Allen G.
Published: October 2013

Cereal crop plants have low nitrogen (N) use efficiency, taking up only 30% to 50% of the applied N fertilizers, with the rest having the potential for loss into the environment as N pollution. One way to address this problem is to improve the nitrogen use efficiency of cereal crops using a transgenic approach. We developed alanine aminotransferase overexpressing rice, and we have previously determined that this modification provided an improved nitrogen-use phenotype to the engineered plants. In this study, the transgenic rice were grown in low, medium, and high nitrogen supply, and morphology, plant N levels, enzymatic activity, metabolite levels, and transcriptome response in the roots and shoots at active and maximum tillering at each N level were measured. The transcriptome response was analysed further using MapMan and PageMan to view multiple comparisons. The transgenic rice plants showed improved nitrogen use efficiency at medium and high N supply, but with few significant changes to the amino acid levels or to the transcriptome. The transgenic plants grown in high N showed up-regulation of transcripts associated with photosynthesis, non-melavonate pathway secondary metabolites, protein degradation, and many unknown function transcripts.
Synthesis of functionalized para- and meta-terphenyls based on site-selective Suzuki cross-coupling reactions of bis(triflates) of methyl 2,5-dihydroxybenzoate and methyl 2,4-dihydroxybenzoate
Authors: Nawaz Muhammad , Ullah Ihsan , Abid Obaid-ur-Rahman , Ali Asad , Patonay Tamás , Saghyan Ashot S. , Ghochikan Tariel V. , Villinger Alexander , Langer Peter
Published: October 2013

The palladium(0)-catalyzed Suzuki cross-coupling reaction of the bis(triflates) of methyl 2,5-dihydroxybenzoate and methyl 2,4-dihydroxybenzoate afforded para- and meta-terphenyls, respectively. The reactions proceeded with very good site selectivity in favor of the sterically less hindered carbon atom.
Isolation and bioassay screening of medicinal plant endophytes from eastern Canada
Authors: Ellsworth Katelyn T. , Clark Trevor N. , Gray Christopher A. , Johnson John A.
Published: October 2013

Eighty-one distinct fungal endophytes were isolated from 12 traditionally used medicinal plants from New Brunswick, Canada. This is the first report of endophytes from 8 of the 12 host plants. One hundred and sixty-two crude extracts derived from the mycelia and spent fermentation broths of liquid cultures of each endophyte were screened for antibacterial and antifungal activity. Twenty-two extracts were active against Staphylococcus aureus while 30 were active against Pseudomonas aeruginosa. Twelve crude extracts were found to be active against Candida albicans.
An eclectic view of our Milky Way galaxy
Authors: Turner David G.
Published: October 2013

The nature of our Milky Way galaxy is re-examined from an eclectic point of view. Evidence for a central bar, for example, is not reflected in the distribution of RR Lyrae variables in the central bulge (Majaess. Acta Astron. 60, 55 (2010); Dékány et al. arXiv:1309.5933. 2013), and it is not clear if either a 2-armed or 4-armed spiral pattern is appropriate for the spiral arms. Radial velocity mapping of the Galaxy using radio H I, H II, or CO observations is compromised by the assumptions adopted for simple Galactic rotation. The Sun’s local standard of rest (LSR) velocity is ∼14 km s−1 rather than 20 km s−1, the local circular velocity is 251 ± 9 km s−1 rather than 220 km s−1, and young groups of stars exhibit a 10–20 km s−1 “kick” relative to what is expected from Galactic rotation. By implication, the same may be true for star-forming gas clouds affected by the Galaxy’s spiral density wave, raising concerns about their use for mapping spiral arms. Proper motion data in conjunction with the newly-estimated velocity components for the Sun’s motion imply a distance to the Galactic centre of R0 = 8.34 ± 0.27 kpc, consistent with recent estimates, which average 8.24 ± 0.09 kpc. A cosinusoidal Galactic potential is not ruled out by observations of open star clusters. The planetary nebula cluster Bica 6, for example, has a near-escape orbit for a Newtonian potential, but a near-normal orbit in a cosinusoidal potential field. The nearby cluster Collinder 464 also displays unusually large tidal effects consistent with those expected for a cosinusoidal potential. A standard Newtonian version of the Virial theorem for star clusters yields very reasonable masses (∼3 × 1011 M⊙ and ∼4 × 1011 M⊙) for the Milky Way and M31 subgroups of the Local Group, respectively. A cosinusoidal relation should yield identical results.
The variety and distribution of building stones used in the churches of West Sussex, England, from AD 950 to 1850
Authors: Cordiner Roger J.
Published: October 2013

A large number of different building stones were used during the period AD 950–1850 in West Sussex churches, with 52 different types identified and named in this study. The building stones include local Tertiary and Cretaceous rocks, as well as imported rocks from the Isle of Wight, Dorset and Normandy. One hundred and eighty churches, mainly built during the period from the eleventh to the sixteenth centuries but with a few ranging in age up until the mid-nineteenth century, have been visited to identify the building stones used. The distribution pattern of use of four building stones – Tunbridge Wells Sandstone, Hythe Formation Sandstone, Mixon Stone and Quarr Stone – is presented and analysed. These building stones show distinctive patterns of distribution, which are related to geological, geographical, economic, architectural and historical factors. The building stones native to West Sussex are of considerable geological interest as few quarries or other exposures showing these strata are now present.
The stone materials of the historical architecture of Tuscany, Italy
Authors: Fratini F. , Rescic S.
Published: October 2013

The paper presents an overview of the principal stone materials used in the historical architecture of Tuscany, a region of central Italy characterized by a great variety of landscapes. The large number of these materials reflects the complex geology of the region, where each village and town has a unique identity conferred by the architecture and typical colours of the construction materials. The urban areas that have developed in the foothills of the Apennines are, characterized by the use of sandstone, while the towns and villages of central-southern Tuscany are generally more heterogeneous, with an abundant use of bricks and travertine. The information presented is focused on the use of the stone materials during the different epochs, their geopetrographical characteristics and their most common durability problems.
Spinal Cord Stimulation and Intrathecal Baclofen Therapy: Combined Neuromodulation for Treatment of Advanced Complex Regional Pain Syndrome
Authors: Goto Shinichi , Taira Takaomi , Horisawa Shiro , Yokote Akiyoshi , Sasaki Toshiyuki , Okada Yoshikazu
Published: October 2013

Objective: Spinal cord stimulation (SCS) is one of the widely used procedures for the treatment of complex regional pain syndrome (CRPS). However, complete pain relief is rarely achieved, and the SCS effect diminishes over time. Recently intrathecal baclofen (ITB) therapy is reported to be a modality for treating fixed dystonia related to CRPS. Other reports have suggested that ITB therapy can enhance the effect of SCS in patients with neuropathic pain. We report the effectiveness of combined SCS and ITB therapy, focusing on the role of ITB therapy as an adjunctive therapy for controlling symptoms of advanced CRPS. Methods: Five affected extremities of 4 patients with CRPS (2 male; mean age, 32.5 years) refractory to conservative treatment were evaluated retrospectively. Three patients underwent SCS implantation first, with ITB pumps being implanted a few years later. Bolus ITB injection was administered under temporary percutaneous SCS in 1 patient. Pain intensity was evaluated using the visual analogue scale (VAS) before and after ITB administration. Results: Pain relief of more than 50% was observed in the upper extremity of 1 patient and one of more than 30% was observed in 2 patients. The mean pain reduction rate in all 4 patients was 28.9% before and 43.8% after treatment. All patients, including those without any improvements in VAS score, showed decreased postural abnormalities after combined SCS and ITB therapy. Improvement in postural abnormalities, such as fixed dystonia or paroxysmal tremor-like movements, resulted in overall pain relief by reducing pain fluctuations. Conclusions: Combined SCS and ITB neuromodulation decreases pain intensity in refractory CRPS cases or improves associated abnormal dystonic posture and movement disorders and reduces pain fluctuations.
Electrical Stimulation-Evoked Dopamine Release in the Primate Striatum
Authors: Gale John T. , Lee Kendall H. , Amirnovin Ramin , Roberts David W. , Williams Ziv M. , Blaha Charles D. , Eskandar Emad N.
Published: October 2013

Background: Primate studies demonstrate that high-frequency electrical stimulation (HFS) of the caudate can enhance learning. Importantly, in these studies, stimulation was applied following the execution of behavior and the effect persisted into subsequent trials, suggesting a change in plasticity rather than a momentary facilitation of behavior. Objectives/Methods: Although the mechanism of HFS-enhanced learning is not understood, evidence suggests that dopamine plays a critical role. Therefore, we used in vivo amperometry to evaluate the effects of HFS on striatal dopamine release in the anesthetized primate. While this does not directly examine dopamine during learning, it provides insight with relation to dopamine dynamics during electrical stimulation and specifically between different stimulation parameters and striatal compartments. Results: We demonstrate that HFS results in significantly more dopamine release in the striatum compared to low-frequency stimulation. In addition, electrical stimulation operates differentially on specific neuronal elements, as the parameters for dopamine release are different for the caudate, putamen and medial forebrain bundle. Conclusions: While not direct evidence, these data suggest that HFS evokes significant dopamine release which may play a role in stimulation-enhanced learning. Moreover, these data suggest a means to modulate extracellular dopamine with a high degree of temporal and spatial precision for either research or clinical applications.
Linear IgA Bullous Disease Presenting as Toxic Epidermal Necrolysis: A Case Report and Review of the Literature
Authors: Kakar Rohit , Paugh Holly , Jaworsky Christine
Published: October 2013

A 91-year-old female presented with widespread skin sloughing and bullae clinically mimicking toxic epidermal necrolysis (TEN). The patient was on multiple antibiotics, including vancomycin and piperacillin/tazobactam. Histopathology and direct immunofluorescence were consistent with a diagnosis of linear IgA bullous disease (LABD). In a PubMed review of the literature from 1975 to the present, there have been 15 cases of LABD presenting as TEN clinically and with characteristic linear IgA deposits on direct immunofluorescence studies. Vancomycin and phenytoin were the most commonly implicated medications. Twelve patients saw a resolution or healing of skin lesions after discontinuation of the implicated medication. There were, however, 5 patients who died of complications related to their comorbidities. It is important to include LABD in the differential diagnosis when evaluating patients who clinically present with TEN.
What Does Elevated High-Sensitive Troponin I in Stroke Patients Mean: Concomitant Acute Myocardial Infarction or a Marker for High-Risk Patients
Authors: Anders B. , Alonso A. , Artemis D. , Schäfer A. , Ebert A. , Kablau M. , Fluechter S. , Findeisen P. , Hennerici M.G. , Fatar M.
Published: October 2013

Background: Acute ischemic stroke patients may occasionally suffer from concomitant acute coronary syndrome (ACS). Troponin I and T are established biomarkers to detect ACS. Recently introduced high-sensitive cardiac troponin (hs-TNI and hs-TNT) assays are increasingly used to identify ACS in stroke patients even without signs or symptoms of ACS. These new test systems very often detect elevated values of hs-troponin, although clinical relevance and consequences of elevated hs-TNI values in these patients are unclear so far. Patients and Methods: We examined hs-TNI values in 834 consecutive ischemic stroke patients admitted to our Comprehensive Stroke Center during a 1-year period. hs-TNI was measured immediately after admission and after 3 h if initial hs-TNI was elevated above the 99th percentile of normal values (>0.045 ng/ml). Patients with elevated values were divided into two groups: (1) constant and (2) dynamic hs-TNI values. The dynamic approach was defined as a 30% rise or fall of the hs-TNI value above the critical value within 3 h. All patients received stroke diagnostic and continuous monitoring according to international stroke unit standards, including a 12-lead ECG, blood pressure, body temperature and continuous ECG monitoring, as well as regular 6-hourly neurological and general physical examination (including NIHSS scores). The cardiologists - as members of the Stroke Unit team - evaluated clinical symptoms/examination, as well as laboratory, echocardiographic and ECG findings for the diagnosis of ACS. Results: 172/834 (20.6%) patients showed elevated hs-TNI levels on admission. Patients with elevated hs-TNI values exhibited a significantly (p < 0.001) increased rate of hypertension (89 vs. 77.2%), history of stroke (24.4 vs. 14.8%), history of coronary artery disease (65.7 vs. 34.1%), history of myocardial infarction (22.1 vs. 7.6%), heart failure (12.8 vs. 5.7%) and atrial fibrillation (44.2 vs. 23.6%). 82/136 patients showed constant and 54/136 patients dynamic hs-TNI values: among the latter, 5 patients were diagnosed with ST segment elevation myocardial infarction (STEMI) and 24 with non-STEMI (NSTEMI). Conclusion: Our data demonstrate that hs-TNI was elevated in about 20.6% of acute ischemic stroke patients but therapeutically relevant ACS was diagnosed only in the dynamic group. hs-TNI elevations without dynamic changes may occur in stroke patients without ACS due to different reasons that stress the heart. Therefore, we suppose that hs-TNI is a sensitive marker to detect high-risk patients but serial measurements are mandatory and expert cardiological workup is essential for best medical treatment and to accurately diagnose ACS in acute ischemic stroke patients.
Randomised Trial of Volume-Targeted Ventilation versus Pressure-Limited Ventilation in Acute Respiratory Failure in Prematurely Born Infants
Authors: Chowdhury Olie , Patel Deena-Shefali , Hannam Simon , Lee Silke , Rafferty Gerrard F. , Peacock Janet L. , Greenough Anne
Published: October 2013

Background: During volume-targeted ventilation (VTV), a constant volume is delivered with each ventilator inflation. Objectives: To determine whether VTV compared to pressure-limited ventilation (PLV) reduced the time to reach weaning criteria in prematurely born infants with acute respiratory distress, and if any difference was explained by better respiratory muscle strength and/or a lower work of breathing (WOB). Methods: Infants of <34 weeks of gestational age ventilated for <24 h in the first week after birth were randomised to receive either VTV or PLV. The primary outcome was the time to achieve pre-specified weaning criteria. Respiratory muscle strength was assessed by the measurement of the maximum inflation and expiratory pressures, and the WOB assessed by the transdiaphragmatic pressure time product. Other outcomes reported are the duration of ventilation, occurrence of patent ductus arteriosus, pneumothorax, intraventricular haemorrhage, periventricular leukomalacia and episodes of hypocarbia. Results: Forty infants, median gestational age 27 (range 23-33) weeks, were recruited. The time taken to achieve weaning criteria was similar in the two groups [median 14 h (VTV) vs. 23 h (PLV)]. There were no significant differences between the groups with regard to respiratory muscle strength, WOB or other outcomes, except that fewer of the VTV compared to the PLV group had episodes of hypocarbia (8 vs. 19; p < 0.001). Conclusion: In prematurely born infants with acute respiratory failure, use of VTV did not reduce the time to reach weaning criteria, but was associated with a reduction in episodes of hypocarbia.
Extra-Intracranial Standard Bypass in the Elderly: Perioperative Risk, Bypass Patency and Outcome
Authors: Sandow Nora , von Weitzel-Mudersbach Paul , Rosenbaum Sverre , König Susanne , Buchert Ralph , Mehl Sebastian Rüdiger , Garbe Anja , Vajkoczy Peter
Published: October 2013

Background: Patients with chronic atherosclerotic vessel occlusion and cerebrovascular hemodynamic insufficiency may benefit from extra-intracranial (EC-IC) bypass surgery. Due to demographic changes, an increasing number of elderly patients presents with cerebrovascular hemodynamic insufficiency. So far, little data for EC-IC bypass surgery in elderly patients suffering occlusive cerebrovascular disease are available. We therefore designed a retrospective study to address the question whether EC-IC bypass is a safe and efficient treatment in a patient cohort ≥70 years. Methods: 50 patients underwent EC-IC standard bypass surgery with translocation of the superficial temporal artery to an M2 segment of the medial cerebral artery. Criteria for bypass surgery were presence of symptomatic occlusive cerebrovascular disease of the anterior circulation and proof of a severely restricted or abrogated reserve capacity (detected by H2O-photon emission tomography or single photon emission computer tomography - before and after forced vessel dilatation by diamox). The incidence of perioperative neurological and surgical complications, bypass patency, bypass function and short-term outcome were retrospectively analyzed. Results: The study cohort consisted of 16 patients ≥70 years (mean = 74.3 years, SE 1.3). It was compared to a cohort of 34 patients <70 years (mean = 61.2 years, SE 1.0). Both groups underwent EC-IC bypass surgery after careful preoperative work-up. Both patient groups did not differ significantly in gender, vascular pathology, previous history of diseases/comorbidity or clinical symptoms. The number of patients which underwent stenting or other endovascular treatments of the internal or common carotid artery prior to EC-IC bypass surgery was significantly higher in the group of patients ≥70 years (37.5 vs. 0%, p < 0.001). Perioperative stroke rate was 0% in both groups and mild morbidity occurred in 18.8 and 14.7%, respectively (p = 0.699). One 84-year-old female patient died due to perioperative endocarditis. Initial bypass patency was 93.8% in patients above the age of 70 years and 97.1% in the younger group (p = 0.542). Secondary occlusion rate was low in both groups (≥70 years: 0% vs. <70 years 3.7%). No new neurologic deficit occurred in patients with a patent bypass during the follow-up period (median 18 ± 13.1 months). Two patients with an initially occluded bypass and one with a secondary bypass occlusion suffered from new neurological symptoms. Conclusions: Our data show comparable safety and efficiency of EC-IC bypass surgery in patients under and above the age of 70 years due to a careful preoperative work-up and a strict indication for bypass surgery.
Chromosomes of Iberian Leuciscinae (Cyprinidae) Revisited: Evidence of Genome Restructuring in Homoploid Hybrids Using Dual-Color FISH and CGH
Authors: Pereira C.S.A. , Ráb P. , Collares-Pereira M.J.
Published: October 2013

Iberian Leuciscinae have been used in many studies as models to explore topics such as hybridization, allopolyploidy, modes of reproduction, and evolution. This article focuses on the contribution of cytogenomics to foster research in this group of cyprinid fish. Conventional and molecular banding results were reviewed, facilitating comparative analysis between nase and chub taxa inhabiting Portuguese freshwaters. Hybridization is known to occur within both Chondrostoma s.l. and Squalius genera although polyploidy has only been reported in the latter; the reasons behind such differential genome flexibility remain unidentified. FISH tools allowed recognizing additional chromosome markers, confirming NOR polymorphism and distinguishing species and their hybrids. Recombination and genome instability were detected in homoploid and polyploid hybrid genomes supporting active NOR transposition. However, the multiplication of rDNAs in these species does not seem to be associated with Rex3 retroelement, though hybrids were not surveyed. CGH and GISH allowed reaffirming the hybrid origin of S. alburnoides and confirming that the conservative karyotype patterns within Iberian leuciscines are restricted to the macrostructure. Current data also support the usefulness of mapping repetitive DNAs, especially for nonmodel compact genomes with less variable karyotypes and sequence data resources unavailable, like in many cyprinid lineages.
A Novel Otoferlin Splice-Site Mutation in Siblings with Auditory Neuropathy Spectrum Disorder
Authors: Runge Christina L. , Erbe Christy B. , McNally Mark T. , Van Dusen Courtney , Friedland David R. , Kwitek Anne E. , Kerschner Joseph E.
Published: October 2013

We characterize a novel otoferlin mutation discovered in a sibling pair diagnosed with auditory neuropathy spectrum disorder and investigate auditory nerve function through their cochlear implants. Genetic sequencing revealed a homozygous mutation at the otoferlin splice donor site of exon 28 (IVS28 + 1G>T) in both siblings. Functional investigation showed that the intronic sequence between exons 28 and 29 was retained in the mutated minigenes that were expressed in 293T cells. Auditory nerve compound action potential recovery functions in the siblings demonstrated different rates of neural recovery, with sibling AN1 showing rapid recovery (1.14 ms) and AN2 showing average recovery (0.78 ms) compared to subjects with sensorineural hearing loss (average: adults 0.71 ms, children 0.85 ms). Differences in neural recovery were consistent with speech perception differences between the siblings. Genotype information may indicate site of lesion in hearing loss; however, additional, as yet, unknown factors may impact clinical outcomes and must be considered.
A Preliminary Genetic Map in Solea senegalensis (Pleuronectiformes, Soleidae) Using BAC-FISH and Next-Generation Sequencing
Authors: García-Cegarra A. , Merlo M.A. , Ponce M. , Portela-Bens S. , Cross I. , Manchado M. , Rebordinos L.
Published: October 2013

This article presents the first physical mapping carried out in the Senegalese sole (Solea senegalensis), an important marine fish species of Southern Europe. Eight probes were designated to pick up genes of interest in aquaculture (candidate genes) from a bacterial artificial chromosome (BAC) library using a method of rapid screening based on a 4-dimension PCR. Seven known and 3 unknown clones were isolated and labeled. The 10 BAC clones were used as probes to map the karyotype of the species by fluorescence in situ hybridization (FISH). Nine out of the 10 clones were localized in only 1 chromosome pair, whereas the remaining one hybridized on 2 chromosome pairs. The 2-color FISH experiments showed colocation of 4 probes in 2 chromosome pairs. In addition, 2-color FISH was carried out both with 5S rDNA and the BAC containing the lysozyme gene published previously. This first genetic map of the Senegalese sole represents a starting point for future studies of the sole genome. In addition, 7 out of the 10 BAC clones were sequenced using next-generation sequencing, and bioinformatic characterization of the sequences was carried out. Hence the anchoring of the sequences to specific chromosomes or chromosome arms is now possible, leading to an initial scaffold of the Senegalese sole genome.
Contribution of Vasoactive Intestinal Peptide to Immune Homeostasis in Trophoblast-Maternal Leukocyte Interaction under LPS Stimulation
Authors: Fraccaroli Laura , Grasso Esteban , Hauk Vanesa , Cortelezzi Marta , Pérez Leirós Claudia , Ramhorst Rosanna
Published: October 2013

Background/Aims: The maternal-fetal interface is a unique immunological site that generates an adequate microenvironment during pregnancy, recognizing and eliminating infections and tolerating the trophoblast/placenta unit. For that purpose, trophoblast cells display several tolerogenic mechanisms to allow fetal survival, such as production of the neuropeptide vasoactive intestinal peptide (VIP). Here we investigated the contribution of VIP to maintain homeostasis at the maternal-placental interface under lipopolysaccharide (LPS) stimulation. Methods: We performed cocultures between trophoblast cells (Swan-71 cell line) and maternal leukocytes obtained from fertile women as an in vitro model of maternal-placental interaction, and we focused on the effects of LPS on the modulation of VIP and their receptors (VPAC1 and VPAC2). Results: VIP could prevent the upregulation of IL-6, MCP-1, and nitrite production and maintain the production of IL-10 and TGF-β under LPS (10 µg/ml) stimulation after 48 h of coculture. To gain deeper insight into the mechanisms of how VIP could contribute to a tolerogenic microenvironment even in the presence of LPS, we investigated VIP production by maternal leukocytes and observed a significant increase in the frequency of CD4+VIP+ cells after interaction with Swan-71 cells in the presence of LPS. LPS increased VIP and inducible receptor VPAC2 expression directly on trophoblast cells in a dose- and time-dependent manner. Conclusions: The present results suggest that VIP might act as an additional homeostatic mechanism during early stages at the maternal-placental interface to control exacerbated inflammatory responses such as the ones observed in intrauterine infections.
Effect of Adenomyosis on In Vitro Fertilization/Intracytoplasmic Sperm Injection Outcomes in Infertile Women: A Retrospective Cohort Study
Authors: Yan Lei , Ding Lingling , Tang Rong , Chen Zi-Jiang
Published: October 2013

Aims: To study the effect of adenomyosis on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in infertile patients. Methods: We performed a retrospective, database-searched cohort study based on 10,268 patients undergoing controlled ovarian hyperstimulation and IVF/ICSI between 2009 and 2011 in our unit. Adenomyosis was diagnosed by transvaginal ultrasound. A high-quality matched cohort study with strict inclusion criteria was conducted. We compared the basic characteristics and main IVF/ICSI outcomes between the two groups. Results: We identified 83 patients with adenomyosis, of whom we included 77, and strictly matched them to 77 patients without adenomyosis. Higher day 3 estrogen levels and a longer duration of gonadotropin stimulation days were found in women with adenomyosis compared to control subjects. Patients with adenomyosis had a nonsignificant trend toward a lower clinical pregnancy rate and a higher miscarriage rate (p = 0.103 and 0.09, respectively). The delivery rate was significantly lower in the adenomyosis group in comparison to the matched controls (p = 0.022). Conclusions: Within the limitations of a retrospective study (albeit with a remarkably large number of observations), our results suggest that transvaginal ultrasound-diagnosed adenomyosis could have a negative impact on the main IVF/ICSI outcomes. Improving the diagnostic validity and scoring of disease severity in patients with adenomyosis is suggested.
Severe Iron Deficiency Is Associated with a Reduced Conception Rate in Female Rats
Authors: Li Yan Qin , Cao Xiao Xiao , Bai Bin , Zhang Jing Ni , Wang Ming Qi , Zhang Yao Hui
Published: October 2013

Background/Aims: Iron deficiency is a global nutritional disorder, especially for pregnant women. There is a close relationship between deficiency in trace elements and unexplained infertility in females. However, the relationship between iron deficiency and unexplained infertility has not been determined. This study was designed to determine the effect of iron deficiency on conception in a rat model. Methods: Female rats were randomly divided into two groups (n = 15 each): an iron-deficiency group fed a low iron diet and a normal control group. Both groups of female rats were mated with healthy male rats after the iron-deficiency model was established. Results: Iron-deficient rats developed white skin and eyes, hair loss, and weight loss. Hemoglobin levels and red blood cell count were significantly lower than in controls, showing successful establishment of the iron-deficiency model. There was a significantly lower conception rate in the iron-deficiency group; there also appeared to be a disruption of estrus and a delay in conception in the iron-deficiency group. Conclusions: Severe iron deficiency has a significant influence on fertility, and may be an important factor in unexplained infertility. Further research on the role of iron in conception is warranted.
Evolution of the Sex Chromosomes in Salmonid Fishes
Authors: Phillips R.B.
Published: October 2013

Most of the information on sex chromosomes in salmonid fishes is for species in the 3 genera of the subfamily Salmoninae found in North America: Salvelinus, Salmo and Oncorhynchus. All of the species are male heterogametic with XY sex determination. Morphologically distinguishable sex chromosomes are found only in Salvelinus namaycush,S. fontinalis and Oncorhynchus mykiss. Sex chromosomes have been identified in the other species using a combination of chromosome mapping and fluorescence in situ hybridization with probes containing sex-linked markers. Although all species share conserved linkage groups, the major sex-determining locus (SD) is found at the telomere of a different linkage group in almost every species, suggesting that the SD often transposes to a new location at the time of speciation. In a couple of species, intraspecific variation has been found in the chromosomal location of the SD. Recently, sdY has been identified as the major sex-determining gene in rainbow trout, and it maps to the sex linkage group in all of these species. BACs containing sdY have been isolated and sequenced in O.mykiss, and the genetic markers adjacent to sdY are not sex-linked in the other Oncorhynchus species, suggesting that the transposed region is very small. Possible explanations for the frequent occurrence of transposition of the SD are discussed.
Disseminated Superficial Actinic Porokeratosis on the Face Treated with Imiquimod 5% Cream
Authors: Riad Hassan , Mansour Khaled , Al Sada Hussein , Abu Shaika Samya , Al Ansari Hamda , Al Mohannadi Haya
Published: October 2013

Porokeratoses are a group of hereditary or acquired disorders characterized by annular lesions with an atrophic center and a prominent peripheral ridge. Pathologically, porokeratosis is characterized by the presence of abnormal clones of keratinocytes that form a column of parakeratotic cells, called the cornoid lamella. Fifteen percent of patients of disseminated superficial actinic porokeratosis (DSAP) have facial lesions; other regions like the extensor surface of extremities constitute the majority of reported cases. Exclusively facial lesions are probably less frequent. Rarely, actinic porokeratosis is confined to the nose only. Of reported porokeratosis cases, 7.5% have revealed a malignancy arising within the lesion. We present a case of facial sporadic DSAP that was treated with imiquimod 5% cream in conjunction with a regular sunscreen. Follow-up of this case is important to rule out the possibility of malignant transformation of the lesions.
Prenatal Detection of Fetal Triploidy from Cell-Free DNA Testing in Maternal Blood
Authors: Nicolaides Kypros H. , Syngelaki Argyro , Gil M.M. , Quezada Maria Soledad , Zinevich Yana
Published: October 2013

Objective: To investigate potential performance of cell-free DNA (cfDNA) testing in maternal blood in detecting fetal triploidy. Methods: Plasma and buffy coat samples obtained at 11-13 weeks' gestation from singleton pregnancies with diandric triploidy (n = 4), digynic triploidy (n = 4), euploid fetuses (n = 48) were sent to Natera, Inc. (San Carlos, Calif., USA) for cfDNA testing. Multiplex polymerase chain reaction amplification of cfDNA followed by sequencing of single nucleotide polymorphic loci covering chromosomes 13, 18, 21, X, and Y was performed. Sequencing data were analyzed using the NATUS algorithm which identifies copy number for each of the five chromosomes. Results: cfDNA testing provided a result in 44 (91.7%) of the 48 euploid cases and correctly predicted the fetal sex and the presence of two copies each of chromosome 21, 18 and 13. In diandric triploidy, cfDNA testing identified multiple paternal haplotypes (indicating fetal trisomy 21, trisomy 18 and trisomy 13) suggesting the presence of either triploidy or dizygotic twins. In digynic triploidy the fetal fraction corrected for maternal weight and gestational age was below the 0.5th percentile. Conclusions: cfDNA testing by targeted sequencing and allelic ratio analysis of single nucleotide polymorphisms covering chromosomes 21, 18, 13, X, and Y can detect diandric triploidy and raise the suspicion of digynic triploidy.
Nodal Melanoma Metastasis under Infliximab Therapy in a Patient with Nevoid Melanoma First Misdiagnosed as Benign Nevus: A Potentially Dangerous Diagnostic Pitfall in the Era of Biologic Therapies
Authors: Safa Gilles , Fromentoux Sophie , Darrieux Laure , Hogenhuis Jean-Anastase , Tisseau Laurent
Published: October 2013

We report the case of a 53-year-old Caucasian woman who developed nodal melanoma metastasis under infliximab therapy 2 years after the removal of a nevoid melanoma, which was initially misdiagnosed as a benign compound nevus. This case illustrates the potential link between tumor necrosis factor (TNF)-α inhibition and the reactivation of latent melanoma. Furthermore, this case highlights the need for a complete skin examination before using anti-TNF-α therapy to rule out atypical malignant lesions or melanomas that can easily be missed because of presentations such as nevoid melanoma.