bluuebunny/crossref_metadata_2025 huggingface dataset:
Confirmation of Novel Noninvasive High-Density Electrocardiographic Mapping With Electrophysiology Study
Authors: Cakulev Ivan , Sahadevan Jayakumar , Arruda Mauricio , Goldstein Robert N. , Hong Mauricio , Intini Anselma , Mackall Judith A. , Stambler Bruce S. , Ramanathan Charu , Jia Ping , Strom Maria , Waldo Albert L.
Published: December 2012

Background—

Twelve lead ECGs have limited value in precisely identifying atrial and ventricular activation during arrhythmias, including accessory atrioventricular conduction activation. The aim of this study was to report a single center’s clinical experience validating a novel, noninvasive, whole heart, beat-by-beat, 3-dimensional mapping technology with invasive electrophysiological studies, including ablation, where applicable.

Methods and Results—

Using an electrocardiographic mapping (ECM) system in 27 patients, 3-dimensional epicardial activation maps were generated from >250 body surface ECGs using heart–torso geometry obtained from computed tomographic images. ECM activation maps were compared with clinical diagnoses, and confirmed with standard invasive electrophysiological studies mapping. (1) In 6 cases of Wolff–Parkinson–White syndrome, ECM accurately identified the ventricular insertion site of an accessory atrioventricular connection. (2) In 10 patients with premature ventricular complexes, ECM accurately identified their ventricular site of origin in 8 patients. In 2 of 10 patients transient premature ventricular complex suppression was observed during ablation at the site predicted by ECM as the earliest. (3) In 10 cases of atrial tachycardia/atrial flutter, ECM accurately identified the chamber of origin in all 10, and distinguished isthmus from nonisthmus dependent atrial flutter. (4) In 1 patient with sustained exercise induced ventricular tachycardia, ECM accurately identified the focal origin in the left ventricular outflow tract.

Conclusions—

ECM successfully provided valid activation sequence maps obtained noninvasively in a variety of rhythm disorders that correlated well with invasive electrophysiological studies.
Prolonged QT Interval Diagnosis Suppression by a Widely Used Computerized ECG Analysis System
Authors: Garg Anubhav , Lehmann Michael H.
Published: December 2012

Background—

Clinicians commonly rely on automated diagnostic interpretations for initial, point-of-care identification of ECG abnormalities. Our study goal was to investigate how one widely used computerized ECG analysis system performs in labeling prolongation of heart rate-corrected QT interval (QTc), an arrhythmia risk marker.

Methods and Results—

ECGs acquired in 2009–2010 from patients ≥18 years old within the University of Michigan Health System, analyzed by the Marquette 12SL ECG Analysis Program (GE Healthcare), and exhibiting sinus rhythms with heart rate <100 beats per minute and QRS duration <120 ms constituted our database. Of 97 046 study ECGs (48.2% from males), a prolonged 12SL-calculated QTc value (ie, ≥470 ms in females >60 years old, and ≥460 ms in other sex/age groups) was displayed in 16 235 (16.7%). Nonetheless, for only 7709 (47.5%) of these ECGs with prolonged QTc did the automated interpretation include an accompanying “Prolonged QT” diagnostic statement. Such prolonged QT under-reporting was manifest across all patient environments and reflected algorithmic suppression of the diagnosis, attributable to ECG waveform-based criteria, in 8526 (52.5%) ECGs with prolonged QTc. Of the latter ECGs with prolonged QT diagnosis suppression, the computer declared 3588 (42.1%) “Normal” despite QTc prolongation.

Conclusions—

In evaluating an adult patient whose 12SL-interpreted ECG lacks a prolonged QT diagnostic statement (assuming sinus rhythm <100 beats per minute and QRS duration <120 ms), physicians should examine the actual QTc value displayed on the report before concluding that this parameter is normal. Assessment of the clinical impact of prolonged QT diagnosis suppression by ECG waveform-based criteria is warranted.
Causal Relevance of Blood Lipid Fractions in the Development of Carotid Atherosclerosis
Authors: Shah Sonia , Casas Juan-Pablo , Drenos Fotios , Whittaker John , Deanfield John , Swerdlow Daniel I. , Holmes Michael V. , Kivimaki Mika , Langenberg Claudia , Wareham Nick , Gertow Karl , Sennblad Bengt , Strawbridge Rona J. , Baldassarre Damiano , Veglia Fabrizio , Tremoli Elena , Gigante Bruna , de Faire Ulf , Kumari Meena , Talmud Philippa J. , Hamsten Anders , Humphries Steve E. , Hingorani Aroon D.
Published: December 2012

Background—

Carotid intima–media thickness (CIMT), a subclinical measure of atherosclerosis, is associated with risk of coronary heart disease events. Statins reduce progression of CIMT and coronary heart disease risk in proportion to the reduction in low-density lipoprotein cholesterol. However, interventions targeting triglycerides (TGs) or high-density lipoprotein cholesterol (HDL-C) have produced inconsistent effects on CIMT and coronary heart disease risk, making it uncertain whether such agents are ineffective for coronary heart disease prevention or whether CIMT is an inadequate marker of HDL-C or TG-mediated effects. We aimed to determine the causal association among the 3 major blood lipid fractions and common CIMT using mendelian randomization analysis.

Methods and Results—

Genetic scores specific for low-density lipoprotein cholesterol, HDL-C, and TGs were derived based on single nucleotide polymorphisms from a gene-centric array in ≈5000 individuals (Cardiochip scores) and from a genome-wide association meta-analysis in >100 000 individuals (Global Lipids Genetic Consortium scores). These were used as instruments in a mendelian randomization analysis in 2 prospective cohort studies. A genetically predicted 1 mmol/L higher low-density lipoprotein cholesterol concentration was associated with a higher common CIMT by 0.03 mm (95% confidence interval, 0.01–0.04) and 0.04 mm (95% confidence interval, 0.02–0.06) based on the Cardiochip and Global Lipids Genetic Consortium scores, respectively. HDL-C and TGs were not causally associated with CIMT.

Conclusions—

Our findings confirm a causal relationship between low-density lipoprotein cholesterol and CIMT but not with HDL-C and TGs. At present, the suitability of CIMT as a surrogate marker in trials of cardiovascular therapies targeting HDL-C and TGs is questionable and requires further study.
Autosomal Recessive Atrial Dilated Cardiomyopathy With Standstill Evolution Associated With Mutation of
Natriuretic Peptide Precursor A
Authors: Disertori Marcello , Quintarelli Silvia , Grasso Maurizia , Pilotto Andrea , Narula Nupoor , Favalli Valentina , Canclini Camilla , Diegoli Marta , Mazzola Silvia , Marini Massimiliano , Del Greco Maurizio , Bonmassari Roberto , Masè Michela , Ravelli Flavia , Specchia Claudia , Arbustini Eloisa
Published: December 2012

Background—

Atrial dilatation and atrial standstill are etiologically heterogeneous phenotypes with poorly defined nosology. In 1983, we described 8-years follow-up of atrial dilatation with standstill evolution in 8 patients from 3 families. We later identified 5 additional patients with identical phenotypes: 1 member of the largest original family and 4 unrelated to the 3 original families. All families are from the same geographic area in Northeast Italy.

Methods and Results—

We followed up the 13 patients for up to 37 years, extended the clinical investigation and monitoring to living relatives, and investigated the genetic basis of the disease. The disease was characterized by: (1) clinical onset in adulthood; (2) biatrial dilatation up to giant size; (3) early supraventricular arrhythmias with progressive loss of atrial electric activity to atrial standstill; (4) thromboembolic complications; and (5) stable, normal left ventricular function and New York Heart Association functional class during the long-term course of the disease. By linkage analysis, we mapped a locus at 1p36.22 containing the
Natriuretic Peptide Precursor A
gene. By sequencing
Natriuretic Peptide Precursor A
, we identified a homozygous missense mutation (p.Arg150Gln) in all living affected individuals of the 6 families. All patients showed low serum levels of atrial natriuretic peptide. Heterozygous mutation carriers were healthy and demonstrated normal levels of atrial natriuretic peptide.

Conclusions—

Autosomal recessive atrial dilated cardiomyopathy is a rare disease associated with homozygous mutation of the
Natriuretic Peptide Precursor A
gene and characterized by extreme atrial dilatation with standstill evolution, thromboembolic risk, preserved left ventricular function, and severely decreased levels of atrial natriuretic peptide.
Permanent Cardiac Pacing in Children: Choosing the Optimal Pacing Site
Authors: Janoušek Jan , van Geldorp Irene E. , Krupičková Sylvia , Rosenthal Eric , Nugent Kelly , Tomaske Maren , Früh Andreas , Elders Jan , Hiippala Anita , Kerst Gunter , Gebauer Roman A. , Kubuš Peter , Frias Patrick , Gabbarini Fulvio , Clur Sally-Ann , Nagel Bert , Ganame Javier , Papagiannis John , Marek Jan , Tisma-Dupanovic Svjetlana , Tsao Sabrina , Nürnberg Jan-Hendrik , Wren Christopher , Friedberg Mark , de Guillebon Maxime , Volaufova Julia , Prinzen Frits W. , Delhaas Tammo ,   for the Working Group for Cardiac Dysrhythmias and Electrophysiology of the Association for European Pediatric Cardiology
Published: December 2012

Background—

We evaluated the effects of the site of ventricular pacing on left ventricular (LV) synchrony and function in children requiring permanent pacing.

Methods and Results—

One hundred seventy-eight children (aged <18 years) from 21 centers with atrioventricular block and a structurally normal heart undergoing permanent pacing were studied cross-sectionally. Median age at evaluation was 11.2 (interquartile range, 6.3–15.0) years. Median pacing duration was 5.4 (interquartile range, 3.1–8.8) years. Pacing sites were the free wall of the right ventricular (RV) outflow tract (n=8), lateral RV (n=44), RV apex (n=61), RV septum (n=29), LV apex (n=12), LV midlateral wall (n=17), and LV base (n=7). LV synchrony, pump function, and contraction efficiency were significantly affected by pacing site and were superior in children paced at the LV apex/LV midlateral wall. LV dyssynchrony correlated inversely with LV ejection fraction (
R
=0.80,
P
=0.031). Pacing from the RV outflow tract/lateral RV predicted significantly decreased LV function (LV ejection fraction <45%; odds ratio, 10.72; confidence interval, 2.07–55.60;
P
=0.005), whereas LV apex/LV midlateral wall pacing was associated with preserved LV function (LV ejection fraction ≥55%; odds ratio, 8.26; confidence interval, 1.46–47.62;
P
=0.018). Presence of maternal autoantibodies, gender, age at implantation, duration of pacing, DDD mode, and QRS duration had no significant impact on LV ejection fraction.

Conclusions—

The site of ventricular pacing has a major impact on LV mechanical synchrony, efficiency, and pump function in children who require lifelong pacing. Of the sites studied, LV apex/LV midlateral wall pacing has the greatest potential to prevent pacing-induced reduction of cardiac pump function.
A Liberalism of Sincerity: The Role of Religion in the Public Square
Authors: Helfand Michael A.
Published: December 2012

This article considers the extent to which the liberal nation-state ought to accommodate religious practices that contravene state law and to incorporate religious discourse into public debate. To address these questions, the article develops a liberalism of sincerity based on John Locke’s theory of toleration. On such an account, liberalism imposes a duty of sincerity to prevent individuals from consenting to a regime that exercises control over matters of core concern such as faith, religion, and conscience. Liberal theory grounds the legitimacy of the state in the consent of the governed, but consenting to an intolerant regime is illegitimate because it empowers government to demand insincere conduct. Thus, demanding that citizens pursue sincerity ensures that they do not consent away their individual liberties in exchange for promises of security and orderliness.

The focus on sincerity also reorients the value that liberalism places on religious pluralism. Although many liberal theorists have proposed that religious pluralism is valuable because it provides individuals with a range of choices on how to live the good life, such theories provide little reason to promote and protect any particular religion. Indeed, if religions are important only because of the range of choice they provide, then the only concern of liberalism is to maintain enough religions so as to provide a meaningful range of options for how to live the good life; conversely, there is no reason to provide accommodations for any particular religion to aid its survival. By contrast, a liberalism of sincerity impels the liberal nation-state to widen the protections afforded to the expressions of sincerity, such as religious conduct and religious discourse. Because religious conduct and religious arguments flow from an individual’s commitment to sincerity, liberalism should provide broad protection for such religious activity in order to enable citizens to pursue sincerity.
Jewish Law and Matters of State: Theory, Policy, and Practice
Authors: Stern Yedidia
Published: December 2012

In recent years Jewish religious leaders have often expressed religious opinions in matters concerning the foreign and security policy of the State of Israel. The present article focuses on the internal religious legitimacy of halakhic rulings in these matters and reveals the prerequisites that decisors must satisfy before voicing a binding halakhic opinion on issues concerning the Israeli Arab conflict, peace agreements, Jewish settlements in Judah and Samaria, etc.

The article is divided into three parts that answer the following questions: (a) are matters of State policy subject to halakhic norms or are they situated outside the realm of Halakha? (b) does Halakha have a judicial policy seeking to rule on these issues? (c) what are the practical difficulties that decisors face if they wish to rule on them? The article points out the diversity of internal halakhic opinions on the questions under investigation, and outlines an analytical method for a halakhic discussion aimed at answering them.
Taking Religion Seriously: On the Legal Relevance of Religious Self-Concepts
Authors: Augsberg Ino
Published: December 2012

How can the law deal with religion in an adequate manner, if on one hand it must guarantee religion its status of autonomy and therefore cannot construct its own idea of religion, and on the other it needs to know the object of legal protection? The present paper scrutinizes one possible solution to this problem developed by the German Federal Constitutional Court. According to this judicial strategy, the law orients itself by referring to the relevance of religious self-concepts that are to a certain degree legally binding.
Violent deaths among Russian and EU male older adults
Authors: Innamorati Marco , Serafini Gianluca , Lester David , Amore Mario , Girardi Paolo , Pompili Maurizio
Published: January 2013

Aims:

This ecological comparison study explored temporal trends since 1985 in age-adjusted suicide and homicide rates for older male adults (over the age of 65) resident in the EU and the Russian Federation.

Methods:

The data were extracted from the World Health Organization’s (WHO) European mortality database.

Results:

Older men resident in the Russian Federation had a higher risk of dying a violent death (by homicide and by suicide) than their younger compatriots (relative risks (RR) ranging from 1.13 to 1.31). Conversely, in the EU, older men had a higher risk of dying from suicide (RRs of 1.52 for men over the age of 65 and 3.27 for men over the age of 75) and a lower risk of being victims of homicide (RRs ranging between 0.84 and 0.89) than their younger compatriots.

Conclusions:

The European region is characterized by great inequalities in rates of violent deaths among the elderly.
The development of public managers’ reflexive capacities
Authors: Broussine Michael , Ahmad Yusuf
Published: January 2013

The aim of this article is to discuss ways in which we as educators of public managers can help our students deal effectively with the challenges thrown up by the sweeping cuts in public services arising as a consequence of the fiscal crisis brought about by the failure of the banks. While our focus is on the UK, we feel that the issues raised have relevance across Europe. Our argument is that by developing a reflexive pedagogical practice we will enable our students to be proactive (agentic), and in accordance with ethical and professional values, to respond to the dilemmas they face arising out of unprecedented public expenditure cuts. We begin by discussing the overall political context which forms the backdrop to the current crisis in public services and its implications. This is followed by a discussion about the pedagogic debate concerning ‘reflexivity’ and the potential role it has in a public management education strategy. A pedagogy for reflexivity needs to be based in an ontology that believes in the efficacy of open, critical and democratic dialogue, and the facilitation of learning in interactional and relational environments. A range of learning and inquiry processes may hold these characteristics, e.g. collaborative inquiry groups, participatory action research. However, we proceed by describing our experience of enabling senior local government managers to work ‘reflexively’ in learning sets and identify key issues emerging for them as they grapple with the impact of the fiscal crisis. In reflecting on this experience we offer some general insights about the role of ‘reflexivity’ in the education of public managers.
Presence of IL-9 in Paired Samples of Human Colostrum and Transitional Milk
Authors: Marcuzzi Annalisa , Vecchi Brumatti Liza , Caruso Lorenzo , Copertino Marco , Davanzo Riccardo , Radillo Oriano , Comar Manola , Monasta Lorenzo
Published: December 2012

Background:

Human colostrum and breast milk are known to contain high levels of cytokines, cytokine receptors, and chemokines.

Objective:

To investigate the presence and compare levels of soluble cytokines in paired samples of human colostrum and milk.

Methods:

Levels of 27 cytokines were measured in 9 paired samples of human colostrum (day 2 after delivery) and breast milk (day 4 or 5 after delivery) by using multiplex technology.

Results:

The majority of cytokines and chemokines investigated have been previously described in colostrum and/or breast milk. For the first time, we describe the presence of IL-9 in both human colostrum and milk. Of the 27 cytokines investigated, only IL-5 was absent in both colostrum and milk, whereas IL-1β, IL-2, IL-4, IL-15, IL-17, and MIP-1α were present in colostrum, but not in breast milk. In general, colostrum contained higher concentrations of cytokines with respect to human milk.

Conclusion:

Our data confirm and expand previous studies showing that human colostrum and breast milk are rich in cytokines and chemokines, including IL-9, which might contribute to the development of the immune system of the newborn.
Intervention Minimizing Preterm Infants’ Exposure to NICU Light and Noise
Authors: Aita Marilyn , Johnston Celeste , Goulet Céline , Oberlander Tim F. , Snider Laurie
Published: December 2012

Neonatal intensive care unit (NICU) light and noise may be stressful to preterm infants. This research evaluated the physiological stability of 54 infants born at 28- to 32-weeks’ gestational age while wearing eye goggles and earmuffs for a 4-hour period in the NICU. Infants were recruited from four NICUs of university-affiliated hospitals and randomized to the intervention–control or control–intervention sequences. Heart rate (HR), heart rate variability (HRV), and oxygen saturation (O2 sat) were collected using the SomtéTM device. Confounding variables such as position and handling were assessed by videotaping infants during the study periods. Results indicated that infants had more stress responses while wearing eye goggles and earmuffs since maximum HR was found to be significantly higher and high-frequency power of HRV significantly lower during the intervention as compared with the control period. Therefore, this intervention is not recommended for the clinical practice.
Performance evaluation of hard turning of AISI 4340 steel with minimal fluid application in the presence of semi-solid lubricants
Authors: Paul P Sam , Varadarajan AS
Published: January 2013

Hard turning with minimal fluid application is an emerging machining technique in which cutting fluid is applied in the form of a minimal high velocity narrow pulsed jet so that for all practical purpose it resembles dry and wet turning but at the same time offers better cutting performance. Semi-solid assisted machining is a novel concept to control cutting force, cutting temperature, tool wear and to improve surface finish. In the present investigation, an attempt is made to improve the cutting performance during turning of hardened AISI 4340 steel with minimal fluid through the application of a semi-solid lubricant namely grease in pure form and as a mixture with 10% graphite applied at the tool–chip interface, tool–work interface and at the back side of the chip using a special semi-solid lubricant applicator developed for this purpose. The results indicated that the use of semi-solid lubricants – grease and graphite at the tool–chip interface along with minimal fluid application reduces tool vibration, cutting force, cutting temperature, tool wear and improves surface finish.
Effect of vacuum annealing on the microstructure and tribological behavior of hydrogenated amorphous carbon films prepared by magnetron sputtering
Authors: Wu Yanxia , Li Hongxuan , Ji Li , Liu Liu , Ye Yinping , Chen Jianmin , Zhou Huidi
Published: January 2013

Hydrogenated amorphous carbon films (a-C:H) were prepared on silicon and steel substrates by medium frequency unbalanced magnetron sputtering with argon (Ar) and methane (CH4) as the source gases. The effect of annealing temperature in vacuum on the microstructure as well as mechanical properties and tribological behavior of as-prepared a-C:H films were investigated. The friction and wear behaviors of the films in different environments (vacuum, N2, and air) were evaluated with a pin-on-disk tribometer; and their sliding lifetime in vacuum was discussed in relation to friction and wear mechanisms. Results show that annealing in vacuum at a low temperature of up to 200 ℃ causes little change in the microstructure and hardness of a-C:H films but reduces their internal stress and surface roughness to some extent. These annealed films exhibit excellent antiwear ability in all test environments and show promising potential as a kind of space lubricants. The film begins to release hydrogen and increases the content of graphite-like structure at about 300 ℃. As a result, a-C:H films annealed above 200 ℃ have increased surface roughness as well as reduced hardness, internal stress, and wear resistance in all test environments.
Angiotensin-converting enzyme I/D gene polymorphism affects early cardiac response to professional training in young footballers
Authors: Saber-Ayad Maha M , Nassar Yasser S , Latif Inas A
Published: January 2013

Background:

The renin–angiotensin–aldosterone system plays a role in physiological and pathological responses of the heart to both static and dynamic exercise. Previous studies showed that the level of angiotensin II is determined by the angiotensin-converting enzyme insertion/deletion (ACE I/D) polymorphism.

Aim:

We aimed in this study to determine the effect of ACE I/D gene polymorphism on the extent of functional and structural cardiac changes in response to one year of professional football training in young footballers.

Methods and results:

We studied 68 young male football players and a comparable control group. Besides medical history and clinical examination, 12 lead ECG and transthoracic 2D echocardiography examination were performed. Genotyping of ACE was analyzed using PCR-based technique. There was no statistically significant difference in distribution of genotypes among athletes compared with control subjects. D allele showed a graded effect on both EF (73.55, 67.5 and 60.2%, p=0.03) and PASP (37.6, 26.1 and 21.39 mmHg, p=0.02) in DD, ID and II subjects, respectively.

Conclusion:

Early cardiac changes in young footballers can be affected by ACE I/D polymorphism. There is a summative effect of the D allele in increasing EF and PASP in response to professional football training.
“Normative Content” and Health Inequity Enculturation
Authors: Leone James E. , Rovito Michael J.
Published: January 2013

Epidemiologic studies and related literature consistently report that males have fewer years of life expectancy than females. Moreover, males experience fewer quality years of life in that they tend to live with greater rates of morbidity such as heart disease, cancer, and diabetes among other conditions. Causal evidence traditionally highlights the role of biology in determining the life course for males. However, emerging literature suggests that social determinants of health play a more central role in male morbidity and mortality, and thus contribute to health inequities between the sexes. The purpose of this article is to explore core concepts of social determinants of health as they pertain to male health inequities and provide a systematic conceptualization of how society has become encultured to view these inequities as “normative.” Strategies to improve male health are discussed using a logic model to illustrate male health advocacy in the face of the social climes of encultured health inequities.
Categorical Perception for Emotional Faces
Authors: Fugate Jennifer M. B.
Published: January 2013

Categorical perception (CP) refers to how similar things look different depending on whether they are classified as the same category. Many studies demonstrate that adult humans show CP for human emotional faces. It is widely debated whether the effect can be accounted for solely by perceptual differences (structural differences among emotional faces) or whether additional perceiver-based conceptual knowledge is required. In this review, I discuss the phenomenon of CP and key studies showing CP for emotional faces. I then discuss a new model of emotion which highlights how perceptual and conceptual knowledge interact to explain how people see discrete emotions in others’ faces. In doing so, I discuss how language (emotion words included in the paradigm) contribute to CP.
AB-QTL analysis reveals new alleles associated to proline accumulation and leaf wilting under drought stress conditions in barley (Hordeum vulgareL.)
Authors: Sayed Mohammed A , Schumann Henrik , Pillen Klaus , Naz Ali A , Léon Jens
Published: December 2012

Background

Land plants have evolved several measures to maintain their life against abiotic stresses. The accumulation of proline is the most generalized response of plants under drought, heat or salt stress conditions. It is known as an osmoprotectant which also acts as an instant source of energy during drought recovery process. But, both its role and genetic inheritance are poorly understood in agriculture crops. In the present work, advanced backcross quantitative trait locus (AB-QTL) analysis was performed to elucidate genetic mechanisms controlling proline accumulation and leaf wilting in barley under drought stress conditions.

Results

The analysis revealed eight QTL associated to proline content (PC) and leaf wilting (WS). QTL for PC were localized on chromosome 3H, 4H, 5H and 6H. The strongest QTL effect QPC.S42.5H was detected on chromosome 5H where drought inducible exotic allele was associated to increase PC by 54%. QTL effects QPC.S42.3H, QPC.S42.4H and QPC.S42.6H were responsible to heighten PC due to the preeminence of elite alleles over the exotic alleles which ranged from 26% to 43%. For WS, QTL have been localized on chromosome 1H, 2H, 3H and 4H. Among these, QWS.S42.1H and QWS.S42.4H were associated to decrease in WS due to the introgression of exotic alleles. In addition, two digenic epistatic interaction effects were detected for WS where the additive effect of exotic alleles imparted a favorable increase in the trait value.

Conclusions

The present data represents a first report on whole-genome mapping of proline accumulation and leaf wilting in barley. The detected QTL are linked to new alleles from both cultivated and wild accessions which bring out an initial insight on the genetic inheritance of PC and WS. These QTL alleles are fixed in the isogenic background of Scarlett, which will allow for positional cloning of underlying genes and to develop drought resilient barley cultivars.
Epidural analgesia and cesarean delivery in multiple sclerosis post-partum relapses: the Italian cohort study
Authors: Pastò Luisa , Portaccio Emilio , Ghezzi Angelo , Hakiki Bahia , Giannini Marta , Razzolini Lorenzo , Piscolla Elisa , De Giglio Laura , Pozzilli Carlo , Paolicelli Damiano , Trojano Maria , Marrosu Maria Giovanna , Patti Francesco , La Mantia Loredana , Mancardi Gian Luigi , Solaro Claudio , Totaro Rocco , Tola Maria Rosaria , Di Tommaso Valeria , Lugaresi Alessandra , Moiola Lucia , Martinelli Vittorio , Comi Giancarlo , Amato Maria Pia ,   and for the MS Study Group of the Italian Neurological Society
Published: December 2012

Background

Few studies have systematically addressed the role of epidural analgesia and caesarean delivery in predicting the post-partum disease activity in women with Multiple Sclerosis (MS).

The objective of this study was to assess the impact of epidural analgesia (EA) and caesarean delivery (CD) on the risk of post-partum relapses and disability in women with MS.

Methods

In the context of an Italian prospective study on the safety of immunomodulators in pregnancy, we included pregnancies occurred between 2002 and 2008 in women with MS regularly followed-up in 21 Italian MS centers. Data were gathered through a standardized, semi-structured interview, dealing with pregnancy outcomes, breastfeeding, type of delivery (vaginal or caesarean) and EA. The risk of post-partum relapses and disability progression (1 point on the Expanded Disability Status Sclae, EDSS, point, confirmed after six months) was assessed through a logistic multivariate regression analysis.

Results

We collected data on 423 pregnancies in 415 women. Among these, 349 pregnancies resulted in full term deliveries, with a post-partum follow-up of at least one year (mean follow-up period 5.5±3.1 years). One hundred and fifty-five patients (44.4%) underwent CD and 65 (18.5%) EA. In the multivariate analysis neither CD, nor EA were associated with a higher risk of post-partum relapses. Post-partum relapses were related to a higher EDSS score at conception (OR=1.42; 95% CI 1.11-1.82; p=0.005), a higher number of relapses in the year before pregnancy (OR=1.62; 95% CI 1.15-2.29; p=0.006) and during pregnancy (OR=3.07; 95% CI 1.40-6.72; p=0.005). Likewise, CD and EA were not associated with disability progression on the EDSS after delivery. The only significant predictor of disability progression was the occurrence of relapses in the year after delivery (disability progression in the year after delivery: OR= 4.00; 95% CI 2.0-8.2; p<0.001; disability progression over the whole follow-up period: OR= 2.0; 95% CI 1.2-3.3; p=0.005).

Conclusions

Our findings, show no correlation between EA, CD and postpartum relapses and disability. Therefore these procedures can safely be applied in MS patients. On the other hand, post-partum relapses are significantly associated with increased disability, which calls for the need of preventive therapies after delivery.
First-attack pediatric hypertensive crisis presenting to the pediatric emergency department
Authors: Yang Wen-Chieh , Zhao Lu-Lu , Chen Chun-Yu , Wu Yung-Kang , Chang Yu-Jun , Wu Han-Ping
Published: December 2012

Background

Hypertensive crisis in children is a relatively rare condition presenting with elevated blood pressure (BP) and related symptoms, and it is potentially life-threatening. The aim of this study was to survey children with first attacks of hypertensive crisis arriving at the emergency department (ED), and to determine the related parameters that predicted the severity of hypertensive crisis in children by age group.

Methods

This was a retrospective study conducted from 2000 to 2007 in pediatric patients aged 18 years and younger with a diagnosis of hypertensive crisis at the ED. All patients were divided into four age groups (infants, preschool age, elementary school age, and adolescents), and two severity groups (hypertensive urgency and hypertensive emergency). BP levels, etiology, severity, and clinical manifestations were analyzed by age group and compared between the hypertensive emergency and hypertensive urgency groups.

Results

The mean systolic/diastolic BP in the hypertensive crisis patients was 161/102 mmHg. The major causes of hypertensive crisis were essential hypertension, renal disorders and endocrine/metabolic disorders. Half of all patients had a single underlying cause, and 8 had a combination of underlying causes. Headache was the most common symptom (54.5%), followed by dizziness (45.5%), nausea/vomiting (36.4%) and chest pain (29.1%). A family history of hypertension was a significant predictive factor for the older patients with hypertensive crisis. Clinical manifestations and severity showed a positive correlation with age. In contrast to diastolic BP, systolic BP showed a significant trend in the older children.

Conclusions

Primary clinicians should pay attention to the pediatric patients who present with elevated blood pressure and related clinical hypertensive symptoms, especially headache, nausea/vomiting, and altered consciousness which may indicate that appropriate and immediate antihypertensive medications are necessary to prevent further damage.
Contracting in specialists for emergency obstetric care- does it work in rural India?
Authors: Randive Bharat , Chaturvedi Sarika , Mistry Nerges
Published: December 2012

Background

Contracting in private sector is promoted in developing countries facing human resources shortages as a challenge to reduce maternal mortality. This study explored provision, practice, performance, barriers to execution and views about contracting in specialists for emergency obstetric care (EmOC) in rural India.

Methods

Facility survey was conducted in all secondary and tertiary public health facilities (44) in three heterogeneous districts in Maharashtra state of India. Interviews (42) were conducted with programme managers and district and block level officials and with public and private EmOC specialists. Locations of private obstetricians in the study districts were identified and mapped.

Results

Two schemes, namely Janani Suraksha Yojana and Indian Public Health standards (IPHS) provided for contracting in EmOC specialists. The IPHS provision was chosen for use mainly due to greater sum for contracting in (US $ 30/service episode vs.300 US$/month). The positions of EmOC specialists were vacant in 83% of all facilities that hence had a potential for contracting in EmOC specialists. Private specialists were contracted in at 20% such facilities. The contracting in of specialists did not greatly increase EmOC service outputs at facilities, except in facilities with determined leadership. Contracting in specialists was useful for non emergency conditions, but not for obstetric emergencies. The contracts were more of a relational nature with poor monitoring structures. Inadequate infrastructure, longer distance to private specialists, insufficient financial provision for contracting in, and poor management capacities were barriers to effective implementation of contracting in. Dependency on the private sector was a concern among public partners while the private partners viewed contracting in as an opportunity to gain experience and credibility.

Conclusions

Density and geographic distribution of private specialists are important influencing factors in determining feasibility and use of contracting in for EmOC. Local circumstances dictate balance between introduction or expansion of contracts with private sector and strengthening public provisions and that neither of these disregard the need to strengthen public systems. Sustainability of contracting in arrangements, their effect on increasing coverage of EmOC services in rural areas and overlapping provisions for contracting in EmOC specialists are issues for future consideration.
Assessment of Anopheles salivary antigens as individual exposure biomarkers to species-specific malaria vector bites
Authors: Ali Zakia M I , Bakli Mahfoud , Fontaine Albin , Bakkali Nawal , Hai Vinh Vu , Audebert Stephane , Boublik Yvan , Pagès Frederic , Remoué Franck , Rogier Christophe , Fraisier Christophe , Almeras Lionel
Published: December 2012

Background

Malaria transmission occurs during the blood feeding of infected anopheline mosquitoes concomitant with a saliva injection into the vertebrate host. In sub-Saharan Africa, most malaria transmission is due to Anopheles funestus s.s and to Anopheles gambiae s.l. (mainly Anopheles gambiae s.s. and Anopheles arabiensis). Several studies have demonstrated that the immune response against salivary antigens could be used to evaluate individual exposure to mosquito bites. The aim of this study was to assess the use of secreted salivary proteins as specific biomarkers of exposure to An. gambiae and/or An. funestus bites.

Methods

For this purpose, salivary gland proteins 6 (SG6) and 5′nucleotidases (5′nuc) from An. gambiae (gSG6 and g-5′nuc) and An. funestus (fSG6 and f-5′nuc) were selected and produced in recombinant form. The specificity of the IgG response against these salivary proteins was tested using an ELISA with sera from individuals living in three Senegalese villages (NDiop, n = 50; Dielmo, n = 38; and Diama, n = 46) that had been exposed to distinct densities and proportions of the Anopheles species. Individuals who had not been exposed to these tropical mosquitoes were used as controls (Marseille, n = 45).

Results

The IgG responses against SG6 recombinant proteins from these two Anopheles species and against g-5′nucleotidase from An. gambiae, were significantly higher in Senegalese individuals compared with controls who were not exposed to specific Anopheles species. Conversely, an association was observed between the level of An. funestus exposure and the serological immune response levels against the f-5′nucleotidase protein.

Conclusion

This study revealed an Anopheles salivary antigenic protein that could be considered to be a promising antigenic marker to distinguish malaria vector exposure at the species level. The epidemiological interest of such species-specific antigenic markers is discussed.
Health seeking behavior for cervical cancer in Ethiopia: a qualitative study
Authors: Birhanu Zewdie , Abdissa Alemseged , Belachew Tefera , Deribew Amare , Segni Hailemariam , Tsu Vivien , Mulholland Kim , Russell Fiona M
Published: December 2012

Background

Although cervical cancer is a leading cause of cancer related morbidity and mortality among women in Ethiopia, there is lack of information regarding the perception of the community about the disease.

Methods

Focus group discussions were conducted with men, women, and community leaders in the rural settings of Jimma Zone southwest Ethiopia and in the capital city, Addis Ababa. Data were captured using voice recorders, and field notes were transcribed verbatim from the local languages into English language. Key categories and thematic frameworks were identified using the health belief model as a framework, and presented in narratives using the respondents own words as an illustration.

Results

Participants had very low awareness of cervical cancer. However, once the symptoms were explained, participants had a high perception of the severity of the disease. The etiology of cervical cancer was thought to be due to breaching social taboos or undertaking unacceptable behaviors. As a result, the perceived benefits of modern treatment were very low, and various barriers to seeking any type of treatment were identified, including limited awareness and access to appropriate health services. Women with cervical cancer were excluded from society and received poor emotional support. Moreover, the aforementioned factors all caused delays in seeking any health care. Traditional remedies were the most preferred treatment option for early stage of the disease. However, as most cases presented late, treatment options were ineffective, resulting in an iterative pattern of health seeking behavior and alternated between traditional remedies and modern treatment methods.

Conclusion

Lack of awareness and health seeking behavior for cervical cancer was common due to misconceptions about the cause of the disease. Profound social consequences and exclusion were common. Access to services for diagnosis and treatment were poor for a variety of psycho-social, and health system reasons. Prior to the introduction or scale up of cervical cancer prevention programs, socio-cultural barriers and health service related factors that influence health seeking behavior must be addressed through appropriate community level behavior change communications.
Pseudo-plaque reduction neutralization test (PPRNT) for the measurement of neutralizing antibodies to Crimean-Congo hemorrhagic fever virus
Authors: Canakoglu Nurettin , Berber Engin , Ertek Mustafa , Yoruk Mustafa D , Tonbak Sukru , Bolat Yusuf , Aktas Munir , Kalkan Ahmet , Ozdarendeli Aykut
Published: January 2013

Background

Crimean-Congo hemorrhagic fever virus (CCHFV) is a tick-borne virus of the genus Nairovirus family Bunyaviridae, which are enveloped viruses containing tripartite, negative polarity, single-stranded RNA. CCHF is characterized by high case mortality, occurring in Asia, Africa, the Middle East and Europe. Currently, there are no specific treatments or licensed vaccines available for CCHFV. Recently, two research groups have found adult mice with defective interferon responses allowed to lethal CCHFV infection. These mouse models could provide invaluable information for further studies. Efforts to develop a vaccine against CCHFV are being made. To determine the efficacy of vaccine candidates it is important to conduct serological studies that can accurately measure levels of protective antibodies. In the present study, a pseudo-plaque reduction neutralization test (PPRNT) based on enzyme-catalyzed color development of infected cells probed with anti-CCHFV antibodies was used to measure neutralization antibody of CCHFV.

Methods

Sixty-nine human serum samples (20 acute and 49 convalescent) were tested. The presence of CCHFV antibodies was determined and confirmed by a commercial ELISA kit. CCHFV RNA was determined by RT-PCR. All the samples were analyzed by PPRNT and fluorescent focus reduction neutralization test (FFRNT) to measure of CCHFV-neutralizing antibodies.

Results

Pseudo-plaque reduction neutralization test showed a high sensitivity (98%), specificity (100%) and agreement (96,6%) in qualitative comparison with those of the FFRNT. There was a high correlation between the titers obtained in PPRNT and FFRNT (R2 = 0.92). The inter- and intra-assay variation of PPRNT revealed good reproducibility and positive cut-off of PPRNT was defined as 1:4 by the geometric mean titers for the individual samples distributed.

Conclusion

The pseudo-plaque reduction neutralization test described in this study is a fast, reproducible and sensitive method for the measurement of CCHF neutralizing antibodies. This novel assay could serve as useful tools for CCHF research in epidemiology, vaccine development and other studies of immunity. It also provides an alternative to PRNT when viruses with no or poor CPE in cell culture.
Genetic Enhancement of Neuropathic and Inflammatory Pain by Forebrain Upregulation of CREB-Mediated Transcription
Authors: Descalzi Giannina , Fukushima Hotaka , Suzuki Akinobu , Kida Satoshi , Zhuo Min
Published: December 2012

CREB has been reported to be activated by injury and is commonly used as marker for pain-related plasticity changes in somatosensory pathways, including spinal dorsal horn neurons and the anterior cingulate cortex (ACC). However no evidence has been reported to support the direct role of activated CREB in injury-related behavioral sensitization (or allodynia). Here we report that genetic enhancement of CREB-mediated transcription selectively in forebrain areas enhanced behavioral responses to non-noxious stimuli after chronic inflammation (CFA model) or nerve injury. In contrast, behavioral acute responses to peripheral subcutaneous injection of formalin did not show any significant difference. Furthermore, acute pain responses to noxious thermal stimuli were also not affected. Our results thus provide direct evidence that cortical CREB-mediated transcription contributes to behavioral allodynia in animal models of chronic inflammatory or neuropathic pain.
Perivascular epithelioid cell neoplasm of the urinary bladder in an adolescent: a case report and review of the literature
Authors: Yin Lijuan , Bu Hong , Chen Min , Yu Jianqun , Zhuang Hua , Chen Jie , Zhang Hongying
Published: December 2012

Perivascular epithelioid cell neoplasms (PEComas) of the urinary bladder are extremely rare and the published cases were comprised predominantly of middle-aged patients. Herein, the authors present the first urinary bladder PEComa occurring in an adolescent. This 16-year-old Chinese girl present with a 3-year history of abdominal discomfort and a solid mass was documented in the urinary bladder by ultrasonography. Two years later, at the age of 18, the patient underwent transurethral resection of the bladder tumor. Microscopically, the tumor was composed of spindled cells mixed with epithelioid cells. Immunohistochemically, the tumor were strongly positive for HMB45, smooth muscle actin, muscle-specific actin, and H-caldesmon. Fluorescence in situ hybridization analysis revealed no evidence of EWSR1 gene rearrangement. The patient had been in a good status without evidence of recurrence 13 months after surgery. Urinary bladder PEComa is an extremely rare neoplasm and seems occur predominantly in middle-aged patients. However, this peculiar lesion can develop in pediatric population and therefore it should be rigorously distinguished from their mimickers.

Virtual slides

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1870004378817301