bluuebunny/crossref_metadata_2025 huggingface dataset:
Angioplasty and Stenting of the Extracranial Carotid Arteries
Authors: Henry Michel , Amor Max , Masson Isabelle , Henry Isabelle , Tzvetanov Kiril , Chati Zukaï , Khanna Narendra
Published: March 2015

Purpose:

To study the feasibility and safety of stent-supported angioplasty in the treatment of atherosclerotic stenoses of the extracranial carotid arteries.

Methods:

Carotid angioplasty was attempted in 174 arteries (163 patients: 126 males; mean age: 71 ± 10 years, range 47 to 93). Mean lesion length was 15.1 ± 4.1 mm, and mean percent stenosis was 83.8% ± 7.3% (reference diameter 5.8 ± 0.7 mm). The majority (106, 65%) were asymptomatic (51% of all patients had severe coronary disease, 32% had peripheral vascular diseases). Patients underwent independent neurological examination, computed tomography, duplex ultrasonography, and angiography preprocedurally, 24 hours after the procedure, and at 6-month follow-up intervals. Most (142, 82%) carotid arteries were treated without cerebral protection, but a protective triple coaxial catheter was used in 32 (18%) patients. Stents (primarily Palmaz and Wallstent) were deployed routinely in all cases; 18% were implanted without predilation.

Results:

Immediate technical success was 173 of 174 (99.4%) (1 access failure referred electively to surgery). Eight (4.6%) neurological complications occurred in the periprocedural period: 3 transient ischemic attacks, 2 minor strokes, and 3 major strokes (1 amaurosis and 2 hemiplegias). Two major complications developed despite cerebral protection. There were no deaths or myocardial infarctions and only 3 cervical access site hematomas. Over a mean 12.7 ± 9.2 month follow-up (range 1 to 36), no ipsilateral neurological complications have been seen. There were 4 (2.3%) restenoses (3 redilated, 1 treated medically) and 1 mild Palmaz stent compression, all found within the first 6 months. Primary and secondary patencies at 3 years are 96% and 99%, respectively.

Conclusions:

Angioplasty with routine stenting seems feasible and safe for treating certain types of carotid stenoses even in high-surgical risk patients; however, randomized trials are necessary before this treatment can be offered as an alternative to endarterectomy.
Endovascular AAA Exclusion: Will Stents with Hooks and Barbs Prevent Stent-Graft Migration?
Authors: Malina Martin , Lindblad Bengt , Ivancev Krasnodar , Lindh Mats , Malina Janne , Brunkwall Jan
Published: March 2015

Purpose:

To investigate if stents with hooks and barbs will improve stent-graft fixation in the abdominal aorta.

Methods:

Sixteen- to 24-mm-diameter Dacron grafts were deployed inside cadaveric aortas. The grafts were anchored by stents as in endovascular abdominal aortic aneurysm repair. One hundred thirty-seven stent-graft deployments were carried out with modified self-expanding Z-stents with (A) no hooks and barbs (n = 75), (B) 4 5-mm-long hooks and barbs (n = 39), (C) 8 10-mm-long, strengthened hooks and barbs (n = 19), or (D) hooks only (n = 4). Increasing longitudinal traction was applied to determine the displacement force needed to extract the stent-grafts. The radial force of the stents was measured and correlated to the displacement force.

Results:

The median (interquartile range) displacement force needed to extract grafts anchored by stent A was 2.5 N (2.0 to 3.4), stent B 7.8 N (7.4 to 10.8), and stent C 22.5 N (17.1 to 27.9), p < 0.001. Both hooks and barbs added anchoring strength. During traction, the weaker barbs were distorted or caused intimal tears. The stronger barbs engaged the entire aortic wall. The radial force of the stents had no impact on fixation, while aortic calcification and graft oversizing had marginal effects.

Conclusions:

Stent barbs and hooks increased the fixation of stent-grafts tenfold, while the radial force of stents had no impact. These data may prove important in future endograft development to prevent stent-graft migration after aneurysm exclusion.
Initial Experiences with Percutaneous Endovascular Repair of Popliteal Artery Lesions Using a New PTFE Stent-Graft
Authors: Bürger Thomas , Meyer Frank , Tautenhahn Jörg , Halloul Zuhir , Fahlke Jörg
Published: March 2015

Purpose:

To report the percutaneous endovascular management of popliteal artery lesions with a new polytetrafluoroethylene (PTFE) stent-graft.

Methods and Results:

Three patients have undergone endovascular treatment in the popliteal region owing to: (1) an iatrogenic false aneurysm with arteriovenous fistula, (2) entrapment syndrome, and (3) an isolated arterial aneurysm. In each case, arterial occlusion was treated initially with thrombolysis. The underlying vascular lesions then were stented using the new Hemobahn endograft, a nitinol stent covered internally with PTFE. Each percutaneous procedure was completed successfully without major complications. During early follow-up (6 to 7 months), no signs of intimal hyperplasia, occlusion, or stent migration have been observed.

Conclusions:

Based on these early experiences, percutaneous treatment of stenotic and aneurysmal lesions in the popliteal artery using the Hemobahn endograft appears feasible and effective. Further experience and longer follow-up are required to evaluate this new prosthesis.
Successful Endoluminal Repair of a Popliteal Artery Aneurysm Using the Wallgraft Endoprosthesis
Authors: Kudelko Paul E. , Alfaro-Franco Carina , Diethrich Edward B. , Krajcer Zvonimir
Published: March 2015

Purpose:

To describe the first application of the Wallgraft endovascular prosthesis to aneurysm exclusion in the popliteal artery.

Methods and Results:

A 61-year-old man was admitted to our institution with a popliteal artery aneurysm complicated by associated popliteal vein compression, deep venous thrombosis, and pulmonary embolism. The endovascular procedure was performed percutaneously with local anesthesia using a low-profile, covered stent (Wallgraft Endoprosthesis). The aneurysm was successfully excluded from the arterial circulation, and there were no postprocedural complications. Follow-up evaluation with appropriate imaging at 10 months revealed no endoleaks.

Conclusions:

This initial result indicates that percutaneous deployment of the Wallgraft endoprosthesis, with its smaller diameter and flexible design, may offer significant advantages over currently available devices for repair of popliteal artery aneurysms. This method obviates the need for general anesthesia or surgical exposure, which is particularly beneficial in patients with comorbid illnesses.
Neurological Monitoring during Carotid Artery Stenting: The Duck Squeezing Test
Authors: Gomez Camilo R. , Roubin Gary S. , Dean Larry S. , Iyer Sri , Vitek Jiri J. , Liu Ming W. , Wadlington Van R. , Terry John B.
Published: March 2015

Purpose:

To examine the usefulness of a novel method for neurological monitoring during carotid artery stenting (CAS).

Methods:

The records of patients who underwent elective CAS between June 1996 and October 1998 were reviewed to identify those who had neurological changes during the procedure. We examined whether the neurological change had been detected by a change in the ability of the patient to respond to predetermined commands involving a small rubber duck placed in the contralateral hand.

Results:

Two hundred seventy patients (320 vessels) underwent monitoring using the Duck Squeezing Test; 10 suffered neurological events during the procedure. Four of these were transient and temporally related to balloon inflation. Another 6 were tentatively ascribed to distal embolism. All instances were accompanied by a change in the patient's ability to perform the Duck Squeezing Test, which allowed the identification of the abnormal clinical situation. In addition, there were 4 false-positive tests secondary to the patient accidentally dropping the rubber duck.

Conclusions:

The Duck Squeezing Test is a sensitive and specific method for monitoring patients during elective CAS. Its practical applicability is based on sound neurophysiological concepts, which underscore the clinical importance of the test.
Intraventricular Hemorrhage after Carotid Stenting
Authors: Mori Takahisa , Fukuoka Masaaki , Kazita Ken , Mima Tatsuo , Mori Koreaki
Published: March 2015

Purpose:

To report an important complication related to carotid stenting.

Methods and Results:

A 71-year-old man with symptomatic subtotal occlusion of the left internal carotid artery had a 30-mm lesion treated percutaneously with implantation of 2 stents. Although the procedure was completed satisfactorily, left intraventricular hemorrhage occurred 4 hours later, possibly related to hyperperfusion injury. The patient expired 30 days after the stent procedure. Preoperative single-photon emission computed tomography revealed severely reduced vasoreactivity in the affected territory after acetazolamide challenge.

Conclusions:

The risk of hyperperfusion injury must be considered and minimized in patients with significant restriction of regional vasoreactivity. We recommend that cerebral hemodynamic status be determined prior to carotid stenting.
Influence of Asafoetida on Prevention and Treatment of Memory Impairment Induced by d-Galactose and NaNO2 in Mice
Authors: Bagheri Seyyed Majid , Dashti-R Mohammad Hossein
Published: March 2015

In Iranian traditional medicine, asafoetida is introduced as a valuable remedy for nervous disorders. Dementia was induced by injection of d-galactose and NaNO2 for 60 consecutive days. Animals were divided into normal control (NC), dementia control (DC), dementia prophylactic (DP), and dementia treated (DT). The learning and memory functions were examined by 1-way active and passive avoidance tests, using a shuttle box device. Avoidance response in training tests and 1 and 3 weeks later was significantly increased in NC, DP, and DT groups compared to the DC group. Step through latency in all groups was significantly greater than the DC group. Total time spent in light room, which shows the memory retention ability, in DP, NC, and DT was significantly greater than the DC group. Our findings indicate that asafoetida could prevent and treat amnesia. These beneficial effects maybe related to some constituent’s effectiveness such as ferulic acid and umbelliferone.
Meaningful Activity for Persons With Dementia
Authors: Roland Kaitlyn P. , Chappell Neena L.
Published: March 2015

Dementia threatens the capacity to engage in activity, suggesting meaningful activity may be helpful for persons with dementia (PWDs). This study explores the concept of meaningful activity, as defined by caregivers of PWDs. Family caregivers of PWDs, who provide 3 hours of care over 3 days/week, were interviewed after 6 months of cholinesterase inhibitors (ChEIs) therapy. Caregiver responses (N = 906) to the open-ended question What do you believe getting involved in activities outside the home means for someone with dementia are assessed. The themes are analyzed in terms of content, frequency, co-occurrence, and dementia severity. Caregivers emphasize the benefits of social connectedness, physical health, and mental stimulation. Activity is also viewed as respite, difficult, and has no meaning for care recipient. The implications of activity for self- and social-identity in PWD and caregiver are discussed. The benefits of activity varied by stage of disease. This knowledge indicates areas for improved activity provision and health care support.
Low-Intensity Extracorporeal Shock Wave as a Novel Treatment for Erectile Dysfunction
Authors: Pan Michael M. , Raees Ayman , Kovac Jason R.
Published: March 2015

The paradigm of erectile dysfunction (ED) treatment was fundamentally altered following the introduction of oral phosphodiesterase type 5 inhibitors. Unfortunately, a significant number of men exhibit a suboptimal response and require additional management strategies. One of the novel, minimally invasive strategies being developed is low-intensity extracorporeal shock wave therapy. Used in the hope of delaying placement of an inflatable penile prosthesis, the final phase of ED treatment, low-intensity extracorporeal shock wave therapy is a unique application of an established technology that may hopefully one day expand the medical options for patients with ED. This commentary will highlight the physiology underlying this technique and summarize the most recent studies.
Experiences of Discrimination and HIV Risk Among Men Who Have Sex With Men in New York City
Authors: Reilly Kathleen H. , Neaigus Alan , Jenness Samuel M. , Wendel Travis , Marshall David M. , Hagan Holly
Published: March 2015

The extent of gay-related discrimination in New York City (NYC) and the demographic and behavioral factors correlated with experiences of gay-related discrimination are not well understood. The Centers for Disease Control and Prevention–sponsored National HIV Behavioral Surveillance System, a cross-sectional study, was conducted in NYC in 2011. Men who have sex with men were venue-sampled, interviewed, and offered HIV testing. Frequencies of types of gay-related discrimination experienced in the past 12 months were calculated. Associations between types of discrimination and demographic and HIV risk variables were examined through the estimation of prevalence ratios (PRs) and 95% confidence intervals (CIs). More than half (53.2%) of all study participants reported having experienced any gay-related discrimination in the past 12 months; 45.0% reported that they had been called names or insulted; 23.6% reported receiving poorer services than other people in restaurants, stores, other businesses, or agencies; 22.0% reported being treated unfairly at work or school; 15.1% reported being physically attacked or injured; and 6.7% reported being denied or given lower quality health care. HIV-positive status (adjusted PR [aPR] = 2.9; 95% CI = 1.5, 5.6) and drug use in the past 12 months (aPR = 0.3; 95% CI = 0.1, 0.7) were independently associated with reports of having been denied or given lower quality health care. High rates of reported gay-related discrimination suggest that greater efforts are needed to reduce gay-related discrimination in affected communities. Future research is needed to better understand the extent of gay-related discrimination in NYC, particularly with regard to the relationship between HIV status and health care access.
Disparities in public protection measures against sexual offending in England and Wales: An example of preventative injustice?
Authors: Hudson Kirsty , Henley Andrew
Published: March 2015

This article analyses the use of criminal justice measures aimed at the prevention of sexual offending across England and Wales. Specifically, it focuses on measures such as the ‘sex offenders register’ and sexual offences prevention orders (SOPOs) and the use of sanctions for their breach. Following a discussion of the apparent tensions between individual rights and public protection measures we present an original analysis of data collated from Multi-Agency Public Protection Arrangements (MAPPA) area reports over a nine-year period. Our analysis reveals considerable variation between areas in both the risk-level allocation of cases, the imposition of SOPOs and sanctions for non-compliance with MAPPA. We argue that these disparities raise issues concerning both the rights and autonomy of those subjected to public protection measures and highlight the need for further detailed research into MAPPA practices.
Treatment of Hemophilic Ankle Arthropathy with One-Step Arthroscopic Bone Marrow–Derived Cells Transplantation
Authors: Buda Roberto , Cavallo Marco , Castagnini Francesco , Cenacchi Annarita , Natali Simone , Vannini Francesca , Giannini Sandro
Published: March 2015

Objective

Ankle arthropathy is a frequent and invalidating manifestation of hemophilia. Arthrodesis is the gold standard surgical procedure in end-stage disease, with many drawbacks in young patients. Recent literature has shown increase interest in regenerative procedures in hemophilic arthropathy, which may be desirable to delay or even avoid arthrodesis. The aim of this article is to present five cases of osteochondral lesions in ankle hemophilic arthropathy treated with a regenerative procedure: bone marrow–derived cells transplantation (BMDCT).

Design

We report five hemophilic patients (four cases with hemophilia type A; one case with hemophilia type B) who have undergone BMDCT treatment, synovectomy, and arthroscopic debridement, with the use of autologous platelet-rich fibrin, to treat osteochondral lesions in hemophilic ankle arthropathy. The patients, included within this retrospective study, were clinically and radiologically evaluated with serial follow-ups, using the American Orthopaedic Foot and Ankle Society (AOFAS) scores, radiographs, and magnetic resonance imaging (MRI).

Results

The mean preoperative AOFAS score was 35. After a mean follow-up of 2 years, the mean postoperative AOFAS score was 81, which included three patients returning back to sporting activities. The MRI Mocart score demonstrated signs of regeneration of chondral and bony tissue. No progression of joint degeneration was shown radiographically.

Conclusion

BMDCT is a promising regenerative treatment for osteochondral lesions in mild ankle hemophilic arthropathy, which may be useful to delay or even avoid ankle arthrodesis. Nevertheless, longer follow-ups and a larger case series are required.
Alginate hydrogel enriched with enamel matrix derivative to target osteogenic cell differentiation in TiO2 scaffolds
Authors: Pullisaar Helen , Verket Anders , Szoke Krisztina , Tiainen Hanna , Haugen Håvard J , Brinchmann Jan E , Reseland Janne E , Østrup Esben
Published: March 2015

The purpose of bone tissue engineering is to employ scaffolds, cells, and growth factors to facilitate healing of bone defects. The aim of this study was to assess the viability and osteogenic differentiation of primary human osteoblasts and adipose tissue–derived mesenchymal stem cells from various donors on titanium dioxide (TiO2) scaffolds coated with an alginate hydrogel enriched with enamel matrix derivative. Cells were harvested for quantitative reverse transcription polymerase chain reaction on days 14 and 21, and medium was collected on days 2, 14, and 21 for protein analyses. Neither coating with alginate hydrogel nor alginate hydrogel enriched with enamel matrix derivative induced a cytotoxic response. Enamel matrix derivative–enriched alginate hydrogel significantly increased the expression of osteoblast markers COL1A1, TNFRSF11B, and BGLAP and secretion of osteopontin in human osteoblasts, whereas osteogenic differentiation of human adipose tissue–derived mesenchymal stem cells seemed unaffected by enamel matrix derivative. The alginate hydrogel coating procedure may have potential for local delivery of enamel matrix derivative and other stimulatory factors for use in bone tissue engineering.
Interprofessional Education in Community Health Contexts
Authors: Suiter Sarah V. , Davidson Heather A. , McCaw Mark , Fenelon Kelley-Frances
Published: March 2015

This pilot study explores an interprofessional, practice-based education initiative that placed students from four different professions (medicine, nursing, social work, and pharmacy) in a community health clinic ½ day per week for 8 months. The study was guided by two research questions: (1) How do clinic experiences contribute to students’ understanding of social determinants of health? (2) What factors influence the creation of an effective learning environment? To address these questions, we conducted a qualitative, ethnographic study that included participant observation, focus groups, and textual analysis. This study allowed us to explore the experiences of students and staff as they interacted in a community-based clinic setting. We found that the interprofessional, clinic-based experience improved students’ knowledge- and practice-based competencies in a variety of areas, including awareness of social determinants of health, skills in securing resources for patients with financial limitations, appreciation for health education and health promotion in clinical practice, and experience working interprofessionally. We observed that creating environments that support this kind of student learning requires time and effort on the part of the clinic staff. We discuss implications of these findings for supporting future interprofessional, practice-based health education initiatives.
Structural and functional characterization of a specific antidote for ticagrelor
Authors: Buchanan Andrew , Newton Philip , Pehrsson Susanne , Inghardt Tord , Antonsson Thomas , Svensson Peder , Sjögren Tove , Öster Linda , Janefeldt Annika , Sandinge Ann-Sofie , Keyes Feenagh , Austin Mark , Spooner Jennifer , Gennemark Peter , Penney Mark , Howells Garnet , Vaughan Tristan , Nylander Sven
Published: March 2015

Key Points

In the clinic, all oral antiplatelet medicines have a risk of bleeding complications. We present an antidote for ticagrelor that reverses its antiplatelet effect in human platelet-rich plasma and its bleeding effect in mice.
Copeptin levels are associated with organ dysfunction and death in the intensive care unit after out-of-hospital cardiac arrest
Authors: Ristagno Giuseppe , Latini Roberto , Plebani Mario , Zaninotto Martina , Vaahersalo Jukka , Masson Serge , Tiainen Marjaana , Kurola Jouni , Gaspari Flavio , Milani Valentina , Pettilä Ville , Skrifvars Markus Benedikt ,   for the FINNRESUSCI Study Group
Published: March 2015

Introduction

We studied associations of the stress hormones copeptin and cortisol with outcome and organ dysfunction after out-of-hospital cardiac arrest (OHCA).

Methods

Plasma was obtained after consent from next of kin in the FINNRESUSCI study conducted in 21 Finnish intensive care units (ICUs) between 2010 and 2011. We measured plasma copeptin (pmol/L) and free cortisol (nmol/L) on ICU admission (245 patients) and at 48 hours (additional 33 patients). Organ dysfunction was categorised with 24-hour Sequential Organ Failure Assessment (SOFA) scores. Twelve-month neurological outcome (available in 276 patients) was classified with cerebral performance categories (CPC) and dichotomised into good (CPC 1 or 2) or poor (CPC 3 to 5). Data are presented as medians and interquartile ranges (IQRs). A Mann–Whitney U test, multiple linear and logistic regression tests with odds ratios (ORs) 95% confidence intervals (CIs) and beta (B) values, repeated measure analysis of variance, and receiver operating characteristic curves with area under the curve (AUC) were performed.

Results

Patients with a poor 12-month outcome had higher levels of admission copeptin (89, IQR 41 to 193 versus 51, IQR 29 to 111 pmol/L, P = 0.0014) and cortisol (728, IQR 522 to 1,017 versus 576, IQR 355 to 850 nmol/L, P = 0.0013). Copeptin levels fell between admission and 48 hours (P <0.001), independently of outcome (P = 0.847). Cortisol levels did not change between admission and 48 hours (P = 0.313), independently of outcome (P = 0.221). The AUC for predicting long-term outcome was weak for copeptin (0.62, 95% CI 0.55 to 0.69) and cortisol (0.62, 95% CI 0.54 to 0.69). With logistic regression, admission copeptin (standard deviation (SD) increase OR 1.4, 95% CI 1.03 to 1.98) and cortisol (SD increase OR 1.5, 95% CI 1.1 to 2.0) predicted ICU mortality but not 12-month outcome. Admission factors correlating with SOFA were shockable rhythm (B −1.3, 95% CI −2.2 to −0.5), adrenaline use (B 1.1, 95% CI 0.2 to 2.0), therapeutic hypothermia (B 1.3 95% CI 0.4-2.2), and copeptin (B 0.04, 95% CI 0.02 to 0.07).

Conclusions

Admission copeptin and free cortisol were not of prognostic value regarding 12-month neurological outcome after OHCA. Higher admission copeptin and cortisol were associated with ICU death, and copeptin predicted subsequent organ dysfunction.
Trigger mechanisms of secondary sclerosing cholangitis in critically ill patients
Authors: Leonhardt Silke , Veltzke-Schlieker Wilfried , Adler Andreas , Schott Eckart , Hetzer Roland , Schaffartzik Walter , Tryba Michael , Neuhaus Peter , Seehofer Daniel
Published: March 2015

Introduction

In recent years the development of secondary sclerosing cholangitis in critically ill patients (SSC-CIP) has increasingly been perceived as a separate disease entity. About possible trigger mechanisms of SSC-CIP has been speculated, systematic investigations on this issue are still lacking. The purpose of this study was to evaluate the prevalence and influence of promoting factors.

Methods

Temporality, consistency and biological plausibility are essential prerequisites for causality. In this study, we investigated the temporality and consistency of possible triggers of SSC-CIP in a large case series. Biological plausibility of the individual triggers is discussed in a scientific context. SSC-CIP cases were recruited retrospectively from 2633 patients who underwent or were scheduled for liver transplantation at the University Hospital Charité, Berlin. All patients who developed secondary sclerosing cholangitis in association with intensive care treatment were included. Possible trigger factors during the course of the initial intensive care treatment were recorded.

Results

Sixteen patients (68% males, mean age 45.87 ± 14.64 years) with a confirmed diagnosis of SSC-CIP were identified. Of the 19 risk factors investigated, particularly severe hypotension with a prolonged decrease in mean arterial blood pressure (MAP) to <65 mmHg and systemic inflammatory response syndrome (SIRS) were established as possible triggers of SSC-CIP. The occurrence of severe hypotension appears to be the first and most significant step in the pathogenesis. It seems that severe hypotension has a critical effect on the blood supply of bile ducts when it occurs together with additional microcirculatory disturbances.

Conclusions

In critically ill patients with newly acquired cholestasis the differential diagnosis of SSC-CIP should be considered when they have had an episode of haemodynamic instability with a prolonged decrease in MAP, initial need for large amounts of blood transfusions or colloids, and early development of a SIRS.
Should Nephrologists Take a Larger Role in Interventional Nephrology, and Should Central Line Insertion Remain a Requirement of Nephrology Residency Training? A Debate
Authors: Mendelssohn David C
Published: March 2015

The Canadian Society of Nephrology must soon provide input concerning the future of procedural training in nephrology. While at one time, the ability to insert a central venous catheter (CVC) was an essential skill required by all nephrologists, in 2014, nephrology training and practice has changed in fundamental ways such that it would be both unreasonable, and impractical, to maintain this requirement. Indeed, survey evidence suggests that many current trainees are not achieving this competency. Amongst the reasons that this requirement should be withdrawn include: 1) Not all trainees have the procedural skills to safely learn to insert CVC's. 2) Most nephrologists in training and in practice are intellectually oriented, not procedurally oriented and are not seeking to perform lots of procedures. 3) In most practice settings, interventional radiologists and intensive care doctors perform dialysis line insertions using real time ultrasound guidance frequently, and offer timely, safer, and better service to patients. 4) Most trainees will not enter practice settings where CVC insertion ability is required. 5) Otherwise excellent future trainees may be denied a nephrology certificate of special competence only because they are unable to insert a CVC by the end of their fellowship. 6) Academic nephrology training programs that cannot provide adequate CVC insertion experience to fellows may lose their status as training centres. As a pragmatic way forward, Canadian nephrology training programs must encourage and offer only those nephrology trainees who have the ability and interest in procedural nephrology, a pathway through which they may be provided superb advanced training to become an expert. There is no longer a compelling reason to mandate this for all trainees.
Oral Salt and Water versus Intravenous Saline for the Prevention of Acute Kidney Injury following Contrast-Enhanced Computed Tomography: Study Protocol for a Pilot Randomized Trial
Authors: Swapnil Hiremath , Knoll Greg A , Kayibanda Jeanne Françoise , Fergusson Dean , Chow Benjamin JW , Shabana Wael , Murphy Erin , Ramsay Tim , James Matthew , White Christine A , Garg Amit , Wald Ron , Hoch Jeffrey , Akbari Ayub
Published: March 2015

Background:

Although intravenous saline is the accepted prophylactic measure for the prevention of contrast- induced acute kidney injury, the oral route could offer an equivalent, practical, and cost saving approach. A systematic review of randomized trials that compared oral versus intravenous volume expansion for the prevention of radiocontrast-induced nephropathy in patients receiving arterial contrast reported no significant difference in the risk of contrast induced acute kidney injury between the oral and intravenous arms. Most trials for contrast nephropathy prevention have been in the setting of arterial contrast such as with cardiac catheterization, and not with venous contrast, such as computed tomography. The aim of this paper is to describe the protocol of a pilot trial comparing the effect of oral salt and water versus intravenous saline on the prevention of Acute Kidney Injury following contrast-enhanced computed tomography.

Methods:

Our study is a pilot, single-centre parallel randomized controlled trial. To be included, participants must be at stage 4 of chronic kidney disease as defined by a glomerular filtration rate <30 mL/min/1.73 m2, aged greater than 18 years and to undergo an outpatient contrast-enhanced computer tomography of the chest or abdomen. A total 50 patients will be randomised to receive either oral salt and water or intravenous isotonic saline. The primary outcome is feasibility, including estimates of recruitment rate, adherence to intervention and completeness of follow-up to assist in planning the definitive trial. The secondary outcome is safety and includes adverse events with oral salt and water loading as compared to intravenous isotonic saline.

Discussion:

The results of this pilot trial will provide critical information to plan a definitive trial to test the efficacy of the route of volume loading regimens in prevention of acute kidney injury after contrast-enhanced CT scans.

Trial registration:

The trial is registered at the US National Institutes of Health ( ClinicalTrials.gov ) # NCT02084771.
Random noise attenuation using local signal-and-noise orthogonalization
Authors: Chen Yangkang , Fomel Sergey
Published: March 2015

We have developed a novel approach to attenuate random noise based on local signal-and-noise orthogonalization. In this approach, we first removed from a seismic section using one of the conventional denoising operators and then applied a weighting operator to the initially denoised section to predict the signal-leakage energy, as well as retrieve it from the initial noise section. The weighting operator was obtained by solving a least-squares minimization problem via shaping regularization with a smoothness constraint. Next, the initially denoised section and the retrieved signal were combined to form the final denoised section. The proposed denoising approach corresponded to orthogonalizing the initially denoised signal and noise in a local manner. We evaluated the denoising performance using local similarity. To test the orthogonalization property of the estimated signal and noise, we calculated the local similarity map between the denoised signal section and removed noise section. Low values of local similarity indicated a good orthogonalization and thus a good denoising performance. Synthetic and field data examples revealed the effectiveness of the proposed approach in applications to noise attenuation for conventional and simultaneous-source seismic data.
Ascl1 phospho-status regulates neuronal differentiation in a Xenopus developmental model of neuroblastoma
Authors: Wylie Luke A. , Hardwick Laura J. A. , Papkovskaia Tatiana D. , Thiele Carol J. , Philpott Anna
Published: March 2015

Neuroblastoma (NB), although rare, accounts for 15% of all paediatric cancer mortality. Unusual among cancers, NBs lack a consistent set of gene mutations and, excluding large-scale chromosomal rearrangements, the genome seems to be largely intact. Indeed, many interesting features of NB suggest that it has little in common with adult solid tumours but instead has characteristics of a developmental disorder. NB arises overwhelmingly in infants under 2 years of age during a specific window of development and, histologically, NB bears striking similarity to undifferentiated neuroblasts of the sympathetic nervous system, its likely cells of origin. Hence, NB could be considered a disease of development arising when neuroblasts of the sympathetic nervous system fail to undergo proper differentiation, but instead are maintained precociously as progenitors with the potential for acquiring further mutations eventually resulting in tumour formation. To explore this possibility, we require a robust and flexible developmental model to investigate the differentiation of NB's presumptive cell of origin. Here, we use Xenopus frog embryos to characterise the differentiation of anteroventral noradrenergic (AVNA) cells, cells derived from the neural crest. We find that these cells share many characteristics with their mammalian developmental counterparts, and also with NB cells. We find that the transcriptional regulator Ascl1 is expressed transiently in normal AVNA cell differentiation but its expression is aberrantly maintained in NB cells, where it is largely phosphorylated on multiple sites. We show that Ascl1's ability to induce differentiation of AVNA cells is inhibited by its multi-site phosphorylation at serine-proline motifs, whereas overexpression of cyclin-dependent kinases (CDKs) and MYCN inhibit wild-type Ascl1-driven AVNA differentiation, but not differentiation driven by a phospho-mutant form of Ascl1. This suggests that the maintenance of ASCL1 in its multiply phosphorylated state might prevent terminal differentiation in NB, which could offer new approaches for differentiation therapy in NB.
Of mice, flies – and men? Comparing fungal infection models for large-scale screening efforts
Authors: Brunke Sascha , Quintin Jessica , Kasper Lydia , Jacobsen Ilse D. , Richter Martin E. , Hiller Ekkehard , Schwarzmüller Tobias , d'Enfert Christophe , Kuchler Karl , Rupp Steffen , Hube Bernhard , Ferrandon Dominique
Published: March 2015

Studying infectious diseases requires suitable hosts for experimental in vivo infections. Recent years have seen the advent of many alternatives to murine infection models. However, the use of non-mammalian models is still controversial because it is often unclear how well findings from these systems predict virulence potential in humans or other mammals. Here, we compare the commonly used models, fruit fly and mouse (representing invertebrate and mammalian hosts), for their similarities and degree of correlation upon infection with a library of mutants of an important fungal pathogen, the yeast Candida glabrata. Using two indices, for fly survival time and for mouse fungal burden in specific organs, we show a good agreement between the models. We provide a suitable predictive model for estimating the virulence potential of C. glabrata mutants in the mouse from fly survival data. As examples, we found cell wall integrity mutants attenuated in flies, and mutants of a MAP kinase pathway had defective virulence in flies and reduced relative pathogen fitness in mice. In addition, mutants with strongly reduced in vitro growth generally, but not always, had reduced virulence in flies. Overall, we demonstrate that surveying Drosophila survival after infection is a suitable model to predict the outcome of murine infections, especially for severely attenuated C. glabrata mutants. Pre-screening of mutants in an invertebrate Drosophila model can, thus, provide a good estimate of the probability of finding a strain with reduced microbial burden in the mouse host.
The evolution of compositionally and functionally distinct actin filaments
Authors: Gunning Peter W. , Ghoshdastider Umesh , Whitaker Shane , Popp David , Robinson Robert C.
Published: March 2015

The actin filament is astonishingly well conserved across a diverse set of eukaryotic species. It has essentially remained unchanged in the billion years that separate yeast, Arabidopsis and man. In contrast, bacterial actin-like proteins have diverged to the extreme, and many of them are not readily identified from sequence-based homology searches. Here, we present phylogenetic analyses that point to an evolutionary drive to diversify actin filament composition across kingdoms. Bacteria use a one-filament-one-function system to create distinct filament systems within a single cell. In contrast, eukaryotic actin is a universal force provider in a wide range of processes. In plants, there has been an expansion of the number of closely related actin genes, whereas in fungi and metazoa diversification in tropomyosins has increased the compositional variety in actin filament systems. Both mechanisms dictate the subset of actin-binding proteins that interact with each filament type, leading to specialization in function. In this Hypothesis, we thus propose that different mechanisms were selected in bacteria, plants and metazoa, which achieved actin filament compositional variation leading to the expansion of their functional diversity.
Hydrodynamic sensing and behavior by oyster larvae in turbulence and waves
Authors: Fuchs Heidi L. , Gerbi Gregory P. , Hunter Elias J. , Christman Adam J. , Diez F. Javier
Published: March 2015

Hydrodynamic signals from turbulence and waves may provide marine invertebrate larvae with behavioral cues that affect the pathways and energetic costs of larval delivery to adult habitats. Oysters (Crassostrea virginica) live in sheltered estuaries with strong turbulence and small waves, but their larvae can be transported into coastal waters with large waves. These contrasting environments have different ranges of hydrodynamic signals, because turbulence generally produces higher spatial velocity gradients, whereas waves can produce higher temporal velocity gradients. To understand how physical processes affect oyster larval behavior, transport, and energetics, we exposed larvae to different combinations of turbulence and waves in flow tanks with 1) wavy turbulence, 2) a seiche, and 3) rectilinear accelerations. We quantified behavioral responses of individual larvae to local instantaneous flows using two-phase, infrared particle-image velocimetry. Both high dissipation rates and high wave-generated accelerations induced most larvae to swim faster upward. High dissipation rates also induced some rapid, active dives, whereas high accelerations induced only weak active dives. In both turbulence and waves, faster swimming and active diving were achieved through an increase in propulsive force and power output that would carry a high energetic cost. Swimming costs could be offset if larvae reaching surface waters had a higher probability of being transported shoreward by Stokes drift, whereas diving costs could be offset by enhanced settlement or predator avoidance. These complex behaviors suggest that larvae integrate multiple hydrodynamic signals to manage dispersal tradeoffs, spending more energy to raise the probability of successful transport to suitable locations.
About Problems Related to Realization of New Disciplines for “Technosphere Safety” Bachelor Training Direction
Authors: Чура  , Chura M. , Туркин  , Turkin V. , Чура  , Chura N.
Published: March 2015

An analysis of educational and methodical support for "Technosphere safety" training direction, as well as of this direction’s

approximate main educational program, and such new disciplines of educational standard’s basic part as "Noxology",

"Supervision and Control in the Safety Sphere" and "Technosphere Safety Management" has been provided. The existing

manuals and approximate programs have been considered.
Age-Related Structural Inertia: A Distance-Based Approach
Authors: Le Mens Gaël , Hannan Michael T. , Pólos László
Published: March 2015

This paper proposes a distance-based characterization of age-related structural inertia as an increasing constraint on the speed of change as organizations age. Our framework regards organizations as points in multidimensional metric spaces of architectures. Organizational change means movement in this space. The speed of change is the ratio of the distance between positions in a space and the time it took for the organization to make the move. We illustrate how our distance-based approach can be used to formulate theories of age-related organizational inertia by using this representation to develop a model for a possible mechanism: age-related cultural resistance to change based on the dynamics of exposure of organizational members to architectural features. Our proposed mechanism is distinct from prevailing explanations and leads to new predictions. We also illustrate the value of our distance-based approach in a reanalysis of Sørensen and Stuart’s study of age variations in firms’ patenting behavior [Sørensen JB, Stuart TE (2000) Aging, obsolescence, and organizational innovation. Admin. Sci. Quart. 45(1):81–112]. On the basis of patent citations, we construct a space that allows us to characterize the positions of organizations and the speed at which they change. We find that organizational age has a negative effect on the speed of change.
Zonisamide: Antipsychotic Weight Gain
Authors: Generali Joyce A. , Gada Dennis J.
Published: March 2015

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature enables the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to jgeneral@ku.edu .
Compatibility of Cloxacillin Sodium with Selected Intravenous Drugs during Simulated Y-Site Administration
Authors: Sullivan Thomas , Forest Jean-Marc , Leclair Grégoire
Published: March 2015

Background

Data regarding Y-site compatibility of intravenous (IV) cloxacillin sodium with other drugs are scarce and incomplete.

Objective

To establish the compatibility of IV cloxacillin with 89 injectable drugs during simulated Y-site administration.

Methods

Cloxacillin sodium (10 mL, 100 mg/mL) was combined with 89 undiluted IV drugs (10 mL, each). Tests were duplicated and performed at room temperature. Visual evaluation and a light obscuration particle count test were performed on 1 of the 2 solutions immediately after mixing. The second mixture underwent visual evaluation after 15 minutes, 1 hour, and 4 hours, followed by a particle count test at 4 hours. Drugs were considered incompatible if the mixture precipitated or became turbid within the 4-hour period or exceeded the particle count limit allowed by Test 1.B of USP <788> initially or at 4 hours.

Results

Of the 89 tested drugs, 64 were compatible for up to 4 hours. The remaining 25 drugs were incompatible. Of these incompatible drugs, 16 were identified visually, and 9 were identified by the light obscuration particle count test.

Conclusions

Sixty-four IV drugs were found to be compatible with cloxacillin via simulated Y-site, whereas 25 drugs were found to be incompatible with the antibiotic. The light obscuration particle count test should be used to complement visual evaluation when samples do not precipitate immediately.
Patterning your Department after Great Leaders: John D. Rockefeller
Authors: Loborec Steven M. , Weber Robert J.
Published: March 2015

Learning through the examples of great leaders can provide pharmacy directors with guidance on how to shape their leadership style. John D. Rockefeller was one of the most successful businessmen in the world, and he is highly regarded as having been a great leader. His example of having the courage of his convictions will be necessary as pharmacy faces drastic changes ahead in pharmacy provider status and practice model changes. His management of his staff serves as an excellent example of the importance of staff retention programs. As health systems strive to do more with less, it is now more important than ever to scrutinize using resources and apply Rockefeller's attention to efficiency and effectiveness when growing patient-centered pharmacy services.
Where Are Patients Positioned in Your Seamless Care Strategies?
Authors: Fox Brent I. , Felkey Bill G.
Published: March 2015

In our earliest thoughts of how to engage patients in self-care management, we found online banking and finance to be the best model for health care to follow. This model is still right for today. Although no digital approach will apply to 100% of any population, there is evidence that older patient populations see the benefit of being able to access their health care providers online and on mobile devices. It's all about the data, the systems, and the people.
Acciones para la disminución del peligro de incendios forestales en áreas de interfaz urbano-forestal. Estudio de caso
Authors: Castillo S. Miguel , Correa J. Luis
Published: March 2015

Acciones para la disminución del peligro de incendios forestales en áreas de interfaz urbano-forestal. Estudio de caso – Se estudia un área de la costa de Valparaíso afectada históricamente por numerosos incendios de interfaz urbano forestal. Uno de los principales factores que ocasionan este problema es la existencia de altas cargas de material vegetal combustible cercana a viviendas y que favorecen la rápida propagación del fuego. Se proponen medidas para el tratamiento de la vegetación, com el fin de aminorar este factor de riesgo para la población localizada en esta área.
Caracterización socioeconómica de la población en áreas de riesgo de incendios forestales. Estudio de caso. Interfaz urbano-forestal, provincia de Valparaíso. Chile central
Authors: Garfias S. Roberto , Castillo S. Miguel , Ruiz G. Francisca , Julio A. Guillermo , Quintanilla P. Victor , Antúnez G. Jessica
Published: March 2015

Se estudia la población inserta en áreas de alto riesgo de incendios forestales en cerros y quebradas del paisaje costero, en la Provincia de Valparaíso, Chile Central. Para ello el estudio considera las poblaciones aledañas a zonas de alta ocurrencia de incendios forestales, que en su perímetro, abarca una superficie aproximada de 14 mil hectáreas, rodeando a los cascos urbanos de Valparaíso y Viña del Mar. El estudio permite identificar cuatro áreas de interfaz, cuyos atributos socioeconómicos y conductuales, sin duda servirán de gran ayuda para apoyar un plan de protección contra incendios forestales que considere abiertamente la participación de la población bajo riesgo en estas áreas.
Regeneración de la vegetación y riesgos de erosion pos incendios forestales. Estudio de casos en paises mediterraneos
Authors: Quintanilla P. Víctor , Lourenço Luciano , Henriques Susete
Published: March 2015

Se presentan tipos de efectos erosivos por fuegos vegetales, acaecidos en sectores de la zona mediterránea de Chile y Portugal. La zona mediterránea de Chile es donde anualmente se desarrolla la mayor parte de los incendios forestales de erano, en una región comprendida aproximadamente entre los 32° y 36° latitud sur. En Portugal, es la región Centro, ubicada entre los 39° y 41° latitud norte, la que detiene más superficie quemada por incendios forestales y la que suele registrar los incendios más grandes.