bluuebunny/crossref_metadata_2025 huggingface dataset:
Brachial plexus palsy after a left-side modified radical mastectomy with immediate latissimusdorsi flap reconstruction: report of a case
Authors: Wu Jun-Dong , Huang Wen-He , Huang Zi-Yi , Chen Ming , Zhang Guo-Jun
Published: October 2013

Brachial plexus injury is a rare complication during operation and anesthesia; it can occur as a result of various mechanisms such as inappropriate positioning, over-abduction and stretching the upper limbs. Brachial plexus injury can cause the poor function of the upper limb before recovery, and sometimes serious injury is unable to completely recovered the function permanently. Here, we report a female breast cancer patient who sustained a left brachial plexus palsy after modified radical mastectomy with immediate breast reconstruction with latissimusdorsi flap (LDF). The patient had fully recovered with normal function of her left upper limb six months postoperation after conservative treatment.
Mesenchymal stem cells from umbilical cord matrix, adipose tissue and bone marrow exhibit different capability to suppress peripheral blood B, natural killer and T cells
Authors: Ribeiro Andreia , Laranjeira Paula , Mendes Sandrine , Velada Isabel , Leite Cristiana , Andrade Pedro , Santos Francisco , Henriques Ana , Grãos Mário , Cardoso Carla M P , Martinho António , Pais M Luísa , da Silva Cláudia Lobato , Cabral Joaquim , Trindade Hélder , Paiva Artur
Published: October 2013

Introduction

The ability to self-renew, be easily expanded in vitro and differentiate into different mesenchymal tissues, render mesenchymal stem cells (MSCs) an attractive therapeutic method for degenerative diseases. The subsequent discovery of their immunosuppressive ability encouraged clinical trials in graft-versus-host disease and auto-immune diseases. Despite sharing several immunophenotypic characteristics and functional capabilities, the differences between MSCs arising from different tissues are still unclear and the published data are conflicting.

Methods

Here, we evaluate the influence of human MSCs derived from umbilical cord matrix (UCM), bone marrow (BM) and adipose tissue (AT), co-cultured with phytohemagglutinin (PHA)-stimulated peripheral blood mononuclear cells (MNC), on T, B and natural killer (NK) cell activation; T and B cells’ ability to acquire lymphoblast characteristics; mRNA expression of interleukin-2 (IL-2), forkhead box P3 (FoxP3), T-bet and GATA binding protein 3 (GATA3), on purified T cells, and tumor necrosis factor-alpha (TNF-α), perforin and granzyme B on purified NK cells.

Results

MSCs derived from all three tissues were able to prevent CD4+ and CD8+ T cell activation and acquisition of lymphoblast characteristics and CD56dim NK cell activation, wherein AT-MSCs showed a stronger inhibitory effect. Moreover, AT-MSCs blocked the T cell activation process in an earlier phase than BM- or UCM-MSCs, yielding a greater proportion of T cells in the non-activated state. Concerning B cells and CD56bright NK cells, UCM-MSCs did not influence either their activation kinetics or PHA-induced lymphoblast characteristics, conversely to BM- and AT-MSCs which displayed an inhibitory effect. Besides, when co-cultured with PHA-stimulated MNC, MSCs seem to promote Treg and Th1 polarization, estimated by the increased expression of FoxP3 and T-bet mRNA within purified activated T cells, and to reduce TNF-α and perforin production by activated NK cells.

Conclusions

Overall, UCM-, BM- and AT-derived MSCs hamper T cell, B cell and NK cell-mediated immune response by preventing their acquisition of lymphoblast characteristics, activation and changing the expression profile of proteins with an important role in immune function, except UCM-MSCs showed no inhibitory effect on B cells under these experimental conditions. Despite the similarities between the three types of MSCs evaluated, we detect important differences that should be taken into account when choosing the MSC source for research or therapeutic purposes.
Disabling Immune Tolerance by Programmed Death-1 Blockade With Pidilizumab After Autologous Hematopoietic Stem-Cell Transplantation for Diffuse Large B-Cell Lymphoma: Results of an International Phase II Trial
Authors: Armand Philippe , Nagler Arnon , Weller Edie A. , Devine Steven M. , Avigan David E. , Chen Yi-Bin , Kaminski Mark S. , Holland H. Kent , Winter Jane N. , Mason James R. , Fay Joseph W. , Rizzieri David A. , Hosing Chitra M. , Ball Edward D. , Uberti Joseph P. , Lazarus Hillard M. , Mapara Markus Y. , Gregory Stephanie A. , Timmerman John M. , Andorsky David , Or Reuven , Waller Edmund K. , Rotem-Yehudar Rinat , Gordon Leo I.
Published: October 2013

Purpose

The Programmed Death-1 (PD-1) immune checkpoint pathway may be usurped by tumors, including diffuse large B-cell lymphoma (DLBCL), to evade immune surveillance. The reconstituting immune landscape after autologous hematopoietic stem-cell transplantation (AHSCT) may be particularly favorable for breaking immune tolerance through PD-1 blockade.

Patients and Methods

We conducted an international phase II study of pidilizumab, an anti–PD-1 monoclonal antibody, in patients with DLBCL undergoing AHSCT, with correlative studies of lymphocyte subsets. Patients received three doses of pidilizumab beginning 1 to 3 months after AHSCT.

Results

Sixty-six eligible patients were treated. Toxicity was mild. At 16 months after the first treatment, progression-free survival (PFS) was 0.72 (90% CI, 0.60 to 0.82), meeting the primary end point. Among the 24 high-risk patients who remained positive on positron emission tomography after salvage chemotherapy, the 16-month PFS was 0.70 (90% CI, 0.51 to 0.82). Among the 35 patients with measurable disease after AHSCT, the overall response rate after pidilizumab treatment was 51%. Treatment was associated with increases in circulating lymphocyte subsets including PD-L1E–bearing lymphocytes, suggesting an on-target in vivo effect of pidilizumab.

Conclusion

This is the first demonstration of clinical activity of PD-1 blockade in DLBCL. Given these results, PD-1 blockade after AHSCT using pidilizumab may represent a promising therapeutic strategy in this disease.
Trastuzumab-Related Cardiotoxicity Among Older Patients With Breast Cancer
Authors: Chavez-MacGregor Mariana , Zhang Ning , Buchholz Thomas A. , Zhang Yufeng , Niu Jiangong , Elting Linda , Smith Benjamin D. , Hortobagyi Gabriel N. , Giordano Sharon H.
Published: October 2013

Purpose

The use of trastuzumab in the adjuvant setting improves outcomes but is associated with cardiotoxicity manifested as congestive heart failure (CHF). The rates and risk factors associated with trastuzumab-related CHF among older patients are unknown.

Patients and Methods

Breast cancer patients at least 66 years old with full Medicare coverage, diagnosed with stage I-III breast cancer between 2005 and 2009, and treated with chemotherapy were identified in the SEER-Medicare and in the Texas Cancer Registry–Medicare databases. The rates and risk factors associated with CHF were evaluated. Chemotherapy, trastuzumab use, comorbidities, and CHF were identified using International Classification of Diseases, version 9, and Healthcare Common Procedure Coding System codes. Analyses included descriptive statistics and Cox proportional hazards models.

Results

In total, 9,535 patients were included, of whom 2,203 (23.1%) received trastuzumab. Median age of the entire cohort was 71 years old. Among trastuzumab users, the rate of CHF was 29.4% compared with 18.9% in nontrastuzumab users (P < .001). Trastuzumab users were more likely to develop CHF than nontrastuzumab users (hazard ratio [HR], 1.95; 95% CI, 1.75 to 2.17). Among trastuzumab-treated patients, older age (age > 80 years; HR, 1.53; 95% CI, 1.16 to 2.10), coronary artery disease (HR, 1.82; 95% CI, 1.34 to 2.48), hypertension (HR, 1.24; 95% CI, 1.02 to 1.50), and weekly trastuzumab administration (HR, 1.33; 95% CI, 1.05 to 1.68) increased the risk of CHF.

Conclusion

In this large cohort of older breast cancer patients, the rates of trastuzumb-related CHF are higher than those reported in clinical trials. Among patients treated with trastuzumab, those with cardiac comorbidities and older age may be at higher risk. Further studies need to confirm the role that the frequency of administration plays in the development of trastuzumab-related CHF.
Oral Tetra-Arsenic Tetra-Sulfide Formula Versus Intravenous Arsenic Trioxide As First-Line Treatment of Acute Promyelocytic Leukemia: A Multicenter Randomized Controlled Trial
Authors: Zhu Hong-Hu , Wu De-Pei , Jin Jie , Li Jian-Yong , Ma Jun , Wang Jian-Xiang , Jiang Hao , Chen Sai-Juan , Huang Xiao-Jun
Published: October 2013

Purpose

This randomized, multicenter, phase III noninferiority trial was designed to test the efficacy and safety of an oral tetra-arsenic tetra-sulfide (As4S4) –containing formula named the Realgar-Indigo naturalis formula (RIF) compared with intravenous arsenic trioxide (ATO) as both induction and maintenance therapies for newly diagnosed acute promyelocytic leukemia (APL).

Patients and Methods

In all, 242 patients with APL were randomly assigned (1:1) to oral RIF (60 mg/kg) or ATO (0.16 mg/kg) combined with all-trans retinoic acid (ATRA; 25 mg/m2) during induction therapy. After achieving complete remission (CR), all patients received three courses of consolidation chemotherapy and maintenance treatment with sequential ATRA followed by either RIF or ATO for 2 years. The primary end point was the rate of disease-free survival (DFS) at 2 years, which was assessed for noninferiority with a 10% noninferiority margin.

Results

The median follow-up time was 39 months. DFS at 2 years was 98.1% (106 of 108) in the RIF group and 95.5% (107 of 112) in the ATO group. The DFS difference was 2.6% (95% CI, −3.0% to 8.0%). The lower limit of the 95% CI of DFS difference was greater than the −10% noninferiority margin, confirming noninferiority (P < .001). No significant differences were noted between the RIF and ATO groups with regard to the CR rate (99.1% v 97.2%; P = .62) or the overall survival at 3 years (99.1% v 96.6%; P = .18). The rates of adverse events were similar in the two groups.

Conclusion

Oral RIF plus ATRA is not inferior to intravenous ATO plus ATRA as first-line treatment of APL and may be considered as a routine treatment option for appropriate patients.
Tumor-Infiltrating Lymphocyte Grade in Primary Melanomas Is Independently Associated With Melanoma-Specific Survival in the Population-Based Genes, Environment and Melanoma Study
Authors: Thomas Nancy E. , Busam Klaus J. , From Lynn , Kricker Anne , Armstrong Bruce K. , Anton-Culver Hoda , Gruber Stephen B. , Gallagher Richard P. , Zanetti Roberto , Rosso Stefano , Dwyer Terence , Venn Alison , Kanetsky Peter A. , Groben Pamela A. , Hao Honglin , Orlow Irene , Reiner Anne S. , Luo Li , Paine Susan , Ollila David W. , Wilcox Homer , Begg Colin B. , Berwick Marianne
Published: October 2013

Purpose

Although most hospital-based studies suggest more favorable survival with tumor-infiltrating lymphocytes (TILs) present in primary melanomas, it is uncertain whether TILs provide prognostic information beyond existing melanoma staging definitions. We addressed the issue in an international population-based study of patients with single and multiple primary melanomas.

Patients and Methods

On the basis of the Genes, Environment and Melanoma (GEM) study, we conducted follow-up of 2,845 patients diagnosed from 1998 to 2003 with 3,330 invasive primary melanomas centrally reviewed for TIL grade (absent, nonbrisk, or brisk). The odds of TIL grades associated with clinicopathologic features and survival by TIL grade were examined.

Results

Independent predictors (P < .05) for nonbrisk TIL grade were site, histologic subtype, and Breslow thickness, and for brisk TIL grade, they were age, site, Breslow thickness, and radial growth phase. Nonbrisk and brisk TIL grades were each associated with lower American Joint Committee on Cancer (AJCC) tumor stage compared with TIL absence (Ptrend < .001). Death as a result of melanoma was 30% less with nonbrisk TIL grade (hazard ratio [HR], 0.7; 95% CI, 0.5 to 1.0) and 50% less with brisk TIL grade (HR, 0.5; 95% CI, 0.3 to 0.9) relative to TIL absence, adjusted for age, sex, site, and AJCC tumor stage.

Conclusion

At the population level, higher TIL grade of primary melanoma is associated with a lower risk of death as a result of melanoma independently of tumor characteristics currently used for AJCC tumor stage. We conclude that TIL grade deserves further prospective investigation to determine whether it should be included in future AJCC staging revisions.
Elective Treatment of Saccular and Broad-necked Intracranial Aneurysms using a Closed-cell Nitinol Stent (Leo)
Authors: Kis Bernhard , Weber Werner , Berlit Peter , Kühne Dietmar
Published: October 2013

OBJECTIVE:

Endovascular coil embolization of saccular intracranial aneurysms is safe and effective, but long-term results are dissatisfying. Reconstructive treatments using stents improve occlusion rate and protect parent vessels. We present data on our experience with a new self-expanding stent manufactured with braided nitinol wires.

METHODS:

Twenty-five saccular, complex, and broad-necked intracranial aneurysms in 21 patients were treated electively. They were located at the internal carotid artery (10), basilar trunk (5), cavernous carotid artery (4), basilar tip (2), anterior cerebral artery (2), anterior communicating artery (1), and middle cerebral artery (1). Eleven aneurysms exhibited recanalization after primary endovascular treatment without stent.

RESULTS:

Stent deployment was successful in 24 lesions, and additional coil embolization was performed in 23. No permanent neurological deficits were encountered consequent to endovascular procedure. Complete or partial occlusion immediately after stent deployment was achieved in 19 aneurysms, whereas no immediate coil embolization was chosen in 6 cases. There were two thromboembolic events related to the deployment of the Leo stent, one failure of stent deployment, difficulties in stent positioning in three cases, and one asymptomatic parent artery occlusion after 7 months. Follow-up (available in 18 patients and 21 aneurysms and obtained at 3–12 mo; average, 5 mo) revealed patent stents in the remaining cases. Angiographic recurrences arose in three lesions, which were retreated without complications.

CONCLUSION:

Primary and recurrence treatment of saccular and broad-necked intracranial aneurysms using the Leo stent is feasible and effective. No permanent neurological deficits were associated with stent placement. Short-term follow-up identified intact parent arteries and stable occlusion rates in the majority of cases.
Spectrum of Nonterminal Myelocystoceles
Authors: Rossi Andrea , Piatelli Gianluca , Gandolfo Carlo , Pavanello Marco , Hoffmann Chen , Van Goethem Johan W. , Cama Armando , Tortori-Donati Paolo
Published: October 2013

OBJECTIVE:

To present the magnetic resonance imaging features, clinical findings, and possible embryologic bases for nonterminal myelocystoceles, a distinct subset of closed spinal dysraphisms.

METHODS:

We retrospectively analyzed imaging series and clinical records from five newborns and one older child with skin-covered soft tissue masses along the posterior midline spine. Spinal (6 patients) and brain (5 patients) magnetic resonance imaging was performed before surgical repair and compared with clinical findings, observations at surgery, and final lesion histology.

RESULTS:

The lesions affected the cervical (n = 3), thoracic (n = 2), and lumbar (n = 1) regions. In each case, the dome of the mass was covered by thickened, dystrophic epithelium with no subcutaneous fat, whereas the base and lateral walls of the mass were covered by normal skin. All patients were neurologically intact at presentation. In three cases, a stalk emanated from the dorsal normal spinal cord, crossed a narrow posterior bony spina bifida, and coursed through a posterior meningocele to attach to the inner aspect of its dome. The other three cases showed dissection of a hydromyelic cavity into the stalk, converting it into a second "cyst" within the meningocele. Concurrent anomalies included focal hydromyelia immediately cranial to the origin of the posterior stalk (n = 2), mild Chiari II malformation (n = 3), triventricular hydrocephalus from aqueductal stenosis (n = 1), filar lipoma (n = 1), and presumed neurenteric cyst (n = 1). At surgery, the sac was resected in all cases, but intradural exploration and untethering was performed in only three children. Embryologic considerations indicate that the spectrum of these lesions likely arises from partial limited closure of the neural tube, failed disjunction of the cutaneous ectoderm, and variable degrees of hydromyelia.

CONCLUSION:

The nonterminal myelocystocele is a distinct form of closed spinal dysraphism characterized by a skin-covered meningocele, which is either crossed by a fibroneurovascular stalk that extends from the dorsal aspect of the spinal cord to attach to the dome of the meningocele (abortive form, or myelocystocele manqué) or contains a hydromyelic cavity that is continuous with the ependymal canal of the spinal cord (complete form).
Neuropsychological Dysfunction in the Absence of Structural Evidence for Cerebral Ischemia after Uncomplicated Carotid Endarterectomy
Authors: Heyer Eric J. , DeLaPaz Robert , Halazun Hadi J. , Rampersad Anita , Sciacca Robert , Zurica Joseph , Benvenisty Alan I. , Quest Donald O. , Todd George J. , Lavine Sean , Solomon Robert A. , Connolly E Sander
Published: October 2013

OBJECTIVE:

Neurocognitive dysfunction has been shown to occur in roughly 25% of patients undergoing carotid endarterectomy (CEA). Despite this, little is known about the mechanism of this injury. Recently, several groups have shown that new diffusion weighted imaging (DWI)-positive lesions are seen in 20% of patients undergoing CEA. We investigated to what degree neurocognitive dysfunction was associated with new DWI lesions.

METHODS:

Thirty-four consecutive patients undergoing CEA were subjected to pre- and postoperative cognitive evaluation with a battery of neuropsychological tests. Postoperative magnetic resonance imaging was performed in all patients within 24 hours of surgery. Lesions that showed high signal on DWI and restricted diffusion on apparent diffusion coefficient maps but no abnormal high signal on the fluid-attenuated inversion recovery images were considered hyperacute.

RESULTS:

Cognitive dysfunction was seen in eight (24%) patients. New hyperacute DWI lesions were seen in three (9%). Only one (13%) of the patients with cognitive dysfunction had a new DWI lesion. Two thirds of the new DWI lesions occurred in the absence of cognitive deterioration. Patients with cognitive dysfunction had significantly longer carotid cross-clamp times.

CONCLUSION:

Neurocognitive dysfunction after CEA does not seem to be associated with new DWI positive lesions.
Augmentation of Anterior Lumbar Interbody Fusion with Anterior Pedicle Screw Fixation: Demonstration of Novel Constructs and Evaluation of Biomechanical Stability in Cadaveric Specimens
Authors: Karim Aftab , Mukherjee Debi , Ankem Murali , Gonzalez-Cruz Jorge , Smith Donald , Nanda Anil
Published: October 2013

OBJECTIVE:

Anterior lumbar interbody fusion (ALIF) has proven effective for indications including discogenic back pain, nonunion, and instability. Current practice involves posterior pedicle screw augmentation of the ALIF procedure (ALIF-PPS). This approach requires intraoperative repositioning of the patient for percutaneous posterior pedicle screw placement. We have developed a novel technique in which the ALIF procedure is augmented with anterior pedicle screws (APS; ALIF-APS). In this study, we introduce this new technique and compare the biomechanical stability of the novel ALIF-APS with the current standard ALIF-PPS.

METHODS:

The technique was demonstrated in a cadaveric L4–S1 specimen using neuronavigation and fluoroscopy. Plain radiographs and computed tomographic scans of the construct were obtained. Twelve cadaveric spines (7 men and 5 women) from donors with an average age of 81 years (range, 64–93 yr) were then harvested from L4–S1. Six specimens were dedicated to ALIF-APS constructs, and the remaining six were dedicated to ALIF-PPS constructs. The specimens were then studied at L5–S1 in the following steps: 1) intact form, 2) after anterior discectomy, 3) after implantation of titanium cages (ALIF), and 4) after APS or PPS fixation in conjunction with the ALIF. Measurements were obtained in axial rotation and left and right lateral bending flexion-extension. Data were normalized by calculating the ratio of the stiffness of the instrumented to the intact spine. Statistical analyses were then performed on the data.

RESULTS:

Radiographs and computed tomographic scans of the construct showed accurate placement of the APS at L5 and S1. The normalized data showed that ALIF-APS and ALIF-PPS had approximately equal stability in axial rotation (1.17 ± 0.43 versus 0.85 ± 0.14), lateral bending (0.93 ± 0.22 versus 0.95 ± 0.16), and flexion- extension (0.77 ± 0.13 versus 0.84 ± 0.2). Paired t test analysis did not show a significant difference between the biomechanical stiffness of ALIF-APS and ALIF-PPS in axial rotation, lateral bending, and flexion-extension.

CONCLUSION:

We demonstrate a new technique in a cadaveric specimen whereby the ALIF procedure is augmented with APS fixation using neuronavigation and fluoroscopy. Biomechanical evaluation of the constructs suggests that the ALIF-APS has comparable stability with ALIF-PPS. APS augmentation of ALIF has potential advantages over the current standard ALIF-PPS because it can 1) eliminate the patient repositioning step, 2) minimize the total number of incisions and the total operative time, and 3) protect against dislocation of the ALIF interbody graft or cage. Work is in progress to develop a low-profile system for the novel APS constructs described here.
Hemispheric Revascularization in the Setting of Carotid Occlusion and Subclavian Steal: A Diagnostic and Management Role for Quantitative Magnetic Resonance Angiography?
Authors: Langer David J. , Lefton Daniel R. , Ostergren Lauren , Brockington Carolyn D. , Song Joon , Niimi Yasunari , Bhargava Peeyush , Berenstein Alejandro
Published: October 2013

OBJECTIVE:

Advances in phase contrast magnetic resonance imaging have facilitated the noninvasive assessment of blood flow rates and flow direction in patients with complex cerebrovascular disorders.

METHODS:

We describe a case of right hemispheric hypoperfusion in which, on noninvasive assessment with quantitative magnetic resonance angiography, the patient was found to harbor an occult subclavian steal with flow reversal in the left vertebral artery.

RESULTS:

The presence of posterior communicating arteries noted on quantitative magnetic resonance angiography suggested that normalization of flow in the vertebral arteries by treating the subclavian occlusion could improve flow in the anterior circulation. Angiography confirmed the noninvasive findings, and the subclavian occlusion was treated with angioplasty and stenting. Postintervention quantitative magnetic resonance angiography documented quantitative improvement in right middle cerebral artery flow and restoration of antegrade flow in the left vertebral artery.

CONCLUSION:

This case illustrates the potential role of noninvasive assessment of blood flow rates and flow direction in the diagnosis, treatment planning, and follow-up of patients with complex cerebrovascular disease.
Stereotactic Radiosurgery of the Rete Mirabile in Swine: A Longitudinal Study of Histopathological Changes
Authors: Jahan Reza , Solberg Timothy D. , Lee Daniel , Medin Paul , Tateshima Satoshi , Sayre James , De Salles Antonio , Vinters Harry V. , Vinuela Fernando
Published: October 2013

OBJECTIVE:

Stereotactic radiosurgery is an established, effective treatment for brain arteriovenous malformations. The mechanisms of vessel occlusion in arteriovenous malformations has not been extensively evaluated. To better understand these mechanisms, we report histopathological changes in the swine rete mirabile after stereotactic radiosurgery.

METHODS:

Thirty-five swine were used, 15 as nonradiated controls and 20 as radiated. Two in the control group and five in the radiated group were sacrificed before the study endpoint. Tissue was obtained from 13 nonradiated (4 at 3 mo, 5 at 6 mo, 4 at 9 mo) and 15 radiated swine (2 at 3 mo, 3 at 6 mo, 10 at 9 mo) for histological, immunohistochemical, and morphometric analysis.

RESULTS:

Radiated vessels showed increasing intimal hyperplasia over the follow-up period. Histometrical analysis confirmed this with evidence of progressive luminal narrowing over the follow-up period. Immunohistochemical analysis showed intimal cells to be proliferating smooth muscle cells with surrounding extracellular collagen Type IV. Adventitial fibrosis composed of collagen Type IV was also seen with smooth muscle cells interspersed within the collagen matrix. The nonradiated animals showed no intimal hyperplasia or change in the appearance or size of the vessels over the same follow-up period. Adventitial fibrosis was minimal in the nonradiated animals.

CONCLUSION:

The vessels show an intimal response to radiation with progressive occlusion caused by migrating, proliferating smooth muscle cells, a likely source of the extracellular collagen in the intima. Cytokine mediated pathways likely produce these morphological changes. Future studies will be directed toward elucidating these underlying molecular mechanisms.
Role of Radiotherapy in a Recurrent Aneurysmal Bone Cyst of the Temporal Bone: Case Report
Authors: Kumar Piyush , Singh Shalini , Phadke Rajendra V. , Diwakar Himanshu , Agarawal Tanu , Jain Manoj , Datta Niloy R.
Published: October 2013

OBJECTIVE AND IMPORTANCE:

A rare case of aneurysmal bone cyst (ABC) of the temporal bone is presented which, following recurrence after surgery, was successfully treated with radiotherapy. The role of radiotherapy in such cases is reviewed.

CLINICAL PRESENTATION:

A 30-year-old man presented with a recurrent swelling and pain in right temporal region following surgery for ABC at that site.

INTERVENTION:

Local radiotherapy to a dose of 31.5 Gy in 18 fractions over 3.5 weeks was delivered to the site of recurrence. The patient had a near total regression of the ABC as evident clinically and on radiological images.

CONCLUSION:

To the best of our knowledge, radiation for the recurrent ABC at the temporal bone has not been described in the literature. However, in view of the response evident in this patient, radiotherapy seems to be effective for recurrent cases of ABC at the temporal bone and a dose of around 30 to 36 Gy could be effectively delivered with satisfactory results.
Long-term Clinical and Angiographic Follow-up of Unclippable Wrapped Intracranial Aneurysms
Authors: Deshmukh Vivek R. , Kakarla Udaya K. , Figueiredo Eberval Gadelha , Zabramski Joseph M. , Spetzler Robert F.
Published: October 2013

OBJECTIVE:

This is the largest contemporary series examining long-term clinical and angiographic follow-up of unclippable wrapped intracranial aneurysms.

METHODS:

The presentation, location and shape of aneurysm, wrapping technique, outcome at discharge and last follow-up, and change in aneurysm at last angiographic follow-up were reviewed retrospectively in 74 patients with wrapped or clip-wrapped aneurysms. Patients in whom wrapping was used in conjunction with primary clipping were excluded.

RESULTS:

Of the 74 patients, 11 were lost to follow-up. The mean age of the remaining 63 patients (16 males, 47 females) was 56.5 years (range, 13–89 yr). Fifty-one aneurysms were located in the anterior circulation, and 17 were located in the posterior circulation. Fourteen patients presented with a ruptured aneurysm. Seventeen aneurysms were fusiform. Seven aneurysms were clip-wrapped, and 61 were wrapped with cotton. At discharge the Glasgow Outcome Scale (GOS) score was 5 in 54 patients and 4 in 5 patients. Two patients died from their presenting hemorrhage, and one from a medical comorbidity. The mean clinical follow-up was 44.1 months (range, 1–120 mo). One patient under clinical follow-up experienced subarachnoid hemorrhage. The mean angiographic follow-up of 34 patients was 41.8 months (range, 3–120 mo). During this follow-up period, no patient's aneurysm changed in size or configuration.

CONCLUSION:

Wrapping or clip-wrapping of unclippable intracranial aneurysms is safe and seems to confer protection against aneurysmal growth or subarachnoid hemorrhage.
To branch or not to branch: the role of pre-patterning in lateral root formation
Authors: Van Norman Jaimie M. , Xuan Wei , Beeckman Tom , Benfey Philip N.
Published: October 2013

The establishment of a pre-pattern or competence to form new organs is a key feature of the postembryonic plasticity of plant development, and the elaboration of such pre-patterns leads to remarkable heterogeneity in plant form. In root systems, many of the differences in architecture can be directly attributed to the outgrowth of lateral roots. In recent years, efforts have focused on understanding how the pattern of lateral roots is established. Here, we review recent findings that point to a periodic mechanism for establishing this pattern, as well as roles for plant hormones, particularly auxin, in the earliest steps leading up to lateral root primordium development. In addition, we compare the development of lateral root primordia with in vitro plant regeneration and discuss possible common molecular mechanisms.
Rapid identification of kidney cyst mutations by whole exome sequencing in zebrafish
Authors: Ryan Sean , Willer Jason , Marjoram Lindsay , Bagwell Jennifer , Mankiewicz Jamie , Leshchiner Ignaty , Goessling Wolfram , Bagnat Michel , Katsanis Nicholas
Published: October 2013

Forward genetic approaches in zebrafish have provided invaluable information about developmental processes. However, the relative difficulty of mapping and isolating mutations has limited the number of new genetic screens. Recent improvements in the annotation of the zebrafish genome coupled to a reduction in sequencing costs prompted the development of whole genome and RNA sequencing approaches for gene discovery. Here we describe a whole exome sequencing (WES) approach that allows rapid and cost-effective identification of mutations. We used our WES methodology to isolate four mutations that cause kidney cysts; we identified novel alleles in two ciliary genes as well as two novel mutants. The WES approach described here does not require specialized infrastructure or training and is therefore widely accessible. This methodology should thus help facilitate genetic screens and expedite the identification of mutants that can inform basic biological processes and the causality of genetic disorders in humans.
Lysosomal exocytosis and caspase-8 mediated apoptosis in UVA-irradiated keratinocytes
Authors: Appelqvist Hanna , Wäster Petra , Eriksson Ida , Rosdahl Inger , Öllinger Karin
Published: October 2013

Ultraviolet (UV)-irradiation is a major environmental carcinogen involved in the development of skin cancer. To elucidate the initial signaling during UV-induced damage in human keratinocytes, we investigated lysosomal exocytosis and apoptosis induction. UVA, but not UVB, induced plasma membrane damage, which was repaired by Ca2+-dependent lysosomal exocytosis. The lysosomal exocytosis resulted in extracellular release of cathepsin D and acid sphingomyelinase (aSMase). Two hours after UVA we detected activation of caspase-8, which was reduced by addition of anti-aSMAse. Furthermore, caspase-8 activation and apoptosis was reduced by prevention of endocytosis and by the use of cathepsin inhibitors. We conclude that lysosomal exocytosis is part of the keratinocyte response to UVA, and is followed by cathepsin-dependent activation of caspase-8. The findings have implications for the understanding of UV-induced skin damage and emphasize that UVA and UVB initiates apoptosis via different signaling pathways in keratinocytes.
Oncogene PKCε controls INrf2:Nrf2 interaction in normal and cancer cells through INrf2 phosphorylation
Authors: Niture Suryakant K. , Gnatt Averell , Jaiswal Anil K.
Published: October 2013

The INrf2 (Keap1):Nrf2 complex plays a critical role in protection against chemical and radiation-induced oxidative stress and cellular transformation. INrf2 in association with Cul3-Rbx1 ubiquitinylates and degrades Nrf2. Exposure to stressors leads to Nrf2 stabilization and coordinated activation of cytoprotective proteins and cellular protection. However, the molecular signal(s) that regulate INrf2 control of Nrf2 remains elusive. In this report, we demonstrate that oncoprotein PKCε phosphorylation of INrf2 at Ser599 and Ser602 is essential for specific INrf2:Nrf2 interaction and Nrf2 ubiquitination/degradation. Inhibition of PKCε, MEFs lacking PKCε, and the INrf2S602A mutant all failed to phosphorylate INrf2 leading to loss of INrf2:Nrf2 interaction, Nrf2 degradation and enhanced cytoprotection/drug resistance. Molecular modeling analyses revealed that phosphorylation of S599 exposes the deeply buried S602 for phosphorylation and enhanced INrf2:Nrf2 interaction. Analysis of human lung and liver tumor protein arrays showed lower PKCε and higher Nrf2 that presumably promoted cancer cell survival and drug resistance. In conclusion, phosphorylation of INrf2 by PKCε leads to regulation of Nrf2 with significant implications in survival of cancer cells that often express lower levels of PKCε.
A cell body groove housing the new flagellum tip suggests an adaptation of cellular morphogenesis for parasitism in bloodstream formTrypanosoma brucei
Authors: Hughes Louise , Towers Katie , Starborg Tobias , Gull Keith , Vaughan Sue
Published: October 2013

Flagella are highly conserved organelles present in a wide variety of species. In Trypanosoma brucei the single flagellum is necessary for morphogenesis, cell motility and pathogenesis and is attached along the cell body. A new flagellum is formed alongside the old during the cell division cycle. In the (insect) procyclic form, the flagella connector (FC) attaches the tip of the new flagellum to the side of the old flagellum, ensuring faithful replication of cell architecture. The FC is not present in the bloodstream form of the parasite. We show here, using new imaging techniques including serial block face scanning electron microscopy (SBF-SEM), that the distal tip of the bloodstream form new flagellum is embedded within an invagination in the cell body plasma membrane, named the groove. We suggest that the groove has a similar function as the flagella connector. The groove is a mobile junction located alongside the microtubule quartet (MtQ) and occurred within a gap in the subpellicular microtubule corset, causing significant modification of microtubules during elongation of the new flagellum. It appears likely that this novel form of morphogenetic structure has evolved to withstand the hostile immune response in the mammalian blood.
Analytical Modeling of Oil Production from a Matrix Block by Free Fall Gravity Drainage Mechanism
Authors: Ghorbanizadeh Salman , Ardakany Muhammad Shojaadini , Ghazanfari Mohammad Hossein
Published: October 2013

Free fall gravity drainage is the most effective mechanism in gas invaded zone of fractured reservoirs. Although several analytical models have been proposed to characterize this mechanism, most of them suffer from inadequate reality, such as neglecting capillary pressure. In this study, a new analytical model was proposed to predict the oil recovery versus time for a homogeneous matrix block under a free fall gravity drainage mechanism. Considering the effect of viscous, gravity as well as capillary forces, the model was developed. This model is applicable to different conditions of gravity and capillary force, as well as when both forces are active. Along with core scale experimental data available in the literature, a series of micro model experiments was also conducted and used to check the model's validity. In addition, a synthetic computer model was constructed and used for further model validation. Results showed that the suggested model predicts the physics of the gravity drainage mechanism very well. The results of this work can be helpful to develop a new transfer function for gravity drainage process modeling in fractured reservoir.
Fast Pyrolysis of Chestnut Cupulae: Yields and Characterization of the Bio-Oil
Authors: Kar T. , Keleş S.
Published: October 2013

Chestnut cupulae pyrolysis experiments were conducted in a fixed-bed reactor in an attempt to determine the effects of pyrolysis temperature, particle size and sweeping gas (N2) flow rate on the product yields. The maximum bio-oil yield of 52.50 wt% was obtained from chestnut cupulae in N2 atmosphere at a pyrolysis temperature of 600 °C, sweeping gas-flow rate of 100 cm3. min−1 and particle size of Dp ≤ 250 mm. The pyrolysis oils were collected in a cold trap maintained liquid nitrogen and characterized by elemental analysis, FTIR, 1HNMR and GC. Chromatographic and spectroscopic studies on bio-oil have shown that chestnut cupulae can be used as a fuel and chemical feedstock.
Laboratory and Modeling Study on Gas Diffusion with Pore Structures in Different-Rank Chinese Coals
Authors: Zheng Guiqiang , Pan Zhejun , Tang Shuheng , Ling Biaocan , Lv Dawei , Connell Luke D.
Published: October 2013

The coalbed methane production rate is mainly controlled by two parameters: diffusivity in the coal matrix and permeability in the cleat system. As one key parameter, diffusion plays an important role in coalbed methane producing process. However, till now there is no systematic study on the relationship of diffusivity, pore size and coal ranks. In this work, three Chinese coal samples which belong to low, middle and high rank, respectively, were studied using experimental and modeling methods. Four gases, H2, N2, CH4 and CO2, are used to study the diffuse characters at four different pressures steps. The experimental results showed that the adsorption balance time varies with different testing gas type and it is closely related with coal rank. Balance time testing with CO2 is the longest, and then is CH4, while He is the slowest. Moreover, high rank coal takes the longest time to reach balance, while low rank coal takes the least. Generally, the sorption balance time for JCC-01 is about 150–350 S 0.5, it is about 250–400 S 0.5 for CZ-1, while it is about 900–1200 S 0.5 for JCC-01. Modeling results showed that for all these three ranked Chinese coals, the bidisperse model can be used to model the diffuse process. The β value, which is the ratio of macropore adsorption/desorption to the total adsorption/desorption, increases with the increasing of pore pressure, except for sample JCC-01 when measured using CO2. There is no regular law for both micropore and macropore diffusion coefficient. In order to study the relationship of diffusivity, pore structure and coal ranks, the experiments of mercury injection test and low-temperature liquid nitrogen experiment were done to analyse the relationship. The results show that, for the low rank coal sample TCG-1, the mesopore takes the majority while the macropore also takes part of the pore distribution, there are few even no micropore. For middle rank sample CZ-1, the mesopore also takes the majority and the macorpore accounts for a small percentage. While for high rank coal sample JCC-01, micropore takes the majority, and mesopore and macropore take small part of the pore structure distribution. The conclusion drawn from these testing results can be used to explain the adsorption and diffusion laws found before.
Proposing a New Integral Method for Fluid Type Identification from Petrophysical Logs in a Carbonate Reservoir
Authors: Mollajan Amir , Memarian Hossein , Tokhmechi Behzad
Published: October 2013

This paper proposes a new method through combining three data processing techniques: Classification, Wavelet Analysis and Fuzzy Data Fusion, to identify reservoir fluid types from Petrophysical Logs (PLs). The proposed method was applied on well log data of interval of Sarvak Formation related to five wells, located on an oil field in southwestern Iran. The obtained results were compared with production test results to check validation of the introduced method. It is concluded that the method proposed by this research is significantly able to identify different types of reservoir fluids with an average accuracy of 62%. Furthermore, applying data fusion techniques improved the final accuracy of generalization step approximately to 13%.
Wave Propagation and Localization in a Randomly Disordered Periodic Piezoelectric Axial-Bending Coupled Beam
Authors: Zhu Hongping , Ding Lan , Yin Tao
Published: October 2013

The wave propagation and localization in periodic and randomly disordered periodic piezoelectric axial-bending coupled beams are studied in this paper. The dynamic stiffness matrix is derived based on the finite element model and the transfer matrix between two adjacent cells is obtained by using the continuity conditions. In addition, the Lyapunov exponent method is employed to calculate the localization factor characterizing the average exponential rate of decay of the wave amplitude in the disordered periodic structure. Through the comprehensive numerical simulations, the effects of different material and geometric properties as well as disordered parameters on the localization factors are investigated. The results show that wave propagation and localization in the periodic and disordered periodic piezoelectric beam can be altered by properly adjusting the structural parameters.
Long-Term Deflections of Crushed Limestone Sand Concrete Beams
Authors: Zhang Yaoting , Zheng Yi
Published: October 2013

Creep tests of three crushed limestone sand concrete beams were conducted. The mid-span creep deflections and creep deflection coefficients of the beams in the first six months were measured. The results show that the creep deflection is significantly affected by the environmental humidity and temperature conditions. The formula of the mid-span creep deflection is derived based on the creep coefficients for simple supported beams. The mid-span creep deflections of beams are calculated using the CEB-FIP 90, ACI 209, and B3 models to predict the creep coefficient separately. Comparisons between the calculated values and experimental results indicate that the coefficients obtained using the ACI 209 model fit the results best. The formula of the creep coefficient is derived from the mid-span creep deflection. The creep coefficient of crushed limestone sand concrete is calculated from the measured mid-span creep deflection, and a best-fit formula is proposed for the creep coefficient.
Experimental Study on Mitigation Devices of Aeolian Vibration of Bundled Conductors
Authors: Li Li , Cao Huajin , Jiang Yicheng , Chen Yuankun
Published: October 2013

Aeolian vibration of transmission conductors could cause triggering off shares and broken due to fatigue damage and thus of concern. To ensure the safety of electrical transmission systems, mitigation devices are usually installed on the conductors to suppress the aeolian vibration. This paper investigates effects of three types of such devices on bundled conductors experimentally, including spacer dampers, damping lines and stockbridge dampers. For this purpose, vibration tests of twin and four bundled conductors were designed and carried out according to IEEE standards. Firstly, the vibration characteristic of the twin bundled conductors equipped with the spacer damper and stockbridge damper were tested with different installation configuration of wire damper sets. The vibration tests of four bundled conductors were also carried out, and the energy dissipation power calculation of spacer damper has been given. The calculation method of energy dissipation power calculation of spacer damper can reflect the properties of the energy dissipation and the method is proven to be reasonable according to the test.
Seismic Behavior of Long-Span Connected Structures under Multi-Supported and Multi-Dimensional Earthquake Excitations
Authors: Lin W. , Chen S. H. , Yu J. X. , Qi A.
Published: October 2013

Seismic behaviors of long-span connected structures under multi-dimensional and earthquake excitation while considering wave passage effect are investigated through both numerical simulation and a shaking table test on a scaled model. It is found that seismic responses will be increased significantly if multi-dimensional earthquake excitation is considered; and wave-passage effect has diverse influence on different elements. Also special attentions should be paid to those elements near connections between the main tower and the corridor which inertial forces may change a lot when subjected to Traveling wave excitation with different apparent velocities. Moreover, the vertical acceleration responses of the corridor can be increased significantly due to wave passage effect. Therefore, it is necessary for aseismic design of long-span connected structure to take into account multi-dimensional earthquake components and multi-support earthquake excitations with different apparent velocities.
Experimental Study on Dynamic Deformation Characteristics of Weathered Conglomerate under Cyclic Loading
Authors: Dan Zhao , Pen Li-Ming , Chen-Hua Shi , Hong-Yuan Fu
Published: October 2013

The durability and safety of the subway tunnel structure is contingent on the substrate deformation under the subway operating load, which is a low frequency, long-term repetitive dynamic load. Using dynamic tri-axial cyclic loading test, the dynamic strain for weathered conglomerate under low-frequency cyclic loading was studied, while the influence of factors such as dynamic stress amplitude, static deviator stress, confining pressure impaction and loading frequency on dynamic strain of weathered conglomerate were analyzed. The results showed that, the deformation development of weathered conglomerate was basically stable convergence curves under low frequency cyclic loading, and the deformation could be divided into early stage (characterized by an increase in deformation) and stable stage with accumulative deformation in the early stage accounted for more than 90% of the total deformation. For the case of exceeding the critical stress amplitude, strain development of weathered conglomerate was quadratic curve type, and reached failure state. The results of dynamic test could provide useful reference to the dynamic design of subway tunnel.
Comparisons between Modal-Parameter-Based and Flexibility-Based Damage Identification Methods
Authors: Wang X.J. , Zhou X.Q. , Xia Y. , Weng S.
Published: October 2013

Modal parameters and modal flexibility obtained from the modal experiment have been used for damage identification in frequency domain. These two methods are compared in this paper numerically and experimentally. The optimization objective function of the former method is a weighted function of the frequency and mode shape residues, in which different weights can be assigned to the frequencies and mode shapes so that their degrees of accuracy can be taken into account. The optimization objective function of the latter method is the modal flexibility residue. Based on the same modal data, the two methods are compared from different aspects, including the damage configurations and uncertainties in the modal data. Results show that using the modal parameters directly can detect damage more accurately and reliably than using the modal flexibility.