bluuebunny/crossref_metadata_2025 huggingface dataset:
Te homogeneous precipitation in Ge dislocation loop vicinity
Authors: Perrin Toinin J. , Portavoce A. , Texier M. , Bertoglio M. , Hoummada K.
Published: June 2016

High resolution microscopies were used to study the interactions of Te atoms with Ge dislocation loops, after a standard n-type doping process in Ge. Te atoms neither segregate nor precipitate on dislocation loops, but form Te-Ge clusters at the same depth as dislocation loops, in contradiction with usual dopant behavior and thermodynamic expectations. Atomistic kinetic Monte Carlo simulations show that Te atoms are repulsed from dislocation loops due to elastic interactions, promoting homogeneous Te-Ge nucleation between dislocation loops. This phenomenon is enhanced by coulombic interactions between activated Te2+ or Te1+ ions.
Polarization of antiferroelectric ceramics for pulse capacitors under transient electric field
Authors: Xu Ran , Xu Zhuo , Feng Yujun , Wei Xiaoyong , Tian Jingjing , Huang Dong
Published: June 2016

The polarization of (Pb0.94La0.04)[(Zr0.7Sn0.3)0.87Ti0.13]O3 antiferroelectric (AFE) ceramics under unipolar pulse electric field was studied, and the transient hysteresis loop was achieved. Compared to the traditional quasi-static results, the forward transition field increases and the backward transition field decreases. The forward and backward phase transitions can be deduced in microseconds scale. Under the transient field, the releasable energy density decreases significantly, while the stored energy density changes slightly. Consequently, the efficiency decreases and the declination of energy density under transient situation is verified by the charge-discharge experiment. The above results prove the necessity of the study of the transient behaviors in AFE and the limitation of quasi-static analysis.
Numerical investigation of the yawed wake and its effects on the downstream wind turbine
Authors: Miao Weipao , Li Chun , Yang Jun , Xie Xiaoyun
Published: June 2016

A numerical simulation for the wake deviation effect in a wind farm is carried out using the full rotor model of the National Renewable Energy Laboratory 5 MW wind turbine. The downstream wind turbine decreases its performance significantly due to the upstream wake interference. To reduce this effect, a control strategy based on the yaw angle is adopted to skew the trajectory of an upstream wake, thereby avoiding the downstream wind turbine and improving the efficiency of whole wind farm power generation. In this paper, the commercial CFD software STAR-CCM+ was used to simulate the wind farm which contains two tandem wind turbines operating in the atmospheric boundary layer condition. The results show that the wind farm's total power increases when the upstream wind turbine applies a yaw angle intentionally. According to the analysis of velocity contours, wake centerlines, and vortex structures, a counter-rotating blade tip vortex pair is observed to be responsible for the wake deviation effects concentrated on the hub height, which reveals that the influence of a yawed wake on the downstream wind turbine may be slightly underestimated.
Self-assembled nanostructures of linear arylacetylenes and their aza-substituted analogues
Authors: Xu Jia-Ju , Yang Xiong-Bo , Feng Hua , Wang Yu-Long , Shan Hai-Quan , Xu Zong-Xiang , Ng Chi-On , Huang Long-Biao , Ko Chi-Chiu , Roy V. A. L.
Published: June 2016

A series of linear phenylene ethynylene molecules have been synthesized, and aza-substitution has been used as a strategy to fine-tune the properties of the molecules. All the compounds exhibited pure blue emission both in solution and solid state, and fluorescence quantum yields as high as 0.66, 0.63 and 0.82 were found in chloroform solutions. The well-defined nanostructures such as quasi-cubes, cubes and rods were fabricated by self-assembly method from these compounds. The photophysical properties and aggregation behavior of self-assembled structures were analyzed in detail. The morphology as well as photophysical properties of these nanostructures have been tuned with selective requirements.
Investigation of local thermodynamic equilibrium of laser induced Al2O3–TiC plasma in argon by spatially resolved optical emission spectroscopy
Authors: Alnama K. , Alkhawwam A. , Jazmati A. K.
Published: June 2016

Plasma plume of Al2O3–TiC is generated by third harmonic Q-switched Nd:YAG nanosecond laser. It is characterized using Optical Emission Spectroscopy (OES) at different argon background gas pressures 10, 102, 103, 104 and 105 Pa. Spatial evolution of excitation and ionic temperatures is deduced from spectral data analysis. Temporal evolution of Ti I emission originated from different energy states is probed. The correlation between the temporal behavior and the spatial temperature evolution are investigated under LTE condition for the possibility to use the temporal profile of Ti I emission as an indicator for LTE validity in the plasma.
Molecular dynamics simulations of point defect production in cementite and Cr23C6 inclusions in α-iron: Effects of recoil energy and temperature
Authors: Henriksson K. O. E.
Published: June 2016

The number of point defects formed in spherical cementite and Cr23C6 inclusions embedded into ferrite (α-iron) has been studied and compared against cascades in pure versions of these materials (only ferrite, Fe3C, or Cr23C6 in a cell). Recoil energies between 100 eV and 3 keV and temperatures between 400 K and 1000 K were used. The overall tendency is that the number of point defects — such as antisites, vacancy and interstitials — increases with recoil energy and temperature. The radial distributions of defects indicate that the interface between inclusions and the host tend to amplify and restrict the defect formation to the inclusions themselves, when compared to cascades in pure ferrite and pure carbide cells.
An involution based left ideal in the Hecke algebra
Authors: Lusztig G.
Published: June 2016

We show that the Hecke algebra module carried by the involutions in a Weyl group (defined by the author and Vogan) can be identified with a left ideal in the Hecke algebra. An analogous result is proved for any Coxeter group.
Communicating about Climate Change with Corporate Leaders and Stakeholders
Authors: Hoffman Andrew J.
Published: June 2016

Within the corporate sector, climate change represents an unfolding market shift, one that is driven by policy but also by pressures from a variety of market constituents such as consumers, suppliers, buyers, insurance companies, banks, and others. The shift takes place in both mitigation of greenhouse gas emissions and adaptation to the physical effects of a changing climate. It is manifest in shifts in market demand, cost of capital, operational efficiency, energy efficiency, access to raw materials within supply chains, and other issues of business concern. In fact, when viewed in this way, business leaders and stakeholders can be agnostic about the science of climate change and still see it as a business issue. In the face of a market shift, successful companies must innovate. And as in any market shift, the implications of addressing climate change are not uniform; the burden will not fall evenly. There are both risks and opportunities; there will be both winners and losers. Certain companies, industries, and sectors will be impacted more than others. This article will discuss the ways in which climate change poses market risk and the strategic responses that companies might adopt to respond to and mitigate that risk. This focus is critically important as the solutions to climate change must come from the market. The market is the most powerful institution on earth, and business is the most powerful entity within it. The market compels business to make the goods and services we rely upon: the clothes we wear, the food we eat, the forms of mobility we use, and the buildings we live and work in. If the market does not lead the way toward solutions for a carbon-neutral world, there will be no solutions.
Predictive Performance of Echocardiographic Parameters for Cardiovascular Events Among Elderly Treated Hypertensive Patients
Authors: Chowdhury Enayet K. , Jennings Garry L.R. , Dewar Elizabeth , Wing Lindon M.H. , Reid Christopher M.
Published: June 2016

BACKGROUND

Hypertension leads to cardiac structural and functional changes, commonly assessed by echocardiography. In this study, we assessed the predictive performance of different echocardiographic parameters including left ventricular hypertrophy (LVH) on future cardiovascular outcomes in elderly hypertensive patients without heart failure.

METHODS

Data from LVH substudy of the Second Australian National Blood Pressure trial were used. Echocardiograms were performed at entry into the study. Cardiovascular outcomes were identified over short term (median 4.2 years) and long term (median 10.9 years). LVH was defined using threshold values of LV mass (LVM) indexed to either body surface area (BSA) or height 2.7 : >115/95g/m 2 (LVH-BSA 115/95 ) or ≥49/45g/m 2.7 (LVH-ht 49/45 ) in males/females, respectively, and ≥125g/m 2 (LVH-BSA 125 ) or ≥51g/m 2.7 (LVH-ht 51 ) for both sexes.

RESULTS

In the 666 participants aged ≥65 years in this analysis, LVH prevalence at baseline was 33%–70% depending on definition; and after adjusting for potential risk factors, only LVH-BSA 115/95 predicted both short- and long-term cardiovascular outcomes. Participants having LVH-BSA 115/95 (69%) at baseline had twice the risk of having any first cardiovascular event over the short term (hazard ratio, 95% confidence interval: 2.00, 1.12–3.57, P = 0.02) and any fatal cardiovascular events (2.11, 1.21–3.68, P = 0.01) over the longer term. Among other echocardiographic parameters, LVM and LVM indexed to either BSA or height 2.7 predicted cardiovascular events over both short and longer term.

CONCLUSIONS

In elderly treated hypertensive patients without heart failure, determining LVH by echocardiography is highly dependent on the methodology adopted. LVH-BSA 115/95 is a reliable predictor of future cardiovascular outcomes in the elderly.
Evaluating the molecule-based prediction of clinical drug responses in cancer
Authors: Ding Zijian , Zu Songpeng , Gu Jin
Published: June 2016

Motivation: Molecule-based prediction of drug response is one major task of precision oncology. Recently, large-scale cancer genomic studies, such as The Cancer Genome Atlas (TCGA), provide the opportunity to evaluate the predictive utility of molecular data for clinical drug responses in multiple cancer types.

Results: Here, we first curated the drug treatment information from TCGA. Four chemotherapeutic drugs had more than 180 clinical response records. Then, we developed a computational framework to evaluate the molecule based predictions of clinical responses of the four drugs and to identify the corresponding molecular signatures. Results show that mRNA or miRNA expressions can predict drug responses significantly better than random classifiers in specific cancer types. A few signature genes are involved in drug response related pathways, such as DDB1 in DNA repair pathway and DLL4 in Notch signaling pathway. Finally, we applied the framework to predict responses across multiple cancer types and found that the prediction performances get improved for cisplatin based on miRNA expressions. Integrative analysis of clinical drug response data and molecular data offers opportunities for discovering predictive markers in cancer. This study provides a starting point to objectively evaluate the molecule-based predictions of clinical drug responses.

Contact:  jgu@tsinghua.edu.cn

Supplementary information:  Supplementary data are available at Bioinformatics online.
Relapsing drug-induced hypersensitivity syndrome
Authors: Tan Sze-Chin , Chan Grace Y.L.
Published: June 2016

Purpose of review

Drug-induced hypersensitivity syndrome (DIHS) is a serious adverse drug reaction with potential morbidity and mortality. ‘Flare up’ or relapses in DIHS is a rare but important feature. These relapses may occur within days to several weeks, even after discontinuation of the offending drug. In this article, we review the pathogenesis of DIHS, implication of human herpesvirus 6 reactivation, and describe published case reports of patients with relapsing DIHS.

Recent findings

Common drugs associated with DIHS include (but are not limited to) antiepileptics such as carbamazepine, phenytoin, and valproic acid; antituberculous drugs; sulfasalazine; allopurinol; and antivirals such as abacavir and nevirapine. Relapses may occur even after cessation of the culprit drug and appropriate management with corticosteroids. Studies have suggested that reactivation of herpesvirus, particularly, human herpesvirus 6, is the main cause of relapses. However, other pathomechanisms have been proposed – case reports have described the importance of drug cosensitization. In such cases, the introduction of a second drug (often an antibiotic) induces the relapse of DIHS. DIHS may also cause multiple drug allergies, where a patient develops sensitisation to other drugs which were previously well tolerated.

Large studies are lacking in this heterogeneous condition. More research is needed to further understand the pathogenesis of drug cosensitization and multiple drug allergies, role of genetics, identification of risk factors, and prevention of relapses in DIHS.
Inequities in Academic Compensation by Gender: A Follow-up to the National Faculty Survey Cohort Study
Authors: Freund Karen M. , Raj Anita , Kaplan Samantha E. , Terrin Norma , Breeze Janis L. , Urech Tracy H. , Carr Phyllis L.
Published: June 2016

Purpose

Cross-sectional studies have demonstrated gender differences in salaries within academic medicine. No research has assessed longitudinal compensation patterns. This study sought to assess longitudinal patterns by gender in compensation, and to understand factors associated with these differences in a longitudinal cohort.

Method

A 17-year longitudinal follow-up of the National Faculty Survey was conducted with a random sample of faculty from 24 U.S. medical schools. Participants employed full-time at initial and follow-up time periods completed the survey. Annual pretax compensation during academic year 2012–2013 was compared by gender. Covariates assessed included race/ethnicity; years since first academic appointment; retention in academic career; academic rank; departmental affiliation; percent effort distribution across clinical, teaching, administrative, and research duties; marital and parental status; and any leave or part-time status in the years between surveys.

Results

In unadjusted analyses, women earned a mean of $20,520 less than men (P = .03); women made 90 cents for every dollar earned by their male counterparts. This difference was reduced to $16,982 (P = .04) after adjusting for covariates. The mean difference of $15,159 was no longer significant (P = .06) when adjusting covariates and for those who had ever taken a leave or worked part-time.

Conclusions

The continued gender gap in compensation cannot be accounted for by metrics used to calculate salary. Institutional actions to address these disparities include both initial appointment and annual salary equity reviews, training of senior faculty and administrators to understand implicit bias, and training of women faculty in negotiating skills.
Factors Associated With Attainment of Specialty Board Qualifications and Doctor of Medical Science Degrees Among Japanese Female Doctors
Authors: Chatani Yuki , Nomura Kyoko , Ishiguro Aya , Jagsi Reshma
Published: June 2016

Purpose

Specialty board qualifications or doctor of medical science (DMSc) degrees are essential for women‘s promotion to leadership positions in medicine in Japan. The authors examined what personal and professional characteristics of female doctors were associated with attainment of specialty board qualifications and DMSc degrees.

Method

This study was based on alumnae surveys of 13 private medical schools in Japan conducted from 2009 to 2011 and investigating 882 alumnae who had at least one child (mean age 47 years). Multinomial logistic regression models were applied to investigate factors associated with attainment of specialty board qualifications alone, DMSc degrees alone, and both, compared with attainment of neither specialty board qualifications nor DMSc degrees.

Results

In total, 34% of the sample obtained both specialty board qualifications and DMSc degrees, 33% obtained specialty board qualifications only, 9% obtained DMSc degrees only, and 24% obtained neither. A one-year increase in age at the time of first birth was associated with an increased likelihood of attaining a specialty board qualification and/or a DMSc versus having neither qualification (P < .0001). Women who resigned from their jobs instead of taking maternity leave at the time of first childbirth had a significantly lower likelihood ratio of obtaining specialty board qualifications either alone or in conjunction with DMSc degrees (P < .0001).

Conclusions

Earlier age and job resignation at the time of first childbirth among physician–mothers in Japan were associated with failure to attain specialty board qualifications and DMSc degrees, with important implications for future career advancement.
Is Science Built on the Shoulders of Women? A Study of Gender Differences in Contributorship
Authors: Macaluso Benoit , Larivière Vincent , Sugimoto Thomas , Sugimoto Cassidy R.
Published: June 2016

Purpose

Women remain underrepresented in the production of scientific literature, and relatively little is known regarding the labor roles played by women in the production of knowledge. This study examined labor roles by gender using contributorship data from science and medical journals published by the Public Library of Science (PLOS), which require each author to indicate their contribution to one or more of the following tasks: (1) analyzed the data, (2) conceived and designed the experiments, (3) contributed reagents/materials/analysis tools, (4) performed the experiments, and (5) wrote the paper.

Method

The authors analyzed contribution data from more than 85,000 articles published between 2008 and 2013 in PLOS journals with respect to gender using both descriptive and regression analyses.

Results

Gender was a significant variable in determining the likelihood of performing a certain task associated with authorship. Women were significantly more likely to be associated with performing experiments, and men were more likely to be associated with all other authorship roles. This holds true controlling for academic age: Although experimentation was associated with academically younger scholars, the gap between male and female contribution to this task remained constant across academic age. Inequalities were observed in the distribution of scientific labor roles.

Conclusions

These disparities have implications for the production of scholarly knowledge, the evaluation of scholars, and the ethical conduct of science. Adopting the practice of identifying contributorship rather than authorship in scientific journals will allow for greater transparency, accountability, and equitable allocation of resources.
An Integrated Framework for Gender Equity in Academic Medicine
Authors: Westring Alyssa , McDonald Jennifer M. , Carr Phyllis , Grisso Jeane Ann
Published: June 2016

In 2008, the National Institutes of Health funded 14 R01 grants to study causal factors that promote and support women’s biomedical careers. The Research Partnership on Women in Biomedical Careers, a multi-institutional collaboration of the investigators, is one product of this initiative.

A comprehensive framework is needed to address change at many levels—department, institution, academic community, and beyond—and enable gender equity in the development of successful biomedical careers. The authors suggest four distinct but interrelated aspects of culture conducive to gender equity: equal access to resources and opportunities, minimizing unconscious gender bias, enhancing work–life balance, and leadership engagement. They review the collection of eight articles in this issue, which each address one or more of the four dimensions of culture. The articles suggest that improving mentor–mentee fit, coaching grant reviewers on unconscious bias, and providing equal compensation and adequate resources for career development will contribute positively to gender equity in academic medicine.

Academic medicine must adopt an integrated perspective on culture for women and acknowledge the multiple facets essential to gender equity. To effect change, culture must be addressed both within and beyond academic health centers (AHCs). Leaders within AHCs must examine their institutions’ processes, resources, and assessment for fairness and transparency; mobilize personnel and financial resources to implement evidence-based initiatives; and assign accountability for providing transparent progress assessments. Beyond AHCs, organizations must examine their operations and implement change to ensure parity of funding, research, and leadership opportunities as well as transparency of assessment and accreditation.
A Conceptual Framework for Understanding the Role of Adverse Childhood Experiences in Pediatric Chronic Pain
Authors: Nelson Sarah M. , Cunningham Natoshia R. , Kashikar-Zuck Susmita
Published: June 2016

Objectives:

This review outlines a conceptual framework adapted from the biopsychosocial model of pain to examine the relationship between adverse childhood experiences (ACEs) and chronic pain in youth to highlight the state of current research and guide future efforts.

Methods:

A review of the literature was performed in the areas of ACEs and health outcomes with general adult and pediatric populations in addition to studies within the pain literature. Potential relationships between ACEs, chronic pain, and its impact in youth are outlined and discussed.

Results:

The literature suggests an association between adverse outcomes of ACEs and chronic pain in children and adolescents although causal links have not been confirmed. However, ACEs are associated with multiple risk factors identified in the biopsychosocial model of pain, and may serve to exacerbate or confer heightened risk for pain and poor outcomes.

Discussion:

Adverse experiences in childhood may be associated with greater risk for the development/maintenance of chronic pain in youth. More research is needed on ACEs and how they uniquely affect the biopsychosocial mechanisms underlying chronic pain in children throughout the lifespan.
Immune Modulation by Volatile Anesthetics
Authors: Stollings Lindsay M. , Jia Li-Jie , Tang Pei , Dou Huanyu , Lu Binfeng , Xu Yan
Published: June 2016

Volatile general anesthetics continue to be an important part of clinical anesthesia worldwide. The impact of volatile anesthetics on the immune system has been investigated at both mechanistic and clinical levels, but previous studies have returned conflicting findings due to varied protocols, experimental environments, and subject species. While many of these studies have focused on the immunosuppressive effects of volatile anesthetics, compelling evidence also exists for immunoactivation. Depending on the clinical conditions, immunosuppression and activation due to volatile anesthetics can be either detrimental or beneficial. This review provides a balanced perspective on the anesthetic modulation of innate and adaptive immune responses as well as indirect effectors of immunity. Potential mechanisms of immunomodulation by volatile anesthetics are also discussed. A clearer understanding of these issues will pave the way for clinical guidelines that better account for the impact of volatile anesthetics on the immune system, with the ultimate goal of improving perioperative management.
Emergency Cricothyrotomy Performed by Surgical Airway–naive Medical Personnel
Authors: Heymans Frédéric , Feigl Georg , Graber Stephan , Courvoisier Delphine S. , Weber Kerstin M. , Dulguerov Pavel
Published: June 2016

Background

When conventional approaches to obtain effective ventilation and return of effective spontaneous breathing fail, surgical airway is the last rescue option. Most physicians have a limited lifetime experience with cricothyrotomy, and it is unclear what method should be taught for this lifesaving procedure. The aim of this study is to compare the performance of medical personnel, naive to surgical airway techniques, in establishing an emergency surgical airway in cadavers using three commonly used cricothyrotomy techniques.

Methods

Twenty medical students, without previous knowledge of surgical airway techniques, were randomly selected from their class. After training, they performed cricothyrotomy by three techniques (surgical, Melker, and QuickTrach II) in a random order on 60 cadavers with comparable biometrics. The time to complete the procedure, rate of success, and number of complications were recorded. A success was defined as the correct placement of the cannula within the trachea in 3 min.

Results

The success rates were 95, 55, and 50% for surgical cricothyrotomy, QuickTrach, and Melker, respectively (P = 0.025). The majority of failures were due to cannula misplacement (15 of 20). In successful procedures, the mean procedure time was 94 ± 35 s in the surgical group, 77 ± 34 in the QuickTrach II group, and 149 ± 24 in the Melker group (P < 0.001). Few significant complications were found in successful procedures. No cadaver biometric parameters were correlated with success of the procedure.

Conclusion

Surgical airway–naive medical personnel establish emergency cricothyrotomy more efficiently and safely with the surgical procedure than with the other two commonly used techniques.
Deep Surgical Site Infections Following Pediatric Cervical Spine Surgery
Authors: Porter David A. , Glotzbecker Michael P. , Timothy Hresko M. , Hedequist Daniel J.
Published: June 2016

Summary of Background Data:

This is the first reported series looking specifically at factors associated with deep surgical site infections (SSI) following pediatric cervical spine surgery.

Objective:

To identify risk factors present in pediatric patients who are at risk for SSI following cervical spine surgery.

Design:

Level of evidence: level IV—retrospective case series.

Introduction:

To date there are no studies regarding SSI in pediatric cervical spine surgery and thus no benchmark data or risk factors have been identified.

Methods:

Patients with acute deep SSIs occurring within 90 days of the index operation were identified. Patient and surgical characteristics were analyzed for possible predictors of SSI outcome using penalized likelihood logistic regression analysis. Characteristics analyzed included: age, diagnosis, comorbidity, levels fused, approach, implants used, allograft, halo, body mass index, revision, antibiotic dosing, and occipital plating.

Results:

A total of 112 patients were included in the study at a mean age of 12.5 years (2 to 18 y). Comorbidities were present in 51 (46%) patients, 15 patients had a documented connective tissue disorder (CTD). The mean number of levels fused was 3.7 (2 to 7) and mean number of screws was 4.4 (2 to 11). Allograft was used alone in 48 patients, occipital plating in 28 patients, and a halo in 39 patients. Deep SSI occurred in 3 patients: two of which had a CTD (1 Trisomy 21, 1 Ehlers-Danlos) and 1 patient with postradiation cervical kyphosis. All were gram-positive infections requiring return to operating room with prolonged IV antibiotics. All patients recovered and fused with spinal implant retention. The incidence of deep SSI was 2.7%. It was determined that a CTD was the only significant predictor of SSI. Subjects with a CTD had 12 times the odds of SSI [odds ratio=12 (1.5, 137.0); P=0.02].

Conclusions:

In our series of pediatric patients the incidence of a deep SSI was 2.7%. The only predictor of SSI was the presence of a CTD.
Intraperitoneal-Free Cancer Cells Represent a Major Prognostic Factor in Colorectal Peritoneal Carcinomatosis
Authors: Trilling B. , Cotte E. , Vaudoyer D. , Isaac S. , Piaton E. , Maurice C. , Glehen O. , Passot G.
Published: June 2016

BACKGROUND:

Intraperitoneal-free cancer cells are considered as an important prognostic tool in gastric and ovarian cancer. However, their significance in colorectal cancer remains more controversial.

OBJECTIVE:

This study aimed to determine the role of intraperitoneal-free cancer cells as a prognostic tool in the outcome in colorectal peritoneal carcinomatosis treated with curative intent by complete cytoreductive surgery.

DESIGN:

This study is an analysis of a prospectively maintained database.

PATIENTS:

Between 1991 and 2012, all patients treated in a single institution for colorectal peritoneal carcinomatosis by complete cytoreductive surgery with peritoneal cytology available were evaluated. Peritoneal cytology was stained in the conventional way (May Grumwald Giemsa).

RESULTS:

Among a population of 162 patients treated for colorectal peritoneal carcinomatosis by complete cytoreductive surgery, 38 presented positive intraperitoneal-free cancer cells (23.5%). Systemic chemotherapy was administered to 135 patients (85%) during the preoperative course. Median follow-up was 34.5 months. Median overall survival was 19 and 44 months for positive and negative intraperitoneal-free cancer cells (p = 0.018). In multivariate analysis, Peritoneal Carcinomatosis Index and positive intraperitoneal-free cancer cells were significant prognostic factors of overall survival (HR, 2.3 (1.18–4.52), p = 0.014; HR, 1.9 (1.08–3.38), p = 0.027).

LIMITATIONS:

Retrospective analysis and the long period were limitations of study.

CONCLUSION:

Along with the Peritoneal Carcinomatosis Index, intraperitoneal-free cancer cells are a strong prognostic factor for patients treated with curative intent for colorectal peritoneal carcinomatosis by complete cytoreductive surgery. The presence of intraperitoneal-free cancer cells should lead to the consideration of different treatment strategies such as extensive intraperitoneal lavage, targeted intraperitoneal therapies, or repeated intraperitoneal chemotherapy.
National Early Rectal Cancer Treatment Revisited
Authors: Stornes Tore , Wibe Arne , Nesbakken Arild , Myklebust Tor Å. , Endreseth Birger H.
Published: June 2016

BACKGROUND:

Treatment of early stage rectal cancer has excellent oncological results. To reduce treatment-related mortality and morbidity and improve functional results, a focus on local resections is increasingly important.

OBJECTIVE:

The purpose of this study was to compare outcomes after transanal endoscopic microsurgery and total mesorectal excision for early stage rectal cancer (T1 + T2) in Norway.

DESIGN:

This was an observational study based on prospective data from the Norwegian Colorectal Cancer Registry.

SETTINGS:

The study was conducted as a national, population-based study.

PATIENTS:

All 543 patients with T1 and 1593 patients with T2 rectal cancer without distant metastases that was treated by transanal endoscopic microsurgery or total mesorectal excision without radiochemotherapy during 2000–2009 were included.

MAIN OUTCOME MEASURES:

The primary outcomes were 5-year relative survival and 5-year local recurrence rate.

RESULTS:

Among 543 patients with T1 cancer, the 5-year overall survival rate was 65.3% after transanal endoscopic microsurgery versus 81.5% after total mesorectal excision (p = 0.012). Adjusted for age and sex there was no excess mortality for transanal endoscopic microsurgery (HR = 1.28 (95% CI, 0.8–1.9); p = 0.22). The 5-year relative survival rate was 96.8% after transanal endoscopic microsurgery versus 98.2% after total mesorectal excision (p = 0.603), and the 5-year local recurrence rate was 14.5% versus 1.4% (p < 0.001). Among 1593 patients with T2 cancer, 5-year overall survival was 42.1% versus 76.1% (p < 0.001), 5-year relative survival was 65.4% versus 93.9% (p < 0.001), and 5 year local recurrence rate was 11.4% versus 4.4% in the 2 groups.

LIMITATIONS:

The study is limited by its observational design and that the 2 groups were different according to patient and tumor characteristics. Another limitation was the low number of transanal endoscopic microsurgery procedures.

CONCLUSIONS:

Transanal endoscopic microsurgery had comparable 5-year relative survival to total mesorectal excision in T1 rectal cancer but inferior 5-year relative survival in T2 rectal cancer. Transanal endoscopic microsurgery was associated with higher local recurrence rates for both T1 and T2 tumors.
Dual-Energy CT of Rectal Cancer Specimens
Authors: al-Najami Issam , Beets-Tan Regina G. H. , Madsen Gunvor , Baatrup Gunnar
Published: June 2016

BACKGROUND:

An accurate method to assess malignant lymph nodes in the mesorectum is needed. Dual-energy CT scans simultaneously with 2 levels of energy and thereby provides information about tissue composition based on the known effective Z value of different tissues. Each point investigated is represented by a certain effective Z value, which allows for information on its composition.

OBJECTIVE:

We wanted to standardize a method for dual-energy scanning of rectal specimens to evaluate the sensitivity and specificity of benign versus malignant lymph node differentiation. Histopathological evaluation of the nodes was our reference.

DESIGN:

This was a descriptive and prospective study.

SETTINGS:

Seventeen rectal specimens were examined in 2 series. The first series was conducted with 3 specimens from patients who were not given perioperative contrast; 3 had iodine-based contrast and 3 had gadolinium-based contrast. We concluded that iodine was the contrast agent of choice and therefore included 8 more patients in a second series, given iodine-based contrast, for further analysis.

PATIENTS:

Quantitative imaging data were collected from 197 individual lymph nodes from 17 specimens, from patients with rectal cancer.

MAIN OUTCOME MEASURES:

We measured accuracy of differentiating benign from malignant lymph nodes by investigating the following: 1) gadolinium, iodine, and water concentrations in lymph nodes; 2) dual-energy ratio; 3) dual-energy index; and 4) effective Z value.

RESULTS:

Optimal discriminations between benign and malignant lymph nodes were obtained using the following cutoff values: 1) effective Z at 7.58 (sensitivity, 100%; specificity, 90%; and accuracy, 93%), 2) dual-energy ratio at 1.0 × 10−4 (sensitivity, 96%; specificity, 87%; and accuracy, 90%), 3) dual-energy index at 0.03 (sensitivity, 97%; specificity, 88%; and accuracy, 91%), and 4) iodine concentration at 2.58 μg/mL (sensitivity, 86%; specificity, 92%; and accuracy, 89%).

LIMITATIONS:

The investigation is conducted on isolated surgical specimens from rectal cancer operations.

CONCLUSIONS:

Dual-energy CT can be performed on rectal specimens. The discrimination between benign and malignant nodes seems promising when using iodine as contrast.
Systematic Review and Meta-Analysis of Extraperitoneal Versus Transperitoneal Colostomy for Preventing Parastomal Hernia
Authors: Kroese Leonard F. , de Smet Gijs H. J. , Jeekel Johannes , Kleinrensink Gert-Jan , Lange Johan F.
Published: June 2016

BACKGROUND:

Parastomal hernia remains a frequent problem after constructing a colostomy. Current research mainly focuses on prophylactic mesh placement as an addition to transperitoneal colostomies. However, for constructing a colostomy, either an extraperitoneal or transperitoneal route can be chosen.

OBJECTIVE:

The aim of this meta-analysis was to investigate which technique results in lower parastomal hernia rates in patients undergoing end colostomy.

DATA SOURCES:

A meta-analysis was conducted according to Preferred Items for Reporting of Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. Embase, MEDLINE, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane, PubMed, and Google Scholar databases were searched. The study protocol was registered in the International Prospective Register of Systematic Reviews database.

STUDY SELECTION:

Studies comparing extraperitoneal and transperitoneal colostomies were included. Only studies written in English were included. The quality of studies and risk of bias were assessed using the Cochrane risk-of-bias tool. The quality of nonrandomized studies was assessed using the Newcastle–Ottawa Scale.

INTERVENTION:

The intervention was colostomy formation.

MAIN OUTCOME MEASURES:

The main outcome measure was parastomal hernia incidence. Secondary outcome measures were stoma prolapse, stoma necrosis, and operating time.

RESULTS:

Of 401 articles found, a meta-analysis was conducted of 10 studies (2 randomized controlled trials and 8 retrospective studies) composed of 1048 patients (347 extraperitoneal and 701 transperitoneal). Extraperitoneal colostomy led to significantly lower parastomal hernia rates (22 of 347 (6.3%) for extraperitoneal versus 125 of 701 (17.8%) for transperitoneal; risk ratio = 0.36 (95% CI, 0.21–0.62); I2 = 26%; p < 0.001) and significantly lower stoma prolapse rates (2 of 185 (1.1%) for extraperitoneal versus 13 of 179 (7.3%) for transperitoneal; risk ratio = 0.21 (95% CI, 0.06–0.73); I2 = 0%; p = 0.01). Differences in stoma necrosis were not significant. Operating time data were insufficient to analyze.

LIMITATIONS:

Most of the studies were nonrandomized, and some were not recent publications.

CONCLUSIONS:

Although the majority of studies included were retrospective, extraperitoneal colostomy was observed to lead to a lower rate of parastomal hernia and stoma prolapse.
The Effects of Physical Exercises on Ocular Physiology: A Review
Authors: Wylęgała Adam
Published: June 2016

Sport has been known to be one of the most important factors in preventing cardiovascular disorders; some studies suggest its role in preventing neurodegenerative diseases. This review discusses the results of various studies regarding the effects of physical exercises on intraocular pressure (IOP), myopia, certain physical parameters of the eye, ocular blood flow, and retinal electrical function. Although dynamic exercises are known to reduce IOP from 1.2 to 5.9 mm Hg only for a short period of time, uncertainty persists about whether isometric exercises or activities such as yoga can increase IOP up to 16.7 mm Hg. There has been an established connection between the time being spent outdoor and reduction in the odds of myopia—2% less odds for every hour spent outdoor. Physical activity and the level of physical fitness have an impact on the changes of b-wave electroretinogram and P100. Physical exercises increase perfusion pressure up to 190% baseline and also increase choroidal blood flow up to 140%, thus providing more blood to retina. Sport-induced change on visual field is a subject of controversy. Majority of patients show a better ocular physiological function due to sports and sports are thus considered essential for preventing common ocular diseases. Further research should focus more on long-term effects of sport-induced changes in ocular physiology and newly discovered techniques may be utilized for such purposes.
A Concomitant Case of Orbital Granuloma Faciale and Eosinophilic Angiocentric Fibrosis
Authors: Chen Valerie H. , Grossniklaus Hans E. , DelGaudio John M. , Kim Hee Joon
Published: June 2016

Granuloma faciale is an eosinophilic dermatosis that typically presents as red-brown facial plaques of middle-aged white men, while eosinophilic angiocentric fibrosis is a histologically similar fibrotic condition affecting the respiratory mucosa. Both are very uncommon conditions and pose a therapeutic challenge. While a handful of reports have reported concurrent presentation, the authors present the first case of eyelid granuloma faciale with eosinophlilic angiocentric fibrosis.
Symptoms Suggestive of Acute Coronary Syndrome
Authors: DeVon Holli A. , Burke Larisa A. , Vuckovic Karen M. , Haugland Trude , Eckhardt Ann L. , Patmon Frances , Rosenfeld Anne G.
Published: June 2016

Background:

Studies have identified sex differences in symptoms of acute coronary syndrome (ACS); however, retrospective designs, abstraction of symptoms from medical records, and variations in assessment forms make it difficult to determine the clinical significance of sex differences.

Objective:

The aim of this study is to determine the influence of sex on the occurrence and distress of 13 symptoms for patients presenting to the emergency department for symptoms suggestive of ACS.

Methods:

A total of 1064 patients admitted to 5 emergency departments with symptoms triggering a cardiac evaluation were enrolled. Demographic and clinical variables, symptoms, comorbid conditions, and functional status were measured.

Results:

The sample was predominantly male (n = 664, 62.4%), white (n = 739, 69.5%), and married (n = 497, 46.9%). Women were significantly older than men (61.3 ± 14.6 vs 59.5 ± 13.6 years). Most patients were discharged with a non-ACS diagnosis (n = 590, 55.5%). Women with ACS were less likely to report chest pain as their chief complaint and to report more nausea (odds ratio [OR], 1.56; confidence interval [CI], 1.00–2.42), shoulder pain (OR, 1.76; CI, 1.13–2.73), and upper back pain (OR, 2.92; CI, 1.81–4.70). Women with ACS experienced more symptoms (6.1 vs 5.5; P = .026) compared with men. Men without ACS had less symptom distress compared with women.

Conclusions:

Women and men evaluated for ACS reported similar rates of chest pain but differed on other classic symptoms. These findings suggest that women and men should be counseled that ACS is not always accompanied by chest pain and multiple symptoms may occur simultaneously.
Aripiprazole-Associated Hypoprolactinemia in the Clinical Setting
Authors: Sogawa Rintaro , Shimomura Yuki , Minami Chikako , Maruo Joji , Kunitake Yutaka , Mizoguchi Yoshito , Kawashima Toshiro , Monji Akira , Hara Hideo
Published: June 2016

Background

The increase in prolactin (PRL) levels is a common adverse effect that occurs when using conventional and atypical antipsychotic drugs. Aripiprazole (ARI) is beneficial for antipsychotic-associated hyperprolactinemia but has been reported to decrease PRL secretion. Therefore, we investigated blood levels of PRL in patients who had taken ARI alone or in combination with other antipsychotics.

Methods

Retrospective information was obtained from 25 psychiatric patients who were prescribed ARI, and the blood levels of PRL were measured.

Results

The incidence of hypoprolactinemia in the current study was 44.0% (11/25). Eighteen patients were treated with ARI alone and 7 received ARI in combination with other antipsychotics. The PRL value of patients who took ARI alone was significantly lower than those who were also taking other antipsychotics (5.45 ± 3.93 vs 10.85 ± 5.53, P = 0.02; mean ± SD). There was no significant correlation of the PRL levels and dose of ARI used in the 18 patients who had taken ARI alone.

Limitations

This was a retrospective study, and the data were obtained from a small number of psychiatric patients treated with ARI.

Conclusions

Monitoring of PRL levels in patients treated with ARI may be useful in minimizing hypoprolactinemia, which has the potential to negatively impact patients. In particular, hypoprolactinemia as a consequence of taking ARI should be discussed with patients of childbearing age and those with immune deficiencies.
Treatment of warts and molluscum: what does the evidence show?
Authors: Sterling Jane
Published: June 2016

Purpose of review

Warts and molluscum contagiosum are very common viral skin infections, usually presenting in childhood. Despite the large number of people affected by them, high-quality trials of treatment are few and treatment is often chosen on the basis of cost, convenience and tradition.

Recent findings

Over recent years, two further trials of the most commonly used treatments for warts, salicylic acid and cryotherapy, have been performed and for molluscum contagiosum, there is growing evidence for the use of irritants. For both infections, there are new evaluations of immunological approaches to therapy.

Strong, high-quality evidence for treatments used very frequently for warts or molluscum is still lacking, but recent publications have helped to strengthen or weaken belief in commonly used therapies and to add weight to the immunological approach to management.
Systematic Review
Authors: Pieścik‐Lech Małgorzata , Chmielewska Anna , Shamir Raanan , Szajewska Hania
Published: June 2016

Background:

In addition to genetic background, a number of environmental factors have been claimed to influence the development of type 1 diabetes (T1D), including infant diet.

Objective:

The aim of the study was to systematically update evidence on the possible relation between early feeding practices and the risk of T1D.

Methods:

The Cochrane Library, MEDLINE, EMBASE, Web of Science, and CINAHL were searched for studies of any design up to July 2015. MEDLINE and EMBASE were additionally searched in March 2016. The primary outcome measures were the development of T1D or T1D‐associated autoimmunity (T1DA).

Results:

Nine publications were identified. Breastfeeding at the time of gluten introduction, as compared to gluten introduction after weaning, did not reduce the risk of developing T1DA or T1D. In children at high risk of developing T1D, except for gluten introduction at 3 months or younger age compared with gluten introduction at older than 3 months, which increased the risk of T1DA, the age of gluten introduction in infants had no effect on the risk of developing T1DA.

Conclusions:

Current evidence, mainly from observational studies, does not support the claim that early infant feeding practices, such as breastfeeding at gluten introduction or the age of the infant at the time of gluten introduction, may decrease the risk of developing T1D. More robust data are needed from randomized controlled trials.
Sustaining Health Care Interventions to Achieve Quality Care
Authors: Stolldorf Deonni P.
Published: June 2016

Rapid response team (RRT) adoption and implementation are associated with improved quality of care of patients who experience an unanticipated medical emergency. The sustainability of RRTs is vital to achieve long-term benefits of these teams for patients, staff, and hospitals. Factors required to achieve RRT sustainability remain unclear. This study examined the relationship between sustainability elements and RRT sustainability in hospitals that have previously implemented RRTs.