bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid Pacing for Better Placing: Comparison of Techniques for Precise Deployment of Endografts in the Thoracic Aorta
Authors: Nienaber Christoph A. , Kische Stephan , Rehders Tim C. , Schneider Henrik , Chatterjee Tushar , Bünger Carsten Michael , Höppner Regina , Ince Hüseyin
Published: March 2015

Purpose:

To investigate the safety, efficacy, impact on positioning, and neurocognitive outcomes of 3 conceptually different methods of avoiding the “windsock” effect during thoracic stent-graft placement.

Methods:

A retrospective review was conducted of 70 patients (48 men; mean age 63 years) who underwent elective or emergency stent-graft placement in the thoracic aorta for various pathologies. Twenty-seven patients (18 men; mean age 64±12 years) had stent-graft positioning during rapid right ventricular (RV) pacing at 180 to 200 beats per minute. Another 27 patients (18 men; mean age 62±12 years) had stent-graft placement under controlled hypotension (≤45 mmHg) achieved with sodium nitroprusside (3 µg/kg/min). Sixteen patients (12 men; mean age 63±14 years) had intermittent cardiac arrest induced by a 0.5-mg/kg adenosine bolus prior to launching the stent-graft. Termination of the endovascular procedure, weaning, and recovery were conducted according to the same routines in all patients. Hemodynamics, landing precision (deviation from planned placement site), cerebral blood flow, and neurocognitive function were compared.

Results:

Rapid RV pacing (median 12 seconds) was conducted without technical difficulty or delayed recovery in any of the 27 patients. Once rapid pacing ceased, blood pressure recovered within 8 seconds from 22±8 mmHg to normal prepacing levels. The level of hypotension was most pronounced in the rapid RV pacing group (20±4 mmHg, p<0.001), and the duration of hypotension was also the shortest (20±10 seconds, p<0.001) at a pacing rate of 190±10 beats per minute. The instantaneous mean flow velocity was lowest (10±4 cm/s, p<0.001) and recovery to normal pressure was quickest (within 1 minute) with rapid pacing. Instrumentation for rapid pacing did not prolong the procedure, but shortened it ∼25 minutes. Moreover, precise positioning at a mean 2±2 mm from the predetermined launch site was observed with rapid pacing (p<0.05). There were no differences in postprocedural neurological assessment among groups.

Conclusion:

Rapid RV pacing is safe in selected patients and in experienced hands. It abbreviates hemodynamic compromise, shortens the endovascular procedure, and may eventually emerge as the preferred method to avoid the windsock effect during stent-grafting. The maneuver, however, requires knowledge of right cardiac anatomy and expertise in selecting patients.
Fenestrated and Branched Grafts for Para-Anastomotic Aortic Aneurysm Repair
Authors: Ziegler Peter , Perdikides Theodossios P. , Avgerinos Efthimios D. , Umscheid Thomas , Stelter Wolf J.
Published: March 2015

Purpose:

To investigate the use of fenestration and branch artery stenting during endovascular stent-graft repair of para-anastomotic aneurysms (PAA).

Methods:

A retrospective review was conducted of 9 patients (all men; mean age 71 years, range 60–80) who received custom-designed fenestrated endoprostheses for PAA repair. Eight tubular fenestrated devices and 1 composite device (fenestrated tube plus modular bifurcated body) with a total of 31 fenestrations were used.

Results:

The mean operating time was 318±93 minutes (range 220–485); the mean fluoroscopy time was 77±38 minutes (range 39–158), during which a mean 121±81 mL (range 33–300) of contrast was used. Technical success was achieved in all cases. Over a mean follow-up of 12±5.5 months (range 6–24), 1 secondary intervention was carried out due to a break in a side branch stent-graft; 2 transient renal impairments and 1 permanent renal insufficiency unrelated to renal artery patency were observed. So far, no vessel loss has emerged.

Conclusion:

Conventional repair of PAA has been a standard procedure for many years, though it carries high surgical risk as well as perioperative mortality. Fenestrated endografts may be a promising alternative in selected patients.
Influence of Wall Compliance on Hemodynamics in Models of Abdominal Aortic Aneurysm
Authors: Gaillard Emmanuel , Bergeron Patrice , Deplano Valérie
Published: March 2015

Purpose:

To determine complementary criteria to existing morphological criteria, which are not reliable but are used to justify surgical intervention to treat abdominal aortic aneurysm (AAA).

Methods:

An experimental study was conducted in which 2 models of AAA, 1 rigid and 1 soft, were used to study the influence of compliance on aneurysm dynamics. The heart rate was 70 beats per minute, and the mean flow rate was 1.02 L/min. Velocity measurements were made with particle image velocimetry in 2 planes parallel to flow (1 vertical and 1 horizontal).

Results:

The general flow patterns generated in the rigid AAA model were in agreement with the literature. In both models, a vortex occurred at the beginning of systolic deceleration in the proximal part of the AAA, near the anterior wall. The vortex remained confined to the proximal part during the entire cycle in the rigid model, whereas in the soft model, the vortex migrated to the distal segment during the cycle and impacted the AAA walls. This impact generated a local pressure increase on the wall. In the soft model, another vortex was created near the posterior wall. These vortices eroded and weakened the walls of the distal segment, which can cause rupture.

Conclusion:

Compliance of the aneurysm wall might become another criterion to justify surgical intervention.
Fenestrated Endografting for Aortic Aneurysm Repair: A 7-Year Experience
Authors: Ziegler Peter , Avgerinos Efthimios D. , Umscheid Thomas , Perdikides Theodosios , Stelter Wolf J.
Published: March 2015

Purpose:

To present a 7-year single-center clinical experience with fenestrated endografts and side branches.

Methods:

Between April 1999 and August 2006, 63 patients (57 men; mean age 70.5611.6 years, range 25–89) received custom-designed Zenith fenestrated endoprostheses for a variety of aneurysms (59 abdominal, 1 thoracoabdominal, and 3 thoracic). They were all unsuitable for standard EVAR owing to short aortic necks and high risk for open surgery.

Results:

Nineteen tube grafts and 44 composite bifurcated grafts with a total of 122 fenestrations and 58 side branches were used. Technical success was achieved in 55 (87.3%) patients and in 118 (96.7%) vessels. Treatment success was 93.7%. The mean follow-up was 23±18 months (median 14, range 6–77). Overall, 9 (7.4%) visceral branches were lost: 4 intraoperative, 2 perioperative, and 3 late. There were 12 (19.0%) endoleaks identified: 5 (7.9%: 4 type Ia and 1 fenestration-related type III) primary and 7 (11.1%: 4 type II, 1 type I, and 2 type III) secondary endoleaks; 4 resolved, 4 were treated, and 4 are under observation. At 77 months, 75.3% of patients were free of a reintervention. All reinterventions were performed within the first 14 months. Fourteen cases of renal impairment were seen [6 permanent (only 1 on dialysis) and 8 transient]. One (1.6%) conversion and 1 (1.6%) rupture were recorded; aneurysm-related mortality was 4.8% (3/63).

Conclusion:

The favorable outcomes in this study, which encompasses the team's learning curve with fenestrated endografts and side branches, support the use of these devices in selected patients.
“Paving and Cracking”: An Endovascular Technique to Facilitate the Introduction of Aortic Stent-Grafts through Stenosed Iliac Arteries
Authors: Hinchliffe Robert J. , Ivancev Krassi , Sonesson Björn , Malina Martin
Published: March 2015

Purpose:

To describe a technique that facilitates the safe introduction of aortic stent-grafts through diseased iliac arteries.

Technique:

The technique involves relining and dilating (“paving and cracking”) stenosed iliac arteries with covered stents prior to the introduction of the main aortic stent-graft. It has been successfully used to introduce aortic stent-grafts in patients where other transfemoral endovascular measures have failed.

Conclusion:

This technique increases the applicability of transfemoral EVAR and prevents serious complications as a result of access-related damage to the iliac arteries.
Effect of Suprarenal Fixation of Aortic Stent-Grafts on the Renal Artery Ostia: Assessment of Morphological Changes by Virtual Intravascular Endoscopy
Authors: Sun Zhonghua , O'Donnell Mark E. , Winder R. John , Ellis Peter K. , Blair Paul H.
Published: March 2015

Purpose:

To investigate the morphological effects of suprarenal fixation of aortic stent-grafts on the renal artery ostia (RaO) by analysis of suprarenal stent wire distribution and vascular calcification across the RaO using virtual intravascular endoscopy (VIE).

Methods:

Fourteen consecutive patients (11 men; mean age 75 years) from a single institution were studied following endovascular aortic aneurysm repair (EVAR) using the Zenith endograft system from September 1999 to March 2002. Imaging assessment included computed tomographic (CT) measurement of renal artery intraluminal ostial diameter and quantification and analysis of uncovered stent struts across the RaO and radiological determination of RaO calcification. Morphological changes following EVAR at 3 time points (before and within 1 week after stent-grafting, and at the most recent follow-up) were compared for each patient to determine whether suprarenal stent struts or RaO calcification affected intraluminal ostial diameter. Renal function was assessed by temporal measurements of serum creatinine concentration and creatinine clearance.

Results:

The renal ostium was distorted to variable degrees in all cases at a mean follow-up of 41±6.6 months. An increase in ostial diameter was identified in most patients if the right RaO was calcified when comparing the 1-week postoperative and most recent follow-up CT images (p<0.05). There was no direct relationship between the number of stent struts crossing the RaO and the morphological/dimensional changes (p>0.05). Renal function was not significantly affected.

Conclusion:

Patients undergoing suprarenal fixation of aortic stent-grafts experienced morphological changes of the RaO to a variable extent at midterm follow-up. Although the presence of stent struts did not significantly affect dimensional changes, we observed that calcification at the renal artery ostium may influence the development of atherosclerotic effects as a direct relationship between the calcification and ostial diameter. Future studies utilizing VIE to determine the long-term safety of this technique in these particular patients requires investigation.
Angioplasty and Stenting versus Carotid-Subclavian Bypass for the Treatment of Isolated Subclavian Artery Disease
Authors: AbuRahma Ali F. , Bates Mark C. , Stone Patrick A. , Dyer Benjamin , Armistead Lauren , Dean L. Scott , Lavigne P. Scott
Published: March 2015

Purpose:

To compare the results of a large series of percutaneous transluminal angioplasty (PTA)/stenting procedures in the subclavian artery with the results of a series of carotid-subclavian by pass grafts (CSBG) performed at the same institution for subclavian artery disease.

Methods:

Between 1993 and 2006, 121 patients (43 men; mean age 63 years, range 38–85) underwent subclavian artery PTA/stenting and were compared to a group of 51 patients (29 men; mean age 62 years, range 46–75) with isolated subclavian artery occlusive disease treated with CSBG using polytetrafluoroethylene grafts. Graft or PTA/stenting patency was determined clinically and confirmed by Doppler pressures and/or duplex ultrasound/angiography. The cumulative patency and overall survival rates were calculated using the life-table method.

Results:

The mean follow-up for the PTA/stent group was 3.4 years versus 7.7 years for the CSBG group. The technical success rate for the CSBG group was 100% versus 98% (119/121) for the PTA/stent group. The overall perioperative complication rate in the stent group was 15.1% (18/119: 11 minor and 7 major complications) versus 5.9% (3/51: 2 phrenic nerve palsy and 1 myocardial infarction) in the bypass group (p=0.093). There was no perioperative stroke or mortality in the CSBG group. The major perioperative complications in the stent group included 4 thromboembolic events, 1 congestive heart failure, 1 reperfusion arm edema, and 1 pseudoaneurysm. There was 1 perioperative death in the stent group. The 30-day patency rate was 100% for the bypass group and 97% (118/121) for the PTA/stent group. The primary patency rates at 1, 3, and 5 years were 100%, 98%, and 96% for the CSBG group versus 93%, 78%, and 70% for the stent group, respectively (p<0.0001). Freedom from symptom recurrence was also statistically superior in the bypass group versus the stent group (p<0.0001). There were no significant differences in the survival rates between both groups at any time point (p=0.322).

Conclusion:

Both CSBGs using PTFE grafts and subclavian PTA/stenting are safe, effective, and durable; however, CSBG is more durable in the long term. PTA/stenting of the subclavian artery should be the procedure of choice for high-risk patients; however, CSBG should be offered to good-risk surgical candidates who may be seeking a more durable procedure.
The Role of Carotid Stenting
Authors: Loftus Ian M. , Thompson Matthew M.
Published: March 2015

Despite a number of randomized trials, debate continues about the role of carotid angioplasty and stenting (CAS) for both symptomatic and asymptomatic disease. None of the trials has shown superiority of one treatment modality over the other, but protagonists of stenting have encouraged a shift away from conventional surgery. The minimally invasive nature of CAS is appealing, but concerns have been raised about the periprocedural stroke rate in the randomized trials. To counter this evidence, there are increasing numbers of registries and series, many partly or wholly sponsored by the endovascular industry, some of which demonstrate reasonable results. These need to be studied with caution, as patients deemed high risk of carotid endarterectomy may actually be at very low risk of stroke. Furthermore, strict inclusion and exclusion criteria mean that results may not be a true reflection of everyday clinical practice.

The aim of this review is to document the evidence to date, predominantly from the randomized trials, for both symptomatic and asymptomatic carotid disease and establish the current role of carotid stenting.
In Vitro Performance Assessment of Distal Protection Devices for Carotid Artery Stenting: Effect of Physiological Anatomy on Vascular Resistance
Authors: Siewiorek Gail M. , Wholey Mark H. , Finol Ender A.
Published: March 2015

Purpose:

To assess in vitro the performance of 5 distal protection devices (DPDs) by evaluating the capture efficiency, pressure gradient, volume flow rate, and vascular resistance in the internal carotid artery (ICA).

Methods:

The time-averaged mean peak velocity in the common carotid artery and a blood-mimicking solution were used to simulate physiological conditions in a silicone carotid phantom representing average human carotid artery geometry with a 70% symmetrical ICA stenosis. Five milligrams of dyed 200-μm nominal diameter polymer microspheres (larger than the pore size of the devices, except Spider RX, which was tested with 300-μm-diameter particles) were injected into the ICA. The percentages of particles missed after injection and lost during device retrieval were measured for the 5 devices (Spider RX, FilterWire EZ, RX Accunet, Angioguard XP, and Emboshield). The normalized pressure gradient, fraction of the volume flow rate, and vascular resistance in the ICA were calculated.

Results:

Spider RX captured the most particles (missing 0.06%, p<0.05) and yielded the smallest normalized pressure gradient increase (4.2%), the largest volume flow rate fraction (0.40), and the smallest vascular resistance in the ICA (272 mmHg/L·min−1, a 5.4% increase with respect to initial conditions). Angioguard XP captured the fewest particles (missing 36.3%, p<0.05 except Emboshield) and resulted in the largest normalized pressure gradient increase (37%) in the ICA. RX Accunet produced the smallest volume flow rate fraction in the ICA (0.30) and the largest vascular resistance in the ICA (470 mmHg/L·min−1, an 82.2% increase). Emboshield migrated ∼6 cm distal to the original position after particle injection. FilterWire EZ lost the fewest particles during retrieval (0.45%, p<0.05 except Accunet RX and Spider RX) and had the best overall performance with 200-μm emboli (p<0.05 except Accunet RX).

Conclusion:

None of the devices tested completely prevented embolization. Overall, Spider RX had the best performance and is conjectured to have the best wall apposition of the devices tested. Vascular resistance should be considered a key filter design parameter for performance testing since it represents a quantitative estimation of the “slow-flow phenomenon.” Our findings should be extrapolated cautiously to help interventionists choose the best device.
Comment on Driskill and Vrooman
Authors: Madden Paul
Published: March 2015

Driskill and Vrooman have recently provided an interesting argument for a Cournot-based approach to modeling duopsony sports leagues with perfectly inelastic talent supply (the usual assumption for major North American sports league), quite different from the suggestion made by this author (and others) that specifications where talent expenditures are strategic variables (rather than Cournot talent levels) are most appropriate for the context. This comment offers some clarifications and comparisons of the merits of the alternative approaches; they continue to point toward the talent expenditure approach as the most fruitful for the leagues under investigation and probably more generally.
Sex hormone affects the severity of non-alcoholic steatohepatitis through the MyD88-dependent IL-6 signaling pathway
Authors: Xin Guangda , Qin Shaoyou , Wang Song , Wang Xu , Zhang Yonggui , Wang Jiangbin
Published: March 2015

Recent research has shown that the occurrence of gender disparity in liver cancer associated with sex differences in MyD88-dependent IL-6 production, but the role of this signaling pathway in sex differences of non-alcoholic steatohepatitis (NASH) remains unknown. To investigate the effects of sex hormone-specific intervention on pathology and progression of NASH, and on the inflammatory TLR-MyD88-IL-6 signaling pathway NASH was modeled in C57/BL6 mice by feeding a methionine and choline-deficient (MCD) diet for 4 weeks. Male mice were subjected to sex hormone-related interventions such as orchidectomy, and orchidectomy combined with administration of either testosterone propionate or estradiol benzoate. Next, the degree of non-alcoholic fatty liver disease activity score (NAS), serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), and the expression level of MyD88 and IL-6, were compared between these groups. Males developed more serious inflammatory problems and had a higher NAS than the females. Sex-specific intervention in male mice by orchidectomy reduced NAS, ALT, and AST, and the expression level of MyD88 and IL-6. But administration of exogenous androgen had no influence on either NAS or the expression of ALT, AST, MyD88, and IL-6. On the other hand, exogenous estrogen could alleviate the pathological damage caused by NASH, as well as reduce NAS, ALT and AST, and the expression of MyD88 and IL-6. The result show different sex hormone-related interventions affected the severity of NASH, possibly by modulating the level of sex hormones and regulating the TLR-MyD88-IL-6 signaling pathway.
Resident Evil’s Rhetoric
Authors: Reed Charley
Published: March 2015

This article examines the role of corruption, and its use as a rhetorical technique, within survival horror video games. As one of the founding examples of the survival horror genre, Resident Evil will be used as a case study example. Specifically, the game will be critically analyzed for its use of corruption in four forms: corruption of media, corruption of nature, corruption of architecture, and corruption of authority. These instances of corruption will be analyzed through two rhetorical theories, schema theory and expectation violations theory, in order to understand why Resident Evil’s design was so effective at evoking fear in the hearts of millions of gamers. The analysis is followed by a reflection on Resident Evil’s legacy and other future areas of research involving rhetoric and video games.
Current Concepts in Hip Preservation Surgery
Authors: Adler Kelly L. , Cook P. Christopher , Geisler Paul R. , Yen Yi-Meng , Giordano Brian D.
Published: March 2015

Context:

Successful treatment of nonarthritic hip pain in young athletic individuals remains a challenge. A growing fund of clinical knowledge has paralleled technical innovations that have enabled hip preservation surgeons to address a multitude of structural variations of the proximal femur and acetabulum and concomitant intra-articular joint pathology. Often, a combination of open and arthroscopic techniques are necessary to treat more complex pathomorphologies. Peri- and postoperative recovery after such procedures can pose a substantial challenge to the patient, and a dedicated, thoughtful approach may reduce setbacks, limit morbidity, and help optimize functional outcomes.

Evidence Acquisition:

PubMed and CINAHL databases were searched to identify relevant scientific and review articles through December 2014 using the search terms hip preservation, labrum, surgical dislocation, femoroacetabular impingement, postoperative rehabilitation, peri-acetabular osteotomy, and rotational osteotomy. Reference lists of included articles were reviewed to locate additional references of interest.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

Hip preservation procedures and appropriate rehabilitation have allowed individuals to return to a physically active lifestyle.

Conclusion:

Effective postoperative rehabilitation must consider modifications and precautions specific to the particular surgical techniques used. Proper postoperative rehabilitation after hip preservation surgery may help optimize functional recovery and maximize clinical success and patient satisfaction.
Cerium oxide nanoparticle aggregates affect stress response and function in Caenorhabditis elegans
Authors: Rogers Steven , Rice Kevin M , Manne Nandini DPK , Shokuhfar Tolou , He Kun , Selvaraj Vellaisamy , Blough Eric R
Published: March 2015

Objective:

The continual increase in production and disposal of nanomaterials raises concerns regarding the safety of nanoparticles on the environmental and human health. Recent studies suggest that cerium oxide (CeO2) nanoparticles may possess both harmful and beneficial effects on biological processes. The primary objective of this study is to evaluate how exposure to different concentrations (0.17–17.21 µg/mL) of aggregated CeO2 nanoparticles affects indices of whole animal stress and survivability in Caenorhabditis elegans.

Methods:

Caenorhabditis elegans were exposed to different concentrations of CeO2 nanoparticles and evaluated.

Results:

Our findings demonstrate that chronic exposure of CeO2 nanoparticle aggregates is associated with increased levels of reactive oxygen species and heat shock stress response (HSP-4) in Caenorhabditis elegans, but not mortality. Conversely, CeO2 aggregates promoted strain-dependent decreases in animal fertility, a decline in stress resistance as measured by thermotolerance, and shortened worm length.

Conclusion:

The data obtained from this study reveal the sublethal toxic effects of CeO2 nanoparticle aggregates in Caenorhabditis elegans and contribute to our understanding of how exposure to CeO2 may affect the environment.
Gaining Insights
Authors: Randolph Susan A.
Published: March 2015

Occupational and environmental health nurses should use insights to solve problems and promote worker health and safety.
Violence Against Nurses in Emergency Departments in Jordan
Authors: Darawad Muhammad W. , Al-Hussami Mahmoud , Saleh Ali M. , Mustafa Waddah Mohammad , Odeh Haifa
Published: March 2015

Violence against nurses in emergency departments (EDs) has become a widespread phenomenon affecting nurses’ job satisfaction and work performance. Literature is scarce regarding prevalence rates and causes of violence directed toward nurses in Jordan. The present study investigated violence experienced by Jordanian nurses in EDs and causes of violence from their perspectives. This descriptive study collected data from 174 Jordanian ED nurses. The majority of the participants (91.4%) reported experiencing violence (verbal 95.3% vs. physical 23.3%). According to participants, the most common causes of violence in the ED were crowding and workload (75.9%), and the least was care of patients with dementia or Alzheimer’s disease (35.6%). Violence is common in Jordanian EDs, giving rise to many heath and behavioral consequences. Health care administrators are obligated to protect nurses from violent incidents by providing adequate safety measures, beneficial administrative procedures, and sincere efforts to overcome the causes of this phenomenon.
Multiple Risk Factors for Work-Related Injuries and Illnesses in Korean-Chinese Migrant Workers
Authors: Lee Hyeonkyeong , Chae Duckhee , Yi Kwan Hyung , Im Soye , Cho Sung Hye
Published: March 2015

Korean-Chinese currently represent the largest group of migrant workers in Korea. The purpose of this study was to investigate the influence of risk factors on the occurrence of work-related injuries and illnesses (WII). Data for 486 Korean-Chinese migrant workers were drawn from the 2010 Migrant Workers’ Health and Safety Survey in Korea. Logistic regression was used to identify the association between WII and multiple risk factors. Individual health status (OR = 3.83, 95% CI [2.01, 7.30]), safety training (OR = 0.39, 95% CI [0.18, 0.85]), job satisfaction (OR = 1.90, 95% CI [1.07, 3.38]), physical and chemical hazard exposure (OR = 1.05, 95% CI [1.02, 1.08]), and length of stay (OR = 1.01, 95% CI [1.00, 1.01]) were identified as risk factors for WII. The findings suggest the need for a comprehensive approach to assess WII risk factors, including personal, work organization and psychosocial demands, and acculturation in Korean-Chinese migrant workers.
Dynamics of institutionalized competition in the geography of inter-ethnic rivalry: The case of the Jarso and the Girhi in Eastern Ethiopia
Authors: Hussein Jeylan Wolyie , Beyene Fekadu
Published: March 2015

This article analyses the dynamics of institutionalized competition in the geography of inter-ethnic rivalry between the Jarso and Girhi ethnic clans. The data required for the study was obtained from the retrospective reflections of the research participants regarding the origins, dynamics and outcomes of the local October 2004 referendum conducted to settle disputes over territorial and administrative issues. The perspectives used to analyse the processes and dynamics of inter-group competition were drawn mainly from social movement theories. To increase the methodological robustness of the analysis, we blend the political analysis of inter-group competition with the sociological dimension of identity framing and processes. We trace identity issues and processes as they occurred in concrete socio-political settings that influenced the shapes identities took and their concrete picture in inter-group competitions. We try also to identify and reconstruct causal patterns and processes of the competitions and their dynamics. We give due attention to the interactive dynamics of these conditions in shaping the social-psychological processes of competition and movement participation. We attempt to show how interaction between historical-political and contextual factors affected the energy of the mobilizing structures and their contested legitimizing narratives. Finally, we indicate the implications of the analysis for understanding and managing ethnic or identity politics of social movements.
Management of bronchiectasis in adults
Authors: Chalmers James D. , Aliberti Stefano , Blasi Francesco
Published: March 2015

Formerly regarded as a rare disease, bronchiectasis is now increasingly recognised and a renewed interest in the condition is stimulating drug development and clinical research. Bronchiectasis represents the final common pathway of a number of infectious, genetic, autoimmune, developmental and allergic disorders and is highly heterogeneous in its aetiology, impact and prognosis.

The goals of therapy should be: to improve airway mucus clearance through physiotherapy with or without adjunctive therapies; to suppress, eradicate and prevent airway bacterial colonisation; to reduce airway inflammation; and to improve physical functioning and quality of life.

Fortunately, an increasing body of evidence supports interventions in bronchiectasis. The field has benefited greatly from the introduction of evidence-based guidelines in some European countries and randomised controlled trials have now demonstrated the benefit of long-term macrolide therapy, with accumulating evidence for inhaled therapies, physiotherapy and pulmonary rehabilitation.

This review provides a critical update on the management of bronchiectasis focussing on emerging evidence and recent randomised controlled trials.
Large trials, new knowledge: the changing face of COPD management
Authors: De Soyza Anthony , Calverley Peter M.A.
Published: March 2015

Large, well-designed, drug-treatment trials have allowed useful advances to be made in the treatment and diagnosis of chronic obstructive pulmonary disease (COPD). The two main clinical trial designs that provide evidence of effectiveness are randomised controlled trials (RCTs) and observational studies. RCTs are generally considered to provide more robust evidence than that obtained from observational studies and can generate informative secondary analyses in addition to the primary research query. In COPD, however, well-designed comparator-controlled RCTs, although successful, have been shown to have some limitations, such as a lack of generalisability. The findings of observational studies, whilst prone to bias, can generate valuable data and have also provided useful information relating to the efficacy of treatments in the current COPD management guidelines. This review focuses on major COPD studies published since 2007 (including UPLIFT, TIOSPIR, ECLIPSE and COPDGene), and assesses the influence such RCTs and large observational studies have had on our knowledge of COPD, and how these may impact future trial designs.
Influenza virus-induced lung injury: pathogenesis and implications for treatment
Authors: Herold Susanne , Becker Christin , Ridge Karen M. , Budinger G.R. Scott
Published: March 2015

The influenza viruses are some of the most important human pathogens, causing substantial seasonal and pandemic morbidity and mortality. In humans, infection of the lower respiratory tract of can result in flooding of the alveolar compartment, development of acute respiratory distress syndrome and death from respiratory failure. Influenza-mediated damage of the airway, alveolar epithelium and alveolar endothelium results from a combination of: 1) intrinsic viral pathogenicity, attributable to its tropism for host airway and alveolar epithelial cells; and 2) a robust host innate immune response, which, while contributing to viral clearance, can worsen the severity of lung injury. In this review, we summarise the molecular events at the virus–host interface during influenza virus infection, highlighting some of the important cellular responses. We discuss immune-mediated viral clearance, the mechanisms promoting or perpetuating lung injury, lung regeneration after influenza-induced injury, and recent advances in influenza prevention and therapy.
Matching strategies of teachers and schools in general equilibrium
Authors: Ahn Tom
Published: March 2015

I use a structural matching model, North Carolina public school data, and a survey of teachers’ career plans to analyze schools’ and teachers’ behaviors in the teacher transfer market. Results show that mid-career teachers with better pre-service qualifications are the most eager to search, different types of teachers and schools have different search strategies, and the market is turbulent, characterized by search friction and large movements of teachers to better, worse, or comparable schools. The market is not as stable and orderly as it may first appear. Simulations show that simple policies to direct teacher transfers are at best inefficient.

Jel codes: I24; J48; J62
Training-induced plasticity of the social brain in autism spectrum disorder
Authors: Bölte Sven , Ciaramidaro Angela , Schlitt Sabine , Hainz Daniela , Kliemann Dorit , Beyer Anke , Poustka Fritz , Freitag Christine , Walter Henrik
Published: March 2015

Background

Autism spectrum disorder (ASD) is linked to social brain activity and facial affect recognition (FAR).

Aims

To examine social brain plasticity in ASD.

Method

Using FAR tests and functional magnetic resonance imaging tasks for FAR, we compared 32 individuals with ASD and 25 controls. Subsequently, the participants with ASD were assigned to FAR computer-aided cognitive training or a control group.

Results

The ASD group performed more poorly than controls on explicit behavioural FAR tests. In the scanner, during implicit FAR, the amygdala, fusiform gyrus and other regions of the social brain were less activated bilaterally. The training group improved on behavioural FAR tests, and cerebral response to implicit affect processing tasks increased bilaterally post-training in the social brain.

Conclusions

Individuals with ASD show FAR impairments associated with hypoactivation of the social brain. Computer-based training improves explicit FAR and neuronal responses during implicit FAR, indicating neuroplasticity in the social brain in ASD.
Socioeconomic gradients and mental health: implications for
public health
Authors: Stewart-Brown Sarah , Samaraweera Preshila Chandimali , Taggart Frances , Kandala Ngianga-Bakwin , Stranges Saverio
Published: March 2015

Background

Research on mental well-being is relatively new and studies of its
determinants are rare.

Aims

To investigate whether the socioeconomic correlates of mental well-being
mirror those for mental illness.

Method

Using logistic regression analyses, the independent odds ratios of high
and low mental well-being, compared with middle-range mental well-being,
were estimated for a number of sociodemographic variables known to be
associated with mental illness from 13 983 participants in the 2010 and
2011 Health Surveys for England.

Results

Independent odds ratios for low mental well-being were as expected from
studies of mental illness with increased odds for the unemployed (OR =
1.46, 95% CI 1.01–2.10) and those aged 35–54 years (OR = 1.58, 95% CI
1.35–1.84) and reduced odds for the married (OR = 0.78, 95% CI
0.62–0.97). A linear trend was observed with education and equivalised
income. Odds ratios for high mental well-being differed from those for
low mental well-being with regard to age (55+ years: OR = 1.48, 95% CI
1.23–1.79); employment status where there was an association only with
retirement (OR = 1.35, 95% CI 1.09–1.69); education where there was no
association; and equivalised income for which the association was
non-linear.

Conclusions

Odds ratios for low mental well-being mirrored those for mental illness,
but not those for high mental well-being, suggesting that the
socioeconomic factors associated with positive mental health are
different from those associated with mental illness.
DRD3 gene and striatum in autism spectrum disorder
Authors: Staal Wouter G. , Langen Marieke , van Dijk Sarai , Mensen Vincent T. , Durston Sarah
Published: March 2015

A single-nucleotide polymorphism (SNP) of the DRD3 gene (rs167771) was recently associated with autism spectrum disorders (ASD). Different polymorphisms of rs167771 corresponded to varying degrees of stereotyped behaviour. As DRD3 receptors are relatively overexpressed in the striatum, we investigated whether striatal volume was related to these polymorphisms in autism. We assessed volumes of caudate nucleus and putamen in 86 participants with ASD (mean age 15.3 years). MANCOVA showed an association between alleles of the rs167771 SNP and the volume of striatal structures. Furthermore, greater caudate nucleus volume correlated with stereotyped behaviour. These findings support a relationship between DRD3 gene SNPs, striatum and stereotyped behaviour in ASD.
Collaborative care for patients with bipolar disorder: randomised controlled trial
Authors: van der Voort Trijntje Y. G. , van Meijel Berno , Goossens Peter J. J. , Hoogendoorn Adriaan W. , Draisma Stasja , Beekman Aartjan , Kupka Ralph W.
Published: March 2015

Background

A substantial number of people with bipolar disorder show a suboptimal response to treatment.

Aims

To study the effectiveness of a collaborative care programme on symptoms and medication adherence in patients with bipolar disorder, compared with care as usual.

Method

A two-armed, cluster randomised clinical trial was carried out in 16 out-patient mental health clinics in The Netherlands, in which 138 patients were randomised. Patient outcomes included duration and severity of symptoms and medication adherence, and were measured at baseline, 6 months and 12 months. Collaborative care comprised contracting, psychoeducation, problem-solving treatment, systematic relapse prevention and monitoring of outcomes. Mental health nurses functioned as care managers in this programme. The trial was registered with The Netherlands Trial Registry (NTR2600).

Results

Collaborative care had a significant and clinically relevant effect on number of months with depressive symptoms, both at 6 months (z =–2.6, P = 0.01, d = 0.5) and at 12 months (z =–3.1, P = 0.002, d = 0.7), as well as on severity of depressive symptoms at 12 months (z =–2.9, P = 0.004, d = 0.4). There was no effect on symptoms of mania or on treatment adherence.

Conclusions

When compared with treatment as usual, collaborative care substantially reduced the time participants with bipolar disorder experienced depressive symptoms. Also, depressive symptom severity decreased significantly. As persistent depressive symptoms are difficult to treat and contribute to both disability and impaired quality of life in bipolar disorder, collaborative care may be an important form of treatment for people with this disorder.
Repression of Igf1 expression by Ezh2 prevents basal cell differentiation in the developing lung
Authors: Galvis Laura A. , Holik Aliaksei Z. , Short Kieran M. , Pasquet Julie , Lun Aaron T. L. , Blewitt Marnie E. , Smyth Ian M. , Ritchie Matthew E. , Asselin-Labat Marie-Liesse
Published: March 2015

Epigenetic mechanisms involved in the establishment of lung epithelial cell lineage identities during development are largely unknown. Here, we explored the role of the histone methyltransferase Ezh2 during lung lineage determination. Loss of Ezh2 in the lung epithelium leads to defective lung formation and perinatal mortality. We show that Ezh2 is crucial for airway lineage specification and alveolarization. Using optical projection tomography imaging, we found that branching morphogenesis is affected in Ezh2 conditional knockout mice and the remaining bronchioles are abnormal, lacking terminally differentiated secretory club cells. Remarkably, RNA-seq analysis revealed the upregulation of basal genes in Ezh2-deficient epithelium. Three-dimensional imaging for keratin 5 further showed the unexpected presence of a layer of basal cells from the proximal airways to the distal bronchioles in E16.5 embryos. ChIP-seq analysis indicated the presence of Ezh2-mediated repressive marks on the genomic loci of some but not all basal genes, suggesting an indirect mechanism of action of Ezh2. We found that loss of Ezh2 de-represses insulin-like growth factor 1 (Igf1) expression and that modulation of IGF1 signaling ex vivo in wild-type lungs could induce basal cell differentiation. Altogether, our work reveals an unexpected role for Ezh2 in controlling basal cell fate determination in the embryonic lung endoderm, mediated in part by repression of Igf1 expression.
Whole-field visual motion drives swimming in larval zebrafish via a stochastic process
Authors: Portugues Ruben , Haesemeyer Martin , Blum Mirella L. , Engert Florian
Published: March 2015

Caudo-rostral whole-field visual motion elicits forward locomotion in many organisms, including larval zebrafish. Here we investigate the dependence on the latency to initiate this forward swimming as a function of the speed of the visual motion: we find that it is highly dependent on the speed for slow speeds (<10 mm/s) and then plateaus for higher values. Typical latencies are >1.5 seconds, much longer than neuronal transduction processes. What mechanisms underlie these long latencies? We propose two alternative, biologically inspired models that could account for this latency to initiate swimming: an integrate and fire model, which is history dependent, and a stochastic Poisson model, which has no history dependence. We use these models to predict the behavior of larvae when presented with whole-field motion of varying speed and find that the stochastic process shows better agreement with the experimental data. Finally, we discuss possible neuronal implementations of these models.
Kinetics of Lithium Extraction with Tri-n-butyl Phosphate from Salt Lake Brine by a Single Drop Method
Authors: Li Hui-fang , Li Li-juan , Shi Dong , Li Jin-feng , Ji Lian-min , Peng Xiao-wu , Song Fu-gen , Nie Feng , Zeng Zhong-min , Song Xue-xue
Published: March 2015

The recovery of lithium resources from salt lake brine has become more and more important. Tri-n-butyl phosphate (TBP) is the most common extractant and has good ability to selectively extract lithium, thus, basic research on it should be carried out. In this study, the kinetics of lithium extraction by TBP in salt lake brine was investigated at 298.15 K via a single rising drop technique. Parameters affecting the mass transfer mechanism, including the interfacial area, lithium concentration, iron concentration, TBP concentration, and temperature were studied. According to this research, we found that the process of extraction is controlled by the diffusion and the chemical reaction occurs at the interfacial area. The mechanism of the lithium extraction with TBP is revealed.
Cross-coupling between Aryl- and Alkenyldimethylsilanes and Organic Halides Promoted by a Copper(I) Iodide/Sodium Hydride/Ethylene Glycol System
Authors: Takeda Takeshi , Takeda Yuichiro , Tsubouchi Akira
Published: March 2015

A copper(I) iodide/sodium hydride/ethylene glycol system promoted reaction of aryl- and alkenyldimethylsilanes with C(sp3)–X electrophiles bearing a β-hydrogen produced the cross-coupling products at ambient temperature within a short period of time.
Asc1, homolog of human RACK1, prevents frameshifting in yeast by ribosomes stalled at CGA codon repeats
Authors: Wolf Andrew S. , Grayhack Elizabeth J.
Published: March 2015

Quality control systems monitor and stop translation at some ribosomal stalls, but it is unknown if halting translation at such stalls actually prevents synthesis of abnormal polypeptides. In yeast, ribosome stalling occurs at Arg CGA codon repeats, with even two consecutive CGA codons able to reduce translation by up to 50%. The conserved eukaryotic Asc1 protein limits translation through internal Arg CGA codon repeats. We show that, in the absence of Asc1 protein, ribosomes continue translating at CGA codons, but undergo substantial frameshifting with dramatically higher levels of frameshifting occurring with additional repeats of CGA codons. Frameshifting depends upon the slow or inefficient decoding of these codons, since frameshifting is suppressed by increased expression of the native tRNAArg(ICG) that decodes CGA codons by wobble decoding. Moreover, the extent of frameshifting is modulated by the position of the CGA codon repeat relative to the translation start site. Thus, translation fidelity depends upon Asc1-mediated quality control.
ECG case: Wellens’ syndrome
Authors: Young Anthony
Published: March 2015

This month, we received an additional ECG as a special contribution from a reader, Anthony Young, who came across an interesting case. He shares his analysis and learning points here
Arts-based research: patient experiences of discharge
Authors: Lapum Jennifer L , Yau Terrence , Church Kathryn
Published: March 2015

Background:

The knowledge translation capacity of cardiovascular research has had little impact on systems of care following discharge specific to the home period of recovery.

Aims:

The focus of this article is to provide an arts-informed dissemination in the form of a poem, to provide readers with the opportunity to engage with patients’ experiences on an emotive and visceral level.

Methods:

In order to explore 16 patients’ experiences of recovery from heart surgery, a narrative methodology was employed using journal writing and interviews. Research findings were reconstructed by the lead author into poetry, using words taken directly from interviews, to create a composite story of participants’ experiential accounts of recovery in the home.

Results:

Findings provide an intimate account of recovery as an emotional and physical experience that occurs in the isolation of one's home, interwoven with contemplations of mortality and unanswered questions.

Conclusion:

There is a need to implement and test interventions aimed at the care of cardiovascular patients during the home period of recovery.
Diagnosing symptomatic arrhythmia via mobile phone
Authors: Richley Dave , Graham Amy
Published: March 2015

Dave Richley and Amy Graham argue that smartphones may provide an innovative solution to capturing ECG when palpitations are too infrequent for conventional recording
The complication of mucocutaneous separation after stoma surgery
Authors: Ndlovu Simekuhle
Published: March 2015

After stoma formation, it is possible for an ostomate (a person with a stoma) to develop a complication known as mucocutaneous separation. This is a postoperative complication and can be experienced by a person with a colostomy, ileostomy, or urostomy—the three most common stoma types. Early assessment and management are crucial to avoid further complications. Effective documentation of the treatment given is also important. This article provides an overview of mucocutaneous separation: the recognition of the problem and management of the separation.
Identification of multiple sclerosis brain lesions in magnetic resonance imaging using texture analysis
Authors: Aldana Ramírez César Augusto , Orozco Higuera Nelson Fabián , Barreto Melo Samuel
Published: March 2015

La esclerosis múltiple (EM) es una enfermedad neurodegenerativa que ataca al sistema nervioso central (SNC), produce lesiones desmielinizantes y causa secuelas funcionales en adultos jóvenes, especialmente mujeres. Su diagnóstico y seguimiento se realizan a través de la resonancia magnética. En la actualidad, el análisis de texturas se ha convertido en una herramienta útil para la detección de este tipo lesiones. Por tal razón, en este artículo se busca identificar lesiones de EM utilizando los métodos de matrices de co-ocurrencia de nivel de gris y transformada wavelet (TW), y como métodos de clasificación redes neuronales (ANN) y máquinas de soporte vectorial (SVM) en imágenes de resonancia magnética (RMI) en secuencia FLAIR de 5 pacientes con diagnóstico de la enfermedad. La combinación apropiada de medidas de matrices de co-ocurrencia y wavelets permitieron obtener precisiones superiores a 96% para las máquinas de soporte vectorial y 90% para las redes neuronales, lo que demuestra que el uso combinado de dichas medidas es superior en la detección de estas lesiones.