bluuebunny/crossref_metadata_2025 huggingface dataset:
Target size matters: target errors contribute to the generalization of implicit visuomotor learning
Authors: Reichenthal Maayan , Avraham Guy , Karniel Amir , Shmuelof Lior
Published: May 2016

The process of sensorimotor adaptation is considered to be driven by errors. While sensory prediction errors, defined as the difference between the planned and the actual movement of the cursor, drive implicit learning processes, target errors (e.g., the distance of the cursor from the target) are thought to drive explicit learning mechanisms. This distinction was mainly studied in the context of arm reaching tasks where the position and the size of the target were constant. We hypothesize that in a dynamic reaching environment, where subjects have to hit moving targets and the targets' dynamic characteristics affect task success, implicit processes will benefit from target errors as well. We examine the effect of target errors on learning of an unnoticed perturbation during unconstrained reaching movements. Subjects played a Pong game, in which they had to hit a moving ball by moving a paddle controlled by their hand. During the game, the movement of the paddle was gradually rotated with respect to the hand, reaching a final rotation of 25°. Subjects were assigned to one of two groups: The high-target error group played the Pong with a small ball, and the low-target error group played with a big ball. Before and after the Pong game, subjects performed open-loop reaching movements toward static targets with no visual feedback. While both groups adapted to the rotation, the postrotation reaching movements were directionally biased only in the small-ball group. This result provides evidence that implicit adaptation is sensitive to target errors.
Auditory Golgi cells are interconnected predominantly by electrical synapses
Authors: Yaeger Daniel B. , Trussell Laurence O.
Published: May 2016

The mossy fiber-granule cell-parallel fiber system conveys proprioceptive and corollary discharge information to principal cells in cerebellum-like systems. In the dorsal cochlear nucleus (DCN), Golgi cells inhibit granule cells and thus regulate information transfer along the mossy fiber-granule cell-parallel fiber pathway. Whereas excitatory synaptic inputs to Golgi cells are well understood, inhibitory and electrical synaptic inputs to Golgi cells have not been examined. Using paired recordings in a mouse brain slice preparation, we find that Golgi cells of the cochlear nucleus reliably form electrical synapses onto one another. Golgi cells were only rarely electrically coupled to superficial stellate cells, which form a separate network of electrically coupled interneurons in the DCN. Spikelets had a biphasic effect on the excitability of postjunctional Golgi cells, with a brief excitatory phase and a prolonged inhibitory phase due to the propagation of the prejunctional afterhyperpolarization through gap junctions. Golgi cells and stellate cells made weak inhibitory chemical synapses onto Golgi cells with low probability. Electrical synapses are therefore the predominant form of synaptic communication between auditory Golgi cells. We propose that electrical synapses between Golgi cells may function to regulate the synchrony of Golgi cell firing when electrically coupled Golgi cells receive temporally correlated excitatory synaptic input.
Taste coding of complex naturalistic taste stimuli and traditional taste stimuli in the parabrachial pons of the awake, freely licking rat
Authors: Sammons Joshua D. , Weiss Michael S. , Victor Jonathan D. , Di Lorenzo Patricia M.
Published: May 2016

Several studies have shown that taste-responsive cells in the brainstem taste nuclei of rodents respond to sensory qualities other than gustation. Such data suggest that cells in the classical gustatory brainstem may be better tuned to respond to stimuli that engage multiple sensory modalities than to stimuli that are purely gustatory. Here, we test this idea by recording the electrophysiological responses to complex, naturalistic stimuli in single neurons in the parabrachial pons (PbN, the second neural relay in the central gustatory pathway) in awake, freely licking rats. Following electrode implantation and recovery, we presented both prototypical and naturalistic taste stimuli and recorded the responses in the PbN. Prototypical taste stimuli (NaCl, sucrose, citric acid, and caffeine) and naturalistic stimuli (clam juice, grape juice, lemon juice, and coffee) were matched for taste quality and intensity (concentration). Umami (monosodium glutamate + inosine monophosphate) and fat (diluted heavy cream) were also tested. PbN neurons responded to naturalistic stimuli as much or more than to prototypical taste stimuli. Furthermore, they convey more information about naturalistic stimuli than about prototypical ones. Moreover, multidimensional scaling analyses showed that across unit responses to naturalistic stimuli were more widely separated than responses to prototypical taste stimuli. Interestingly, cream evoked a robust and widespread response in PbN cells. Collectively, these data suggest that natural foods are more potent stimulators of PbN cells than purely gustatory stimuli. Probing PbN cells with pure taste stimuli may underestimate the response repertoire of these cells.
Demographic and Clinical Features of Endometrial Polyps in Patients with Endometriosis
Authors: Wang Ningning , Zhang Yufeng , Liu Bin
Published: May 2016

Aims. To compare the clinical features of endometrial polyps (EPs) between patients with endometriosis (EM) (EM group) and without EM (non-EM group).Methods and Results. Seventy-six cases in the EM group and 133 cases in the non-EM group underwent laparotomy or hysteroscopy and laparoscopy; later, it was confirmed that the results by pathology from July 2002 to April 2008 in the Department of Gynecology and Obstetrics at the First Affiliated Hospital of Sun Yat-sen University. The recurrence of EPs was followed up after the surgery until 2013. The following parameters were assessed: age, gravidity, parity, infertility, and menstrual cycle changes, as well as polyps diameters, locations, number, association with the revised American Fertility Society (r-AFS) classification, and their recurrence. On review, 76 EPs cases of EM group histologically resembled EPs but the majority of EPs with EM occurred in primary infertility cases and in fewer pregnancy rate women who had stable and smaller EPs without association with the AFS stage. The recurrence rate of EPs in EM group was higher than that in non-EM group.Conclusion. It is important to identify whether infertile patients with EM are also having EPs. Removing any coexisting EPs via hysteroscopy would be clinically helpful in treating endometriosis-related infertility in these patients.
Potential of Biological Agents in Decontamination of Agricultural Soil
Authors: Javaid Muhammad Kashif , Ashiq Mehrban , Tahir Muhammad
Published: May 2016

Pesticides are widely used for the control of weeds, diseases, and pests of cultivated plants all over the world, mainly since the period after the Second World War. The use of pesticides is very extensive to control harm of pests all over the globe. Persistent nature of most of the synthetic pesticides causes serious environmental concerns. Decontamination of these hazardous chemicals is very essential. This review paper elaborates the potential of various biological agents in decontamination of agricultural soils. The agricultural crop fields are contaminated by the periodic applications of pesticides. Biodegradation is an ecofriendly, cost-effective, highly efficient approach compared to the physical and chemical methods which are expensive as well as unfriendly towards environment. Biodegradation is sensitive to the concentration levels of hydrogen peroxide and nitrogen along with microbial community, temperature, and pH changes. Experimental work for optimum conditions at lab scale can provide very fruitful results about specific bacterial, fungal strains. This study revealed an upper hand of bioremediation over physicochemical approaches. Further studies should be carried out to understand mechanisms of biotransformation.
Treatment of Dermatological Conditions Associated with HIV/AIDS: The Scarcity of Guidance on a Global Scale
Authors: Paul Suchismita , Evans Rachel , Maurer Toby , Muhe Lulu M. , Freeman Esther E.
Published: May 2016

Background. Skin diseases associated with Human Immunodeficiency Virus (HIV) infection are associated with significant morbidity and mortality. In resource-limited settings, nondermatologists and lay health care providers on the front line of HIV care provide much of the treatment for these conditions.Objective. To evaluate guidelines for treatment of HIV-related skin conditions and assess their accessibility, comprehensiveness, and quality of evidence employed.Methods. A review was undertaken of all national and society guidelines which included treatment information on the ten highest burden HIV-related skin conditions. The search strategy included gray and peer-reviewed literature.Results. Of 430 potential guidelines, 86 met inclusion criteria, and only 2 were written specifically to address HIV-related skin diseases as a whole. Treatment information for HIV-related skin conditions was embedded within guidelines written for other purposes, primarily HIV/AIDs treatment guidelines (49%). Development of guidelines relied either partially or completely on expert opinion (62%). Only 16% of guidelines used gradation of evidence quality and these were primarily from high-income countries(p=0.001).Limitations. Due to the nature of gray literature, not all guidelines may have been identified.Conclusion. This review highlights the need for evidence-based summary guidelines that address treatment for HIV-related skin conditions in an accessible format.
Ultrasmall, Ligand-Free Ag Nanoparticles with High Antibacterial Activity Prepared by Pulsed Laser Ablation in Liquid
Authors: Kőrösi László , Rodio Marina , Dömötör Dora , Kovács Tamás , Papp Szilvia , Diaspro Alberto , Intartaglia Romuald , Beke Szabolcs
Published: May 2016

Since ancient times, silver and its compounds have been known to have a broad spectrum of antimicrobial activities for bacteria, fungi, and viruses. Due to the increasing bacterial resistance to classic antibiotics, the investigations of Ag NPs have increased. Herein, we present the preparation of ligand-free Ag NPs with 3 and 20 nm sizes by applying picosecond laser ablation in liquid at 355 and 1065 nm. Our laser processing system allows a high control on particle sizes. The produced nanoparticles were characterized by means of transmission electron microscopy, UV-Vis spectroscopy, and X-ray diffraction. The size effect on the antibacterial activity of Ag NPs was tested againstE. coliandS. aureus. The growth curves of bacteria were monitored at 0–5 mg/L of Ag NPs by a multimode microplate reader. The size effects as well as the concentration of Ag NPs on their antibacterial activity are discussed.
Genetic Engineering of Mesenchymal Stem Cells to Induce Their Migration and Survival
Authors: Nowakowski Adam , Walczak Piotr , Lukomska Barbara , Janowski Miroslaw
Published: May 2016

Mesenchymal stem cells (MSCs) are very attractive for regenerative medicine due to their relatively easy derivation and broad range of differentiation capabilities, either naturally or induced through cell engineering. However, efficient methods of delivery to diseased tissues and the long‐term survival of grafted cells still need improvement. Here, we review genetic engineering approaches designed to enhance the migratory capacities of MSCs, as well as extend their survival after transplantation by the modulation of prosurvival approaches, including prevention of senescence and apoptosis. We highlight some of the latest examples that explore these pivotal points, which have great relevance in cell‐based therapies.
Chemokines and Heart Disease: A Network Connecting Cardiovascular Biology to Immune and Autonomic Nervous Systems
Authors: Dusi Veronica , Ghidoni Alice , Ravera Alice , De Ferrari Gaetano M. , Calvillo Laura
Published: May 2016

Among the chemokines discovered to date, nineteen are presently considered to be relevant in heart disease and are involved in all stages of cardiovascular response to injury. Chemokines are interesting as biomarkers to predict risk of cardiovascular events in apparently healthy people and as possible therapeutic targets. Moreover, they could have a role as mediators of crosstalk between immune and cardiovascular system, since they seem to act as a “working-network” in deep linkage with the autonomic nervous system. In this paper we will describe the single chemokines more involved in heart diseases; then we will present a comprehensive perspective of them as a complex network connecting the cardiovascular system to both the immune and the autonomic nervous systems. Finally, some recent evidences indicating chemokines as a possible new tool to predict cardiovascular risk will be described.
Solo Sonographically Guided PCNL under Spinal Anesthesia: Defining Predictors of Success
Authors: Nouralizadeh Akbar , Pakmanesh Hamid , Basiri Abbas , Aayanifard Mohammad , Soltani Mohammad Hossein , Tabibi Ali , Sharifiaghdas Farzaneh , Ziaee Seyed Amir Mohsen , Shakhssalim Naser , Valipour Reza , Narouie Behzad , Radfar Mohammad Hadi
Published: May 2016

Aim. Sonography has been brought in percutaneous nephrolithotripsy (PCNL) as an adjunct to or substitute for X-ray to restrict radiation exposure. This study was designed to investigate the possible predictors for the success of the solo sonographically guided PCNL.Methods. 148 consecutive cases were prospectively enrolled. All steps of PCNL were performed solely with sonography guidance under spinal anesthesia. Residual stones were evaluated the day after surgery using sonography and plain radiography.Results. The mean age was46±15years; 40% of kidneys had hydronephrosis. The mean stone burden was504±350 mm2. The mean duration of surgery was43±21minutes. The early stone-free rate was 92% in inferior or middle calyceal stones, 89.5% in single pelvic stones, 81.5% in partial staghorn stones, and 61.9% in staghorn stones. The mean residual stone size was13±8 mm. Logistic regression showed that a lower age and a larger stone burden significantly predicted positive residual stones. Fifteen percent of patients presented with grade I or II and six percent showed grade III complication based on Clavien classification. There was no cases of organ injury or death.Conclusion. Solo ultrasonographically guided PCNL under spinal anesthesia is feasible with an acceptable stone-free rate and complication rate.
Lung Ultrasound Diagnostic Accuracy in Neonatal Pneumothorax
Authors: Cattarossi Luigi , Copetti Roberto , Brusa Giacomo , Pintaldi Stefano
Published: May 2016

Background. Pneumothorax (PTX) still remains a common cause of morbidity in critically ill and ventilated neonates. At the present time, lung ultrasound (LUS) is not included in the diagnostic work-up of PTX in newborns despite of excellent evidence of reliability in adults. The aim of this study was to compare LUS, chest X-ray (CXR), and chest transillumination (CTR) for PTX diagnosis in a group of neonates in which the presence of air in the pleural space was confirmed.Methods. In a 36-month period, 49 neonates with respiratory distress were enrolled in the study. Twenty-three had PTX requiring aspiration or chest drainage (birth weight 2120 ± 1640 grams; gestational age = 36 ± 5 weeks), and 26 were suffering from respiratory distress without PTX (birth weight 2120 ± 1640 grams; gestational age = 34 ± 5 weeks). Both groups had done LUS, CTR, and CXR.Results. LUS was consistent with PTX in all 23 patients requiring chest aspiration. In this group, CXR did not detect PTX in one patient while CTR did not detect it in 3 patients. Sensitivity and specificity in diagnosing PTX were therefore 1 for LUS, 0.96 and 1 for CXR, and 0.87 and 0.96 for CTR.Conclusions. Our results confirm that also in newborns LUS is at least as accurate as CXR in the diagnosis of PTX while CTR has a lower accuracy.
Managing Sleep Disturbances in Cirrhosis
Authors: Zhao Xun , Wong Philip
Published: May 2016

Sleep disturbances, particularly daytime sleepiness and insomnia, are common problems reported by patients suffering from liver cirrhosis. Poor sleep negatively impacts patients’ quality of life and cognitive functions and increases mortality. Although sleep disturbances can be an early sign of hepatic encephalopathy (HE), many patients without HE still complain of poor quality sleep. The pathophysiology of these disturbances is not fully understood but is believed to be linked to impaired hepatic melatonin metabolism. This paper provides an overview for the clinician of common comorbidities contributing to poor sleep in patients with liver disease, mainly restless leg syndrome and obstructive sleep apnea. It discusses nondrug and pharmacologic treatment options in these patients, such as the use of light therapy and histamine (H1) blockers.
Energy-Efficient Opportunistic Transmission Scheduling for Sparse Sensor Networks with Mobile Relays
Authors: Liu Wei , Zhao Xiaojie , An Yuan , Dai Xiangjun , Ma Qingtian , Guo Hongjian
Published: May 2016

Wireless sensing devices have been widely used in civilian and military applications over the past decade. In some application scenarios, the sensors are sparsely deployed in the field and are costly or infeasible to have stable communication links for delivering the collected data to the destined server. A possible solution is to utilize the motion of entities that are already present in the environment to provide opportunistic relaying services for sensory data. In this paper, we design and propose a new scheduling scheme that opportunistically schedules data transmissions based on the optimal stopping theory, with a view of minimizing the energy consumption on network probes for data delivery. In fact, by exploiting the stochastic characteristics of the relay motion, we can postpone the communication up to an acceptable time deadline until the best relay is found. Simulation results validate the effectiveness of the derived optimal strategy.
Evaluation of Clinical Alvarado Scoring System and CT Criteria in the Diagnosis of Acute Appendicitis
Authors: Gunes Tatar Idil , Yilmaz Kerim Bora , Sahin Alpaslan , Aydin Hasan , Akinci Melih , Hekimoglu Baki
Published: May 2016

Aim. The aim was to evaluate the clinical Alvarado scoring system and computed tomography (CT) criteria for the diagnosis of acute appendicitis.Material and Methods. 117 patients with acute abdominal pain who underwent abdominal CT were enrolled in this retrospective study. Patient demographics, clinical Alvarado scoring, CT images, and pathologic results of the patients were evaluated.Results. 39 of the 53 patients who were operated on had pathologically proven acute appendicitis. CT criteria of appendiceal diameter, presence of periappendiceal inflammation, fluid, appendicolith, and white blood cell (WBC) count were significantly correlated with the inflammation of the appendix. The best cut-off value for appendiceal diameter was 6.5 mm. The correlation between appendiceal diameter and WBC count was 80% (P=0.01<0.05). The correlation between appendiceal diameter and Alvarado score was 78.7% (P=0.01<0.05).Conclusion. Presence of CT criteria of appendiceal diameter above 6.5 mm, periappendiceal inflammation, fluid, and appendicolith should prompt the diagnosis of acute appendicitis. Since patients with acute appendicitis may not always show the typical signs and symptoms, CT is a helpful imaging modality for patients with relatively low Alvarado score and leukocytosis and when physical examination is confusing.
Immunostimulatory Monoclonal Antibodies and Immunomodulation: Harvesting the Crop
Authors: Berraondo Pedro , Ochoa María Carmen , Rodriguez-Ruiz María Esperanza , Minute Luna , Lasarte Juan José , Melero Ignacio
Published: May 2016

The recent approval by the FDA of the combination of anti-CTLA4 and anti-PD-1 mAbs for the treatment of BRAF-unmutated unresectable or metastatic melanoma is a landmark for the development of cancer immunotherapy. On October 18 to 22, 2015, a symposium was held in Pamplona (Spain) to present and discuss the basic and clinical discoveries that have brought us to this milestone and to explore other targets and immunotherapy strategies aimed at attaining more efficacious oncology practice in the short term. Cancer Res; 76(10); 2863–7. ©2016 AACR.
Targeting Androgen Receptor Activation Function-1 with EPI to Overcome Resistance Mechanisms in Castration-Resistant Prostate Cancer
Authors: Yang Yu Chi , Banuelos Carmen Adriana , Mawji Nasrin R. , Wang Jun , Kato Minoru , Haile Simon , McEwan Iain J. , Plymate Stephen , Sadar Marianne D.
Published: May 2016

Purpose: Persistent androgen receptor (AR) transcriptional activity is clinically evident in castration-resistant prostate cancer (CRPC). Therefore, AR remains as a viable therapeutic target for CRPC. All current hormonal therapies target the C-terminus ligand-binding domain (LBD) of AR. By using EPI to target AR activation function-1 (AF-1), in the N-terminal domain that is essential for AR transactivation, we evaluate the ability of EPI to overcome several clinically relevant AR-related mechanisms of resistance.

Experimental Design: To study the effect of EPI on AR transcriptional activity against overexpressed coactivators, such as SRC1-3 and p300, luciferase reporter assays were performed using LNCaP cells. AR-negative COS-1 cells were employed for reporter assays to examine whether the length of polyglutamine tract affects inhibition by EPI. The effect of EPI on constitutively active AR splice variants was studied in LNCaP95 cells, which express AR-V7 variant. To evaluate the effect of EPI on the proliferation of LNCaP95 cells, we performed in vitro BrdUrd incorporation assay and in vivo studies using xenografts in mice.

Results: EPI effectively overcame several molecular alterations underlying aberrant AR activity, including overexpressed coactivators, AR gain-of-function mutations, and constitutively active AR-V7. EPI inhibited AR transcriptional activity regardless of the length of polyglutamine tract. Importantly, EPI significantly inhibited the in vitro and in vivo proliferation of LNCaP95 prostate cancer cells, which are androgen independent and enzalutamide resistant.

Conclusions: These findings support EPI as a promising therapeutic agent to treat CRPC, particularly against tumors driven by constitutively active AR splice variants that are resistant to LBD-targeting drugs. Clin Cancer Res; 22(17); 4466–77. ©2016 AACR.

See related commentary by Sharp et al., p. 4280
Malignant Triton Tumor of the Sciatic Nerve as a Secondary Malignancy after Extended Field Radiotherapy and Chemotherapy of Hodgkin's Disease
Authors: Nitsche Mirko , Reible Michael , Pflüger Karl-Heinz , Bergmann Markus , Hermann Robert Michael
Published: May 2016

Late effects of therapy for Hodgkin's disease include secondary malignancies like leukemia, lymphoma or solid tumors developing after long periods of latency. Ionizing radiation often causes the last group. The highest risks have been described for induced breast and lung cancers. We are the first to report a malignant triton tumor (MTT) as a secondary malignancy after radiotherapy and chemotherapy for Hodgkin's lymphoma. MTT is a very rare subtype of malignant peripheral nerve sheath tumors with rhabdomyoblastic differentiation and an aggressive course of disease.
Surgery without Blood Transfusion for Giant Paraganglioma in a Jehovah's Witness Patient
Authors: Narita Takuya , Hamano Itsuto , Kusaka Ayumu , Murasawa Hiromi , Tokui Noriko , Imanishi Kengo , Okamoto Teppei , Yamamoto Hayato , Imai Atsushi , Hatakeyama Shingo , Yoneyama Takahiro , Hashimoto Yasuhiro , Koie Takuya , Ohyama Chikara , Hakamada Kenichi
Published: May 2016

A retroperitoneal tumor was identified in a 57-year-old female belonging to Jehovah's Witnesses during a health check. Subsequent examination led to the suspicion of a right pheochromocytoma. The patient wished to be treated by bloodless surgery and consulted our hospital after being refused surgery by several hospitals. She signed a liability waiver for blood transfusion refusal. After obtaining consent for diluted autotransfusion and preoperative administration of erythropoietin, the surgery was scheduled. The tumor was attached to the inferior vena cava and left renal vein and engulfed the right renal artery and vein. The tumor and right kidney were removed en bloc. Operative time was 8 h and 18 min, with 1,770 ml of blood loss. The histopathological diagnosis was paraganglioma with the normal adrenal gland within the border of the tumor. The patient was discharged from the hospital with no postoperative complications.
Fatal Interstitial Lung Disease after Addition of Sorafenib to a Patient with Lung Adenocarcinoma Who Had Failed to Improve with Erlotinib Alone
Authors: Guan Yin , Meng Jing , Zhao Hong , Hu Yi , Yan Xiang , Zhao Shao-Hong , Jiao Shun-Chang
Published: May 2016

Interstitial lung disease (ILD) induced by epidermal growth factor receptor tyrosine kinase inhibitors has been extensively documented with decreasing incidence after appropriate patient selection due to increasing awareness over the years. However, ILD induced by sorafenib was mentioned with lower frequency only in patients with hepatocellular and renal cell carcinoma living in Japan but not in patients with other carcinomas or living outside Japan, and it has been overlooked in clinical practice. In the present case, sorafenib was added to the treatment of a 60-year-old non-smoking patient with non-small cell lung cancer (NSCLC). After his failing to improve with erlotinib alone, erlotinib was continued to be given in combination with sorafenib as a salvage therapy. Although clinical signs of ILD were observed 2 weeks after the addition of sorafenib, the radiological diagnosis of ILD was only made 41 days after the initiation of the combination treatment, and the patient died 56 days after treatment onset. It was concluded that ILD was indeed induced by sorafenib. This is the first report of ILD induced by sorafenib in a patient with NSCLC living outside Japan. Oncologists should be aware of this fatal complication for its early detection in order to avoid a severe course of ILD leading to a decrease in the ILD mortality rate.
Aortic Arch Atherosclerosis in Ischaemic Stroke of Unknown Origin Affects Prognosis
Authors: Abe Arata , Harada-Abe Mina , Ueda Masayuki , Katano Takehiro , Nakajima Masataka , Muraga Kanako , Suda Satoshi , Nishiyama Yasuhiro , Okubo Seiji , Mishina Masahiro , Katsura Ken-ichiro , Katayama Yasuo
Published: May 2016

Background: Cerebral infarction of unknown origin at admission accounts for half of all cerebral infarction cases in some institutions. However, the factors associated with cerebral infarction prognosis have not been sufficiently examined. Here, we investigated whether aortic arch plaques (AAPs) on transoesophageal echocardiography (TOE) were associated with the prognosis of cerebral infarction of unknown origin at admission. Methods: Of 571 patients who were hospitalised between June 2009 and September 2011, 149 (age: 67 ± 14 years; 95 men) with cerebral infarctions of unknown origin at admission underwent TOE and were enrolled in this study. We examined their clinical characteristics, the incidence of intermittent atrial fibrillation detected on 24-hour electrocardiography, and the echographic findings of the carotid artery in the hospital. A poor prognostic outcome was defined as a modified Rankin Scale score of ≥3 after 90 days. Results: In all, 110 patients (74%) showed good prognoses and 39 patients (26%) showed poor outcomes. A National Institutes of Health Stroke Scale score of >6 on admission [odds ratio (OR) = 6.77; 95% confidence interval (CI): 2.59-18.8; p < 0.001] and AAPs of ≥4 mm (OR = 2.75; 95% CI: 1.19-6.91; p = 0.024) showed significant associations with a poor prognosis of cerebral infarction of unknown origin at admission. Conclusions: Thick AAPs could be a factor in the prediction of a poor prognosis of cerebral infarction of unknown origin at admission. The establishment of international standards for aortogenic brain embolisms is required. Future prospective studies should examine cerebral infarctions of unknown origin.
Long-Term Response in a Patient with del(5q) Myelodysplastic Syndrome Who Discontinued Lenalidomide and Obtained a Good Response and Tolerance to Rechallenge
Authors: Pisani Francesco , Orlandi Giulia , Merola Roberta
Published: May 2016

Background: The introduction of the immunomodulatory drug lenalidomide has revolutionized the treatment of patients with myelodysplastic syndromes (MDS) and deletion of the long arm of chromosome 5. Treatment with lenalidomide results in transfusion independence in the majority of patients, but some questions remain unresolved, among them the duration of treatment. Moreover, a number of unexpected long-term remissions in patients who stopped lenalidomide for various reasons have been observed. Case Report: We report the case of a 60-year-old Caucasian male with deletion of the long arm of chromosome 5 and International Prognostic Scoring System (IPSS)-defined low-risk MDS who was treated with lenalidomide, achieving complete cytogenetic remission and erythroid response. After tapering off and interrupting the treatment, the patient relapsed and showed a new response by lenalidomide retreatment. Six years after the initial treatment, we registered a durable erythroid long-term response and good tolerance, but there was no evidence of a very profound cytogenetic response compared to using lenalidomide as a first-line treatment. Cytogenetic and fluorescence in situ hybridization together with hemoglobin level, mean corpuscular volume (MCV) and vitamin B12 level helped us to monitor the patient response; during the various phases of lenalidomide treatment, MCV and vitamin B12 normalization correlated with good response. Conclusion: Lenalidomide interruption and rechallenge in some 5q- MDS patients, with low risk according to the IPSS, is safe and feasible but does not result in a profound cytogenetic response.
Perianal Paget's Disease Co-Associated with Anorectal Adenocarcinoma: Primary or Secondary Disease
Authors: Liao Xiujun , Mao Weiming , Lin A'Li
Published: May 2016

Perianal Paget's disease (PPD) represents a skin neoplasm which can be either primary or secondary to carcinoma from an adjacent internal organ. PPD with underlying colorectal adenocarcinoma is usually looked upon as a secondary disease. We report a rare case of co-associated PPD and anorectal adenocarcinoma. The PPD was found to be located near the anorectal adenocarcinoma with normal tissues between them. Immunohistochemical stains demonstrated that the Paget's cells were CK7+/GCDFP-15-/CK20-/MUC2-/CDX2-, whereas the anorectal adenocarcinoma was shown to be CK7+/GCDFP-15-/CK20+/MUC2+/CDX2+. This immunological phenotypic profile supported the notion that PPD and anorectal adenocarcinoma were of different origins, but could not define the exact origins of PPD. In our determination, this case was a primary PPD with anorectal adenocarcinoma. PPD remains a heterogeneous and complex pathology, and additional studies are required to differentiate between the various possible origins.
Chronic Kidney Disease Is an Independent Predictor of Adverse Clinical Outcomes in Patients with Recent Small Subcortical Infarcts
Authors: Saji Naoki , Sato Takahiro , Sakuta Kenichi , Aoki Junya , Kobayashi Kazuto , Matsumoto Noriko , Uemura Junichi , Shibazaki Kensaku , Kimura Kazumi
Published: May 2016

Background: Chronic kidney disease (CKD) is associated with cerebral small vessel diseases (SVD) and predicts stroke, cardiovascular events and mortality. However, its association with recent small subcortical infarcts (RSSI), a novel subtype of cerebral SVD, has not yet been established in stroke patients. The aim of this longitudinal study was to clarify whether CKD can predict clinical outcome in patients with RSSI. Methods: We enrolled patients with first-ever RSSI (formerly categorized as acute lacunar stroke). CKD was defined as an estimated glomerular filtration rate of <60 ml/min/1.73 m2 on admission. The patients were divided into two groups according to the presence or absence of CKD. The endpoints were recurrent stroke, cardiovascular events or all-cause mortality. The patients were followed up at 3, 6 and 12 months after stroke onset and yearly thereafter. Event-free survival analysis was undertaken using Kaplan-Meier plots and the log-rank test. Cox's proportional-hazards analysis was conducted regarding age, sex and the presence of any cerebral SVD. Results: A total of 152 patients (66% males; mean age: 67.6 years) were consecutively enrolled, and 44 (29%) had CKD. During the follow-up period (median: 3 years; interquartile range: 1-4), 27 patients (18%) reached endpoints. The numbers of patients per endpoint were as follows: all-cause mortality 14, ischemic stroke 9, hemorrhagic stroke 2 and aortic dissection 2. Patients with CKD were significantly older (77 vs. 64 years; p < 0.001), had higher serum creatinine (0.96 vs. 0.65 mg/dl; p < 0.001), higher brain natriuretic peptide (51.1 vs. 18.5 pg/ml; p < 0.001) and a higher National Institutes of Health Stroke Scale score on admission (3 vs. 2; p < 0.001), and were less likely to have modified Rankin Scale scores of 0-2 after stroke onset (52 vs. 77%; p = 0.003). Patients with white matter hyperintensity [odds ratio (OR) 3.0; 95% confidence interval (CI): 1.5-6.2; p = 0.003] and those with microbleeds (OR 2.5; 95% CI: 1.2-5.1; p = 0.015) had more pronounced CKD than the remaining patients. A Kaplan-Meier curve analysis showed that patients with CKD had a less favorable outcome than those without CKD (p < 0.001). The multivariate Cox proportional-hazards analysis revealed that CKD was associated with recurrent stroke, cardiovascular events or all-cause mortality (hazard ratio 2.22; 95% CI: 1.12-4.25; p = 0.02). Conclusions: CKD was found to be independently associated with recurrent stroke, cardiovascular events or all-cause mortality in patients with RSSI.
Arteriovenous Malformation Detected by Small Bowel Endoscopy
Authors: Fujii Takaaki , Morita Hiroki , Sutoh Toshinaga , Takada Takahiro , Tsutsumi Soichi , Kuwano Hiroyuki
Published: May 2016

Gastrointestinal bleeding that originates in the small intestine is often difficult to diagnose. When successful diagnosis reveals a lesion that can be localized preoperatively, the laparoscopic approach is an appropriate and beneficial treatment modality for small bowel resection. A 69-year-old man presented with a 6-month history of gastrointestinal bleeding and symptomatic transfusion-dependent anemia. Upper and lower endoscopy were normal. Double-balloon endoscopy established the source of the bleeding as a 0.5-cm polypoid mass appearing as a submucosal tumor with redness and pulsation in the lower ileum, suggesting a vascular lesion. Laparoscopic small bowel resection was successful in removing the mass in the ileum. Histological evaluation of the mass revealed an arteriovenous malformation. Preoperative small bowel endoscopy can be useful for diagnosing the cause and localization of arteriovenous malformation in the small intestine.
Efficacy of Triplet Combination Chemotherapy with Oxaliplatin, Irinotecan and Capecitabine (OCX) in Metastatic Colorectal Cancer in Relation to RAS/RAF Mutation Status: Results of a Retrospective Analysis
Authors: Brunner Stefan , von Moos Roger , Mey Ulrich , Camenisch Gross Ulrike , Freyholdt Tobias , Cathomas Richard
Published: May 2016

SummaryBackground: The triplet combination of fluorouracil, oxaliplatin and irinotecan for metastatic colorectal cancer improves efficacy at the cost of increased toxicity. Preliminary reports indicate that triplet combination regimens might improve outcome in the RAS/RAF-mutated subgroup. Patients and Methods: This retrospective analysis included 25 patients with metastatic colorectal cancer, who received treatment with OCX (oxaliplatin, irinotecan, capecitabine). The regimen consisted of oxaliplatin 70 mg/m2 on days 1 and 15, irinotecan 100 mg/m2 on days 8 and 22, and capecitabine 1,400 mg/m2 on days 1-29 every 5 weeks. KRAS, NRAS, and BRAF mutations were determined by Sanger sequencing. Results: 23 patients received at least 1 cycle and were evaluable for efficacy. In 10 patients, a KRAS or BRAF mutation was detected. Partial remission rate was 61%, median progression-free survival 9.8 months, and median overall survival 32.9 months for all evaluable patients. No difference in efficacy was detected between the RAS/RAF wild-type and the mutant group. OCX was well tolerated with no grade 3/4 haematological events. Diarrhoea was the major non-haematological toxicity (24% grade 3). Conclusion: In this retrospective analysis, triplet chemotherapy with OCX was well tolerated and achieved encouraging efficacy in metastatic colorectal cancer irrespective of RAS/RAF mutation status.
Signet Ring Cell Carcinoma of the Extrahepatic Bile Duct Diagnosed by Preoperative Biopsy: A Case Report
Authors: Kita Emiri , Tsujimoto Akiko , Nakamura Kazuyoshi , Sudo Kentaro , Hara Taro , Kainuma Osamu , Yamamoto Hiroshi , Itami Makiko , Yamaguchi Taketo
Published: May 2016

A 73-year-old woman was admitted because of obstructive jaundice. Computed tomography revealed a stricture in the lower bile duct with enhanced bile duct wall. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a tapering stenosis at the lower bile duct. Transpapillary histological biopsy using biopsy forceps through ERCP was performed; the diagnosis of signet ring cell carcinoma (SRCC) of the bile duct was established. Regional lymph node enlargement and distant metastases were not detected on diagnostic imaging. Pancreaticoduodenectomy with pylorus preservation was performed. Histological examination of the resected specimen confirmed SRCC of the extrahepatic bile duct coexisting with adenocarcinoma (ADC) of the extrahepatic bile duct with negative resection margins. However, tumor cells directly invaded the pancreatic parenchyma and the muscle layer of the duodenum, prompting us to administer adjuvant chemotherapy to the patient, with no sign of tumor recurrence at 1-year follow-up. Almost all tumors originating from the extrahepatic bile duct are ADC and other histological variants are rare. Of these, SRCC is extremely rare and only four cases have been reported. Furthermore, to the best of our knowledge, this is the first case report regarding the preoperative diagnosis of SRCC of the bile duct. Current reports indicate that younger age and Asian ethnicity are the clinical features of SRCC of the extrahepatic bile duct. Immunohistochemical staining of CK7, CK20 and MUC2 may be useful for predicting prognosis. Chemotherapy has not resulted in increased survival rates and only surgical resection currently serves as a curative treatment.
Orale Gesundheit von Menschen mit Demenz
Authors: Besimo Christian E. , Besimo-Meyer Ruth H.
Published: May 2016

Hintergrund: Demenzerkrankungen stellen nicht nur aus allgemeinmedizinischer, sondern auch aus zahnmedizinischer Sicht eine spezielle Herausforderung dar. Die vorliegende Arbeit untersuchte 2013 die Mundgesundheit von demenzkranken Menschen mit dem Ziel, die interdisziplinären Anforderungen für eine verbesserte orale Prävention und Therapie aufzuzeigen. Methoden: Die Mundgesundheit aller 17 Bewohner einer Demenzstation der ländlichen Schweiz wurde beurteilt. Die Untersuchung wurde rein visuell durchgeführt, um die einzelnen Personen nicht übermässig zu belasten. Ergebnisse: Das Durchschnittsalter der Bewohner war mit 81,7 Jahren relativ hoch. Viele litten neben der Demenz an zusätzlichen Krankheiten. Nur 3 Bewohner waren in beiden Kiefern zahnlos, 4 nur im Oberkiefer. Mehr als die Hälfte der Bewohner mit eigenen Zähnen (57,1%) war kariesaktiv, und 85,7% wiesen eine parodontale Entzündung auf. Der letzte Zahnarztbesuch lag durchschnittlich 25,2 Monate zurück. Regelmässige Mund- und Prothesenhygiene waren erschwert; Kommunikation war nur bedingt möglich. Schlussfolgerungen: Eine oralmedizinische Gesamtabklärung demenzkranker Menschen sollte bereits bei der Diagnosestellung der Erkrankung erfolgen, um rechtzeitig eine problembezogene zahnmedizinische Langzeitbetreuung sicherzustellen.
Robotic-Assisted Approach Improves Vessel Preservation in Spleen-Preserving Distal Pancreatectomy
Authors: Eckhardt Sabine , Schicker Christoph , Maurer Elisabeth , Fendrich Volker , Bartsch Detlef K.
Published: May 2016

Background: Vessel-preserving spleen preservation (SP) during distal pancreatectomy (DP) is supposed to be beneficial for patients with benign and borderline tumors. This study evaluated the first experiences with robotic-assisted laparoscopic DP (RA-LDP) and its rate of vessel preservation and SP compared to conventional laparoscopic DP (C-LDP). Methods: Patients scheduled for spleen-preserving DP for benign or borderline tumors by either C-LDP or RA-LDP were retrieved from a prospective database and retrospectively analyzed regarding vessel-preservation and SP, conversion rate, blood loss, operating time, complications, perioperative blood transfusion, postoperative hospital stay (PHS) and mortality. Results: Twenty-nine patients underwent C-LDP and 12 patients underwent RA-LDP between September 2009 and May 2015. SP rates were 79% (23 of 29) in the C-LDP and 92% (11 of 12) in the RA-LDP group (p = 0.32). Splenic vessels could be preserved in 17% (5 of 29) of the C-LDP and 50% (6 of 12) of the RA-LDP group (p = 0.052). Operating time, intraoperative blood loss, the number of perioperative red blood cell transfusions, overall morbidity and the rate of postoperative pancreatic fistulas were not different between the groups. PHS was shorter in the RA-LDP group (10.5 vs. 13 days; p = 0.02). Conclusion: RA-LDP for benign or borderline tumors of the pancreas is a safe procedure and tended to be associated with a better vessel-preservation rate, thereby making it a good alternative to C-LDP.
Insights into the Virulence Traits of Streptococcus mutans in Dentine Carious Lesions of Children with Early Childhood Caries
Authors: Bezerra Daniela S. , Stipp Rafael N. , Neves Beatriz G. , Guedes Sarah F.F. , Nascimento Marcelle M. , Rodrigues Lidiany K.A.
Published: May 2016

Streptococcus mutans is an oral bacterium considered to play a major role in the development of dental caries. This study aimed to investigate the prevalence of S. mutans in active and arrested dentine carious lesions of children with early childhood caries and to examine the expression profile of selected S. mutans genes associated with survival and virulence, within the same carious lesions. Dentine samples were collected from 29 active and 16 arrested carious lesions that were diagnosed in preschool children aged 2-5 years. Total RNA was extracted from the dentine samples, and reverse transcription quantitative real-time PCR analyses were performed for the quantification of S. mutans and for analyses of the expression of S. mutans genes associated with bacterial survival (atpD, nox, pdhA) and virulence (fabM and aguD). There was no statistically significant difference in the prevalence of S. mutans between active and arrested carious lesions. Expression of the tested genes was detected in both types of carious dentine. The pdhA (p = 0.04) and aguD (p = 0.05) genes were expressed at higher levels in arrested as compared to active lesions. Our findings revealed that S. mutans is part of the viable microbial community in active and arrested dentine carious lesions. The increase in expression of the pdhA and aguD genes in arrested lesions is likely due to the unfavourable environmental conditions for microbial growth, inherent to this type of lesions.
Neuroepidemiologic and Neurobehavioral Characteristics of Motoric Cognitive Risk Syndrome in an Old-Old Population: The Kurihara Project
Authors: Kumai Keiichi , Meguro Kenichi , Kasai Mari , Nakamura Kei , Nakatsuka Masahiro ,   the Kurihara Project members
Published: May 2016

Background: Recently, the concept of motoric cognitive risk (MCR) syndrome was proposed, where slow gait is considered a risk factor for conversion to dementia. Aim: To retrospectively investigate the characteristics of MCR among a population aged 75+ years, focusing on the aspects of epidemiology and neurobehavioral characteristics. Method: The participants were 590 residents aged 75+ years living in Kurihara who underwent MRI and neurobehavioral assessments including walking velocity. The prevalence of MCR and conversion to dementia (AD8 Dementia Screening Interview cutoff 2/8), together with the neurobehavioral characteristics of the MCR group, were analyzed. Results: The prevalence was 11.1%, and the conversion ratio in the MCR group was higher than that in the non-MCR group (OR = 1.38). The MCR group had lower scores on the executive function test as well as gait velocity. Conclusions: The MCR syndrome increases the rate of conversion to dementia, and both slow gait and lower scores in executive tests, which are ‘frontal-based' functions, are predictive of higher rates of conversion to dementia.
The Value of Routine Hysteroscopy before the First Intracytoplasmic Sperm Injection Treatment Cycle
Authors: Alleyassin Ashraf , Abiri Ameneh , Agha-Hosseini Marzieh , Sarvi Fatemeh
Published: May 2016

Background/Aims: To assess uterine cavity with office hysteroscopy in order to diagnose and treat pathologies in patients who have started their first intracytoplasmic sperm injection (ICSI) cycles and evaluate its impact on pregnancy rate. Methods: A number of 220 infertile women scheduled for ICSI participated in this prospective randomized study. They were randomly divided into 2 equal groups. Group I (intervention) underwent office hysteroscopy before starting assisted reproductive techniques (ART) cycle. Group II (control) started ART cycles without office hysteroscopy. All women had normal transvaginal ultrasonography and hysterosalpingography. The detected intrauterine abnormalities were treated during hysteroscopy. Four weeks after embryo transfer, ultrasonography was done for detecting clinical pregnancy. Results: Abnormal findings were seen in hysteroscopy in 22.7% of the intervention group. The pregnancy rate in the intervention group (48.20%) was significantly higher than that in the control group (38.60%; p = 0.004). Conclusion: Routine office hysteroscopy before ICSI cycles provides direct evaluation of uterine cavity. Also, pregnancy rate improves after correction of endometrial cavity abnormalities.