bluuebunny/crossref_metadata_2025 huggingface dataset:
GSK3β Regulates Milk Synthesis in and Proliferation of Dairy Cow Mammary Epithelial Cells via the mTOR/S6K1 Signaling Pathway
Authors: Zhang Xia , Zhao Feng , Si Yu , Huang Yuling , Yu Cuiping , Luo Chaochao , Zhang Na , Li Qingzhang , Gao Xuejun
Published: July 2014

Glycogen synthase kinase 3 (GSK3) is a serine/threonine kinase, whose activity is inhibited by AKT phosphorylation. This inhibitory phosphorylation of GSK3β can in turn play a regulatory role through phosphorylation of several proteins (such as mTOR, elF2B) to promote protein synthesis. mTOR is a key regulator in protein synthesis and cell proliferation, and recent studies have shown that both GSK3β and mTORC1 can regulate SREBP1 to promote fat synthesis. Thus far, however, the cross talk between GSK3β and the mTOR pathway in the regulation of milk synthesis and associated cell proliferation is not well understood. In this study the interrelationship between GSK3β and the mTOR/S6K1 signaling pathway leading to milk synthesis and proliferation of dairy cow mammary epithelial cells (DCMECs) was analyzed using techniques including GSK3β overexpression by transfection, GSK3β inhibition, mTOR inhibition and methionine stimulation. The analyses revealed that GSK3β represses the mTOR/S6K1 pathway leading to milk synthesis and cell proliferation of DCMECs, whereas GSK3β phosphorylation enhances this pathway. Conversely, the activated mTOR/S6K1 signaling pathway downregulates GSK3β expression but enhances GSK3β phosphorylation to increase milk synthesis and cell proliferation, whereas inhibition of mTOR leads to upregulation of GSK3β and repression of GSK3β phosphorylation, which in turn decreases milk synthesis, and cell proliferation. These ﬁndings indicate that GSK3β and phosphorylated GSK3β regulate milk synthesis and proliferation of DCMECs via the mTOR/S6K1 signaling pathway. These findings provide new insight into the mechanisms of milk synthesis.
Blumea balsamifera—A Phytochemical and Pharmacological Review
Authors: Pang Yuxin , Wang Dan , Fan Zuowang , Chen Xiaolu , Yu Fulai , Hu Xuan , Wang Kai , Yuan Lei
Published: July 2014

The main components of sambong (Blumea balsamifera) are listed in this article. The whole plant and its crude extracts, as well as its isolated constituents, display numerous biological activities, such as antitumor, hepatoprotective, superoxide radical scavenging, antioxidant, antimicrobial and anti-inflammation, anti-plasmodial, anti-tyrosinase, platelet aggregation, enhancing percutaneous penetration, wound healing, anti-obesity, along with disease and insect resistant activities. Although many experimental and biological studies have been carried out, some traditional uses such as rheumatism healing still need to be verified by scientific pharmacological studies, and further studies including phytochemical standardization and bioactivity authentication would be beneficial.
Effects of Icariin on Reproductive Functions in Male Rats
Authors: Chen Maoxin , Hao Jie , Yang Qiaozhen , Li Gang
Published: July 2014

The present study investigated the effects and potential mechanism(s) of action of icariin on the reproductive functions of male rats. Adult rats were treated orally with icariin at doses of 0 (control), 50, 100, or 200 mg/kg body weight for 35 consecutive days. The results show that icariin had virtually no effect on the body weight or organ coefficients of the testes or epididymides. However, 100 mg/kg icariin significantly increased epididymal sperm counts. In addition, 50 and 100 mg/kg icariin significantly increased testosterone levels. Real-time PCR suggests icariin may be involved in testosterone production via mRNA expression regulation of genes such as peripheral type benzodiazepine receptor (PBR) and steroidogenic acute regulatory protein (StAR). Furthermore, 100 mg/kg icariin treatment also affected follicle stimulating hormone receptor (FSHR) and claudin-11 mRNA expression in Sertoli cells. Superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels were measured in the testes; 50 and 100 mg/kg icariin treatment improved antioxidative capacity, while 200 mg/kg icariin treatment upregulated oxidative stress. These results collectively suggest that icariin within a certain dose range is beneficial to male reproductive functions; meanwhile, higher doses of icariin may damage reproductive functions by increasing oxidative stress in the testes.
The Flux of Select NSAIDs through Silicone Membranes from Mineral Oil
Authors: Mertz Paul , Sloan Kenneth
Published: July 2014

Here we report the experimental log maximum fluxes of n = 9 non-steroidal anti-inflammatory drugs (NSAID) through silicone membranes from the lipid mineral oil (experimental (Exp.) log JMPMO) and correlate those Exp. log JMPMO values with their experimental log maximum fluxes through human skin in vivo from mineral oil (Exp. log JMHMO). The correlation was only fair (r2 = 0.647) for n = 9 but improved dramatically if Nabumetone was removed from the correlation (n = 8, r2 = 0.858). Non-linear regression of the n = 8 Exp. log JMPMO values as the dependent variable against their log solubilities in mineral oil (log SMO) and in pH 7.4 or 1.0 buffers (log S7.4 or S1.0, respectively), and their molecular weights as independent variables in the Roberts–Sloan (RS) equation gave a new set of coefficients for the independent variables in RS. Those coefficients have been used to calculate log JMPMO values which have been correlated with the Exp. log JMPMO values to give r2 = 0.911 if log S7.4 and r2 = 0.896 if log S1.0 were used as aqueous phases. Thus, silicone membranes appear to be good surrogates for predicting flux through human skin if the vehicle is a lipid such as mineral oil.
Cell Patterning for Liver Tissue Engineering via Dielectrophoretic Mechanisms
Authors: Yahya Wan , Kadri Nahrizul , Ibrahim Fatimah
Published: July 2014

Liver transplantation is the most common treatment for patients with end-stage liver failure. However, liver transplantation is greatly limited by a shortage of donors. Liver tissue engineering may offer an alternative by providing an implantable engineered liver. Currently, diverse types of engineering approaches for in vitro liver cell culture are available, including scaffold-based methods, microfluidic platforms, and micropatterning techniques. Active cell patterning via dielectrophoretic (DEP) force showed some advantages over other methods, including high speed, ease of handling, high precision and being label-free. This article summarizes liver function and regenerative mechanisms for better understanding in developing engineered liver. We then review recent advances in liver tissue engineering techniques and focus on DEP-based cell patterning, including microelectrode design and patterning configuration.
A Depth Video Sensor-Based Life-Logging Human Activity Recognition System for Elderly Care in Smart Indoor Environments
Authors: Jalal Ahmad , Kamal Shaharyar , Kim Daijin
Published: July 2014

Recent advancements in depth video sensors technologies have made human activity recognition (HAR) realizable for elderly monitoring applications. Although conventional HAR utilizes RGB video sensors, HAR could be greatly improved with depth video sensors which produce depth or distance information. In this paper, a depth-based life logging HAR system is designed to recognize the daily activities of elderly people and turn these environments into an intelligent living space. Initially, a depth imaging sensor is used to capture depth silhouettes. Based on these silhouettes, human skeletons with joint information are produced which are further used for activity recognition and generating their life logs. The life-logging system is divided into two processes. Firstly, the training system includes data collection using a depth camera, feature extraction and training for each activity via Hidden Markov Models. Secondly, after training, the recognition engine starts to recognize the learned activities and produces life logs. The system was evaluated using life logging features against principal component and independent component features and achieved satisfactory recognition rates against the conventional approaches. Experiments conducted on the smart indoor activity datasets and the MSRDailyActivity3D dataset show promising results. The proposed system is directly applicable to any elderly monitoring system, such as monitoring healthcare problems for elderly people, or examining the indoor activities of people at home, office or hospital.
Physiological Sensor Signals Classification for Healthcare Using Sensor Data Fusion and Case-Based Reasoning
Authors: Begum Shahina , Barua Shaibal , Ahmed Mobyen
Published: July 2014

Today, clinicians often do diagnosis and classification of diseases based on information collected from several physiological sensor signals. However, sensor signal could easily be vulnerable to uncertain noises or interferences and due to large individual variations sensitivity to different physiological sensors could also vary. Therefore, multiple sensor signal fusion is valuable to provide more robust and reliable decision. This paper demonstrates a physiological sensor signal classification approach using sensor signal fusion and case-based reasoning. The proposed approach has been evaluated to classify Stressed or Relaxed individuals using sensor data fusion. Physiological sensor signals i.e., Heart Rate (HR), Finger Temperature (FT), Respiration Rate (RR), Carbon dioxide (CO2) and Oxygen Saturation (SpO2) are collected during the data collection phase. Here, sensor fusion has been done in two different ways: (i) decision-level fusion using features extracted through traditional approaches; and (ii) data-level fusion using features extracted by means of Multivariate Multiscale Entropy (MMSE). Case-Based Reasoning (CBR) is applied for the classification of the signals. The experimental result shows that the proposed system could classify Stressed or Relaxed individual 87.5% accurately compare to an expert in the domain. So, it shows promising result in the psychophysiological domain and could be possible to adapt this approach to other relevant healthcare systems.
The Potential of IT for Corporate Sustainability
Authors: Hack Stefan , Berg Christian
Published: July 2014

Several studies have proven that information technology (IT) can improve enterprises’ performance. The effective and efficient management of enterprise resources has for long been the role of enterprise resource planning (ERP) systems. Whereas traditional ERP systems focused on the optimization of financial resources and assets, the manifold challenges of a sustainable development necessitate broadening that view. Business applications need to provide informational transparency on all kinds of financial, environmental and social indicators, both within the enterprise and along the value chain; they need to support business processes and enable the measuring, tracking and reporting of sustainability performance, as well as the compliance with legal regulations, all implying substantial potential for improving corporate sustainability. However, the understanding of the potential of IT for corporate sustainability poses an interesting and valuable research topic. Drawing on previous works of Luftman, Melville et al. and Dao et al., we propose a conceptual model for the sustainability value of IT. We will summarize the main aspects of the recent discussion around the capabilities of IT and, then, illustrate with best-practice examples how these capabilities can be utilized for improved sustainability performance in a corporate setting. The paper concentrates on the second order effects of IT, like process improvements or substitution effects, which have also been described as “green through IT”.
Social Life Cycle Assessment Revisited
Authors: Wu Ruqun , Yang Dan , Chen Jiquan
Published: July 2014

To promote the development of Social Life Cycle Assessment (SLCA), we conducted a comprehensive review of recently developed frameworks, methods, and characterization models for impact assessment for future method developers and SLCA practitioners. Two previous reviews served as our foundations for this review. We updated the review by including a comprehensive list of recently-developed SLCA frameworks, methods and characterization models. While a brief discussion from goal, data, and indicator perspectives is provided in Sections 2 to 4 for different frameworks/methods, the focus of this review is Section 5 where discussion on characterization models for impact assessment of different methods is provided. The characterization models are categorized into two types following the UNEP/SETAC guidelines: type I models without impact pathways and type II models with impact pathways. Different from methods incorporating type I/II characterization models, another LCA modeling approach, Life Cycle Attribute Assessment (LCAA), is also discussed in this review. We concluded that methods incorporating either type I or type II models have limitations. For type I models, the challenge lies in the systematic identification of relevant stakeholders and materiality issues; while for type II models, identification of impact pathways that most closely and accurately represent the real-world causal relationships is the key. LCAA may avoid these problems, but the ultimate questions differ from those asked by the methods using type I and II models.
New Aspects of the Pathogenesis of Canine Distemper Leukoencephalitis
Authors: Lempp Charlotte , Spitzbarth Ingo , Puff Christina , Cana Armend , Kegler Kristel , Techangamsuwan Somporn , Baumgärtner Wolfgang , Seehusen Frauke
Published: July 2014

Canine distemper virus (CDV) is a member of the genus morbillivirus, which is known to cause a variety of disorders in dogs including demyelinating leukoencephalitis (CDV-DL). In recent years, substantial progress in understanding the pathogenetic mechanisms of CDV-DL has been made. In vivo and in vitro investigations provided new insights into its pathogenesis with special emphasis on axon-myelin-glia interaction, potential endogenous mechanisms of regeneration, and astroglial plasticity. CDV-DL is characterized by lesions with a variable degree of demyelination and mononuclear inflammation accompanied by a dysregulated orchestration of cytokines as well as matrix metalloproteinases and their inhibitors. Despite decades of research, several new aspects of the neuropathogenesis of CDV-DL have been described only recently. Early axonal damage seems to represent an initial and progressive lesion in CDV-DL, which interestingly precedes demyelination. Axonopathy may, thus, function as a potential trigger for subsequent disturbed axon-myelin-glia interactions. In particular, the detection of early axonal damage suggests that demyelination is at least in part a secondary event in CDV-DL, thus challenging the dogma of CDV as a purely primary demyelinating disease. Another unexpected finding refers to the appearance of p75 neurotrophin (NTR)-positive bipolar cells during CDV-DL. As p75NTR is a prototype marker for immature Schwann cells, this finding suggests that Schwann cell remyelination might represent a so far underestimated endogenous mechanism of regeneration, though this hypothesis still remains to be proven. Although it is well known that astrocytes represent the major target of CDV infection in CDV-DL, the detection of infected vimentin-positive astrocytes in chronic lesions indicates a crucial role of this cell population in nervous distemper. While glial fibrillary acidic protein represents the characteristic intermediate filament of mature astrocytes, expression of vimentin is generally restricted to immature or reactive astrocytes. Thus, vimentin-positive astrocytes might constitute an important cell population for CDV persistence and spread, as well as lesion progression. In vitro models, such as dissociated glial cell cultures, as well as organotypic brain slice cultures have contributed to a better insight into mechanisms of infection and certain morphological and molecular aspects of CDV-DL. Summarized, recent in vivo and in vitro studies revealed remarkable new aspects of nervous distemper. These new perceptions substantially improved our understanding of the pathogenesis of CDV-DL and might represent new starting points to develop novel treatment strategies.
Peptide Vaccine: Progress and Challenges
Authors: Li Weidang , Joshi Medha , Singhania Smita , Ramsey Kyle , Murthy Ashlesh
Published: July 2014

Conventional vaccine strategies have been highly efficacious for several decades in reducing mortality and morbidity due to infectious diseases. The bane of conventional vaccines, such as those that include whole organisms or large proteins, appear to be the inclusion of unnecessary antigenic load that, not only contributes little to the protective immune response, but complicates the situation by inducing allergenic and/or reactogenic responses. Peptide vaccines are an attractive alternative strategy that relies on usage of short peptide fragments to engineer the induction of highly targeted immune responses, consequently avoiding allergenic and/or reactogenic sequences. Conversely, peptide vaccines used in isolation are often weakly immunogenic and require particulate carriers for delivery and adjuvanting. In this article, we discuss the specific advantages and considerations in targeted induction of immune responses by peptide vaccines and progresses in the development of such vaccines against various diseases. Additionally, we also discuss the development of particulate carrier strategies and the inherent challenges with regard to safety when combining such technologies with peptide vaccines.
Treatment of bicondylar femoral fractures complicated by concurrent ligament or tendon injuries in four dogs
Authors: Frydman G. H. , Cuddy L. C. , Kim S. E. , Pozzi A.
Published: July 2014

Objective: Retrospective case series describing the surgical treatment and outcome in dogs with bicondylar femoral fractures complicated by ligament or tendon injuries.

Methods: Medical records were reviewed for three immature and one mature dog with traumatic bicondylar fractures of the distal femur and concurrent ligament or tendon injury treated surgically. Data retrieved included physical examination, imaging, and treatment. Long-term follow-up and return to function was assessed by owner feedback, physical examination, radiology, and force plate analysis. The immediate, four-week, and two-year postoperative outcomes were described.

Results: All four dogs were presented with injuries to either the cranial or caudal cruciate ligament. Only two dogs underwent surgical repair of the caudal cruciate ligament. Anatomical reduction and rigid internal fixation of the distal femoral fractures was performed using a combination of lag screws, Kirschner wires, and bone plates. At the long-term follow-up, all cases had good to excellent return to function, as assessed by force plate analysis and owner assessment of quality of life and satisfaction. Radiographs revealed evidence of complete fracture healing, with moderate to severe osteoarthritis of the stifle.

Clinical significance: Bicondylar femoral fractures can be associated with ligament or tendon injuries. Anatomical reduction and internal fixation of bicondylar femoral fractures is recommended and may offer a good to excellent return function, with or without repair of associated caudal cruciate ligament injuries.
The relevance of threaded external skeletal fixation pin insertion speed in canine bone with and without predrilling
Authors: Rochat M. C. , Snider T. A. , Payton M. E. , Walker J. T.
Published: July 2014

Objectives: The effects of insertion speed in revolutions per minute (RPM) and pilot hole predrilling for placement of threaded external skeletal fixation pins on temperature and morphological damage in cortical bone were evaluated. The null hypothesis states that insertion speed and predrilling will have no significant effect on temperature and morphological damage.

Methods: Fixation pins were inserted into cadaveric canine femurs at speeds of 700 RPM and 150 RPM, with and without predrilling. Temperature was measured at each cortex 0.5 mm and 3.0 mm from each insertion site. Samples were examined grossly and by scanning electron microscopy for evidence of morphological damage. Data were analysed for maximum temperature, temperature increase, sites above thermal necrosis thresholds, microcracks, thread quality and gross damage.

Results: Predrilling had a significant effect on maximum temperature, temperature increase, sites exceeding necrosis thresholds, microcracks, thread quality and gross damage. Speed of insertion had no significant effect on any of the measured parameters following predrilling, but had a significant effect on thread quality without predrilling.

Clinical significance: Our results fail to reject the null hypothesis concerning insertion speed, which had no significant effect on thermal damage, and minimal effect on morphological damage, which was negated by predrilling. Our results reject the null hypothesis concerning predrilling and support the practice of predrilling fixation pin insertion sites.
VISUAL IMPACT ASSESSMENT OF WIND TURBINES AND THEIR FARMS ON LANDSCAPE OF KRETINGA REGION (LITHUANIA) AND GROBINA TOWNSCAPE (LATVIA)
Authors: ABROMAS Jonas , KAMIČAITYTĖ-VIRBAŠIENĖ Jūratė , ZIEMEĻNIECE Aija
Published: July 2014

Early in 2013 as many as 5 wind farms were in operation in Kretinga region and the sixth was under construction. The wind farms are concentrated within two territories, i.e. in the south-west part of the region (between Kretinga and Palanga towns) and in the north-west (between Darbėnai and the Senoji Įpiltis villages). The region also houses seven individual wind turbines, the total number being 58 units. In seeking to assess the impact of wind turbines based in Kretinga region on the landscape and the villages, the analysis of cartography material was carried out and the inventory of all wind turbines was made (GIS data base). On assessing the importance of the roads with regard to the intensity of traffic and tourist flows, the observation places were established and photo fixation was performed. The impact was assessed from eleven observation places (all the places were close to the roads). During the study, the nature, importance and degree of contrast of the visual impact of wind turbines were assessed. In assessing the visual impact of wind turbines on the landscape, it was found that woodlands and villages make a significant impact on the visibility of turbines. The wind turbines seen on the axis of the road perspective are not only observed for some length of time, but often serve as a landmark. The investigation results were compared with the situation in western Latvia region (Grobina case).
Investigation into Drug-Resistant Mutations of HBV from 845 Nucleoside/Nucleotide Analogue-Naive Chinese Patients with Chronic HBV Infection
Authors: Li Xiaodong , Liu Yan , Zhao Pan , Wang Yan , Chen Li , Xin Shaojie , Zhang Xin-Xin , Xu Dongping
Published: July 2014

Background

This study aimed to clarify the clinical significance of drug-resistant HBV in nucleoside/nucleotide analogue (NA)-naive Chinese patients with chronic HBV infection in real clinical practice.

Methods

A total of 845 NA-naive patients who were admitted to Beijing 302 Hospital between July 2007 and March 2012 were included in the study. HBV drug-resistant mutations were examined by direct sequencing of the viral reverse transcriptase gene and verified by clonal sequencing. Phenotypic analysis of viral replication capacity and drug susceptibility were performed by measuring viral replicative intermediate level in 1.1-mer mutant or wild-type HBV amplicon-transfected HepG2 cells in absence or presence of serially diluted drugs.

Results

Drug-resistant mutations were detected in 2.01% (17/845) of the patients by direct sequencing, including 15 with lamivudine-resistant mutations (rtM204V, rtM204I), one with adefovir-resistant mutation (rtA181V), and one with both lamivudine- and adefovir-resistant mutations (rtA181V, rtM204I). Clonal sequencing identified 13 drug-resistant HBV strains: rtL80I+M204I, rtL80I+M204V, rtL180M+M204I, rtL180M+M204V, rtM204I, rtM204V, rtL80I+L180M+M204I, rtL80I+L180M+M204V, rtA181V, rtA181V+M204I, rtA181T+N236T, rtA181V+N236T and rtN236T. Phenotypic analysis showed that two preexisting lamivudine-resistant strains (rtL80I+M204I, rtL180M+M204V) had >1,000-fold resistance to lamivudine, and one pre-existing adefovir-resistant strain (rtA181V+N236T) had 15.4-fold resistance to adefovir compared with the wild-type strain. A follow-up study showed that the presence of pre-existing rtM204I strain in one patient increased from 20% at baseline to 85% after 13 months of entecavir treatment with corresponding recession of wild-type strain in the viral pool.

Conclusions

The incidence of drug-resistant HBV mutations was low in NA-naive Chinese HBV-infected patients. Pre-existing mutants had similar resistance characteristics to those from NA refractory patients.
La labellisation comme stratégie de desserrement des contraintes de l'environnement. Le cas des centres d'appels en France
Authors: Dubrion Benjamin , Tessier Nathalie , Vivel Christel
Published: July 2014

Cet article analyse à la lumière de la théorie de la dépendance des ressources les effets de la mise en place d’un label de responsabilité sociale en direction des salariés créé récemment dans le secteur de la relation client. Nous montrons que si ce label a eu pour effet de déclencher une dynamique de structuration des politiques de GRH dans les centres d’appels étudiés, il constitue en même temps un outil ambivalent du fait des normes qu’il véhicule. Il peut être vu comme une stratégie adoptée par les dirigeants des centres d’appels pour influencer à leur profit les attentes des organisations ou groupes d’intérêts constitutifs de leur environnement.
L'analyse du risque pays : plus qu'une discipline postmoderne
Authors: Story Jonathan , Hoff Loïc
Published: July 2014

Les débats de méthode sont anciens et nombreux sur les étapes de la croissance et les voies de la modernisation politique des pays. La mondialisation et la dialectique internationale nouvelle qu’elle induit, entre tension à la convergence et tension à la divergence, remet en cause nombre de méthodes d’évaluation. Au-delà de l’élaboration des critères les plus objectifs possibles, la formalisation des avenirs imaginables doit laisser toute leur place à l’approche subjective et à l’incertitude. politique étrangère
La stratégie en théories
Authors: Desportes Vincent
Published: July 2014

Le terme « stratégie » remonte à l’Antiquité grecque et sa signification a évolué avec le temps. S’il est aujourd’hui galvaudé et utilisé dans tous les domaines, il a précédemment fait l’objet d’essais de définition par les plus grands penseurs de la guerre. Ces derniers s’accordent sur le fait que la stratégie suppose une finalité et un adversaire. Pour atteindre son but en dépit des actions adverses, le stratège a besoin de liberté d’action et doit faire preuve d’une grande faculté d’adaptation. politique étrangère
Les relations entre le Saint-Siège et la République populaire de Chine
Authors: McFeat Raphaël
Published: July 2014

L’Église catholique de Chine est divisée en deux branches : l’une encadrée par le Parti communiste et largement indépendante du Saint-Siège ; l’autre placée sous l’autorité du pape et brimée par le gouvernement de Pékin qui rejette toute forme d’ingérence. Le remplacement de Benoît XVI par François a suscité des espoirs de normalisation des relations entre le siège apostolique et la Chine. Toutefois, le nouveau pape affichera probablement la même fermeté que son prédécesseur à l’égard de Pékin. politique étrangère
Place à la théorie des affaires comme guide de gestion stratégique de marché
Authors: Turgeon Normand
Published: July 2014

Savoir créer ou repérer les occasions d’affaires et éviter les multiples écueils posés sur le chemin de leur appropriation est requis autant des entrepreneurs que des gestionnaires. À cette fin, une théorie de l’existence de l’organisation en affaires – dite théorie des affaires de l’entreprise – est un outil de base dans l’élaboration, les choix et la révision des décisions de gestion stratégique et tactique de marché. Cet article explique ce qu’est une théorie des affaires et présente sa place, son rôle et ses bienfaits dans la toile des décisions de gestion. Une bonne théorie des affaires est fort pratique car, par sa validité, elle favorise à la fois efficience et efficacité, permettant d’éviter des dérapages commerciaux dispendieux, voire tragiques. Plusieurs exemples sont offerts afin de rendre plus conviviale la découverte de cet outil de gestion.
Spring Ligament Reconstruction Using the Autogenous Flexor Hallucis Longus Tendon
Authors: Lee Woo-Chun , Yi Young
Published: July 2014

The calcaneonavicular (spring) ligament complex is the soft tissue most often seen to fail in flatfoot pathology and is associated with deformity of the talonavicular joint. The spring ligament complex supports the talar head, preventing it from displacing into excessive plantar flexion/adduction. An anatomical reconstruction of the spring ligament should replicate this function. A new method of spring ligament reconstruction using autogenous flexor hallucis longus tendon transfer is reported. [
Orthopedics
. 2014; 37(7):467–471.]
Osteonecrosis Following Short-term, Low-dose Oral Corticosteroids: A Population-based Study of 24 Million Patients
Authors: Dilisio Matthew F.
Published: July 2014

Although the association between chronic, high-dose corticosteroid use and osteonecrosis is well known, the incidence of osteonecrosis following short-term, low-dose steroid taper packs has never been reported across a large population. The goal of this study was to report the incidence and risk of osteonecrosis after methylprednisolone taper pack (MTP) prescriptions in a multicenter electronic medical records database. A commercially available software platform was used to evaluate the records of 24,533,880 patients to determine the incidence of osteonecrosis in patients who had received single or multiple MTP over a 12-year period. This was compared with the incidence of osteonecrosis in patients who had never been prescribed an MTP. Patients with a history of osteonecrosis or prior corticosteroid use were excluded from the study. A total of 98,390 patients were identified who had received a single MTP. One hundred thirty (0.132%; 95% confidence interval [CI], 0.176%–0.283%) of these patients were subsequently diagnosed with osteonecrosis. The incidence of osteonecrosis in patients who had been prescribed 2 or more MTPs was 0.230% (95% CI, 0.176%–0.283%). Compared with the 0.083% incidence of osteonecrosis in the control group that had never been prescribed an MTP, the relative risk of osteonecrosis after the prescription of a single MTP or multiple MTPs was 1.591 and 2.763, respectively, with a statistically significant difference between cohorts (
P
<.001). Short-term, low-dose oral corticosteroid administration may be associated with a low but statistically significant increased incidence of osteonecrosis when compared with patients who have never been prescribed a steroid product.
Multiple Collagenase Injections Are Safe for Treatment of Dupuytren’s Contractures
Authors: Gajendran Varun K. , Hentz Vincent , Kenney Deborah , Curtin Catherine M.
Published: July 2014

The authors report the case of a 65-year-old, right-hand-dominant man who had severe Dupuytren’s disease with multiple cords and flexion contractures of the metacarpophalangeal and proximal interphalangeal joints of both hands and underwent repeated collagenase injections for treatment. Collagenase has been shown to be safe and effective in the treatment of Dupuytren’s contractures when administered as a single dose, but the results of multiple injections over a prolonged period are unknown. Antibodies to collagenase develop in all patients after several treatments, raising concerns about safety and efficacy as a result of sensitization from repeated exposures. The antibodies generated as a result of repeated exposure to collagenase could theoretically render it less effective with time and could also lead to immune reactions as severe as anaphylaxis. The authors present the case of a single patient who experienced continued correction of his contractures with only minor and self-limited adverse reactions after administration of 12 collagenase doses through 15 injections during a 4-year period. Over time, the injections continued to be effective at correcting metacarpophalangeal joint contractures, but less effective at correcting proximal interphalangeal joint contractures. The patient did eventually require a fasciectomy, but the safety and modest success of the repeated collagenase injections shows promise for a less invasive treatment with a better risk profile than open fasciectomy. Although further studies are needed, repeated administration of collagenase appears to be safe and modestly effective for severe Dupuytren’s contractures, although a fasciectomy may ultimately be required in the most severe cases.
Reverse Adipofascial Flap After Resection of a Malignant Perineurioma of the Forearm
Authors: Takahashi Mitsuhiko , Kasai Tokio , Nishisho Toshihiko , Takai Michihiro , Endo Hideko , Hirose Takanori , Sairyo Koichi
Published: July 2014

The authors describe a patient with recurrent perineurioma arising in the subcutaneous tissue of the dorsal forearm and extending along the forearm fascia. Soft tissue perineurioma is a rare, originally benign peripheral nerve sheath neoplasm arising from the perineurium, a protective cell barrier surrounding the individual fascicles in peripheral nerves. Perineurioma has only recently been recognized as an entity distinct from other nerve sheath tumors, such as schwannoma and neurofibroma, with unique morphologic, ultrastructural, and immunoreactive features. The recurrent tumor had converted into malignant perineurioma, defined as increased nuclear pleomorphism and cellularity. The ill-marginate feature extending along the fascia required wide resection, leaving a substantial defect on the distal forearm. Surgical repair of large forearm skin defects is challenging because of limited skin extensibility for flap creation, the prominence of the site in terms of aesthetic outcome, and the risk of damage to extrinsic muscles that control delicate hand movements. The reverse forearm adipofascial flap, which was based on distal perforators of the radial artery, was suitable for the current case to cover the exposed myotendinous junctions of the forearm extensor muscles. This flap did not sacrifice skin, a major vessel, or skeletal muscles, and preserved function at both the donor and the recipient sites. The texture of the graft was similar to that of the surrounding skin. The clinical and histopathologic features of this rare tumor are also described to aid in the differential diagnosis and as a reference for surgeons who treat soft tissue neoplasms and may encounter this type of soft tumor.
Complete Encasement of the Peroneal Tendons by the Peroneal Tubercle
Authors: Lalli Trapper A. J. , King Jonathan C. , Santrock Robert D.
Published: July 2014

The peroneal tubercle is an osseous structure on the lateral side of the calcaneus present in 90% of individuals. Hypertrophy of the peroneal tubercle resulting in stenosing peroneal tenosynovitis has been well described in the literature. Repair of this condition involves operative treatment to remove the hypertrophied peroneal tubercle and repair any resulting tendon pathology. The authors report a unique case of a hypertrophied peroneal tubercle with an associated tarsal coalition, resulting in complete bony encasement of the peroneal tendons. In this case, a 50-year-old white man presented with worsening bilateral foot and ankle pain for several years. On examination, he had fixed hindfoot varus and bilateral equinocavovarus feet. Magnetic resonance imaging and weight-bearing radiographs showed a calcaneonavicular coalition. Intraoperatively, the authors discovered complete bony encasement of the peroneal longus and brevis tendons. On examination, the peroneal longus and brevis were severely stenotic, with the peroneal brevis to the point of near laceration. This painful condition was repaired by takedown of the calcaneonavicular coalition, the peroneal tubercle was resected, and the peroneal tendons were freed from their bony encasement. Tenodesis of the peroneus brevis to longus was performed and the hindfoot varus was corrected with wedge osteotomy of the calcaneus. The patient reported excellent postoperative results. At 3 months postoperatively, he was pain-free and his calcaneal osteotomy was well healed. This case appears to be the first of its type to be reported in the literature. The details of the case are presented along with a review of the relevant literature.
Differential Requirement for CCR4 and CCR7 during the Development of Innate and Adaptive αβT Cells in the Adult Thymus
Authors: Cowan Jennifer E. , McCarthy Nicholas I. , Parnell Sonia M. , White Andrea J. , Bacon Andrea , Serge Arnauld , Irla Magali , Lane Peter J. L. , Jenkinson Eric J. , Jenkinson William E. , Anderson Graham
Published: July 2014

αβT cell development depends upon serial migration of thymocyte precursors through cortical and medullary microenvironments, enabling specialized stromal cells to provide important signals at specific stages of their development. Although conventional αβT cells are subject to clonal deletion in the medulla, entry into the thymus medulla also fosters αβT cell differentiation. For example, during postnatal periods, the medulla is involved in the intrathymic generation of multiple αβT cell lineages, notably the induction of Foxp3+ regulatory T cell development and the completion of invariant NKT cell development. Although migration of conventional αβT cells to the medulla is mediated by the chemokine receptor CCR7, how other T cell subsets gain access to medullary areas during their normal development is not clear. In this study, we show that combining a panel of thymocyte maturation markers with cell surface analysis of CCR7 and CCR4 identifies distinct stages in the development of multiple αβT cell lineages in the thymus. Although Aire regulates expression of the CCR4 ligands CCL17 and CCL22, we show that CCR4 is dispensable for thymocyte migration and development in the adult thymus, demonstrating defective T cell development in Aire−/− mice is not because of a loss of CCR4-mediated migration. Moreover, we reveal that CCR7 controls the development of invariant NKT cells by enabling their access to IL-15 trans-presentation in the thymic medulla and influences the balance of early and late intrathymic stages of Foxp3+ regulatory T cell development. Collectively, our data identify novel roles for CCR7 during intrathymic T cell development, highlighting its importance in enabling multiple αβT cell lineages to access the thymic medulla.
Bilateral Carotid Paraganglioma: Surgery and Radiotherapy
Authors: Kiziltan Huriye S. , Ozucer Berke , Eris Ali H. , Veyseller Bayram
Published: July 2014

Background

Paragangliomas are relatively rare vascular tumors that develop from the neural crest cells of carotid bifurcation. They usually present as slow-growing, painless unilateral neck masses; bilateral presentation is rare and is mostly associated with familial forms. Bilateral total resection is not always possible for high-grade bilateral tumors, and radiotherapy is a good alternative, with cure rates similar to surgery.

Case Report

A 35-year-old female patient was admitted with a chief complaint of a bilateral, painless mass located on her neck. Subsequent magnetic resonance imaging (MRI) and angiographic imaging revealed bilateral hypervascular masses surrounding her carotid at 360°, and they were interpreted as stage 3 carotid paragangliomas according to the Shamblin classification protocol. Surgery was carried out on the left carotid paraganglioma and the mass was totally resected. It was thought that the patient could not tolerate bilateral surgery. Primary radiotherapy was planned on the right carotid paraganglioma: 59.8 gray (Gy) conformal, Linac-based multileaf collimator radiotherapy with a 180 cGy daily dosage, and five fractions per week were planned.

Results

Follow-up at 3 months following the conclusion of radiotherapy revealed no significant regression. A follow-up MRI 6 months and 24 months later revealed 59% regression. Grade 2 esophagitis and minimal neck edema were the only complications noted during the course of radiotherapy and during the 24-month follow-up period. No complications or relapse were observed except for edema following neck surgery.
An application of Khovanov homology to quantum codes
Authors: Audoux Benjamin
Published: July 2014

We use Khovanov homology to define families of LDPC quantum error-correcting codes: unknot codes with asymptotical parameters

[[ \frac{3^{2 \ell+1}}{\sqrt{8\pi\ell}};1;2^\ell]]

; unlink codes with asymptotical parameters

[[\sqrt{\frac{3}{2\pi \ell}}6^\ell;2^\ell;2^\ell ]]

and

(2,\ell)

-torus link codes with asymptotical parameters

[[n;1;d_n]]

where

d_n>\frac{\sqrt{n}}{1.62}

.
“Exports‐at‐Risk”: The Effect of Multimarket Contact in International Trade
Authors: Feinberg Robert M.
Published: July 2014

Despite a well‐established literature examining possible impacts on competition in oligopolistic markets from multimarket contact (MMC) among diversified firms, only recently have trade theorists considered the possible effects of MMC among exporters in limiting the anticipated procompetitive role of imports. This article presents a first effort to test the empirical importance of a measure of this MMC, called “exports‐at‐risk,” on import prices (unit‐values). Suggestive evidence of anticompetitive impacts of MMC among exporters is obtained for highly traded four‐digit harmonized system (HS) products within the broad category of “fats and oils.” Exporters in fats and oils seem to price higher in markets where they meet rivals with the ability to retaliate against their “exports at risk.”
Evaluating Simulation-Based ACLS Education on Patient Outcomes: A Randomized, Controlled Pilot Study
Authors: Han Jenny E. , Trammell Antoine R. , Finklea James D. , Udoji Timothy N. , Dressler Daniel D. , Honig Eric G. , Abraham Prasad , Ander Douglas S. , Cotsonis George A. , Martin Greg S. , Schulman David A.
Published: July 2014

Background

Simulation training is widely accepted as an effective teaching tool, especially for dealing with high-risk situations.

Objective

We assessed whether standardized, simulation-based advanced cardiac life support (ACLS) training improved performance in managing simulated and actual cardiac arrests.

Methods

A total of 103 second- and third-year internal medicine residents were randomized to 2 groups. The first group underwent conventional ACLS training. The second group underwent two 2 1/2-hour sessions of standardized simulation ACLS teaching. The groups were assessed by evaluators blinded to their assignment during in-hospital monthly mock codes and actual inpatient code sheets at 3 large academic hospitals. Primary outcomes were time to initiation of cardiopulmonary resuscitation, time to administration of first epinephrine/vasopressin, time to delivery of first defibrillation, and adherence to American Heart Association guidelines.

Results

There were no differences in primary outcomes among the study arms and hospital sites. During 21 mock codes, the most common error was misidentification of the initial rhythm (67% [6 of 9] and 58% [7 of 12] control and simulation arms, respectively, P  =  .70). There were no differences in primary outcome among groups in 147 actual inpatient codes.

Conclusions

This blinded, randomized study found no effect on primary outcomes. A notable finding was the percentage of internal medicine residents who misidentified cardiac arrest rhythms.
Workplace-Based Assessment of Internal Medicine Resident Diagnostic Accuracy
Authors: Jain Michael D. , Tomlinson George A. , Lam Danica , Liu Jessica , Damaraju Deepti , Detsky Allan S. , Devine Luke A.
Published: July 2014

Background

Making an accurate diagnosis is a core skill residents must develop. Assessments of this skill and decisions to grant residents clinical independence often are based on global impressions. A workplace-based assessment of diagnostic accuracy could be a useful part of a competency-based assessment program and could inform decisions about granting residents independence.

Innovation

We developed a method for measuring diagnostic accuracy that was integrated into the workflow of internal medicine residents and attending physicians.

Methods

Four senior medical residents and 6 attending physicians working in the internal medicine clinical teaching unit of a tertiary hospital participated in this study. To determine their diagnostic accuracy, residents documented a leading diagnosis for each patient they evaluated in the emergency department. After reviewing each case with the resident and after examining the patient, the resident's attending physician documented the diagnosis. Discharge diagnosis was determined by retrospective chart review to allow determination of resident and attending physician diagnostic accuracy. Data were collected for 240 consecutive patients referred for a medicine consultation.

Results

Resident diagnostic accuracy was 66% (95% CI 60–72), whereas attending physician accuracy was significantly higher at 79% (95% CI 74–84, P < .001). By logistic regression, the accuracy of the attending physician was found to be influenced by the accuracy of the resident. Participants felt this process motivated them to improve their clinical reasoning.

Conclusions

Measuring resident diagnostic accuracy provides information that could be used in a competency-based assessment program to provide feedback and motivation to stimulate performance improvement.
Comparison of GEOS-5 AGCM planetary boundary layer depths computed with various definitions
Authors: McGrath-Spangler E. L. , Molod A.
Published: July 2014

Abstract. Accurate models of planetary boundary layer (PBL) processes are important for forecasting weather and climate. The present study compares seven methods of calculating PBL depth in the GEOS-5 atmospheric general circulation model (AGCM) over land. These methods depend on the eddy diffusion coefficients, bulk and local Richardson numbers, and the turbulent kinetic energy. The computed PBL depths are aggregated to the Köppen–Geiger climate classes, and some limited comparisons are made using radiosonde profiles. Most methods produce similar midday PBL depths, although in the warm, moist climate classes the bulk Richardson number method gives midday results that are lower than those given by the eddy diffusion coefficient methods. Additional analysis revealed that methods sensitive to turbulence driven by radiative cooling produce greater PBL depths, this effect being most significant during the evening transition. Nocturnal PBLs based on Richardson number methods are generally shallower than eddy diffusion coefficient based estimates. The bulk Richardson number estimate is recommended as the PBL height to inform the choice of the turbulent length scale, based on the similarity to other methods during the day, and the improved nighttime behavior.