bluuebunny/crossref_metadata_2025 huggingface dataset:
Alginate Particles as Platform for Drug Delivery by the Oral Route: State-of-the-Art
Authors: Sosnik Alejandro
Published: April 2014

Pharmaceutical research and development aims to design products with ensured safety, quality, and efficacy to treat disease. To make the process more rational, coherent, efficient, and cost-effective, the field of Pharmaceutical Materials Science has emerged as the systematic study of the physicochemical properties and behavior of materials of pharmaceutical interest in relation to product performance. The oral route is the most patient preferred for drug administration. The presence of a mucus layer that covers the entire gastrointestinal tract has been exploited to expand the use of the oral route by developing a mucoadhesive drug delivery system that showed a prolonged residence time. Alginic acid and sodium and potassium alginates have emerged as one of the most extensively explored mucoadhesive biomaterials owing to very good cytocompatibility and biocompatibility, biodegradation, sol-gel transition properties, and chemical versatility that make possible further modifications to tailor their properties. The present review overviews the most relevant applications of alginate microparticles and nanoparticles for drug administration by the oral route and discusses the perspectives of this biomaterial in the future.
Clinical and Structural Features of Sperm Head Vacuoles in Men Included in the In Vitro Fertilization Programme
Authors: Fekonja Nina , Štrus Jasna , Tušek Žnidarič Magda , Knez Katja , Vrtacnik Bokal Eda , Verdenik Ivan , Virant-Klun Irma
Published: April 2014

The human sperm head vacuoles and their role in male infertility are still poorly understood. The aim of this study was to identify the clinical and ultrastructural features of human sperm head vacuoles in men included in the in vitro fertilization programme: men with normal (normozoospermia) and impaired sperm morphology (teratozoospermia). The sperm samples were observed under 6000-time magnification using motile sperm organelle morphology examination (MSOME). The proportion of sperm with head vacuoles was evaluated and related to the outcome of in vitro fertilization. The sperm of men with impaired sperm morphology was characterized by a higher proportion of sperm head vacuoles. The sperm head vacuoles were related to impaired semen quality (sperm concentration, motility, and morphology) but were not influenced by male factors (semen volume, height, age, weight, or body mass index). Moreover, sperm head vacuoles were related to impaired fertilization rate merely after classical in vitro fertilization (IVF), while there was no relation to pregnancy. In a subgroup of men, the sperm was fixed and observed by transmission electron microscopy (TEM). The ultrastructural study revealed that sperm head vacuoles are large nuclear indentations of various sizes and positions, packed with membranous material organized in membrane whorls (MW).
Divisible Load Theory Based Active-Sleep Workload Assignment Schemes for Wireless Sensor Networks
Authors: Shi Haiyan , Kwok Ngaiming , Wang Wanliang , Chen Shengyong
Published: April 2014

Wireless sensor networks (WSNs) have been widely applied in many monitoring and surveillance processes. Due to the limited onboard energy resources, the operation of a WSN is severely hindered by its shortened lifespan arising from energy depletion. In order to alleviate this problem, and with the possibility of partitioning sensing workloads, the divisible load theory (DLT) can be adopted to derive a proper workload assignment scheme. However, special considerations have to be paid for its generic applicability in feasible workload assignment for WSNs. In this paper, an examination of DLT based WSN operations including the effect of assignment, measurement, and report times is presented, and the problem of negative workloads inherently generated in some schemes is revealed. Furthermore, by making use of the negativity phenomenon, an active-sleep scheme is proposed for the WSN such that sensor energy consumptions can be reduced and consequently extend the WSN operation lifespan. Specifically, sensors with smaller amount of residual energies are put into the sleep mode when the assigned workloads are negative. On the other hand, positive workloads are normalized and reassigned to sensors with larger amount of onboard energies. Simulation studies are carried out to demonstrate the negative workload phenomenon, and satisfactory performances of the proposed active-sleep scheme are verified.
The Effect of Probiotics on Childhood Constipation: A Randomized Controlled Double Blind Clinical Trial
Authors: Sadeghzadeh M. , Rabieefar A. , Khoshnevisasl P. , Mousavinasab N. , Eftekhari K.
Published: April 2014

Background. Inconsistent data exist about the role of probiotics in the treatment of constipated children. The aim of this study was to investigate the effectiveness of probiotics in childhood constipation.Materials and Methods. In this placebo controlled trial, fifty-six children aged 4–12 years with constipation received randomly lactulose plus Protexin or lactulose plus placebo daily for four weeks. Stool frequency and consistency, abdominal pain, fecal incontinence, and weight gain were studied at the beginning, after the first week, and at the end of the 4th week in both groups.Results. Forty-eight patients completed the study. At the end of the fourth week, the frequency and consistency of defecation improved significantly (P=0.042andP=0.049, resp.). At the end of the first week, fecal incontinence and abdominal pain improved significantly in intervention group (P=0.030andP=0.017, resp.) but, at the end of the fourth week, this difference was not significant (P=0.125andP=0.161, resp.). A significant weight gain was observed at the end of the 1st week in the treatment group.Conclusion. This study showed that probiotics had a positive role in increasing the frequency and improving the consistency at the end of 4th week.
Traveling Wave Solutions and Infinite-Dimensional Linear Spaces of Multiwave Solutions to Jimbo-Miwa Equation
Authors: Zhang Lijun , Khalique C. M.
Published: April 2014

The traveling wave solutions and multiwave solutions to (3 + 1)-dimensional Jimbo-Miwa equation are investigated in this paper. As a result, besides the exact bounded solitary wave solutions, we obtain the existence of two families of bounded periodic traveling wave solutions and their implicit formulas by analysis of phase portrait of the corresponding traveling wave system. We derive the exact 2-wave solutions and two families of arbitrary finiteN-wave solutions by studying the linear space of its Hirota bilinear equation, which confirms that the (3 + 1)-dimensional Jimbo-Miwa equation admits multiwave solutions of any order and is completely integrable.
Formulation of Synthesized Zinc Oxide Nanopowder into Hybrid Beads for Dye Separation
Authors: Shokry Hassan H. , Elkady M. F. , El-Shazly A. H. , Bamufleh Hisham S.
Published: April 2014

The sol‐gel prepared zinc oxide nanopowder was immobilized onto alginate‐polyvinyl alcohol polymer blend to fabricate novel biocomposite beads. Various physicochemical characterization techniques have been utilized to identify the crystalline, morphological, and chemical structures of both the fabricated zinc oxide hybrid beads and their corresponding zinc oxide nanopowder. The thermal stability investigations demonstrate that ZnO nanopowder stability dramatically decreased with its immobilization into the polymeric alginate and PVA matrix. The formulated beads had very strong mechanical strength and they are difficult to be broken up to 1500 rpm. Moreover, these hybrid beads are chemically stable at the acidic media (pH < 7) especially within the pH range of 2–7. Finally, the applicability of the formulated ZnO hybrid beads for C.I. basic blue 41 (BB41) decolorization from aqueous solution was examined.
Graft-versus-Host Disease after Living-Unrelated Kidney Transplantation
Authors: Zacharias N. , Gallichio M. H. , Conti D. J.
Published: April 2014

Graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation and consists of a reaction of donor derived immune cells directed against host tissues. The vast majority of cases reported in the literature involve liver, small intestine and pancreas transplantation. We report a case of GVHD in a 48-year-old man after living-unrelated kidney transplantation at another center. Six months postoperatively he developed a skin rash, anorexia, and diarrhea that resulted in malnutrition and a 90 pound weight loss. At this point he was transferred to our center with a BMI of 16 and severe cachexia. Intravenous hyperalimentation was initiated and an extensive work-up for an infectious etiology was performed and was negative. An esophagogastroduodenoscopy was performed and revealed nodularity of the gastric mucosa, atrophy, and edema in the first and second portion of his duodenum. Biopsy findings were consistent with GVHD. Aggressive immunosuppressive therapy was instituted with a good response. The anorexia and diarrhea resolved, and he was discharged on hospital day 20. Three months later, there had been no recurrence of the diarrhea, the patient had gained an additional 40 pounds, BMI of 25, and a repeat upper endoscopy revealed complete resolution of the initial endoscopic abnormalities.
Arrabidaea chicaHexanic Extract Induces Mitochondrion Damage and Peptidase Inhibition onLeishmaniaspp.
Authors: Rodrigues Igor A. , Azevedo Mariana M. B. , Chaves Francisco C. M. , Alviano Celuta S. , Alviano Daniela S. , Vermelho Alane B.
Published: April 2014

Currently available leishmaniasis treatments are limited due to severe side effects.Arrabidaea chicais a medicinal plant used in Brazil against several diseases. In this study, we investigated the effects of 5 fractions obtained from the crude hexanic extract ofA. chicaagainstLeishmania amazonensisandL. infantum, as well as on the interaction of these parasites with host cells. Promastigotes were treated with several concentrations of the fractions obtained fromA. chicafor determination of their minimum inhibitory concentration (MIC). In addition, the effect of the most active fraction (B2) on parasite’s ultrastructure was analyzed by transmission electron microscopy. To evaluate the inhibitory activity of B2 fraction onLeishmaniapeptidases, parasites lysates were treated with the inhibitory and subinhibitory concentrations of the B2 fraction. The minimum inhibitory concentration of B2 fraction was 37.2 and 18.6 μg/mL forL. amazonensisandL. infantum, respectively. Important ultrastructural alterations as mitochondrial swelling with loss of matrix content and the presence of vesicles inside this organelle were observed in treated parasites. Moreover, B2 fraction was able to completely inhibit the peptidase activity of promastigotes at pH 5.5. The results presented here further support the use ofA. chicaas an interesting source of antileishmanial agents.
Cancer Stem Cells: Constantly Evolving and Functionally Heterogeneous Therapeutic Targets
Authors: Yang Tao , Rycaj Kiera , Liu Zhong-Min , Tang Dean G.
Published: April 2014

Elucidating the origin of and dynamic interrelationship between intratumoral cell subpopulations has clear clinical significance in helping to understand the cellular basis of treatment response, therapeutic resistance, and tumor relapse. Cancer stem cells (CSC), together with clonal evolution driven by genetic alterations, generate cancer cell heterogeneity commonly observed in clinical samples. The 2013 Shanghai International Symposium on Cancer Stem Cells brought together leaders in the field to highlight the most recent progress in phenotyping, characterizing, and targeting CSCs and in elucidating the relationship between the cell-of-origin of cancer and CSCs. Discussions from the symposium emphasize the urgent need in developing novel therapeutics to target the constantly evolving CSCs. Cancer Res; 74(11); 2922–7. ©2014 AACR.
Correlation of Somatic Mutations and Clinical Outcome in Melanoma Patients Treated with Carboplatin, Paclitaxel, and Sorafenib
Authors: Wilson Melissa A. , Zhao Fengmin , Letrero Richard , D'Andrea Kurt , Rimm David L. , Kirkwood John M. , Kluger Harriet M. , Lee Sandra J. , Schuchter Lynn M. , Flaherty Keith T. , Nathanson Katherine L.
Published: April 2014

Purpose: Sorafenib is an inhibitor of VEGF receptor (VEGFR), platelet-derived growth factor receptor (PDGFR), and RAF kinases, amongst others. We assessed the association of somatic mutations with clinicopathologic features and clinical outcomes in patients with metastatic melanoma treated on E2603, comparing treatment with carboplatin, paclitaxel ± sorafenib (CP vs. CPS).

Experimental Design: Pretreatment tumor samples from 179 unique individuals enrolled on E2603 were analyzed. Genotyping was performed using a custom iPlex panel interrogating 74 mutations in 13 genes. Statistical analysis was performed using Fisher exact test, logistic regression, and Cox proportional hazards models. Progression-free survival (PFS) and overall survival were estimated using Kaplan–Meier methods.

Results: BRAF and NRAS mutations were found at frequencies consistent with other metastatic melanoma cohorts. BRAF-mutant melanoma was associated with worse performance status, increased number of disease sites, and younger age at diagnosis. NRAS-mutant melanoma was associated with better performance status, fewer sites of disease, and female gender. BRAF and NRAS mutations were not significantly predictive of response or survival when treated with CPS versus CP. However, patients with NRAS-mutant melanoma trended toward a worse response and PFS on CP than those with BRAF-mutant or WT/WT melanoma, an association that was reversed for this group on the CPS arm.

Conclusions: This study of somatic mutations in melanoma is the last prospectively collected phase III clinical trial population before the era of BRAF-targeted therapy. A trend toward improved clinical response in patients with NRAS-mutant melanoma treated with CPS was observed, possibly due to the effect of sorafenib on CRAF. Clin Cancer Res; 20(12); 3328–37. ©2014 AACR.
Impact of Radical and Partial Nephrectomy on Renal Function in Patients with Renal Cancer
Authors: Krebs R.K. , Andreoni C. , Ortiz V.
Published: April 2014

Objective: To evaluate renal function in renal cancer patients undergoing radical nephrectomy (RN) or partial nephrectomy (PN) (open or laparoscopic - ORN, OPN, LRN or LPN) and to identify risk factors contributing to renal function loss. Methods: We analysed 228 consecutive renal cancer patients admitted for OPN, LPN, ORN or LRN. The variables analysed were age, gender, weight, type of surgery (radical versus partial), type of surgical access (open versus laparoscopic), preoperative renal function and history of hypertension, diabetes or malignancy. Absolute renal function was calculated as the difference in glomerular filtration rate (ΔGFR) between the renal function before (GFR₀) and 12 months after surgery (GFR12). The relative renal function of patients undergoing PN and RN was evaluated by the change in chronic kidney disease stage. Results: LRN caused the greatest loss in absolute renal function, followed by ORN, LPN and OPN. A GFR of ≥60 ml/min was noted for 90 (68.7%) patients before and 65 (49.6%) patients after RN and for 80 (82.5%) patients before and 74 (76.3%) patients after PN. The chronic kidney disease stage dropped to 4 or 5 in the case of 6 (4.6%) patients who underwent RN and 2 (2.1%) patients who underwent PN. Multivariate analysis revealed that only preoperative weight and type of surgery (radical versus partial) had a significant impact on renal function. Conclusion: Renal function significantly decreased in patients undergoing RN, irrespective of the access route. Patients with preoperative poor renal function are at risk of postoperative end-stage renal disease.
Bone Abnormal Signal Incidentally Found in Pre-Biopsy Diffusion-Weighted MRI for Suspected Prostate Cancer: What Does It Reflect?
Authors: Yachida Yuki , Yoshida Soichiro , Takeshita Hideki , Sawamura Chigusa , Tanaka Hiroshi , Satoh Shiro , Uchida Yusuke , Ishioka Junichiro , Matsuoka Yoh , Numao Noboru , Koga Fumitaka , Saito Kazutaka , Fujii Yasuhisa , Kihara Kazunori
Published: April 2014

Objective: To clarify the clinical significance of incidentally found diffusion-weighted MRI (DW-MRI)-positive findings on pre-biopsy MRI in patients with suspected prostate cancer. Patients and Methods: 754 consecutive patients with suspected prostate cancer underwent pelvic MRI including DW-MRI. 43 DW-MRI-positive bone lesions were found in 27 patients. Imaging findings of these lesions were compared with the clinical diagnosis. Results: Of the 43 DW-MRI-positive bone lesions, 21 (48.8%) were diagnosed as metastatic prostate cancer. The remaining 22 (51.2%) were diagnosed as red bone marrow in 17, enchondroma in 1, ganglion in 1, osteoma in 1, fibrous dysplasia in 1 and bone infarction in 1. Enchondroma, ganglion, osteoma and fibrous dysplasia all showed T1-weighted imaging (T1WI) low and T2-weighted imaging (T2WI) high signals, while others, including prostate cancer metastases, showed T1WI and T2WI low signals. Of the 40 lesions with T1WI and T2WI low signals, metastatic prostate cancer had higher apparent diffusion coefficient values (median 0.42 × 10-3 mm2/s) than other lesions (0.26 × 10-3 mm2/s; p < 0.0001). Conclusions: DW-MRI-positive bone lesions represent various coexisting types of bone lesions, including metastatic cancer in patients with suspected prostate cancer. T2WI findings and apparent diffusion coefficient values can be helpful in diagnosing metastatic cancer.
Schwedenkräuter
Authors: Burkl Regina
Published: April 2014

Schwedenkräuter oder Schwedenbitter zählen zu den auch noch in der heutigen Zeit verwendeten Kräuterelixieren. Obwohl ihre ursprüngliche Zusammensetzung wahrscheinlich im 16. Jahrhundert zu suchen ist, gelangten Schwedenbitter durch die österreichische Kräuterkundige Maria Treben in den 1980er-Jahren zu erneuter Bekanntheit. Schwedenkräutermischungen nach Maria Treben enthalten neben Bitterstoffdrogen vorwiegend Anthranoid-Drogen. Schwedenkräuter zeichnen sich, wie alle Elixiere, durch ein breites Anwendungsspektrum aus, wodurch sie auch heute noch volksmedizinisch bekannt sind und verwendet werden. In der vorliegenden Arbeit konnte durch den Spezialitäten-Vergleich verschiedener süddeutscher Apotheken sowie durch Kundenbefragungen in einer Apotheke gezeigt werden, dass Maria Treben einen sehr grossen Einfluss auf die Verwendung von Schwedenkräutern hat.
Brief Distress Screening in Clinical Practice: Does it Help to Effectively Allocate Psycho-Oncological Support to Female Cancer Inpatients?
Authors: Hermelink Kerstin , Höhn Henrik , Hasmüller Stephan , Gallwas Julia , Härtl Kristin , Würstlein Rachel , Köhm Janna
Published: April 2014

Background: The usefulness of distress screening in cancer inpatient settings has rarely been investigated. This study evaluated a brief distress screening of inpatients in a breast cancer centre and a gynaecological cancer centre. Patients and Methods: Hospitalised patients with breast or gynaecological cancers were screened with the Distress Thermometer. Patients who scored above the cut-off, were referred by the medical staff, or self-referred were offered bedside psycho-oncological counselling. Results: Of 125 patients, 68 (54.4%) received an offer of counselling, and 62 patients (49.6%) accepted. Most of the counselling was induced by distress screening. Only 4 (3.2%) patients self-referred to the counselling service. Of the counselled patients, 65.8% stated that they had substantially benefited from psycho-oncological support; only 5.6% of the non-counselled patients indicated that they might have benefited from psycho-oncological support. Conclusion: Almost all patients who will accept and benefit from psycho-oncological counselling can be identified if distress screening is used in conjunction with referrals by physicians and nurses. Distress screening is a worthwhile component in a framework of psycho-oncological support in a cancer inpatient setting. It paves the way to counselling for cancer inpatients who need it and are willing to accept it but hesitate to self-refer to psycho-oncological services.
Should a Drain Be Placed in Early Breast Cancer Surgery?
Authors: Ebner Florian , deGregorio Niko , Vorwerk Elena , Janni Wolfgang , Wöckel Achim , Varga Dominic
Published: April 2014

Background: The current surgical debate has led to a reduction in the extent of surgery performed and thereby to a reduced occurrence of surgical trauma and, over the recent years, reduced seroma formation. This reduction in surgical procedures calls the need for a drain into question. Method: Using Google Scholar and the National Library of Medicine (PubMed), a literature review was performed on systematic reviews and meta-analyses regarding breast cancer surgery ± axillary dissection. Additionally, randomized trials for the time period after the last systematic review were included and evaluated according to the Jadad score. Results: The search returned 5 systematic reviews, in which a total of 1,075 patients were included (537 cases and 538 controls). Since the last review, no prospective randomized trial meeting the inclusion criteria has been published. The current reviews conclude that insertion of a drain is associated with a longer hospital stay and reduced seroma formation. The data regarding wound infection and drain insertion is inconclusive. The omission of a drain is associated with early discharge, reduced postsurgical pain, and early mobilization, but also with an increase in out-patient seroma aspirations. Conclusion: The omission of a drain is possible in early breast cancer surgery (wide local excision and sentinel node biopsy) with adequate surgical techniques and instruments.
Important Factors Affecting Adjuvant Treatment Decision in Stage IA Breast Cancer Patients in Turkey
Authors: Oven Ustaalioglu Bala B. , Bilici Ahmet , Yilmaz Burçak E. , Aliustaoglu Mehmet , Seker Mesut , Vardar Fugen , Gumus Mahmut
Published: April 2014

Introduction: In Turkey, the gene expression profile test is not standard, so adjuvant treatment is planned according to clinicopathological factors. Therefore, we retrospectively analyzed important parameters that affect the decision on adjuvant chemotherapy, and also factors related to survival in stage IA breast cancer patients in Turkey. Methods: We retrospectively evaluated 347 stage IA patients. The relationship between the clinicopathological parameters and adjuvant chemotherapy was analyzed. Results: The median age and follow-up time were 52 years (range: 25-86) and 22.6 months (range: 1-113), respectively. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 87.9% and 98.7%, respectively, but the median DFS was not reached. Age, estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, and the presence of triple-negative breast tumor (TNBC) were related to DFS, and lymphovascular invasion (LVI), perineural invasion (PNI), HER2 status, the presence of TNBC, and recurrence were related to OS (p < 0.05). Furthermore, age, menopausal status, multicentricity, grade, tumor size, necrosis, ER, the presence of TNBC, and HER2 were found to be related to adjuvant therapy decision (p < 0.05). All these parameters, in addition to LVI and PNI, were independent factors for chemotherapy by logistic regression analysis. Conclusions: In decisions about adjuvant therapy in stage IA breast cancer patients, clinicopathological factors should be kept in mind.
Alleviation of Brain Edema and Restoration of Functional Independence by Bevacizumab in Brain-Metastatic Breast Cancer: A Case Report
Authors: Berghoff Anna S. , Sax Cornelia , Klein Martin , Furtner Julia , Dieckmann Karin , Gatterbauer Brigitte , Widhalm Georg , Rudas Margaretha , Zielinski Christoph C. , Bartsch Rupert , Preusser Matthias
Published: April 2014

Background: Brain metastases (BM) are an increasing challenge in modern oncology, as treatment options especially after exhaustion of local treatment approaches are very limited. Patient and Methods: A long-term surviving patient with brain-only metastatic breast cancer, who presented at our department with massive corticosteroid-refractory brain edema with serious neurological symptoms after exhaustion of all local therapy options, was started on bevacizumab. Results: Initiation of bevacizumab monotherapy led to rapid decrease of contrast-enhancing lesions and alleviation of brain edema, and allowed tapering and termination of corticosteroid administration. Neurological and neurocognitive function was restored and marked improvement in quality of life was observed. Conclusion: Our case highlights that bevacizumab may represent a feasible and effective salvage treatment option in selected patients with BM.
Cardio-Ankle Vascular Index and Its Potential Clinical Implications for Sleep Apnea
Authors: Kotani Kazuhiko
Published: April 2014

Sleep apnea is a prevalent disorder associated with an increased risk of cardiovascular disease (CVD). While arterial stiffness is a surrogate marker for the development of CVD, the cardio-ankle vascular index (CAVI) is a recently developed metric for evaluating arterial stiffness. Clinical studies have shown that the CAVI is higher in patients with the sleep apnea syndrome. In particular, a reduction in the CAVI can clearly be seen during short-term therapy for these patients. Although clinical evidence on sleep apnea using the CAVI is currently limited, the CAVI is expected to be useful for identifying patients with an increased risk of CVD and for monitoring treatment effectiveness in sleep apnea practice.
A Case of Successful Remission of Extensive Primary Gastric Diffuse Large B Cell Lymphoma: Radiologic, Endoscopic and Pathologic Evidence
Authors: Bismar Mike M. , Alasadi Mazen , Hendawy Bassem S. , Waness Abdelkarim
Published: April 2014

Though rare amongst stomach neoplasms, primary gastric diffuse large B cell lymphoma is one of the commonest extranodal non-Hodgkin lymphomas. If left untreated, it can have a devastating progression and life-threatening consequences. We present the case of a successfully treated large antral ulcer confirmed to be large B cell lymphoma as evidenced by radiologic, endoscopic and histopathologic findings. A brief discussion about the types of gastric lymphoma, their Helicobacter pylori relation and therapeutic modalities follows.
Prevention of Contrast-Induced Nephropathy With N-Acetylcysteine or Sodium Bicarbonate in Patients With ST-Segment–Myocardial Infarction
Authors: Thayssen Per , Lassen Jens Flensted , Jensen Svend Eggert , Hansen Knud Nørregaard , Hansen Henrik Steen , Christiansen Evald Høj , Junker Anders , Ravkilde Jan , Thuesen Leif , Veien Karsten Tange , Jensen Lisette Okkels
Published: April 2014

Background—

Contrast-induced nephropathy (CIN) is a serious condition in patients with ST-segment–elevation myocardial infarction treated with primary percutaneous coronary intervention. We compared the risk of acute CIN and the influence of preventive strategies in patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention.

Methods and Results—

A total of 720 patients were randomized in the Prevention of Contrast-induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (CINSTEMI) trial. Patients were randomly assigned in a 1:1:1:1 ratio to receive hydration with sodium chloride together with 1 of 4 prophylactic regimes (1) N-acetylcysteine (NAC), (2) sodium bicarbonate (NaHCO
3
) infusion, (3) NAC in combination with NaHCO
3
, or (4) hydration with sodium chloride infusion alone. Patients in cardiogenic shock were excluded. Acute CIN was defined as an increase in serum creatinine concentration >25% from the baseline value within a 3-day period. Overall, CIN occurred in 141 (21.9%) patients. The prevention treatment with NAC, NaHCO
3
, or the combined NAC and NaHCO
3
did not reduce the rate of CIN significantly compared with hydration with intravenous sodium chloride infusion alone (20.1% versus 20.1% versus 20.8% versus 26.5%;
P
=NS). However, an increase in serum creatinine >25% from the baseline value to 30 day was significantly lower in patients treated with combined NAC and NaHCO
3
(18.7% versus 19.1% versus 9.2% versus 21.3%;
P
=0.033).

Conclusions—

Treatment with NAC or NaHCO
3
did not reduce the rate of acute CIN significantly. Combined treatment with NAC and NaHCO
3
may reduce the risk of renal dysfunction after 30 days.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01160627.
Strategies Used by Hospitals to Improve Speed of Tissue-Type Plasminogen Activator Treatment in Acute Ischemic Stroke
Authors: Xian Ying , Smith Eric E. , Zhao Xin , Peterson Eric D. , Olson DaiWai M. , Hernandez Adrian F. , Bhatt Deepak L. , Saver Jeffrey L. , Schwamm Lee H. , Fonarow Gregg C.
Published: April 2014

Background and Purpose—

The benefits of intravenous tissue-type plasminogen activator in acute ischemic stroke are time dependent, and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are using these strategies and their association with DTN times have not been well studied.

Methods—

We surveyed 304 Get With The Guidelines-Stroke hospitals joining Target: Stroke regarding their baseline use of strategies to reduce DTN times in the January 2008 to December 2009 time frame before the initiation of Target: Stroke and determined the association between hospital strategies and DTN times.

Results—

Among 5460 patients receiving tissue-type plasminogen activator within 3 hours of symptom onset in surveyed hospitals, the median DTN time was 72 minutes (interquartile range, 55–94). Reported use of the different strategies varied considerably. Of 11 hospital strategies analyzed individually by multivariable analysis, 3 strategies were independently associated with shorter DTN times. These included rapid triage/stroke team notification (209/304 [69%] hospitals, 8.1-minute reduction in DTN time), single-call activation system (190/304 [63%] hospitals, 4.3 minutes), and tissue-type plasminogen activator stored in the emergency department (189/304 [62%] hospitals, 3.5 minutes). When analyzed incrementally, hospitals that used a greater number of strategies had shorter DTN times with 1.3 minutes (adjusted mean difference) saved for each strategy implemented (14 minutes if all strategies were used).

Conclusions—

Although the majority of participating hospitals reported using some strategy to reduce delays in tissue-type plasminogen activator administration for acute ischemic stroke, the strategies applied vary considerably and those most strongly associated with shorter DTN times were applied relatively less frequently.
Risk Factors, Stroke Prevention Treatments, and Prevalence of Cerebral Microbleeds in the Framingham Heart Study
Authors: Romero José Rafael , Preis Sarah R. , Beiser Alexa , DeCarli Charles , Viswanathan Anand , Martinez-Ramirez Sergi , Kase Carlos S. , Wolf Philip A. , Seshadri Sudha
Published: April 2014

Background and Purpose—

Cerebral microbleeds (CMBs) are associated with increased risk of stroke and poor cognition. Vascular risk factors and medications used for stroke prevention may increase the risk of CMB. We examined the prevalence of CMB and the association of these risk factors with CMB, postulating that risk factors for cerebral amyloid angiopathy would be associated with lobar CMB and markers of hypertensive vasculopathy with deep CMB.

Methods
—

We include 1965 Framingham Original and Offspring participants (age, 66.5±11.0 years; 54% women) and evaluated the age- and sex-specific prevalence of CMB. We related various vascular and genetic (apolipoprotein E [
APOE
]) risk factors and medication use to the presence of CMB overall and stratified by brain location (deep, lobar, or mixed).

Results
—

CMBs were observed in 8.8% of participants, being mostly lobar (63%). CMB prevalence increased with age (
P
<0.0001) and was higher in men (
P
<0.001). Hypertension increased risk of any CMB, and in deep and mixed locations (
P
<0.05), and low total cholesterol and
APOE
ε4 increased risk of lobar CMB (
P
<0.05). Statin use increased risk of lobar and mixed location CMB (
P
<0.05). The latter association was not affected by adjustment for cholesterol levels or concomitant medication use.

Conclusions
—

We observed the expected association of hypertension with deep CMB and low cholesterol and
APOE
ε4 with lobar CMB. In addition, statin use was independently associated with CMB risk. This potential adverse effect of statin use needs to be examined in other cohorts.
Myeloperoxidase in Human Intracranial Aneurysms
Authors: Gounis Matthew J. , Vedantham Srinivasan , Weaver John P. , Puri Ajit S. , Brooks Christopher S. , Wakhloo Ajay K. , Bogdanov Alexei A.
Published: April 2014

Background and Purpose—

Noninvasive imaging identifying a predictive biomarker of the bleeding risk of unruptured intracranial aneurysms (UIAs) is needed. We investigated a potential biomarker of UIA instability, myeloperoxidase, in human aneurysm tissue.

Methods
—

Human brain aneurysms were harvested after clipping and were histologically and biochemically evaluated for the presence of myeloperoxidase. Of the tissue collected, 3 were from ruptured aneurysms and 20 were from UIAs. For each UIA, its 5-year aneurysm rupture risk was determined using the Population, Hypertension, Age, Size of Aneurysm, Earlier Subarachnoid Hemorrhage From Another Aneurysm and Site of Aneurysm (PHASES) model.

Results
—

All ruptured aneurysms were myeloperoxidase positive. Of the UIAs, half were myeloperoxidase positive. The median 5-year aneurysm rupture risk was higher for myeloperoxidase-positive UIA (2.28%) than myeloperoxidase-negative UIA (0.69%), and the distributions were statistically different (
P
<0.005, Wilcoxon–Mann–Whitney test). The likelihood for myeloperoxidase-positive UIA was significantly associated (
P
=0.031) with aneurysm rupture risk (odds ratio, 4.79; 95% confidence limits, 1.15–19.96).

Conclusions
—

Myeloperoxidase is associated with PHASES estimated risk of aneurysm rupture and may potentially be used as an imaging biomarker of aneurysm instability.
Climate Suffering
Authors: Wapner Paul
Published: April 2014

Mitigation and adaptation represent the two main ways the world is responding to climate change. However, a third response is being practiced by the most vulnerable: widespread suffering. No matter how much we mitigate or adapt to climate change, pervasive suffering is inevitable. In fact, it is already being experienced throughout the world. This article reports on interviews conducted with subsistence farmers living on the frontlines of climate change in northern India in the spring of 2013. It relates the ways in which sustained drought and then punishing rains wreaked hardship on the farmers, and the ways farmers endured such challenges. By relating farmers' tales and describing how this experience personally influenced the researcher, the article offers and invites reflection on the many meanings of climate suffering.
Explaining Variation in Transnational Climate Change Activism: The Role of Inter-Movement Spillover
Authors: Hadden Jennifer
Published: April 2014

How can we explain variation in the volume and character of transnational collective action on climate change? This paper presents original qualitative and quantitative data to document how transnational activism on climate change has changed over time. The author draws attention to the role of transnational social movement spillover—a process by which ideas, activists, and tactics are diffused from one movement to another—in explaining this evolution. The article examines the spillover of the global justice movement to the climate justice movement from 2007 to 2009, linking this spillover to changes in the nature of activism. In contrast to previous approaches, this work shows that transnational social movement spillover can result in the expansion of contention without radicalizing those actors already involved. This case demonstrates the theoretical importance of the spillover process and offers lessons for future climate activism.
Security in Climate Change Discourse: Analyzing the Divergence between US and EU Approaches to Policy
Authors: Hayes Jarrod , Knox-Hayes Janelle
Published: April 2014

Why has Europe implemented a quite-proactive climate policy while the US has adopted a far less ambitious climate strategy? Does variation in security concerns or other factors better explain this difference in policy? Using a multimethod case study approach, the authors find that in the US, constructions of climate change as a security threat play an important role in developing public support. In Europe, leadership and opportunity discourses predominate. Other factors including centralization of governance, trust in the technocratic elite, and cultural norms contribute to the variation in policy construction.
Athanasius on God as Creator and Recreator
Authors: Meijering Eginhard
Published: April 2014

This article considers the ideas of Athanasius of Alexandria with regard to the relation between creation and recreation. Attention is given to the intention of his apologetic, and internally coherent, work Contra Gentes/De Incarnatione Verbi. This work provides evidence of Athanasius’s conviction that the Recreator is no other God than the Creator. In coherence with this fundamental ideas, Athanasius voices four manners of revelation, which are all analyzed in this article: the first manner of revelation appears in the fact that man was created in God’s image and likeness, as a result of which man is able to know God. The second manner of revelation is found in the harmony of creation. However, since his Fall, man did not respond to that in the right way either. The third manner is the revelation through the Holy Scriptures of the Jews, the Old Testament. According to Athanasius, these Scriptures were meant for all of mankind. The fourth and final manner of revelation to be discussed, is Athanasius’s view of Incarnation.
‘… seeing that for monks the life of Antony is a sufficient pattern of discipline.’ Athanasius as Mystagogue in his Vita Antonii
Authors: van Geest Paul
Published: April 2014

This article argues that in the Vita Antonii Athanasius’s realistic colouring of some commonplaces indicates that more justice has been done to Anthony’s personality, as Athanasius experienced it, than the emphasis on his indebtedness to classical literature suggests. The central question in this article is: how does Athanasius show himself to be a mystagogue in his Vita Antonii? It is shown that the monastic formation process, by which Athanasius represents Anthony’s life, comprehends five stages. At the first two stages the fear of God’s judgement is the driving and purifying force in the ordo vitae. In the third and fourth stages, Athanasius formulates the first aim of his mystagogy: the restoration of Adam’s original state of the soul, marked by imperturbability and serenity. During the fifth and last stage, however, the teacher is faithful to the directives that were taught to him at the very beginning of his monastic life. Now, however, ascesis is not inspired by the fear of the Lord but merely by the love of Christ.
Athanasius in Reformed Protestantism: Some Aspects of Reception History (1527–1607)
Authors: Goudriaan Aza
Published: April 2014

This article considers how Athanasius of Alexandria was read by Reformed Protestants of the early modern period. Attention is given to anthologies of patristic material, to John Calvin, Reiner Bachoff (Bachofius), and his Catechesis religionis christianae (1603), Abraham Scultetus’s Medulla theologiae patrum (1606), and Amandus Polanus of Polansdorf’s Symphonia catholica (1607, 1612). The latter three works provide evidence of a direct acquaintance with Athanasius’s writings. Though in comparison with other patristic quotations the Athanasian citations contained in them are in number rather limited, they do come from a broad range of Athanasius’s writings. The references are further not limited to Christology, but deal with a variety of themes relevant to Reformed theology.
Four new species of Cladorhizidae (Porifera, Demospongiae, Poecilosclerida) from the Northeast Pacific
Authors: LUNDSTEN LONNY , REISWIG HENRY M. , AUSTIN WILLIAM C.
Published: April 2014

Interest in cladorhizid sponges has grown rapidly in the past 19 years since a unique feeding strategy, carnivory, was described by Vacelet and Boury-Esnault in 1995. Since that time, 31% of the 133 extant cladorhizids have been described. Previously, seven species of cladorhizid sponges were known from the Northeast Pacific. Here we describe four additional species, including two species of Asbestopluma and two species of Cladorhiza. We report on species ranges, habitat, and ecology, including one from a chemosynthetic environment that appears to be using methane-oxidizing bacteria as a nutrient source. In fact, three of the four species described here were found in chemosynthetic habitats. The presence of small crustacean prey was also documented for three of these species.
Taxonomic assessment of Alligator Snapping Turtles (Chelydridae: Macrochelys), with the description of two new species from the southeastern United States
Authors: THOMAS TRAVIS M. , GRANATOSKY MICHAEL C. , BOURQUE JASON R. , KRYSKO KENNETH L. , MOLER PAUL E. , GAMBLE TONY , SUAREZ ERIC , LEONE ERIN , ROMAN JOE
Published: April 2014

The Alligator Snapping Turtle, Macrochelys temminckii, is a large, aquatic turtle limited to river systems that drain into the Gulf of Mexico. Previous molecular analyses using both mitochondrial and nuclear DNA suggested that Macrochelys exhibits significant genetic variation across its range that includes three distinct genetic assemblages (western, central, and eastern = Suwannee). However, no taxonomic revision or morphological analyses have been conducted previously. In this study, we test previous hypotheses of distinct geographic assemblages by examining morphology, reanalyzing phylogeographic genetic structure, and estimating divergence dating among lineages in a coalescent framework using Bayesian inference. We reviewed the fossil record and discuss phylogeographic and taxonomic implications of the existence of three distinct evolutionary lineages. We measured cranial (n=145) and post-cranial (n=104) material on field-captured individuals and museum specimens. We analyzed 420 base pairs (bp) of mitochondrial DNA sequence data for 158 Macrochelys. We examined fossil Macrochelys from ca. 15–16 million years ago (Ma) to the present to better assess historical distributions and evaluate named fossil taxa. The morphological and molecular data both indicate significant geographical variation and suggest three species-level breaks among genetic lineages that correspond to previously hypothesized genetic assemblages. The holotype of Macrochelys temminckii is from the western lineage. Therefore, we describe two new species as Macrochelys apalachicolae sp. nov. from the central lineage and Macrochelys suwanniensis sp. nov. from the eastern lineage (Suwannee River drainage). Our estimates of divergence times suggest that the most recent common ancestor (MRCA) of M. temminckii (western) and M. apalachicolae (central) existed 3.2–8.9 Ma during the late Miocene to late Pliocene, whereas M. temminckii-M. apalachicolae and M. suwanniensis last shared a MRCA 5.5–13.4 Ma during the mid-Miocene to early Pliocene. Examination of fossil material revealed that the fossil taxon M. floridana is actually a large Chelydra. Our taxonomic revision of Macrochelys has conservation and management implications in Florida, Georgia, and Alabama.
Schistura phamhringi, a new stone loach from Chindwin Basin in Manipur, India (Cypriniformes: Nemacheilidae)
Authors: Shangningam BungDon , Lokeshwor Yumnam , Vishwanath Waikhom
Published: April 2014

Schistura phamhringi, new stone loach, is described from Dutah Stream, tributary of the Yu River (Chindwin basin), near Larong Village, Chandel District, Manipur, India. It is distinguished from all its congeners by a unique combination of characters: 6–7 black saddles, each continued on both flanks forming broad diamond-shaped black bars with narrow ventral margin; bars superimposed on a grey stripe along lateral line; upper lip with numerous melanophores; black basicaudal bar arc-shaped; complete lateral line; and prominent oar-like suborbital flap on male.
Seasonal Forecasting of North China Summer Rainfall Using a Statistical Downscaling Model
Authors: Guo Yan , Li Jianping , Li Yun
Published: April 2014

A statistical downscaling model was developed with reanalysis data and applied to forecast northern China summer rainfall (NCSR) using the outputs of the real-time seasonal Climate Forecast System, version 2 (CFSv2). Large-scale climate signals in sea level pressure, 850-hPa meridional wind, and 500-hPa geopotential height as well as several well-known climate indices were considered as potential predictors. Through correlation analysis and stepwise screening, two “optimal” predictors (i.e., sea level pressure over the southwestern Indian Ocean and 850-hPa meridional wind over eastern China) were selected to fit the regression equation. Model reliability was validated with independent data during a test period (1991–2012), in which the simulated NCSR well represented the observed variability with a correlation coefficient of 0.59 and a root-mean-square error of 18.6%. The statistical downscaling model was applied to forecast NCSR for a 22-yr period (1991–2012) using forecast predictors from the CFSv2 with lead times from 1 to 6 months. The results showed much better forecast skills than that directly from the CFSv2 for all lead months, except the 3-month-lead example. The biggest improvement occurred in the 1-month-lead forecast, in which the hit rate increased to 77.3% from 45.5% in the CFSv2 forecast. In the forecast of rainfall at 15 stations, the statistical downscaling model also showed superior capability when compared with the CFSv2, with forecast skill being improved at 73% of stations. In particular, 13 of 15 stations obtained a hit rate exceeding 55%.
Occurrence of Winter Stratospheric Sudden Warming Events and the Seasonal Timing of Spring Stratospheric Final Warming
Authors: Hu Jinggao , Ren Rongcai , Xu Haiming
Published: April 2014

Based on the NCEP–NCAR reanalysis dataset covering 1958–2012, this paper demonstrates a statistically significant relationship between the occurrence of major stratospheric sudden warming events (SSWs) in midwinter and the seasonal timing of stratospheric final warming events (SFWs) in spring. Specifically, early spring SFWs that on average occur in early March tend to be preceded by non-SSW winters, while late spring SFWs that on average take place up until early May are mostly preceded by SSW events in midwinter. Though the occurrence (absence) of SSW events in midwinter may not always be followed by late (early) SFWs in spring, there is a much higher (lower) probability of late SFWs than early SFWs in spring after SSW (non-SSW) winters, particularly when the winter SSWs occur no earlier than early January or in the period from late January to early February. Diagnosis shows that, corresponding to an SSW (non-SSW) winter and the following late (early)-SFW spring, intensity of planetary wave activity in the stratosphere tends to evolve out of phase from midwinter to the following spring, being anomalously stronger (weaker) in winter and anomalously weaker (stronger) in spring. Furthermore, the strengthening of the western Eurasian high, which appears during early to mid-January in late-SFW years but does not appear until late February to mid-March in early-SFW years, always precedes the strengthening of planetary wave activity in the stratosphere and thus acts as a tropospheric precursor to the seasonal timing of SFWs.