bluuebunny/crossref_metadata_2025 huggingface dataset:
Entangled Titanium Fibre Balls Combined with Nano Strontium Hydroxyapatite in Repairing Bone Defects
Authors: Liu Ping , Wang Nan , Hao Yongqiang , Zhao Qinghua , Qiao Yongmin , Li Hui , Li Jipeng
Published: May 2014

Objective: To investigate the effect of entangled titanium fibre balls (ETFBs) combined with nano strontium hydroxyapatite (nano-Sr-HAP) on the repair of bone defects in vivo. Materials and Methods: Twenty-four 6-month-old, specific pathogen-free, male Sprague-Dawley rats were used. Drill defects were created in bilateral femoral condyles. ETFBs combined with nano-Sr-HAP were selected randomly from 72 samples and implanted into the femoral bone defects of left legs, which served as the experimental group, while ETFBs without nano-Sr-HAP were implanted into right legs for comparison. The bone defects on both sides were X-rayed. The anteroposterior positions and histological procedures and evaluations of each sample were performed at 1, 2, 4 and 8 weeks post-surgery. Results: Histological results showed that the ETBs allowed new bone to grow within their structure. Additionally, an increase in new bone was seen on the nano-Sr-HAP side compared to the control side. The results of histomorphometric analysis confirmed that the new bone formation on the left side gradually increased with time. There was a statistical increase in new bone at 2, 4 and 8 weeks, and the differences between the two sides were statistically significant at weeks 4 and 8 (p < 0.05 for all comparisons). Conclusion: The results showed that ETFBs possess a unique 3-dimensional interconnective porous structure and have excellent biocompatibility, cell affinity and osteoconductivity, which makes them useful as scaffold materials for repairing bone defects. On the other hand, nano-Sr-HAP improved the bone defect-repairing capacity of the ETFBs, which showed osteoinductive properties.
Owl Monkeys (Aotus spp.) Perform Self- and Social Anointing in Captivity
Authors: Jefferson Jay P. , Tapanes Elizabeth , Evans Sian
Published: May 2014

Several species of primates, including owl monkeys (Aotus spp.), anoint by rubbing their fur with odiferous substances. Previous research has shown that capuchin monkeys (Cebus and Sapajus) anoint socially by rubbing their bodies together in groups of two or more while anointing. Owl monkeys housed at the DuMond Conservancy have been observed to anoint over the last 10 years, and we report detailed new information on the anointing behavior of this population, including descriptions of social anointing which occurs frequently. We first investigated the occurrence of self-anointing in 35 Aotus spp. presented with millipedes. Detailed descriptions regarding body regions anointed were obtained for all anointers (n = 28). The median duration for a self-anointing bout was 3.6 min (range from approx. 2 s to 14.15 min). While the latency and length of anointing bouts showed considerable interindividual differences, no statistically significant differences were found between sexes, wild- or captive-born owl monkeys or across age groups. However, we found the lower back and tail were anointed at a rate significantly greater than other body parts, but there were no differences in these patterns across sex or wild- or captive-born owl monkeys. More recently, social anointing was investigated in 26 Aotus spp. presented with millipedes, of which half were observed to anoint socially. The average duration for all social anointing bouts was 72.88 s, with a median duration of 30 s (range 5-322 s). A detailed ethogram was also generated that included behaviors that were performed while anointing, including facial expressions and vocalizations. The intraindividual variability for 8 monkeys used in both investigations is discussed. These findings extend our knowledge of anointing and confirm the existence of social anointing in another genus with a unique biology (nocturnal and socially monogamous) distinct from capuchins.
Topical Retinoids in Skin Ageing: A Focused Update with Reference to Sun-Induced Epidermal Vitamin A Deficiency
Authors: Sorg Olivier , Saurat Jean-Hilaire
Published: May 2014

Vitamin A is an important constituent of the epidermis, where it plays a crucial role in epidermal turnover. A deficiency of epidermal vitamin A may be the consequence of nutritional vitamin A deficiency, exposure to sunlight or any UV source, oxidative stress or chronological ageing. As a consequence, any treatment aiming at increasing epidermal vitamin A would exert a protective effect against these deleterious conditions. Retinoids may counteract some deleterious actions of UV radiation by physical and biological mechanisms. Topical natural retinoic acid precursors such as retinaldehyde or retinol are less irritant than acidic retinoids and may prevent epidermal vitamin A deficiency due to nutritional deficiency, exposure to sunlight or any condition leading to free radical production. Retinoids may be combined with other compounds with complementary actions against ageing, nutritional deficiency and cancer, such as antioxidants, to potentiate their beneficial effects in the skin.
Priapism in Homozygous Sickle Cell Patients: Important Clinical and Laboratory Associations
Authors: Madu Anazoeze Jude , Ubesie Agozie , Ocheni Sunday , Chinawa Josephat , Madu Kenechi Anthony , Ibegbulam Obike Goodswill , Nonyelu Charles , Eze Alozie
Published: May 2014

Objective: To evaluate the relationship between the occurrence of priapism and important steady-state clinical and laboratory parameters in homozygous sickle cell disease (SCD). Subjects and Methods: Steady-state clinical and laboratory data were obtained from the medical records of 126 male patients seen in the clinic over a 7-year period. Estimated prevalence rates, correlation coefficients and independent t tests were calculated to assess the relationship between priapism and several important clinical and laboratory indices. Patient data on age, haemoglobin concentrations, the frequency of crises per annum, leucocyte counts, platelet counts, serum bilirubin and aspartate transaminase were evaluated. Results: The prevalence of priapism was determined to be 21.4%, and 22.2% of those affected had erectile dysfunction. There was a significant positive correlation between priapism and older age (p = 0.049) and lower leucocyte counts (p = 0.008). There was no significant relationship with other clinical or laboratory indices. Conclusion: About 1 in 4 of all homozygous older SCD patients had priapism, and an approximately similar ratio developed erectile dysfunction; they also had lower steady-state leucocyte counts. Other clinical and laboratory indicators of disease severity in SCD did not positively correlate with the occurrence of priapism, and this may imply an alternative pathogenetic mechanism.
Orthognathic Surgery: Pretreatment Information and Patient Satisfaction
Authors: AlKharafi Lateefa , AlHajery Dalal , Andersson Lars
Published: May 2014

Objectives: This study sought to (1) analyze the demographic profile of patients who completed combined orthodontic and surgical treatments at the Kuwait Ministry of Health dental clinics, (2) evaluate the source, type, amount and timing of preoperative patient information, (3) determine posttreatment patient satisfaction and (4) examine whether patient satisfaction is associated with preoperative information. Subjects and Methods: Of the 145 patients who completed combined orthodontic and surgical treatments at least 6 months prior to the initiation of this study, 74 agreed to be interviewed by telephone by means of a structured survey including questions covering the study's objectives. Results: The mean age of participants was 21.1 years; 52 (70.3%) were female and 22 (29.7%) were male. Of these 74 patients, 70 (94%) did not regret their decision to undergo orthognathic surgery and 62 (83.8%) would repeat the same treatment if it was needed. The majority of the respondents reported that the importance of treatment compliance had been explained very well prior to surgery, but that information about the associated functional and social problems was lacking. The orthodontist was the most prominent source of information before treatment began. As the presurgical orthodontic treatment phase progressed, the roles of the surgeon and orthodontist became more evenly distributed. Conclusion: The patients who underwent orthognathic surgery were satisfied and generally well informed. However, information regarding surgical risks and functional discomforts was not adequate. Participants were more likely to be satisfied when they were provided with more information about discomfort and surgical risks.
Omalizumab for Severe Allergic Asthma: 7 Years and Open Questions
Authors: Solèr Markus
Published: May 2014

Anti-IgE treatment for severe allergic asthma has been available for more than seven years now. This treatment has clear clinical benefits and a good safety record. However, important questions concerning long-term dosing and treatment duration remain unanswered. This paper discusses the available information concerning the long-term use of omalizumab.
Degrees of Kidney Disease in Nigerian Adults with Sickle-Cell Disease
Authors: Aneke John C. , Adegoke Adegbola O. , Oyekunle Anthony A. , Osho Patrick O. , Sanusi Abubakra A. , Okocha Emmanuel C. , Ibeh Nancy C. , Akinola Norah O. , Durosinmi Muheez A.
Published: May 2014

Objective: To study degrees of chronic kidney disease (CKD) using creatinine clearance in adult Nigerian patients with sickle-cell disease (SCD). Methods: One hundred SCD patients, made up of 79 HbSS (homozygous haemoglobin S) patients and 21 HbSC (heterozygous haemoglobins S and C) patients, were investigated prospectively, along with 50 normal controls. Their sociodemographic data, weight and drug history were documented. Each participant underwent dipstick urinalysis, and creatinine clearance was calculated following a 24-hour urine collection and serum creatinine measurement. They were categorized into stages of CKD based on the creatinine clearance. Results: Of the 79 HbSS patients, 14 (18%), 28 (35%), 33 (42%) and 4 (5%) had stage 1, 2, 3 and 4 CKD, respectively. In the HbSC group, 3 (14%), 9 (43%) and 9 (43%) patients had stage 1, 2 and 3 CKD, respectively. Proteinuria was noted in 16 (20%) HbSS patients but not in any of the HbSC patients. Of the subjects aged ≤24 years (n = 49), 9 (18%), 18 (37%), 21 (43%) and 1 (2%) had stage 1, 2, 3 and 4 CKD, respectively. Of those aged >24 years (n = 51), 8 (16%), 19 (37%), 21 (41%) and 3 (6%) had stage 1, 2, 3 and 4 CKD, respectively. None of the subjects had stage 5 CKD. Conclusion: In this study, the adult subjects with SCD had various degrees of CKD. Adequate follow-up and active intervention are advocated to delay the onset of end-stage nephropathy.
Role of Preferential Cyclooxygenase-2 Inhibition by Meloxicam in Ischemia/Reperfusion Injury of the Rat Liver
Authors: Tolba René H. , Fet Ngwi , Yonezawa Kei , Taura Kojiro , Nakajima Akio , Hata Koichiro , Okamura Yusuke , Uchinami Hiroshi , Klinge Uwe , Minor Thomas , Yamaoka Yoshio , Yamamoto Yuzo
Published: May 2014

Background: Ischemia/reperfusion injury (IRI) is one of the major clinical problems in liver and transplant surgery. Livers subjected to warm ischemia in vivo often show a severe dysfunction and the release of numerous inflammatory cytokines and arachidonic acid metabolites. Cyclooxygenase (COX)-2 is the inducible isoform of an intracellular enzyme that converts arachidonic acid into prostaglandins. The aim of the study was to evaluate the effect of COX-2 inhibition and the role of Kupffer cells in IRI of the liver. Methods: Male Wistar rats [250- 280 g body weight (BW)] were anesthetized and subjected to 30-min warm ischemia of the liver (Pringle's maneuver) and 60-min reperfusion after median laparotomy. The I/R group received no additional treatment. In the COX-2 inhibitor (COX-2I) group, the animals received 1 mg/kg BW meloxicam prior to operation. Gadolinium chloride (GdCl3) (10 mg/kg BW) was given 24 h prior to operation in the GdCl3 and GdCl3 + COX-2I groups for the selective depletion of Kupffer cells. The GdCl3 + COX-2I group received both GdCl3 and meloxicam treatment prior to operation. Blood and liver samples were obtained at the end of the experiments for further investigations. Results: After 30 min of warm ischemia in vivo, severe hepatocellular damage was observed in the I/R group. These impairments could be significantly prevented by the selective COX-2 inhibition and the depletion of Kupffer cells. Alanine aminotransferase was significantly reduced upon meloxicam and GdCl3 treatment compared to the I/R group: I/R, 3,240 ± 1,262 U/l versus COX-2I, 973 ± 649 U/l, p < 0.001; I/R versus GdCl3, 1,611 ± 600 U/l, p < 0.05, and I/R versus GdCl3 + COX-2I, 1,511 ± 575 U/l, p < 0.01. Plasma levels of tumor necrosis factor alpha (TNF-α) were significantly reduced in the COX-2I treatment group compared to I/R (3.5 ± 1.5 vs. 16.3 ± 11.7 pg/ml, respectively; p < 0.05). Similarly, the amount of TxB2, a marker for COX-2 metabolism, was significantly reduced in the meloxicam treatment groups compared to the I/R group: I/R, 22,500 ± 5,210 pg/ml versus COX-2I, 1,822 ± 938 pg/ml, p < 0.001, and I/R versus GdCl3 + COX-2I, 1,530 ± 907 pg/ml, p < 0.001. All values are given as mean ± SD (n = 6). Conclusion: These results suggest that the inhibition of COX-2 suppressed the initiation of an inflammatory cascade by attenuating the release of TNF-α, which is an initiator of the inflammatory reaction in hepatic IRI. Therefore, we conclude that preferential inhibition of COX-2 is a possible therapeutic approach against warm IRI of the liver.
Adipositas: State of the Art
Authors: de Zwaan Martina , Müller Astrid
Published: May 2014

Adipositas ist gemäß den WHO-Kriterien über einen BMI von ≥ 30 kg/m2 definiert. Die Adipositasprävalenz hat in den letzten Jahren in Deutschland weiter zugenommen und liegt bei etwa 24% der Bevölkerung. Als ursächlich für die Zunahme der Adipositas werden bei zugrundeliegender genetischer Vulnerabilität vor allem die leichte Verfügbarkeit hochkalorischer Nahrungsmittel und die Bewegungsarmut in der Überflussgesellschaft angesehen. Die Grundlage jedes konservativen Gewichtsmanagements sollte ein Basisprogramm sein, das die Komponenten Ernährungs-, Bewegungs- und Verhaltenstherapie umfasst. Insgesamt sollten die Therapieziele realistisch sein und an individuelle Bedingungen angepasst werden. Dabei sollten individuelle Komorbiditäten, Risiken, Erwartungen und Ressourcen des Betroffenen stärker berücksichtigt werden und nicht nur die alleinige Gewichtsreduktion im Fokus stehen. Langfristiger Gewichtserhalt ist jedoch weiterhin schwer zu erreichen. Bei extremer Adipositas sind chirurgische Interventionen erfolgreich. Die psychische Komorbidität ist bei Menschen mit Adipositas erhöht, sowohl in der Bevölkerung als auch in klinischen Gruppen. Dies betrifft vor allem affektive Störungen, Angststörungen und Essstörungen (vor allem Binge-Eating-Störung). Auch ADHS ist mit Adipositas assoziiert, im Kindes- und Jugendlichen- wie im Erwachsenenalter. Adipositas wird in unserer Gesellschaft mehr stigmatisiert als andere körperliche und seelische Erkrankungen.
Intraperitoneal Interleukin-6 Levels Predict Peritoneal Solute Transport Rate: A Prospective Cohort Study
Authors: Yang Xiaoxiao , Zhang He , Hang Ying , Yan Hao , Lin Aiwu , Huang Jiaying , Ni Zhaohui , Qian Jiaqi , Fang Wei
Published: May 2014

Background: To evaluate the association of dialysate interleukin-6 (IL-6), a marker of ongoing peritoneal inflammation, with the alteration of peritoneal solute transport rate (PSTR) in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: Stable CAPD patients were enrolled in the present study. A total of 128 patients were analyzed in this prospective study. IL-6 concentration in the overnight effluent was determined and expressed as the IL-6 appearance rate (IL-6AR). Mass transfer area coefficients of creatinine (MTACcr) were measured at enrollment and 12 months later. Logistic regression was used to examine the association between IL-6AR and change in MTACcr. Results: Multivariable linear regression showed that historical glucose exposure was significantly associated with dialysate IL-6AR level [β = 0.008 (0.001-0.015), p = 0.021]. After 12 months, MTACcr was significantly increased [6.40 (4.70-8.75) vs. 7.14 (5.69-8.73) ml/min, p = 0.004], while ultrafiltration capacity decreased [4 h UF 340 (220-400) vs. 280 (180-380) ml, p = 0.006]. Compared to the patients with stable PSTR, the dialysate IL-6AR in patients with increasing PSTR was significantly higher [277.08 (247.45-349.53) vs. 263.18 (69.94-286.72) pg/min, p = 0.015]. Patients with increasing PSTR had lower residual renal function [0.79 (0-2.12) vs. 1.70 (0.39-3.38) ml/min, p = 0.006] and less urine output [225 (0-600) vs. 500 (125-900) ml/24 h, p = 0.014]. Logistic analysis showed that both high dialysate IL-6AR [OR 1.333 and 95% CI (1.024-1.735), p = 0.033] and low RRF [OR 0.831 and 95% CI (0.699-0.988), p = 0.036] were independent risk factors for increasing PSTR. Conclusions: This prospective study suggests that intraperitoneal IL-6 is a predictor of increasing PSTR in peritoneal dialysis patients.
Adenostoma fasciculatum, California Chamise: Chemistry and Use in Skin Conditions
Authors: Bouttemy Alexis , Ruiter Faria Filho Osvaldo , Adams James David , Williams Travis
Published: May 2014

Adenostoma fasciculatum is used traditionally to treat skin conditions such as eczema. The plant was found to contain monoterpenoids, including hydroquinone and geranial. Other terpenoids were found, including the triterpenoids 7α-hydroxybaruol and glutinol, the diterpenoids thalianol and thaliandiol as well as the steroids suberosol and campesterol. The new compound, 7α-hydroxybaruol, was further analyzed by two-dimensional nuclear magnetic resonance (NMR) imaging, 13C NMR and high-resolution high-performance liquid chromatography combined with mass spectrometry. A balm was made from the plant with olive oil and bees wax. Several patients tried the balm and reported improvements in Adams disease, eczema symptoms and seborrhea within 1 week.
Psychoendokrinologie: Trends und ihr Bezug zur Praxis
Authors: Ehlert Ulrike
Published: May 2014

Die Psychoendokrinologie ist ein interdisziplinäres Forschungs- und Arbeitsgebiet, das mit experimentellen Untersuchungen an Gesunden und Patienten die Bedeutung hormoneller Systeme auf das biopsychosoziale Gesamtgefüge im Kontext von Gesundheit und Krankheit aufklärt. Neben dem autonomen Nervensystem und der Hypothalamus-Hypophysen-Nebennieren-Achse als den etablierten Stresssystemen werden in der aktuellen Forschung vermehrt geschlechtsspezifische und altersbezogene Einflussfaktoren auf die psychobiologische Verarbeitung von akuten, chronischen und/oder traumatischen Belastungen einbezogen. Für die psychotherapeutische Praxis sind psychoendokrinologische Forschungsergebnisse aus 3 Gründen von Bedeutung: Verbesserung der Differenzialdiagnostik, Entwicklung individueller Krankheitsmodelle und Therapieevaluation.
Dandy-Walker Malformation and Down Syndrome Association: Good Developmental Outcome and Successful Endoscopic Treatment of Hydrocephalus
Authors: Nigri Flavio , Fiuza Cabral Isaias , Boy da Silva Raquel Tavares , Viscaíno Pereira Heloisa , Telles Ribeiro Carlos Roberto
Published: May 2014

The association of Down syndrome (DS) with Dandy Walker malformation (DWM) is extremely rare, with only 3 cases reported to date. All cases reported have shown a bad life expectancy and a bad developmental outcome. The present case reveals the possibility of a good prognosis. A 19-month-old male patient had successful endoscopic hydrocephalus treatment and a good developmental outcome. He probably had a better outcome because of good DS and DWM prognostic parameters. Our patient suffered from a DWM with vermis identification of 2 fissures and 3 lobes and a DS with a well-preserved tonus, which was not associated with other congenital systemic defects. We may conclude that the prognosis of DS-DWM association may separately depend on the degree of clinical and neurological involvement of each malformation.
Primary Clear-Cell Sarcoma in the Mediastinum
Authors: Tanaka Yumi , Yoshimasu Tatsuya , Oura Shoji , Hirai Yoshimitsu , Kawago Mitsumasa , Okamura Yoshitaka
Published: May 2014

We report a case of primary clear-cell sarcoma (CCS) in the mediastinum. In October 2011, a 63-year-old man was admitted to our hospital for surgical resection. The tumor was completely excised by video-assisted thoracoscopic surgery. The tumor was well encapsulated and did not invade the pleura. Histological examination led to a final diagnosis of primary CCS in the mediastinum. The patient remains alive without evidence of recurrence at 15 months after surgery.
Genome-Wide Association Study of Plasma N6 Polyunsaturated Fatty Acids Within the Cohorts for Heart and Aging Research in Genomic Epidemiology Consortium
Authors: Guan Weihua , Steffen Brian T. , Lemaitre Rozenn N. , Wu Jason H.Y. , Tanaka Toshiko , Manichaikul Ani , Foy Millennia , Rich Stephen S. , Wang Lu , Nettleton Jennifer A. , Tang Weihong , Gu Xiangjun , Bandinelli Stafania , King Irena B. , McKnight Barbara , Psaty Bruce M. , Siscovick David , Djousse Luc , Ida Chen Yii-Der , Ferrucci Luigi , Fornage Myriam , Mozafarrian Dariush , Tsai Michael Y. , Steffen Lyn M.
Published: May 2014

Background—

Omega6 (n6) polyunsaturated fatty acids (PUFAs) and their metabolites are involved in cell signaling, inflammation, clot formation, and other crucial biological processes. Genetic components, such as variants of fatty acid desaturase (
FADS
) genes, determine the composition of n6 PUFAs.

Methods and Results—

To elucidate undiscovered biological pathways that may influence n6 PUFA composition, we conducted genome-wide association studies and meta-analyses of associations of common genetic variants with 6 plasma n6 PUFAs in 8631 white adults (55% women) across 5 prospective studies. Plasma phospholipid or total plasma fatty acids were analyzed by similar gas chromatography techniques. The n6 fatty acids linoleic acid (LA), γ-linolenic acid (GLA), dihomo-GLA, arachidonic acid, and adrenic acid were expressed as percentage of total fatty acids. We performed linear regression with robust SEs to test for single-nucleotide polymorphism–fatty acid associations, with pooling using inverse-variance–weighted meta-analysis. Novel regions were identified on chromosome 10 associated with LA (rs10740118;
P
=8.1×10
−9
; near
NRBF2
), on chromosome 16 with LA, GLA, dihomo-GLA, and arachidonic acid (rs16966952;
P
=1.2×10
−15
, 5.0×10
−11
, 7.6×10
−65
, and 2.4×10
−10
, respectively;
NTAN1
), and on chromosome 6 with adrenic acid after adjustment for arachidonic acid (rs3134950;
P
=2.1×10
−10
;
AGPAT1
). We confirmed previous findings of the
FADS
cluster on chromosome 11 with LA and arachidonic acid, and further observed novel genome-wide significant association of this cluster with GLA, dihomo-GLA, and adrenic acid (
P
=2.3×10
−72
, 2.6×10
−151
, and 6.3×10
−140
, respectively).

Conclusions—

Our findings suggest that along with the
FADS
gene cluster, additional genes may influence n6 PUFA composition.
Induction of MicroRNA-21 With Exogenous Hydrogen Sulfide Attenuates Myocardial Ischemic and Inflammatory Injury in Mice
Authors: Toldo Stefano , Das Anindita , Mezzaroma Eleonora , Chau Vinh Q. , Marchetti Carlo , Durrant David , Samidurai Arun , Van Tassell Benjamin W. , Yin Chang , Ockaili Ramzi A. , Vigneshwar Navin , Mukhopadhyay Nitai D. , Kukreja Rakesh C. , Abbate Antonio , Salloum Fadi N.
Published: May 2014

Background—

Maintaining physiological levels of hydrogen sulfide during ischemia is necessary to limit injury to the heart. Because of the anti-inflammatory effects of hydrogen sulfide, we proposed that the hydrogen sulfide donor, sodium sulfide (Na
2
S), would attenuate myocardial injury through upregulation of protective microRNA-21 (miR-21) and suppression of the inflammasome, a macromolecular structure that amplifies inflammation and mediates further injury.

Methods and Results—

Na
2
S-induced miR-21 expression was measured by quantitative polymerase chain reaction in adult primary rat cardiomyocytes and in the mouse heart. We measured inflammasome formation and activity in cardiomyocytes challenged with lipopolysaccharide and ATP or simulated ischemia/reoxygenation and in the heart after regional myocardial ischemia/reperfusion, in the presence or absence of Na
2
S. To assess the direct anti-inflammatory effects of hydrogen sulfide in vivo, we used a peritonitis model by way of intraperitoneal injection of zymosan A. Na
2
S attenuated inflammasome formation and activity, measured by counting cytoplasmic aggregates of the scaffold protein apoptosis speck-like protein containing a caspase-recruitment domain (−57%) and caspase-1 activity (−50%) in isolated cardiomyocytes and in the mouse heart (all
P
<0.05). Na
2
S also inhibited apoptosis (−38%) and necrosis (−43%) in cardiomyocytes in vitro and reduced myocardial infarct size (−63%) after ischemia/reperfusion injury in vivo (all
P
<0.05). These protective effects were absent in cells treated with the miR-21 eraser, antagomiR-21, and in miR-21 knockout mice. Na
2
S also limited the severity of inflammasome-dependent inflammation in the model of peritonitis (
P
<0.05) in wild-type but not in miR-21 knockout mice.

Conclusions—

Na
2
S induces cardioprotective effects through miR-21–dependent attenuation of ischemic and inflammatory injury in cardiomyocytes.
Mechanical Unloading Promotes Myocardial Energy Recovery in Human Heart Failure
Authors: Gupte Anisha A. , Hamilton Dale J. , Cordero-Reyes Andrea M. , Youker Keith A. , Yin Zheng , Estep Jerry D. , Stevens Robert D. , Wenner Brett , Ilkayeva Olga , Loebe Matthias , Peterson Leif E. , Lyon Christopher J. , Wong Stephen T.C. , Newgard Christopher B. , Torre-Amione Guillermo , Taegtmeyer Heinrich , Hsueh Willa A.
Published: May 2014

Background—

Impaired bioenergetics is a prominent feature of the failing heart, but the underlying metabolic perturbations are poorly understood.

Methods and Results—

We compared metabolomic, gene transcript, and protein data from 6 paired samples of failing human left ventricular tissue obtained during left ventricular assist device insertion (heart failure samples) and at heart transplant (post-left ventricular assist device samples). Nonfailing left ventricular wall samples procured from explanted hearts of patients with right heart failure served as novel comparison samples. Metabolomic analyses uncovered a distinct pattern in heart failure tissue: 2.6-fold increased pyruvate concentrations coupled with reduced Krebs cycle intermediates and short-chain acylcarnitines, suggesting a global reduction in substrate oxidation. These findings were associated with decreased transcript levels for enzymes that catalyze fatty acid oxidation and pyruvate metabolism and for key transcriptional regulators of mitochondrial metabolism and biogenesis, peroxisome proliferator-activated receptor γ coactivator 1α (
PGC1A
, 1.3-fold) and estrogen-related receptor α (
ERRA
, 1.2-fold) and γ (
ERRG
, 2.2-fold). Thus, parallel decreases in key transcription factors and their target metabolic enzyme genes can explain the decreases in associated metabolic intermediates. Mechanical support with left ventricular assist device improved all of these metabolic and transcriptional defects.

Conclusions—

These observations underscore an important pathophysiologic role for severely defective metabolism in heart failure, while the reversibility of these defects by left ventricular assist device suggests metabolic resilience of the human heart.
A Point Mutation in
Myh10
Causes Major Defects in Heart Development and Body Wall Closure
Authors: Ma Xuefei , Adelstein Robert S.
Published: May 2014

Background—

The 3 isoforms of nonmuscle myosin (NM) II (NMII-A, NMII-B, and NMII-C) play various roles during mouse embryonic development. Previous work, using knockout and hypomorphic mice, showed that Myh10 encoding myosin heavy chain II-B is critical for cardiac and brain development. Ablating or decreasing NMII-B by 80% results in cardiac (ventricular septal defect, double outlet of the right ventricle) and brain defects but not midline fusion defects. Neither NMII-A nor II-C seems to play roles in early myocardial development.

Methods and Results—

We had previously generated point mutant knock-in mice and now report novel findings as a result of expressing motor-deficient NMII-B at wild-type levels. Homozygous mice die at embryonic day 14.5 in cardiac failure, exhibiting abnormalities not seen in NMII-B null and hypomorphic mice: a failure in midline fusion resulting in a cleft palate, ectopia cordis, and a large omphalocele. Fusion of the sternum and endocardial cushions is impaired in the mutant mice associated with a failure in apoptosis of the mesenchymal cells. Failure to disassemble myocyte cell–cell adhesions during cardiac outflow tract development contributes to impaired outflow tract myocardialization and displacement of the aorta to the right ventricle.

Conclusions—

Expression of motor-impaired NMII-B disrupts normal ventral body wall closure because of a dominant-negative effect. This is not because of the loss of NMII-B function but rather a gain-of-function resulting from prolonged cross-linking of NMII-B to actin filaments, thereby interfering with the dynamics of actomyosin cytoskeletal structure. Furthermore, impaired NMII-B motor activity inhibits outflow tract myocardialization, leading to mislocalization of the aorta.
Cross-Sectional Survey of Workload and Burnout Among Japanese Physicians Working in Stroke Care
Authors: Nishimura Kunihiro , Nakamura Fumiaki , Takegami Misa , Fukuhara Schunichi , Nakagawara Jyoji , Ogasawara Kuniaki , Ono Junichi , Shiokawa Yoshiaki , Miyachi Shigeru , Nagata Izumi , Toyoda Kazunori , Matsuda Shinya , Kataoka Hiroharu , Miyamoto Yoshihiro , Kitaoka Kazuyo , Kada Akiko , Iihara Koji
Published: May 2014

Background—

Burnout is common among physicians and affects the quality of care. We aimed to determine the prevalence of burnout among Japanese physicians working in stroke care and evaluate personal and professional characteristics associated with burnout.

Methods and Results—

A cross-sectional design was used to develop and distribute a survey to 11 211 physicians. Physician burnout was assessed using the Maslach Burnout Inventory General Survey. The predictors of burnout and the relationships among them were identified by multivariable logistic regression analysis. A total of 2724 (25.3%) physicians returned the surveys. After excluding those who were not working in stroke care or did not complete the survey appropriately, 2564 surveys were analyzed. Analysis of the participants’ scores revealed that 41.1% were burned out. Multivariable analysis indicated that number of hours worked per week is positively associated with burnout. Hours slept per night, day-offs per week, years of experience, as well as income, are inversely associated with burnout. Short Form 36 mental health subscale was also inversely associated with burnout.

Conclusions—

The primary risk factors for burnout are heavy workload, short sleep duration, relatively little experience, and low mental quality of life. Prospective research is required to confirm these findings and develop programs for preventing burnout.
Impact of Socioeconomic Status Measures on Hospital Profiling in New York City
Authors: Blum Alexander B. , Egorova Natalia N. , Sosunov Eugene A. , Gelijns Annetine C. , DuPree Erin , Moskowitz Alan J. , Federman Alex D. , Ascheim Deborah D. , Keyhani Salomeh
Published: May 2014

Background—

Current 30-day readmission models used by the Center for Medicare and Medicaid Services for the purpose of hospital-level comparisons lack measures of socioeconomic status (SES). We examined whether the inclusion of an SES measure in 30-day congestive heart failure readmission models changed hospital risk-standardized readmission rates in New York City (NYC) hospitals.

Methods and Results—

Using a Centers for Medicare & Medicaid Services (CMS)-like model, we estimated 30-day hospital-level risk-standardized readmission rates by adjusting for age, sex, and comorbid conditions. Next, we examined how hospital risk-standardized readmission rates changed relative to the NYC mean with inclusion of the Agency for Healthcare Research and Quality (AHRQ)−validated SES index score. In a secondary analysis, we examined whether inclusion of the AHRQ SES index score in 30-day readmission models disproportionately impacted the risk-standardized readmission rates of minority-serving hospitals. Higher AHRQ SES scores, indicators of higher SES, were associated with lower odds (0.99) of 30-day readmission (
P
<0.019). The addition of the AHRQ SES index did not change the model’s C statistic (0.63). After adjustment for the AHRQ SES index, 1 hospital changed status from worse than the NYC average to no different than the NYC average. After adjustment for the AHRQ SES index, 1 NYC minority-serving hospital was reclassified from worse to no different than average.

Conclusions—

Although patients with higher SES were less likely to be admitted, the impact of SES on readmission was small. In NYC, inclusion of the AHRQ SES score in a CMS-based model did not impact hospital-level profiling based on 30-day readmission.
Choices for Patients “Without a Choice”
Authors: Ottenberg Abigale L. , Cook Katlyn E. , Topazian Rachel J. , Mueller Luke A. , Mueller Paul S. , Swetz Keith M.
Published: May 2014

Background—

Patients undergo major physical and psychological changes after implantation of a left ventricular assist device as destination therapy (DT). We sought to qualitatively study outcomes and attitudes of patients after DT.

Methods and Results—

Ambulatory outpatients with DT at our institution were invited to be interviewed between June and August 2011. In-person interviews were audio-recorded, transcribed, and analyzed qualitatively using thematic analysis. The study included 12 patients (11 men) from the Midwestern United States with a median age of 71.5 years (range, 33–78 years). Interviews were conducted at a median (range) time of 1.37 (0.43–5.04) years after DT implantation. Most patients were white (n=11), married (n=10), and Christian (n=10). We identified 6 themes commonly discussed by the interviewees: preparedness planning, new lease on life, optimizing support networks, systemic limitations, reflections on time, and communication matters. Analysis revealed that most patients saw DT as their only choice, despite other alternatives.

Conclusions—

Ambulatory patients reported varied experiences after DT but commonly reported gratitude for improved functional status and a perception of improved symptom burden. Recommendations for improving post-DT care include developing patient support systems, systematizing education for community providers, and expanding respite services.
Resuscitation Preferences in Community Patients With Heart Failure
Authors: Dunlay Shannon M. , Swetz Keith M. , Redfield Margaret M. , Mueller Paul S. , Roger Véronique L.
Published: May 2014

Background—

Little is known about the resuscitation preferences of patients with heart failure, how they may change over the course of the disease, and their association with mortality.

Methods and Results—

We enrolled consecutive Southeastern Minnesota residents with heart failure from October 2007 through September 2011 into a longitudinal study. Information on resuscitation preferences (Full Code or do-not-resuscitate [DNR]) was obtained from medical records through April 1, 2013. Of 608 patients enrolled, 237 died during follow-up. At enrollment, most patients (73.4%) were Full Code, whereas at death, most (78.5%) were DNR. The independent predictors of DNR status at enrollment were advanced age, chronic obstructive pulmonary disease, previous malignancy, and decreased mobility. Patients who were DNR were at increased risk of death (unadjusted hazard ratio, 2.03; 95% confidence interval, 1.48–2.73;
P
<0.001), but this risk did not persist after adjusting for age, comorbidity, and self-perceived general health (hazard ratio, 0.97; 95% confidence interval, 0.74–1.30;
P
=0.83). Of 481 patients who were Full Code during follow-up, 22 (4.6%) received cardiopulmonary resuscitation for an in-hospital cardiac arrest. Eight patients survived to hospital discharge; only 2 (9.1% of those receiving cardiopulmonary resuscitation) made a complete recovery and returned home. The median time from a final decision to be DNR until death was only 37 (7,70) days.

Conclusions—

The resuscitation preferences of patients with heart failure seem to be driven by the decline in clinical status that often accompanies advanced age and multimorbidity. Furthermore, these data suggest that electing DNR status does not independently affect a patient’s risk of death.
Stratifying the Risks of Oral Anticoagulation in Patients With Liver Disease
Authors: Efird Lydia M. , Mishkin Daniel S. , Berlowitz Dan R. , Ash Arlene S. , Hylek Elaine M. , Ozonoff Al , Reisman Joel I. , Zhao Shibei , Jasuja Guneet K. , Rose Adam J.
Published: May 2014

Background—

Chronic liver disease presents a relative contraindication to warfarin therapy, but some patients with liver disease nevertheless require long-term anticoagulation. The goal is to identify which patients with liver disease might safely receive warfarin.

Methods and Results—

Among 102 134 patients who received warfarin from the Veterans Affairs from 2007 to 2008,
International Classification of Diseases
-Ninth Revision codes identified 1763 patients with chronic liver disease. Specific diagnoses and laboratory values (albumin, aspartate aminotransferase, alanine aminotransferase, creatinine, and cholesterol) were examined to identify risk of adverse outcomes, while controlling for available bleeding risk factors. Outcomes included percent time in therapeutic range, a measure of anticoagulation control, and major hemorrhagic events, by
International Classification of Diseases
-Ninth Revision codes. Patients with liver disease had lower mean time in therapeutic range (53.5%) when compared with patients without (61.7%;
P
<0.001) and more hemorrhages (hazard ratio, 2.02;
P
<0.001). Among patients with liver disease, serum albumin and creatinine levels were the strongest predictors of both outcomes. We created a 4-point score system: patients received 1 point each for albumin (2.5–3.49 g/dL) or creatinine (1.01–1.99 mg/dL), and 2 points each for albumin (<2.5 g/dL) or creatinine (≥2 mg/dL). This score predicted both anticoagulation control and hemorrhage. When compared with patients without liver disease, those with a score of zero had modestly lower time in therapeutic range (56.7%) and no increase in hemorrhages (hazard ratio, 1.16;
P
=0.59), whereas those with the worst score (4) had poor control (29.4%) and high hazard of hemorrhage (hazard ratio, 8.53;
P
<0.001).

Conclusions—

Patients with liver disease receiving warfarin have poorer anticoagulation control and more hemorrhages. A simple 4-point scoring system using albumin and creatinine identifies those at risk for poor outcomes.
Impact of Sociodemographic Patient Characteristics on the Efficacy of Decision Aids
Authors: Coylewright Megan , Branda Megan , Inselman Jonathan W. , Shah Nilay , Hess Erik , LeBlanc Annie , Montori Victor M. , Ting Henry H.
Published: May 2014

Background—

Decision aids (DAs) increase patient knowledge, reduce decisional conflict, and promote shared decision making (SDM). The extent to which they do so across diverse sociodemographic patient groups is unknown.

Methods and Results—

We conducted a patient-level meta-analysis of 7 randomized trials of DA versus usual care comprising 771 encounters between patients and clinicians discussing treatment options for chest pain, myocardial infarction, diabetes mellitus, and osteoporosis. Using a random effects model, we examined the impact of sociodemographic patient characteristics (age, sex, education, income, and insurance status) on the outcomes of knowledge transfer, decisional conflict, and patient involvement in SDM. Because of small numbers of people of color in the study population, we were not powered to investigate the role of race. Most patients were aged ≥65 years (61%), white (94%), and women (59%); two thirds had greater than a high school education. Compared with usual care, DA patients gained knowledge, were more likely to know their risk, and had less decisional conflict along with greater involvement in SDM. These gains were largely consistent across sociodemographic patient groups, with DAs demonstrating similar efficacy when used with vulnerable patients such as the elderly and those with less income and less formal education. Differences in efficacy were found only in knowledge of risk in 1 subgroup, with greater efficacy among those with higher education (35% versus 18%;
P
=0.02).

Conclusions—

In this patient-level meta-analysis of 7 randomized trials, DAs were efficacious across diverse sociodemographic groups as measured by knowledge transfer, decisional conflict, and patient involvement in SDM. To the extent that DAs increase patient knowledge and participation in SDM, they have potential to impact health disparities related to these factors.
Pholiota oblita, new species in sect. Adiposae stirps Subflammans (Strophariaceae, Agaricomycetes), from the Argentinean Yungas
Authors: NIVEIRO NICOLÁS , POPOFF ORLANDO F. , LECHNER BERNARDO E. , ALBERTÓ EDGARDO O.
Published: May 2014

We present a study on the genus Pholiota sect. Adiposae stirps Subflammans from the Republic of Argentina. Pholiota oblita is proposed as a new species. It is characterized by its narrow lamellae, elongated cheilocystidia and broad spores. Singer originally described this species as P. digilioi, but this name was never validly published. Pholiota oblita is close to P. flammans, from the Northern Hemisphere, and P. subflammans, from the South American Andino-Patagonic forest, but differs by the diagnostic characters previously mentioned. The species was found in the southern end of the Yungas Forest, a cloud forest located on the eastern slopes of the sub-Andean mountains. Numerous collections of P. oblita were found in the Yungas forest but not in other areas. We believe that it could be an endemic species. Furthermore, we found that there are no herbarium specimens for the type of Pholiota subflammans (Speg.) Sacc. With the absence of original material, and to preserve current usage of the name, a neotype is designated hereby. The neotype chosen for P. subflammans is a specimen determined, described, and collected by Singer in the same area where the type specimen was found by Spegazzini.
A new genus of Conopidae from Europe (Diptera)
Authors: STUKE JENS-HERMANN
Published: May 2014

The monotypic genus Merziella gen. nov. (Palaearctic Region: Europe) is described. A key to the genera of the subfamily Myopinae is presented.
A 40-Year Climatology of Extratropical Transition in the Eastern North Pacific
Authors: Wood Kimberly M. , Ritchie Elizabeth A.
Published: May 2014

A 42-yr study of eastern North Pacific tropical cyclones (TCs) undergoing extratropical transition (ET) is presented using the Japanese 55-yr Reanalysis dataset. By using cyclone phase space (CPS) to differentiate those TCs that undergo ET from those that do not, it is found that only 9% of eastern North Pacific TCs that developed from 1971 to 2012 complete ET, compared with 40% in the North Atlantic.

Using a combination of CPS, empirical orthogonal function (EOF) analysis, and composite analysis, it is found that the evolution of ET in this basin differs from that observed in the North Atlantic and western North Pacific, possibly as a result of the rapidly decreasing sea surface temperatures north of the main genesis region. The presence of a strong, deep subtropical ridge extending westward from North America into the eastern North Pacific is a major factor inhibiting ET in this basin. Similar to other basins, eastern North Pacific ET generally occurs in conjunction with an approaching midlatitude trough, which helps to weaken the ridge and allow northward passage of the TC. The frequency of ET appears to increase during developing El Niño events but is not significantly affected by the Pacific decadal oscillation.
Applying Scaled Vegetation Greenness Metrics to Constrain Simulated Transpiration Anomalies: A Study over Australia*
Authors: Decker Mark , Pitman Andy J. , Evans Jason
Published: May 2014

The feasibility of using vegetation greenness metrics as a proxy for transpiration variability over Australia is demonstrated. Several global evapotranspiration datasets, one of which provides transpiration data and is constructed independently of the vegetation greenness measurements, are compared to four satellite-based observations representative of the state of the vegetation over several regions in Australia. Further estimates of the transpiration are obtained by decomposing the evapotranspiration datasets using an ensemble of land surface model simulations. On monthly time scales, the greenness anomaly metrics show a near one-to-one relationship with the transpiration estimates when the time series are appropriately scaled by the mean. The authors demonstrate that anomalous vegetation greenness metrics, when properly scaled, provide a tool for evaluating transpiration variability simulated by land surface models and observation-based evapotranspiration datasets that include transpiration. These methods provide a new test to help constrain the dynamic behavior of the land surface in climate model simulations.
Resection of the Innominate Artery to Prevent an Impending Tracheoinnominate Fistula and to Permit Tracheotomy in a Patient With Subglottic Stenosis and High-riding Innominate
Authors: Tokita Joshua , Kung Raymond , Parekh Kalpaj , Hoffman Henry
Published: May 2014

Objective:

This study aimed to determine the long-term viability of innominate artery resection and tracheotomy for a patient at high risk of developing a tracheoinnominate fistula (TIF) in the setting of subglottic stenosis and a high-riding innominate artery.

Methods:

Chart review with 2-year follow-up.

Results:

A 45-year-old diabetic man with obstructive sleep apnea and multiple admissions for coma and delirium tremens associated with alcohol abuse developed subglottic stenosis. He was found to have a palpable supraclavicular pulse during preoperative examination for a tracheotomy. Computed tomography examination revealed a high-riding innominate artery at the level of stenosis along with granulation tissue and disruption of the cartilaginous trachea, suggesting a high risk of impending TIF. The patient underwent a sternotomy-approach resection of the innominate artery with closure of the distal stump with a sternohyoid muscle flap. Intraoperatively, a plane of adhesions between the posterior innominate artery and trachea was dissected. The anterior tracheal wall appeared calcified but without evidence of erosion of either the trachea or the artery. Six weeks later, a tracheotomy was performed. Follow-up at 27 months did not identify complications from the innominate artery resection.

Conclusion:

Resection of the innominate artery is an option for some patients either to address the warning signs of TIF or to permit a tracheotomy to be performed in the presence of a high innominate artery.